Achieve Blood Pressure Levels Research Articles

Optimal blood pressure control with fewer antihypertensive medications: Achieved mostly in low-risk hypertensive patients.

Recent studies indicate that intensive blood pressure (BP) targets can be reached with less than two medications. This cross-sectional study, involving 4991 individuals from the Majiapu community, assessed the correlation between BP control and the burden of antihypertensive drugs. Participants on medication were categorized into controlled (BP<140/90mm Hg) and uncontrolled (BP≥140/90mm Hg) groups, with the former further divided into optimal (BP<130/80mm Hg) and good control (BP<140/90 but >130/80mm Hg) subgroups. Multivariate logistic regression analyzed factors affecting hypertension control across these BP categories. The study found that, 54% of participants had hypertension. Of those treated (62.5%), 55.7% achieved BP control, including 23.15% maintaining BP below 130/80mm Hg. The average number of antihypertensive medications was 1.61 for the controlled group (with an average BP of 126.6/76mm Hg) and 1.75 for the uncontrolled group (with an average BP of 150.6/84.0mm Hg). Additionally, the average number of antihypertensive medications was 1.66 in the good control group and 1.55 in the optimal control group. The uncontrolled group had a higher mean systematic coronary risk estimation (SCORE) of 5.59, against 3.97 and 2.5 in the good and optimal control groups, respectively. Key factors linked to poor BP control included age over 65, male sex, obesity, and former smoking, whereas lipid-lowering medication use was associated with better control. In conclusions, patients needing fewer antihypertensive drugs to achieve stricter targets may have a lower risk profile. Notably, only a small proportion of treated patients are low-risk individuals who can easily achieve BP levels below 130/80mm Hg.

Clinical benefit of systolic blood pressure within the target range among patients with or without diabetes mellitus: a propensity score-matched analysis of two randomized clinical trials

BackgroundRecent guidelines recommended a systolic blood pressure (SBP) target of < 130 mmHg for patients with or without diabetes but without providing a lower bound. Our study aimed to explore whether additional clinical benefits remain at achieved blood pressure (BP) levels below the recommended target.MethodsWe performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) among the non-diabetic population and the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD-BP) trial among diabetic subjects. We used the propensity score method to match patients from the intensive BP group to those from the standard group in each trial. Individuals with different achieved BP levels from the intensive BP group were used as “reference.” For each stratum, the trial-specific primary outcome (i.e., composite outcome of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure (HF), or cardiovascular death for SPRINT; non-fatal MI, non-fatal stroke, or cardiovascular death for ACCORD-BP) was compared by Cox regression.ResultsA non-linear association was observed between the mean achieved BP and incidence of composite cardiovascular events, regardless of treatment allocation. The significant treatment benefit for primary outcome remained at SBP 110–120 mmHg (hazard ratio, 0.59 [95% CI, 0.46, 0.76] for SPRINT; 0.67 [0.52, 0.88] for ACCORD-BP) and SBP 120–130 mmHg for SPRINT (0.47 [0.34, 0.63]) but not for ACCORD-BP (0.93 [0.70, 1.23]). The results were similar for the secondary outcomes including all-cause mortality, cardiovascular mortality, MI, stroke, and HF. Intensive BP treatment benefits existed among patients maintaining a diastolic BP of 60–70 mmHg but were less distinct.ConclusionsThe treatment benefit persists at as low as SBP 110–120 mmHg irrespective of diabetes status. Achieved very low BP levels appeared to increase cardiovascular events and all-cause mortality.

Association of adherence measured by self-reported pill count with achieved blood pressure level in hypertension patients: a cross-sectional study

