Achieve Target Blood Pressure Research Articles

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana.

Optimal blood pressure (BP) control is essential in averting cardiovascular disease and associated complications, yet multiple factors influence the achievement of BP targets. We explored patient-, provider-, and health facility-level factors of systolic and diastolic BP and controlled BP status among patients with hypertension in Ghana. Using a cross-sectional design, we recruited 15 health facilities, and from each facility, we recruited four healthcare providers involved in managing hypertension and 15 patients diagnosed with hypertension. The primary outcome of interest was systolic and diastolic BP; the secondary outcome was BP control (<140/90 mmHg) in compliance with Ghana's national standard treatment guidelines. We used mixed-effects regression models to explore the patient- and facility-level predictors of the outcomes. Two hundred twenty-four patients and 67 healthcare providers were sampled across 15 health facilities. The mean (SD) age of providers and patients was 32 (7) and 61 (13) years, respectively. Most (182 [81%]) of the patient participants were female, and almost half (109 [49%]) had controlled BP. At the patient level, traveling for 30 minutes to one hour to the health facility was associated with higher diastolic BP (Coeff.:3.75, 95% CI: 0.12, 7.38) and lower odds of BP control (OR: 0.51, 95% CI: 0.28, 0.92) compared to traveling for less than 30 minutes. Receiving hypertension care at government health facilities than at private health facilities was associated with lower systolic BP (Coeff.: -13.89; 95% CI: -23.99, -3.79). A higher patient-to-physician or physician-assistant ratio was associated with elevated systolic BP (Coeff.: 21.34; 95% CI: 8.94, 33.74) and lower odds of controlled BP (OR: 0.19, 95% CI: 0.05, 0.72). Along with addressing the patient-level factors influencing BP outcomes in Ghana, there is a need for public health and policy interventions addressing the inaccessibility of hypertension services, the shortage of clinical care providers, and the underperformance of private health facilities.

Combination therapy for hypertension management: insights from the Indian experts

Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.

RESULTS OF BLOOD PRESSURE SCREENING IN PEOPLE 18 YEARS AND OLDER IN NGHE AN: A CROSS-SECTIONAL STUDY IN 5 YEARS FROM 2016-2020

Aim: Determine the rate of hypertension, the proportion of hypertensive people taking medication, the proportion of people taking antihypertensive medication to achieve the target and the proportion of people who were measured the blood pressure in the last 12 months. Subjects and methods: People at the age of 18 years and older, including both sexes, including people with blood pressure. The total number of people having screening test accounts for 12303 people. All patients were allowed to have a rest at least 5 minutes before the measurement, then they have their blood pressure measured in a sitting position, measured 3 times with one-minute observation interval. The measuring room is airy and has an ambient temperature of 300 C. The person doing the measurement is a final-year student and the nurses are thoroughly trained in how to measure and record data. Results: The overall prevalence of hypertension in the study population was 31.4%. The rate of grade I hypertension accounts for 82.1%. The rate of isolated systolic hypertension is 43.7%. The rate of people with treated hypertension is 40.8%. Percentage of people with the target blood pressure over the total number of hypertensive people is 29.7%. Percentage of hypertensive people taking medication with the target blood pressure is 72.9%. The proportion of people who were not measured the blood pressure in the last 12 months is up to 60.4%. Conclusion: nearly 1/3 of the population aged 18 years and older has hypertension. The proportion of people using medication to treat hypertension is low (40.8%). The rate of achieving target blood pressure among people with hypertension is still low.