BackgroundMedication adherence plays an essential role in controlling blood pressure to reduce morbidity and mortality of hypertension disease. Thus, this study aimed to determine the association of medication adherence measured by self-reported pill count with blood pressure levels among patients at several community health centers in Surabaya.MethodsAdherence was assessed using the pill count method by comparing the total number of antihypertension drugs taken with the prescribed drugs. The inclusion criteria involved hypertensive patients who received antihypertension drugs, specifically adults and elderly, except the pregnant woman. The patient blood pressure was measured by healthcare workers in the targeted community health centers. Descriptive and multivariable logistic regression analyses were performed to assess factors associated with medication adherence with blood pressure levels.ResultsA total of 264 hypertensive outpatients participating in this study, 77.65% of participants were adherent to antihypertensive drugs based on the pill count method, and 40.91% of participants had controlled blood pressure. Patients with uncontrolled blood pressure were about six times (adjusted odds ratio [AOR]: 6.15; 95% confidence interval [CI]: 2.694–14.039; P = 0.000) more likely to have non-adherent medication than patients with controlled blood pressure. Reciprocally, non-adherent participants (pill count < 80%) were about six times (AOR: 6.081; 95% CI: 2.672–13.838; P = 0.000) more likely to have uncontrolled blood pressure compared to adherent patients (pill count ≥ 80%). Age less than 40 years old (AOR: 5.814; 95% CI: 1.519–22.252; P = 0.01) and having middle school educational level (AOR: 0.387; 95% CI: 0.153–0.974; P = 0.045) were found to be independent factors associated with uncontrolled blood pressure.ConclusionsThe result showed that non-adherence to antihypertension drugs is associated with uncontrolled blood pressure. Then, age could be associated with uncontrolled blood pressure. Thus, pharmacists and other healthcare providers should pay attention to improving medication adherence and maintaining the controlled blood pressure.

Blood Pressure Control in Individuals With Hypertension Who Used a Digital, Personalized Nutrition Platform: Longitudinal Study.

BackgroundWhile there is a strong association between adhering to a healthy dietary pattern and reductions in blood pressure, adherence remains low. New technologies aimed to help facilitate behavior change may have an effect on reducing blood pressure among individuals with hypertension.ObjectiveThis study aims to evaluate characteristics of participants with stage 2 hypertension who used Foodsmart and to assess changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP).MethodsWe analyzed demographic, dietary, and clinical characteristics collected from 11,934 adults with at least two blood pressure readings who used the Foodsmart platform. Stage 2 hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg. We calculated mean changes in blood pressure among participants with stage 2 hypertension and stratified by length of follow-up and the covariates associated with achieving blood pressure levels below stage 2 hypertension. We compared changes in diet quality and weight between participants with stage 2 hypertension at baseline who achieved stage 1 hypertension or below and those who did not.ResultsWe found that 10.63% (1269/11,934) of participants had stage 2 hypertension at baseline. Among Foodsmart participants with stage 2 hypertension at baseline, SBP and DBP decreased, on average, by 5.7 and 4.0 mmHg, respectively; 33.02% (419/1269) of participants with stage 2 hypertension at baseline achieved blood pressure levels below stage 2 hypertension (SBP <140 mmHg and DBP <90 mmHg). Using a multivariable ordinal logistic regression model, changes in Nutriscore (P=.001) and weight (P=.04) were statistically significantly associated with changes in blood pressure categories for users with stage 2 hypertension at baseline. Using a multivariable logistic regression model, we found that baseline Nutriscore, change in Nutriscore, and change in weight were associated with greater likelihood of users with stage 2 hypertension at baseline achieving a lower blood pressure category.ConclusionsThis study evaluated changes in SBP and DBP among users (with hypertension) of the Foodsmart platform and found that those with stage 2 hypertension, on average, improved their blood pressure levels over time.

Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care-A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial.

Background: The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn.Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records.Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs.Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months.Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg.Results: A total of 71 GPs from 43 different practices were included along with 3,854 of their patients with diabetes mellitus. Throughout the study, the proportion of patients with annual HbA1c measurements was stable in the intervention group (78.8–78.9%) and decreased slightly in the control group (81.5–80.2%) [odds ratio (OR): 1.21; 95% CI: 1.04–1.42, p < 0.05]. The proportion of patients achieving blood pressure levels below 140/85 mmHg decreased in the control group (51.2–47.2%) and increased in the intervention group (49.7–51.9%) (OR: 1.18; 95% CI: 1.04–1.35, p < 0.05) where it peaked at 54.9% after 18 months and decreased steadily over the last 6 months.Conclusion: After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.

Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function.

Little is known regarding the association of blood pressure (BP) after treatment for primary aldosteronism (PA) (i.e., adrenalectomy and mineralocorticoid receptor antagonists) with long-term renal outcomes, and whether the association is independent of BP before treatment. Using a dataset from a nationwide registry of PA in Japan, we assessed whether achieved BP levels 6 months after treatment for PA are associated with annual changes in estimated glomerular filtration rate (eGFR), rapid eGFR decline, and incident chronic kidney disease (CKD) during the 5-year follow-up period. The cohort included 1266 PA patients. In multivariable linear regression including systolic BP (SBP) levels before treatment for PA, estimates (95% confidence interval [CI]) for annual changes in eGFR after month 6 associated with one-standard deviation (1-SD) higher SBP at month 6 were -0.08 (-0.15, -0.02) mL/min/1.73 m2/year. After multivariable adjustment, the estimate (95% CI) for annual changes in eGFR after month 6 was -0.12 (-0.21, -0.02) for SBP ≥ 130 mmHg vs. SBP < 130 mmHg at month 6. Among 537 participants without CKD at baseline, a 1-SD higher SBP was associated with a higher risk for incident CKD events (hazard ratio [95% CI]: 1.40 [1.00, 1.94]). Higher SBP after treatment for PA was associated with a higher risk for kidney dysfunction over time, independently of BP levels before treatment. Achieving SBP lower than 130 mmHg after treatment for PA may be linked to better kidney outcomes.

HYPERTENSION CONTROL IN RUSSIAN RESIDENTS WITH MULTICOMPONENT ANTIHYPERTENSIVE THERAPY

Objective: To assess the hypertension control depending on the number of antihypertensive drugs in Russian sampling in terms of MMM19 screening. Design and method: An opportunistic cross-sectional survey of volunteers the age of 18 from 21 Russian Regions (n = 5274) was performed in terms of international campaign MMM19. 1,834 of the residents were men (34.8%). 49.2% of the respondents were younger than 25 years, therefore, considering significant differences in age, further analysis of the data was performed among participants over 25 years (n = 2681). The questionnaire was being completed on presence of diabetes mellitus, history of cardiovascular complications, smoking and drinking. Information regarding intake and omission of antihypertensive medication were clarified. Blood pressure (BP) was measured three times with automated and manual sphygmomanometers. Results: Average age of the participants was 49.3 ± 16.2 years (17–96 years old). 51.5% of the participants had history of hypertension (n = 1343), while 73.6% (n = 989) received antihypertensive therapy. 44.8% of patients (n = 444) achieved target BP of less than 140/90 mm Hg, and only 20.5% (n = 203) - less than 130/80 mm Hg. The percentage of achieving the target BP depending on medication number is illustrated in Figure 1. Conclusions: In Russian screening sample older 25 years the level of hypertension control remains low, especially when the criteria of target blood pressure is tightened. Half of patients achieved blood pressure level of less than 140/90 mm Hg and only one fifth of the participants achieved blood pressure level of less than 130/80 mm Hg. Despite multicomponent therapy, only 20–30% of patients in this category achieved target blood pressure level even they were less likely to miss medication.

Prospects for Blood Pressure Remote Monitoring in Hypertensive Patients in the Ryazan Region

Aim. To study the effectiveness and benefits of blood pressure (BP) remote monitoring in outpatients with hypertension.Material and methods. The study included 100 patients with a verified diagnosis of hypertension, who didn’t achieve target BP pressure levels. The patients measured their BP twice a day over 6 months with facilities with automatic data transmission over GSM-channel to a remote monitoring center. BP parameters were being transmitted online to the remote monitoring center, where they were being processed and transferred to the personal account planner (created by the Web interface based on the software and hardware complex) of the attending physician and operator of the remote monitoring center. It is important that doctor received information only on clinically significant measurement results, based on which he determined the urgency of contact with the patient and the further tactics of his management.Results. No malfunctions in the work of communication facilities, technical failures in the software and hardware complex were registered over the entire period of the study. After 6 months of the monitoring it was possible to achieve target BP levels less than 135/85 mm Hg in 70% of patients. The proportion of patients with a high level of normal BP increased from 10% to 19%, while the proportion of patients with grade 1 and 2 of hypertension decreased significantly (from 33% to 7% and from 54% to 3%, respectively). At the beginning of telemedicine monitoring 3% of patients had stage 3 of hypertension, at the end of the study – 1%.Conclusion. The technology of telemedicine monitoring has shown itself as a simple, affordable and reliable way of management of outpatients with hypertension in conditions of real clinical practice. It was possible to achieve BP levels less than 135/85 mm Hg in 70% of patients by the method of remote outpatient monitoring. BP remote monitoring changed fundamentally the decision-making strategy of the patients management: it was not the patient who independently determined the need for consultation with a medical professional, but the attending physician made a decision on the method and urgency of contact with the patient on the basis of the data of objective monitoring indicators.