FOLLOW-UP OF SURVIVAL PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Resistant arterial hypertension (RAH) contributes to high mortality worldwide. Aim of the study: to assess 7-year follow-up survival and development of a composite end point (CEP) in patients with RAH. Design and method: The analysis includes 50 patients with RAH who were discharged from hospital. After 7 years discharge from the hospital, the patients underwent office BP measurement. Adverse events or death were reported as the composite endpoint (CEP). The average age of patients as of 2016 was 57.89 ± 11.81 y.o. 16% had type 2 diabetes (n=8). Results: After 7 years, in 32% (n=16) developed CEP, and 10% (n=5) of them died. The BMI increased from 30.87 ± 6.30 to 33.80 ± 6.90 kg/m2 (p&lt;0.05). 20% had smoke (n=10), but 8% (n=4) (quit smoking after developing CEP). After 7 years, 48.88% of patients (n=22) controlled office blood pressure below 140/90 mmHg and 51.11% did not (n=23). Among patients who reached the target office BP (130.73 ± 6.61/81.59 ± 4.13 mmHg), there was a decrease in the number of drugs from 3.76 ± 0.19 to 2.85 ± 0.14, p&lt;0.05. 45% (n=10) from the group took fixed combinations. Among patients who did not reach target office BP (148.04 ± 7.49/92.17 ± 4.66 mmHg), there was also a decrease in the number of drugs from 3.52 ± 0.18 to 2.50 ± 0.13, p&lt;0.05 – patients decision. After regression analysis the main factors that were associated with the occurrence of CEP in patients with RAH were: the presence of diabetes (β= 5,237, p= 0,032) smoking (β=4,326, p= 0,037), increased body weight (β =3,423, p=0,024), failure to achieve target blood pressure levels (β =4,152, p=0,041) Conclusions: Mortality among patients with RAH were 10% during 7 years. The total composite endpoint were 32%. Did not reach the target office BP in patients with RAH the factors for the development of combined end point was diabetes mellitus, smoking and weight gain.

Changing Concepts About Optimal Target Blood Pressure and the Therapeutic Advantages of Azilsartan for Achieving it

The article discusses current issues of the treatment of arterial hypertension. According to presented data, so-called therapeutic nihilism is becoming one of the main barriers to achieving target blood pressure (BP). This nihilism is that despite evidence of the effectiveness of achieving lower BP values, practitioners do not intensify antihypertensive therapy sufficiently to achieve such values. The article specially addresses new criteria for the effectiveness of antihypertensive therapy, which reflect the therapy sustainability. The most commonly used indicator is the duration of the period, during which systolic BP remains in the therapeutic range. The prognostic significance of such indicators is discussed. In these conditions, it is very important to use the most effective antihypertensive drugs for initial antihypertensive therapy, including as a part of combination therapy. This tactic provides more frequent achievement of BP goals without the need for dose adjustment. In this regard, a systematic review was performed, which included sufficiently large randomized studies of the antihypertensive effectiveness of azilsartan medoxomil. This systematic review will provide comprehensive information on a possible role of using the angiotensin II receptor blocker azilsartan as a basic drug for the treatment of a wide range of patients with high BP. Most of the studies included in the systematic review assessed the effectiveness of combination therapy including azilsartan.

Controlled and uncontrolled arterial hypertension: comparison of clinical and demographic characteristics in patients (according to the National Registry of Hypertension, 2019-2022)

Aim: to study the clinical and demographic characteristics of patients in a sample of patients with arterial hypertension observed in primary healthcare (20192022). To compare data from patients with uncontrolled and controlled hypertension.Materials and methods. An analysis of medical data of 4543 patients was carried out (history, clinical and laboratory data, concomitant cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, revascularization (coronary bypass grafting, transluminal balloon angioplasty of the coronary arteries). For statistical data processing, the SPSS statistical software package was used.Results. The patients in the study sample were middle-aged and elderly. 51,5% of patients did not achieve target blood pressure values. More than 90% of patients in the studied sample are high and very high risk patients. The ratio of groups of patients with controlled and uncontrolled arterial hypertension among patients of different ages did not differ. Higher values of low-density lipoprotein cholesterol, a higher frequency (1,3 times) of failure to achieve target values of low-density lipoprotein cholesterol &lt;2,6 mmol/l, and obesity (1,3 times) were identified in patients with uncontrolled arterial hypertension. More than 80% of patients had low-density lipoprotein cholesterol values higher than recommended. Patients with controlled arterial hypertension were more likely to have coronary heart disease, myocardial infarction and a history of coronary angioplasty and coronary artery bypass grafting.Сonclusions. In hypertensive patients, more careful monitoring of cardiovascular risk factors is required, including blood pressure levels and achieving target LDL cholesterol levels. The association of a higher incidence of obesity, type 2 diabetes mellitus and the severity of dyslipidemia with uncontrolled hypertension may indicate less adherence of patients to both drug and non-drug treatment methods. While the presence of coronary heart disease, surgical interventions performed on the coronary arteries can serve as an illustration of increased adherence to therapy when hypertension is combined with coronary heart disease.