ACHIEVED BLOOD PRESSURE AND THE RISK OF OSTEOPOROTIC FRACTURE

Objective:Optimal blood pressure (BP) target has been debated. Studies have linked intensive BP lowering with the risk of injurious fall or fracture. This study aimed to investigate the association between achieved BP level and the risk of osteoporotic fracture among hypertensive patients who are ta

Rational antihypertensive therapy in patients with obstructive sleep apnea

Background. The relationship between obstructive sleep apnea (OSA) and hypertension (AH) is well known. In numerous studies it was found that obstructive sleep apnea was an independent predictor of the development of resistant AH (RAH), and the severity of apnea was directly correlated with the severity of RAH with the exception of the such confounders as age, obesity, sex. The purpose of this publication is to present a new strategy and modern approaches of drug and non-drug therapy of resistant hypertension in patients with OAS with the possibility of their implementation in real clinical practice. Conclusion. Currently, for a practitioner, the therapy of the patient with OSA and RAH is a serious clinical problem. A new rational therapeutic strategy for the treatment of such patients includes a combination of three-component drug therapy and non-drug continuous positive air pressure therapy (CPAP therapy). A reasonable duration of CPAP therapy should exceed 12 weeks. The proposed strategy for the treatment of patients with OAS+RAH has the highest efficiency of achieving blood pressure levels and significantly reduces the risks of fatal cardiovascular events.

Achieved blood pressure level and target organ damage in post-stroke hypertensive patients

Objective. To assess the impact of the achieved blood pressure level on the structure and function of kidneys, carotid arteries and depression level in hypertensive post-stroke survivors.Design and methods.Carotid arteries and kidneys were assessed by ultrasound study. All parameters including depression level (Hamilton scale) were evaluated depending on the achieved systolic blood pressure level (SBP) in 88 hypertensive patients in acute post-stroke period and at follow-up (8–12 months after stroke). Multiple regression analysis was applied to assess the associations between the factors.Results.Office SBP directly correlates with the creatinine level (r = 0,5; р = 0,01). Moderate direct correlation was found between mean office SBP at the follow-up visit and intima-media thickness (IMT) (r = 0,47; р = 0,004), resistance index of the right common carotid artery (CCA) (r = 0,47; р = 0,006), resistance index of the left CCA (r = 0,5; р = 0,002), and resistance index of the left internal carotid artery (ICA) (r = 0,4; р = 0,02). Regression analysis demonstrated that mean office SBP has an impact on the following parameters: plasma creatinine level (β = 0,43; р = 0,04) and CCA IMT (β = 0,36; р = 0,03). The depression decreased in subjects with SBP 125–134 mmHg.Conclusion. SBP stabilization at the level 125–134 mmHg leads to the decrease in the resistance index of the carotid arteries, improves renal function and reduces depression level in post-stroke survivors.

Current status of achieving blood pressure target and its clinical correlates in Japanese type 2 diabetes.

Aims/IntroductionTo investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drug classes as of 2013, and to explore the clinical correlates with achievement of target blood pressure in a large‐scale cohort of Japanese individuals with type 2 diabetes.Materials and MethodsA nationwide survey was carried out including 12,811 individuals with type 2 diabetes. Participants were divided by achieved blood pressure, <130/80 or 140/90 mmHg, and the number of drug classes taken.ResultsThe percentages achieving a blood pressure of <130/80 or 140/90 mmHg were 52.0% and 86.1%, respectively. The prevalence of hypertension, if defined as ≥130/80 mmHg or treated, became 67.9%. Among participants taking antihypertensive drugs, a blood pressure of <130/80 or <140/90 mmHg was 46.7% and 83.2%, respectively. The percentages of <130/80 mmHg were 55.9% without drugs, 47.1% on one drug, 42.5% on two drugs, 47.2% on three drugs and 56.8% on four or more drugs, respectively. The most prescribed drugs were renin–angiotensin system inhibitors, followed by calcium channel blockers, diuretics and beta‐blockers. The multiple logistic regression analysis showed that a blood pressure <130/80 mmHg was associated with lower values in age, body mass index, albuminuria and glomerular filtration rate, higher proportions on targets for glycosylated hemoglobin A1c and lipids, and less retinopathy.ConclusionsIn type 2 diabetes, hypertension is common, and just 52% achieved <130/80 mmHg, indicating a difficulty in blood pressure lowering. This was correlated with difficulties in glycemic and lipid management, obesity, and vascular complications, implying this clustering to be a serious problem.

On-treatment blood pressures of older hypertensive patients in Canada: implications for Systolic blood PRessure INtervention Trial.

The therapeutic target level for the blood pressure (BP) on antihypertensive drug treatment in older hypertensive patients is still extensively debated. We assessed the achieved BP levels in older treated hypertensive patients in a representative sample of the population. During the 2006 Ontario Survey on the Prevalence and Control of Hypertension, BP (using the SPRINT protocol) and treatment data were collected in 2551 respondents from a random and representative sample of the adult (20-79 years) population. Responses are weighted to the Ontario hypertensive population of 1367 384, of which 684 928 were in the 60-79-year age range. Among 60-79-year-old individuals, using traditional definitions the prevalence of hypertension was 49%. Hypertension treatment rates were high (85%) as were control rates among treated hypertensive patients (85% for 60-69-year-old and 70% for 70-79-year-old patients). A total of 38% of older hypertensive patients were treated with a single antihypertensive drug. A total of 54% of these had a SBP less than 130 mmHg and 23% less than 120 mmHg. Of those treated with combination therapy, 75% had a SBP less than 130 mmHg, and 44% had a SBP less than 120 mmHg. For treated and controlled hypertensive patients, average SBP was 120 mmHg for the 60-69-year age groups, and 119 mmHg in the 70-79-year age groups. These findings suggest that intensive BP control, now being considered for high-risk hypertensive patients based on results from SPRINT, was actually already being achieved ∼10 years ago in a large section of the general hypertensive population of Ontario, Canada.

PP.28.09] VISIT-TO-VISIT VARIABILITY OF BLOOD PRESSURE AND END-STAGE RENAL DISEASE, LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Visit-to-visit long term variability of blood pressure (BP) is an important independent risk factor for premature death and cardiovascular events, but relatively little is known about this parameter in patients with chronic kidney disease (CKD). The aim of the study was to clarify the influence of BP long-term variability on the progression of CKD in hypertensive patients. Design and method: 34 patients (16 men and 18 woman) with essential hypertension and CKD included in the study. Mean age was 68,8 ± 13,6 years. 7 pts had impaired glucose tolerance and 9 diabetes mellitus 64% of patients had left ventricular hypertrophy (LVH) by Echocardiography. 34% of patients had carotid atherosclerosis. 10 pts had 2 st of CKD at the beginning of the study, 24 – 3 st CKD. All patients receive antihypertensive treatment: 56% ACE inhibitors, 30% – ARB, 43% - calcium antagonists, 61% - beta-blocker and 30% - diuretics. 86% of patients achieved BP goal. The participants had their office BP measured during the 12-month follow-up We defined systolic and diastolic visit-to-visit variability of BP using three metrics: coefficient of variation, standard deviation of the mean SBP, and average real variability. Results: Glomerular filtration rate correlate significantly with systolic BP variability, but not with BP level. After the 1 year of follow up 6 patients had end-stage renal disease End-stage renal disease in multiple regression analysis was independently associated with systolic BP variability (OR 1,84 CI 95%[1,22–2,46], p = 0,031) and patients age (OR 2,89CI 95%[1,47–10,71], p = 0,034). Left ventricular mass index also significantly correlate with systolic BP variability (r = 0,456; p = 0,050) The correlation was more significant in patients with diabetes mellitus (r = 0,635; p = 0,036). Multiple regression analysis indicated that only mean visit-to-visit systolic BP remained independently associated with LVH after adjustment for age, sex, hypertension, diabetes mellitus, and glomerular filtration rate (p = 0.047). In patients with carotid atherosclerosis diastolic BP variability was higher, then in patients without it (p = 0,05). Conclusions: Thus, the variability of blood pressure may be more significant determinant of CKD progression and development of LVH in patients with hypertension than the achieved BP level.

Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials.