Relationship between PiCCO parameters and achieving target blood pressure in early resuscitation of patients with septic shock at Khanh Hoa general hospital, Khanh Hoa province in 2023

Hemodynamic resuscitation guided by the Pulse Contour Cardiac Output (PiCCO) system is an advanced, reliable and minimally invasive method. In prospective interventional study, 40 patients with septic shock admitted to the Intensive Care Unit of Khanh Hoa General Hospital from August 2022 to September 2023. Measure PiCCO parameters at several times. The rate of achieving target blood pressure at the time 1 hour (T1) was 87.5% (n = 35), at the time 3 hours (T3) was 90.0% (n = 36). At T1 and T3, Global End-Diastolic Volume Index (GEDVI), Extravascular Lung Water Index (EVLWI) and Systemic Vascular Resistance Index (SVRI) were related to achieving target blood pressure (p &lt; 0.05). At T1, there were significant differences exist between two groups: GEDVI (764.2 ± 172.8 vs 659.4 ± 26.5mL/m2, p = 0.02); EVLWI (10.4 ± 2.6 vs 13.9 ± 2.79mL/kg, p = 0.02); SVRI (1658.8 ± 594.1 vs 1094.8 ± 135.2DS/ cm5/m2, p = 0.01). At T3, after urgent resuscitation, the significant differences between groups were: GEDVI (756.3 ± 141.1 vs 668.0 ± 10.3mL/m2, p = 0.01); EVLWI (10.9 ± 2.9 vs 14.1 ± 1.8mL/kg, p = 0.03); SVRI (1676.67 ± 628.3 vs 1127 ± 370.3DS/cm5/m2, p = 0.049). Early resuscitation according to the guidance of the PiCCO system helps achieve target blood pressure better in patients with septic shock. GEDVI, EVLWI and SVRI are indexes on the PiCCO system related to achieving target blood pressure.

Efficacy of sacubitril/valsartan versus valsartan in patients with arterial hypertension

Objective. To identify the effectiveness of sacubitril/valsartan versus valsartan in reducing blood pressure (BP) in patients with arterial hypertension (HTN) 1–2 degree.Design and methods. The study included 105 patients, among them 90 were included in the effectiveness analysis and were observed for 12 months in an outpatient setting. In accordance with the protocol, 90 patients completed the study, 44 of them received sacubitril/ valsartan (97/103 mg), 46 received valsartan (160 mg). The dynamics of clinical BP in mm Hg and rates of achieving target BP levels in treatment groups were assessed.Results. Systolic after 12 months decreased more significantly in sacubitril/valsartan group versus valsartan: by 14,68 ± 9,33 vs 6,17 ± 4,81 mmHg (p = 0,007). The rate of achieving target BP was higher in the sacubitril/valsartan group (61,41 % vs 34,8 %, p &lt; 0,01).Conclusions. Among patients with 1–2 degree HTN, sacubitril/valsartan reduced blood pressure to a greater extent than valsartan alone and was not inferior to the latter in terms of safety criteria.

Relationship of Blood Pressure, Health Behaviors, and New Diagnosis and Control of Hypertension in the BP-CHECK Study.

Undiagnosed hypertension and uncontrolled blood pressure (BP) are common and contribute to excess cardiovascular morbidity and mortality. We examined whether BP control, changes in BP, and patient behaviors and attitudes were associated with a new hypertension diagnosis. We performed a post hoc analysis of 323 participants from BP-CHECK (Blood Pressure Checks for Diagnosing Hypertension), a randomized diagnostic study of BP measuring methods in adults without diagnosed hypertension with elevated BP recruited from 12 primary care clinics of an integrated health care system in Washington State during 2017 to 2019. All 323 participants returned a positive diagnostic test for hypertension based on 24-hour ambulatory BP monitoring and were followed for 6 months. We used linear regression to examine the relationships between a new hypertension diagnosis (primary independent variable) and differences in the change in study outcomes from baseline to 6-month. Mean age of study participants was 58.3 years (SD, 13.1), 147 (45%) were women, and 253 (80%) were of non-Hispanic White race. At 6 months, 154 of 323 (48%) participants had a new hypertension diagnosis of whom 88 achieved target BP control. Participants with a new hypertension diagnosis experienced significantly larger declines from baseline in BP (adjusted mean difference: systolic BP, -7.6 mm Hg [95% CI, -10.3 to -4.8]; diastolic BP, -3.8 mm Hg [95% CI, -5.6 to -2.0]) compared with undiagnosed peers. They were also significantly more likely to achieve BP control by 6 months compared with undiagnosed participants (adjusted relative risk, 1.5 [95% CI, 1.1 to 2.0]). At 6 months, 101 of 323 participants (31%) with a positive ambulatory BP monitoring diagnostic test remained with undiagnosed hypertension, uncontrolled BP, and no antihypertensive medications. Approximately one-third of participants with high BP on screening and ambulatory BP monitoring diagnostic testing remained with undiagnosed hypertension, uncontrolled BP, and no antihypertensive medications after 6 months. New strategies are needed to enhance integration of BP diagnostic testing into clinical practice. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03130257.