Previous meta-analyses of our group have investigated the cardiovascular effects of more vs. less intense blood pressure (BP) treatment and the BP levels to be achieved by treatment. A few additional trials have been completed recently, particularly the large SPRINT study. Updating of the previous meta-analyses has been done with the objective of further clarifying the practical question of BP targets of antihypertensive treatment. Among randomized-controlled trials (RCTs) of BP lowering treatment between 1966 and 2015, 16 (52 235 patients) compared more vs. less intense treatment and fulfilled other preset criteria, and in 34 (138 127 patients) SBP in the active (vs. placebo) or the more (vs. less) intense treatment was below (vs., respectively, above) three predetermined cutoffs. For their meta-analyses risk ratios (RR) and 95% confidence intervals, standardized to -10/-5 mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. More intense BP lowering significantly reduced risk of stroke [RR 0.71 (0.60-0.84)], coronary events [0.80 (0.68-0.95)], major cardiovascular events [0.75 (0.68-0.85)] and cardiovascular mortality [0.79 (0.63-0.97)], but not heart failure and all-cause death. When the 16 RCTs were stratified according to cardiovascular death risk, relative risk reduction did not differ between strata, but absolute risk reduction increased with cardiovascular risk, though the residual risk also increased. Stratification of the 34 RCTs according to the three different SBP cutoffs (150, 140 and 130 mmHg) showed that a SBP/DBP difference of -10/-5 mmHg across each cutoff significantly reduced risk of all outcomes to the same proportion (relative risk reduction), but absolute risk reduction of most outcomes had a significant trend to decrease at lower cutoffs. Updating of previous meta-analyses indicates that more vs. less intense BP lowering can reduce not only stroke and coronary events, but also cardiovascular mortality. Including data from recent RCTs also shows that all major outcomes can be reduced by lowering SBP a few mmHg below vs. above 130 mmHg, but absolute risk reduction becomes smaller, suggesting patients at lower initial SBP were at a lower level of cardiovascular risk.

Optimal achieved blood pressure in acute intracerebral hemorrhage

To investigate the effects of intensive blood pressure (BP) lowering according to baseline BP levels and optimal achieved BP levels in patients with acute intracerebral hemorrhage (ICH). INTERACT2 was an open, blinded endpoint, randomized controlled trial in 2,839 patients with ICH within 6 hours of onset and elevated systolic BP (SBP) (150-220 mm Hg) who were allocated to receive intensive (target SBP <140 mm Hg within 1 hour, with lower limit of 130 mm Hg for treatment cessation) or guideline-recommended (target SBP <180 mm Hg) BP-lowering treatment. Outcome was physical function across all 7 levels of the modified Rankin Scale at 90 days. Analysis of the randomized comparisons showed that intensive BP lowering produced comparable benefits on physical function at 90 days in 5 subgroups defined by baseline SBP of <160, 160-169, 170-179, 180-189, and ≥190 mm Hg (p homogeneity = 0.790). Analyses of achieved BP showed linear increases in the risk of physical dysfunction for achieved SBP above 130 mm Hg for both hyperacute (1-24 hours) and acute (2-7 days) phases while modest increases were also observed for achieved SBP below 130 mm Hg. Intensive BP lowering appears beneficial across a wide range of baseline SBP levels, and target SBP level of 130-139 mm Hg is likely to provide maximum benefit in acute ICH. This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP.

Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels--overview and meta-analyses of randomized trials.

Relevant clinical questions not approached by randomized controlled trials (RCTs) of blood pressure (BP)-lowering treatment can be explored by meta-analyses stratified by clinical criteria. Investigating whether all grades of hypertension benefit from BP-lowering treatment and which are the target BP levels to maximize outcome reduction. Of the 68 RCTs of intentional and nonintentional BP-lowering, those without baseline antihypertensive drugs were stratified by the average baseline SBP and DBP (hypertension grades 1, 2, and 3). RCTs with or without baseline treatment were considered for investigating the effects of mean achieved SBP/DBP across three SBP cutoffs and two DBP cutoffs. Risk ratios (RR) and 95% confidence interval (CI) (random-effects model), standardized to 10/5 mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. Differences between relative and absolute risk reductions in the different strata of baseline or achieved SBP/DBP were evaluated by trend or heterogeneity analyses. In 32 RCTs (104,359 individuals), significant outcome reductions were found independently of the hypertension grade, with no trend toward risk ratio changes with increasing baseline BP. A secondary analysis limited to RCTs on grade 1 hypertension at low-to-moderate risk showed significant outcome reductions [risk ratio: stroke 0.33 (0.11-0.98), coronary events 0.68 (0.48-0.95), and death 0.53 (0.35-0.80)]. In 32 RCTs (128,232 individuals), relative and absolute outcome reductions were significant for the SBP differences across 150 and 140 mmHg cutoffs. Below 130 mmHg, only stroke and all-cause death were significantly reduced. Absolute outcome reduction showed a significant trend to decrease, the lower the SBP cutoff considered. In 29 RCTs (107,665 individuals), outcomes were significantly reduced across DBP cutoffs of 90 and 80 mmHg. After excluding RCTs with baseline DBP less than 90 mmHg, only stroke reduction was significant at achieved DBP less than 80 mmHg. Meta-analyses favor BP-lowering treatment even in grade 1 hypertension at low-to-moderate risk, and lowering SBP/DBP to less than 140/90 mmHg. Achieving less than 130/80 mmHg appears safe, but only adds further reduction in stroke.

Interaction Between Chromosome 2 and 3 Regulates Pulse Pressure in the Stroke-Prone Spontaneously Hypertensive Rat

In an F2 cross between stroke-prone spontaneously hypertensive (SHRSP) and Wistar Kyoto (WKY) rats, we previously identified blood pressure quantitative trait loci (QTL) on rat chromosome (RNO) 2 and a pulse pressure QTL on RNO3. The aims of this study were to confirm the QTL on RNO3 and to investigate interaction between RNO2 and RNO3 loci through the generation and phenotypic assessment of single RNO3 congenic (SP.WKY(Gla)3a) and bicongenic (SP.WKY(Gla)2a/3a) strains. Hemodynamic profiling, vascular function, and renal histology were examined in these newly generated strains along with the previously reported RNO2 congenic strain (SP.WKY(Gla)2a). Our results demonstrate significant equivalent reduction in systolic, diastolic, and pulse pressure phenotypes in SP.WKY(Gla)3a and SP.WKY(Gla)2a rats, whereas greater reductions were observed with the SP.WKY(Gla)2a/3a bicongenic strain achieving blood pressure levels similar to normotensive WKY rats. Epistasis was observed between pulse pressure QTL on RNO2 and 3 at baseline and during 1% salt challenge. Vascular function and renal pathology studies indicate that QTL on RNO3 are responsible for salt-induced kidney pathology, whereas QTL on RNO2 seem to have greater impact on vascular function. RNO3 congenic and bicongenic strains have confirmed the importance of SHRSP alleles in the RNO3 congenic interval on pulse pressure variability and end-organ damage. These strains will allow interrogation of complex gene-gene and gene-environment interactions contributing to salt-sensitive hypertension and renal pathology in the SHRSP rat.

Angiotensin converting enzyme inhibitors for prevention of new-onset type 2 diabetes mellitus: A meta-analysis of 72,128 patients

BackgroudAngiotensin converting enzyme inhibitors (ACEIs) have been linked to reduced risk of new-onset diabetes, but the evidence was insufficient. Objective and methodsThe aim of this study was to evaluate the effect of ACEIs on the development of new-onset type 2 diabetes. Randomized controlled trials (RCTs) about ACEIs and new-onset diabetes were identified by electronic and manual searches. ResultsNine RCTs with 92,404 patients (72,128 non-diabetic patients at baseline) were included in this study. Compared with control group, incidence of new-onset diabetes was significantly reduced in the ACEIs group [OR 0.80, (0.71, 0.91)], irrespective of achieved blood pressure levels at the follow-up. ACEIs therapy was associated with significant reduction in the risk of new-onset diabetes compared with beta-blockers/diuretics [OR 0.78, (0.65, 0.93)], placebo [OR 0.79, (0.64, 0.96)], or calcium channel blockers [OR 0.85, (0.73, 0.99)]. ACEIs treatment was associated with significant reduction in the risk of new-onset diabetes in patients with hypertension [OR 0.80, (0.68, 0.93)], coronary artery disease (CAD) or cardiovascular disease [OR 0.83, (0.68, 1.00)], or heart failure [OR 0.22, (0.10, 0.47)]. Among patients with impaired glucose tolerance or impaired fasting glucose, ramipril did not significantly reduce the incidence of diabetes [OR 0.91, (0.79, 1.05)], but significantly increased regression to normoglycemia. ConclusionACEIs have beneficial effects in preventing new-onset diabetes. ACEIs provide additional benefits of lowering the risk of new-onset diabetes in patients with hypertension, CAD or other cardiovascular disease.

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

Hypertension is one of the most important determinants of micro- and macrovascular complications in patients with diabetes. Recent guidelines on treating hypertension in diabetes patients, based on clinical evidence of protection against target organ damage, especially as demonstrated by renal outcomes, recommended that office blood pressure (BP) be lowered to 130/80 mmHg in these patients.1 However, very few studies have consistently achieved BP levels as low as 130/80 mmHg in diabetic patients.