Effect of insertion/deletion polymorphism of angiotensin-converting enzyme gene on efficacy of antihypertensive therapy with angiotensin II receptor blockers

The efficacy of the antihypertensive therapy may be related to genetic factors that can influence not only the degree of the blood pressure (BP) elevation but also contribute to the interindividual variability of response to the antihypertensive treatment.The aim of the work was to study pharmacodynamic parameters of the therapy efficacy with angiotensin II receptor blockers in the form of monotherapy and as part of combined drugs in patients with the arterial hypertension depending on the genetic features of patients – polymorphism of the gene encoding angiotensin-converting enzyme, or I/D-polymorphism.Materials and methods. The study included 179 patients of the Moscow region with a first-diagnosed arterial hypertension (AH) of 1–2 degree, including 141 (78.8%) women and 38 (21.2%) men aged from 32 to 69 years. By a simple randomization method, the patients were randomly allocated into groups receiving irbesartan and valsartan as mono- or combination therapy with hydrochlorthiazide. After 3 weeks of this pharmacotherapy, the presence of rs4646994 Alu Ins / Del genetic polymorphism of the angiotensin-converting enzyme (ACE) gene and the minimum equilibrium concentration of angiotensin II receptor blockers (ARBs) were determined.Results. The patients treated with irbesartan, the D/D genotype carriers, were significantly less likely to reach the target BP and more likely to require a pharmacotherapy intensification compared to I/D heterozygotes (p=0.042 and p=0.058, respectively) and I/I homozygotes (p=0.011 and p=0.011, respectively). The patients treated with valsartan, the D/D genotype carriers, significantly more often reached the target BP and significantly less often required a pharmacotherapy intensification than the I/D genotype carriers (p=0.05 and p=0.05, respectively). Herewith, at the end of the study, according to the results of the office BP measurements and daily BP monitoring, the target BP achievement was not significantly correlated with the I/D polymorphism of the ACE gene.Conclusion. When personalizing the AH therapy in patients of the Moscow region, the genotype I/I carriers by I/D polymorphism of the ACE gene, can be recommended irbesartan in the form of mono- or bicomponent therapy as a starting therapy of ARBs; the D/D genotype carriers can be recommended valsartan. A more pronounced decrease in the daytime systolic BP (SBP), the daytime diastolic BP (DBP) and the nighttime SBP variabilities in the valsartan group of patients, the D allele carriers may indicate a more persistent effect of the antihypertensive therapy.

Role of Home Blood Pressure Monitoring in Treatment Follow-up by Hypertensive Patients Cohort

Background: The main benefit of home-based blood pressure monitoring (HBPM) is the potential approach to reduce the risk of white-coat hypertension (HTN) and to encourage patients to take ownership of their condition. This study was conducted to assess the role of HBPM in treatment follow-up in a cohort of hypertensive patients. Materials and methods: This was a prospective observational study conducted from December 2017 to May 2018. A total of 100 patients fulfilling the inclusion and exclusion criteria were selected by purposive sampling from Medicine Outdoor of Dhaka Medical College Hospital (DMCH). In total, 100 hypertensive patients were enrolled, and informed consent was obtained. Subsequently, the study subjects received information and training on BP self-management and performed 2 resting measurements per day for 4 days per week for 3 months. All measurements were performed using validated BP monitors.The study endpoints included patient awareness, attainment of BP goals, adherence to antihypertensive treatment, lifestyle modification, assessment of discrepancy between office and HBPM, and white coat HTN or masked HTN at 3 months. SPSS version 22.0 was used for data analysis and reporting. Results: Overall, the mean age was 57.76 ±12.60 years with a range of 34 – 80 years. Males were more prevalent than females, and the ratio was 1.17:1. The majority of cases (76.0%) had established HTN with a history of taking medication, whereas others were non-compliant with medications. Among them 47% had obesity, and 24% had diabetes mellitus. Of the patients, 91% adherence to HBP monitoring, 84.0% adherence to medication, and 75.0% achieved their target BP. The achievement of target blood pressure was significantly higher among the study subjects who adhered to HBP monitoring, and the p-value was &lt; 0.04 (Fisher’s Exact test). Conclusion: In a cohort of patients with arterial hypertension, information, and training on BP self-measurement and direct involvement of patients using HBPM led to improvement in BP control and could be an effective method by incorporating it into the usual care of hypertensive patients in the hypertension management center of the community. J MEDICINE 2024; 25: 17-23

ФИКСИРОВАННАЯ КОМБИНАЦИЯ ИРБЕСАРТАН/ГИДРОХЛОРТИАЗИД В ЛЕЧЕНИИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ

Almost a third of the population of the Republic of Belarus suffers from elevated blood pressure which results in a high risk of cardiovascular disease developing. Despite the availability of numerous antihypertensive drugs, more than 40% of patients receiving antihypertensive therapy do not achieve target blood pressure levels and continue to be at an increased risk of cardiovascular events. A fixed combination drug irbesartan/hydrochlorothiazide, which includes two active ingredients in one dosage form of a tablet, is an anti-hypertensive combination balanced on the basis of clinical and pharmacological properties, which is approved by the Ministry of Health of the Republic of Belarus for use in patients when indicated in case of essential arterial hypertension. This fixed-dose combination is intended for adult patients whose blood pressure is not adequately controlled by irbesartan or hydrochlorothiazide monotherapy. The clinical efficacy and safety of this combination was demonstrated in randomized clinical trials, including patients with a combination of hypertension and type 2 diabetes, metabolic syndrome, and obesity. The use of the fixed-dose combination of irbesartan/hydrochlorothiazide leads to a more rapid decrease in blood pressure compared to irbesartan monotherapy, allows the majority of patients with severe hypertension to achieve the target blood pressure, and increases drug compliance. Thus, the irbesartan/hydrochlorothiazide combinationis a valuable addition to clinicians’ armamentarium for the treatment of hypertension.

A Retrospective Study to Evaluate Real-world Evidence of Azelnidipine in Indian Patients (REDEFINE Study).

Azelnidipine, a selective calcium channel blocker, effectively lowers blood pressure (BP) and heart rate (HR) in hypertensive patients, as demonstrated in a retrospective real-world evidence (RWE) study in Indian patients. This was a retrospective cohort study that included 882 patients aged 18 years or older who had been on azelnidipine treatment for the last 3 months for mild to moderate hypertension (HTN). A structured proforma was utilized to gather data from prescribing physicians to assess the efficacy of azelnidipine (8 and 16 mg) as monotherapy or in combination with other antihypertensive drugs. The primary endpoints of the study were to capture changes in systolic blood pressure (SBP) and diastolic BP (DBP) from baseline to the subsequent visits (4 and 12 weeks), while the secondary endpoints were to measure similar changes in the diabetic group and to estimate the proportion of patients achieving target BP of <130/80 mm Hg and <140/90 mm Hg, respectively. The overall mean reduction of systolic/diastolic BP from baseline to 12 weeks was 13.92/7.91 mm Hg (p-value < 0.0001). The mean reduction of systolic/diastolic BP from baseline to 12 weeks was 11.77/7.43 mm Hg (p-value < 0.0001) in newly diagnosed HTN patients, while in known cases of HTN, it was 16.50/8.48 mm Hg (p-value < 0.0001). In the diabetic group, the mean reduction was 15.35/8.69 mm Hg (p-value < 0.0001). Overall the study showed that in 44 (4.99%) and 408 (46.26%) patients, target BP of <130/80 mm Hg and <140/90 mm Hg, respectively was achieved. The mean change in HR from baseline was a reduction of 5.22 beats/minute. Azelnidipine can be an effective antihypertensive drug to treat mild to moderate HTN in Indian patients.

Influence of Antihypertensive Drugs on Left Ventricular Hypertrophy Regression in Hypertensive Patients

Background: Hypertension and its effect on heart in the form of left ventricular hypertrophy are the important predictors of heart failure. Hypertension treatment and left ventricular hypertrophy regression is crucial in the prevention of cardiovascular disease. However, the impact of antihypertensive treatment on left ventricular hypertrophy is less studied and which particular class of antihypertensive medicine is more effective is largely unexplored in our population. We designed this study to explore this issue in subjects taking treatment by evaluation initial and after six months echocardiography findings. Methods: One hundred fifty subjects aged 25-75 years, taking antihypertensive medicine were enrolled in the study. Along with basic demographic and epidemiological data, initial and after 6 months echocardiographic findings were analyzed for the presence of LV hypertrophy regression. Choice of medicine and necessary changes for the achievement of blood pressure targets were done on treating physician’s discretion.Results: Out of 150 subjects, data for 130 subjects were available for final analysis. Mean age was 54.4 years with standard deviation of 12.3 years. Apart from age, smoking, overweight and obesity, dyslipidemia, and diabetes were the important risk factors with a prevalence of 28%, 26%, 22% and 20% respectively. Although the decrease in rates of LV hypertrophy over the duration of 6 months were not significant in overall and in subjects treated with various antihypertensive medicines, the reductions in LV mass index (108.76+/-11.3 to 98.46+/-11.23) in overall and in different antihypertensives were significant (p&lt;0.001). The decrease in LV mass index was statistically significant in subjects taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers when compared to subjects taking calcium channel blockers (p&lt;0.05). This decrease in LV mass index was not significant when compared between CCBs and mixed drugs.Conclusion: There was regression in LV hypertrophy among subjects taking antihypertensive treatment. It was more obvious in subjects taking angiotensin converting enzyme inhibitors/angiotensin receptor blockers when compared with subjects taking calcium channel blockers or both.

Complications of arterial hypertension

Complications of arterial hypertension (AH), beginning to show a direct relationship with the level of blood pressure 145/95 mm Hg. Art., for many decades are the leading cause of death among all causes of death. Arterial hypertension, without a doubt, is the leading medical and social problem of our time, the role of which in mortality and disability of people continues to grow, despite the great attention paid to this problem by the scientific community, practitioners and authorities. Against the backdrop of growing knowledge and progress in the field of pharmacology and therapy of hypertension, the frequency of achieving target blood pressure today in the United States and European countries has stabilized by 25-34%, in Russia in the 1990s. was - in men 5.7%, in women - 17.5%, decreasing with age[2]. According to the National Guidelines for the Prevention, Diagnosis and Treatment of Arterial Hypertension (draft) in Russia in 2006, this indicator slightly improved (21.5%)[2, 4]. Apparently, it is within these limits that one can speak of the limit of population possibilities of the unconditionally dominant drug therapy of hypertensive conditions today.

Faktor Prediktor Ketercapaian Target Tekanan Darah Pasien Hipertensi di RS PKU Muhammadiyah Gamping

Hypertension is a disease that ranks third as the cause of death in Indonesia and Yogyakarta is in third place. Many factors that affect achieving blood pressure targets, such as age, comorbidities, gender, duration of hypertension, and antihypertensive drug regimens are significantly associated with increased blood pressure. The purpose of this study was to describe using antihypertensive drugs and risk factors for achieving blood pressure targets in outpatient hypertension patients at PKU Muhammadiyah Gamping Hospital, Yogyakarta. This research is a non-experimental research by designing analytical descriptive research. Data collection was carried out retrospectively from medical records of outpatient hypertension patients from January to July 2019. Data were collected by purposive sampling. The sample in this study was obtained as many as 103 patients. The data were analyzed descriptively to see the pattern of use of antihypertensive drugs and the percentage of achievement of blood pressure targets. The relationship between age, comorbidities, gender, duration of hypertension, and antihypertensive drug regimen with achieving blood pressure targets was analyzed using bivariate and multivariate analysis. Results Based on the study, it was found that 42% of patients had achieved the blood pressure target based on Joint National Committee (JNC) VIII. Patients who received antihypertensive monotherapy were 33% and antihypertensive combinations were 67%. The most common monotherapy was Calcium Chanel Blocker (17.48%) while the most common antihypertensive combination was Angiotensin Receptor Blocker and Calcium Channel Blocker (30.10%). There was a significant relationship between age, comorbidities, duration of hypertension, and antihypertensive drug regimen on achieving blood pressure targets (p&lt;0.05). The predictor factors that significantly influence achieving blood pressure targets in hypertensive patients are age, comorbidities, duration of hypertension, and antihypertensive therapy regiment

Hypertension in the Russian population during the COVID-19 pandemic: sex differences in prevalence, treatment and its effectiveness. Data from the ESSE-RF3 study

Aim. To study the epidemiological characteristics and changes of hypertension (HTN), as well as factors associated with HTN in the Russian population aged 35-74 years.Material and methods. The Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study examined a representative sample of the population aged 35-74 years of 15 Russian regions with a response &gt;70% (n=28611). Modular design questionnaire was used. Blood pressure (BP) was measured twice after a 5-minute rest in a sitting position on the right arm with an Omron blood pressure monitor. There were following criteria for hypertension: systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, and/or antihypertensive therapy. The effectiveness of treatment was considered the proportion (%) of people who achieved target blood pressure values among those being treated, while the control was considered the proportion (%) of patients with a BP &lt;140/90 mm Hg of the total number of hypertensive patients. HTN changes were studied in a single age range of 35-64 years with the inclusion of materials from the ESSE-RF (2012-14) and ESSE-RF2 (2017) studies, carried out using the same methodology as ESSE-RF3. Statistical analysis was carried out using the open-source R 3.6.1 environment. Analysis of the association between factors and a binary variable was performed using logistic regression. The significance level for all tested hypotheses was 0,05.Results. According to ESSE-RF3, the average levels of SBP and DBP in the population were 131,9±18,7 and 84,4±10,9 mm Hg, respectively, while the proportion of those with BP ≥140/90 mm Hg — 38,8% (men: 44,8%, women: 33,9%). Prevalence of hypertension was 53,9% (men: 56,0%, women: 52,1%), awareness — 77,7% (men: 71,5%, women: 82,3%), while the treatment received 63,4%, significantly higher among women than among men: 72,3 vs 53,3%. The effectiveness of treatment was 44,0%, higher among women compared to men (48,2 vs 37,4%). In addition, 27,9% of patients have controlled HTN.Conclusion. The problem of controlled HTN in Russia remains unresolved in the 21st century. The following significant sex differences remain: the prevalence of HTN is higher among men, but awareness of the disease, treatment rate and its effectiveness are lower compared to women.

Modern ideas about the consequences of sympathoadrenal hyperactivation in hypertensive patients with metabolic disorders: modulation possibilities

The prevalence of hypertension (HTN) in the Russian Federation and the world continues to grow. This is largely due to the epidemic of obesity and related conditions — metabolic syndrome and type 2 diabetes. The most common and proven hypothesis of the relationship between hypertension and obesity is the activation of the sympathetic nervous system. However, modern research shows that the consequences of sympathetic hyperactivation are not limited only to hemodynamic effects, but extend to many organs and systems. Long-term sympathetic hyperactivation can lead to insulin resistance and type 2 diabetes. Neurotransmitters affect fat cells by increasing lipolysis and leading to increased fatty acid release, the liver by increasing gluconeogenesis, and pancreatic β-cells by decreasing insulin secretion. The sympathetic nervous system plays an important role in energy management by regulating metabolic rate. Obese individuals have significantly less pronounced postprandial thermogenesis, despite a higher insulin response, while the hemodynamic response to isometric or heterometric exercise is reduced. Chronic stress serves not only as a trigger for behavioral disorders, but also directly leads to various physiological disorders, including through sympathetic activation. However, the choice of antihypertensive agents affecting the sympathetic activity in patients with obesity and metabolic disorders is very limited. According to current guidelines, β-blockers are not the drugs of choice in patients with uncomplicated HTN, since it has a weaker evidence base compared to other classes of drugs and have metabolic and other side effects. Therefore, selective I1-imidazoline receptor agonists, and in particular, moxonidine may be the drugs of choice in this category of patients. Moxonidine in combination therapy of patients with HTN and metabolic disorders, including metabolic disorders in menopause, as well as with a physiological estrogen decrease, significantly improves the effectiveness of antihypertensive therapy and increases the achievement of target blood pressure. In addition, its metabolic effects improve prognosis of such patients.

The safety and efficacy of quadruple ultra-low-dose combination (quadpill) for hypertension treatment: a meta-analysis of randomized controlled trials

Abstract Background Hypertension is a significant healthcare burden, with an average global prevalence of 1.28 billion adults aged between 30 -79 years old. Using antihypertensive drug combinations is considered more effective in controlling elevated blood pressure than monotherapy; however, psychological factors of the patients and the physicians’ caution from the drugs' adverse effects are still barriers against antihypertensive drug combinations. Quadpill, a single pill containing a quadruple combination of quarter doses of four antihypertensive agents, has been investigated for hypertension treatment. Purpose We aim to evaluate the efficacy and safety of the quadruple ultra-low-dose combination of antihypertensive drugs (quadpill) in patients with hypertension. Methods We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) evaluating quadpill versus monotherapy or placebo in patients with hypertension, which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through February 17th, 2023. Continuous and dichotomous outcomes were pooled using mean difference (MD) and risk ratio (RR) along with confidence interval (CI), using Revman V. 5.4 software. Results Four RCTs with a total of 781 patients (372 in the quadpill group and 425 in the control group) were included in our analysis. Quadpill was effective in controlling automated systolic blood pressure on the short-term (4-6 weeks) (RR: -13.00 with 95% CI [-17.22, -8.78], P= 0.00001) and on the long-term (12 weeks) (RR: -6.18 with 95% CI [-9.35, -3.01], P= 0.0001). Quadpill was also effective in controlling automated diastolic blood pressure on the short-term (4-6 weeks) (MD: -8.15 with 95% CI [-9.42, -6.89], P= 0.00001) and on the long-term (12 weeks) (MD: -6.35 with 95% CI [-10.37, -2.33], P= 0.002). Moreover, patients in the quadpill group significantly achieved target blood pressure &amp;lt; 140/90 (RR: 1.77 with 95% CI [1.26, 2.51], P= 0.001), compared to the control group. Finally, there was no difference between the quadpill and the control groups regarding the safety outcomes, including the incidence of any adverse events (RR: 1.36 with 95% CI [0.86, 2.15], P= 0.19), any serious adverse events (RR: 1.13 with 95% CI [0.56, 2.25], P= 0.74), and any adverse events leading to drug discontinuation (RR: 0.89 with 95% CI [0.19, 4.11], P= 0.88). Conclusion Quadruple ultra-low-dose combination of antihypertensive drugs (quadpill) was effective and safe for hypertension treatment. However, further large-scale multicenter RCTs are still warranted before endorsement in the clinical practice as current evidence is based on a small number of RCTs and quadpill holds a promising strategy for hypertension treatment.Figure 1Figure 2

Clinical efficacy of a fixed-dose combination of amlodipine/indapamide/perindopril in patients with hypertension and multiple risk factors

Aim. To evaluate the antihypertensive and organ protective efficacy of the triple fixed-dose combination of amlodipine/indapamide/perindopril in patients with hypertension (HTN) who did not achieve target blood pressure (BP) on previous antihypertensive therapy (AHT).Material and methods. The study included 47 patients with HTN and multiple risk factors who did not achieve target blood pressure during previous AHT. They were prescribed triple fixed-dose combination of amlodipine/indapamide/perindopril with preliminary prescription of amlodipine, indapamide and perindopril in the free-dose combination. At baseline and after 3 months of AHT, 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography and arterial stiffness were analyzed.Results. Initially, in patients included in the study, the main ABPM parameters were increased, while non dipper and reduced dipper (66% of patients) patterns prevailed. The results of echocardiography indicated left ventricular (LV) hypertrophy (LVH) by left ventricular mass index (LVMI), left ventricular posterior wall thickness (LVPWT), interventricular septum (IVS) and its diastolic dysfunction by E/A, while an increase in CAVI and biological vascular age reflected an increase in arterial stiffness. After 3 months of AHT, significant (p£0,05) ABPM changes and a predominance of the dipper-type 24-hour BP pattern were recorded in more than half of the patients (53%). A decrease in LVMI, LVPWT and IVS by 7%, 12% and 8%, respectively (p£0,05), while an E/A increase by 12% reflected LVH regression and LV diastolic function improvement. A decrease in arterial stiffness was evidenced by a decrease (p£0,05) in CAVI by an average of 10% and biological vascular age by 4 years.Conclusion. Triple fixed-dose therapy of amlodipine/indapamide/perindopril after 3-month treatment made it possible to achieve target blood pressure in 78% of patients, improved ABPM parameters and ensured pronounced cardioand vasoprotective effects, reflected in LVH regression, improvement of LV diastolic function and reduction of arterial stiffness.