Achieving Target BP Research Articles

EFFECTIVENESS & TOLERABILITY OF METOPROLOL ER, TELMISARTAN & CHLORTHALIDONE IN PATIENTS OF ESSENTIAL HYPERTENSION WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY BMI

Objective: We conducted real world study to assess effectiveness (on blood pressure [BP; mmHg]) and tolerability of fixed dose combination (FDC) of 25/50 mg Metoprolol + 40 mg Telmisartan + 12.5 mg Chlorthalidone in treating hypertension and stable coronary artery disease (CAD). Body mass index (BMI) is one of the factors that affects hypertension and CAD. Hence, we performed this subgroup analysis to assess effectiveness of the FDC based on patients’ BMI. Design and method: A retrospective, multicenter study retrieved data over 15 months from electronic medical records of 1,810 adult patients with systolic BP greater or equal to 140 and/or diastolic BP greater or equal to 90 and stable CAD; 1,784 were treated with FDC for 24 ± 2 weeks. Mean change in BP from baseline, proportion of patients achieving target BP (systolic BP < 140 and diastolic BP < 90) and incidence of adverse events were analyzed in patients with BMI < 18.5 kg/m2 (underweight n= 9); 18.5-22.9 kg/m2 (normal n= 249), 23.0-24.9 kg/m2 (overweight n= 464) and greater or equal to 25 kg/m2 (obese n=1,062). Results: Mean changes in systolic (underweight, -33.6; normal, -29.9; overweight, -27.7; obese, -31) and diastolic BP (underweight, -12.2; normal, -11.5; overweight, -12; obese, -12.2) from baseline to 24 ± 2 weeks were significant (p<0.001), Fig 1. Proportion of patients achieving target BP at 24 ± 2 weeks in all except underweight category was >84%. Fourteen patients had adverse events; hypotension being most common. Conclusions: In a real-world setting, the FDC of Metoprolol + Telmisartan + Chlorthalidone was effective in reducing blood pressure and was well-tolerated in treating hypertension with CAD across all BMI categories. The study demonstrated significant reductions in both systolic and diastolic BP for patients with different BMI levels, highlights the potential benefits of FDC in managing hypertension in various body weight groups.

EFFECTIVENESS & TOLERABILITY OF METOPROLOL ER, TELMISARTAN & CHLORTHALIDONE IN ESSENTIAL HYPERTENSION PATIENTS WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY COMORBIDITIES

Objective: We conducted a real-world study to assess effectiveness (on blood pressure [BP; mmHg]) and tolerability of fixed dose combination (FDC) of 25/50 mg Metoprolol + 40 mg Telmisartan + 12.5 mg Chlorthalidone in treating hypertension and stable coronary artery disease (CAD). Considering comorbidities as risk factors for hypertension and CAD, this subgroup analysis was conducted in patients with common comorbidities. Design and method: A retrospective, multicenter study retrieved data over 15 months from electronic medical records of 1,810 adult patients with essential hypertension [systolic BP (SBP) greater than or equal to 140 and/or diastolic BP (DBP) greater than or equal to 90] and stable CAD. Of 1,784 patients who received this FDC for 24 ± 2 weeks; 1,224 had comorbidities (obesity: 1,062; diabetes mellitus: 494; dyslipidaemia: 270; hypothyroidism: 121). Results: Mean change in SBP / DBP (obese: -31.1 / -12.2; diabetes mellitus: -29.8 / -11.4; dyslipidaemia: -28.6 / -10.7; hypothyroidism: -26.4 / -8.5) from baseline to 24 ± 2 weeks was significant (p<0.001, Fig 1). Proportions of patients achieving target BP (SBP < 140 and DBP < 90) was >90% in diabetes mellitus and hypothyroidism and >82% in obese and dyslipidaemia patients. Of 14 patients with adverse events (hypotension being most common), 10 had comorbidities. Conclusions: This real-world study demonstrated that the FDC of Metoprolol + Telmisartan + Chlorthalidone was effective in reducing blood pressure and well tolerated in treating patients with hypertension and CAD who had common comorbidities.

Impact of Hemodialysis Time Prolongation on Blood Pressure Control

Abstract Introduction Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours. We aim to study the effect of increasing hemodialysis session time on blood pressure control. Methods This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study. Patients were divided into 2 groups: (A) 25 patients who received longer session hemodialysis session (4.5 hour) and (B) 25 patients HD who received the usual 4 hours session. Revision of antihypertensive medications& dosages, dry weight was reassessed regularly, and they were instructed to restrict their salt intake as much as possible aiming at BP < 140/90 mmHg. they were followed up for a period of 6 months assess changes of pre-dialysis blood pressure to monitor response. Results Patients in both groups were age matched, with male sex predominance (64%in groupA&56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (pvalue <0.001 vs 0.523). Longer HD session time session was associated with highly significant decline in mean SBP, (p-value <0.001). Longer HD session time session was associated with highly statistically significant decline in mean DBP, (p-value <0.001). The decline in mean perdialysis SBP & DBP was -17.27 &-9 mmHg, respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg, respectively at 6th month compared to values in 1st month of follow up period. Conclusion Longer HD session duration is associated with better improvement in UF volume, mean SBP&DBP, pre-dialysis SBP&DBP and post-dialysis SBP&DBP as well.

POOR ACHIEVEMENT OF THE TARGET BLOOD PRESSURE LEVELS ASSOCIATED WITH DIASTOLIC HEART FAILURE IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: Aim of this study was to assess the impact of not achievement of the target blood pressure levels on the presence of the diastolic heart failure in patient with resistant hypertension (RH). Design and method: The study included patients with arterial hypertension who received 3 and more AH drugs and had BP > 140/90 mm Hg and were admitted to the department of secondary hypertension. In all patients we performed the following examinations: anthropometry, office blood pressure, electrocardiography (ECG), echocardiography, ABPM, sleep apnea determination, blood biochemical analysis, determination of levels of TTH, T3, T4, blood renin, blood aldosterone levels, blood cortisol level and metanephrine in the urine. Results: The study included 1146 patients with RH who received 3 or more antihypertensive drugs with the level of office blood pressure at admission > = 140/90 mm Hg. The mean age was 57,9 ± 0,37 years. The average body weight is 87,7 ± 0,61 kg, body mass index - 31,0 ± 0,19 kg/m2. Baseline office SBP/DBP - 174,6 ± 0,64/100,5 ± 0,38 mmHg. Half of the patients (51.4%) received 3 antihypertensive drugs, four drugs - 37.1%, five drugs - 9.1%, and six drugs - 2.4% respectively. Our data showed that after correction of the therapy only 31% of patients who received 3 or more antihypertensive drugs had true resistant hypertension. Fixed combinations were taken by 71.9% of patients. Patients who did not achieve target BP had significantly higher cortisol level (155.0 ± 44.0 vs 35.9 ± 20.8 ng/l) and the highest left ventricular mass index (147.5 ± 3.46 vs 135.3 ± 1.74 g/m2), obesity (42.9 vs 37.5 %), kidney function abnormalities (2.7 vs 0.8 %), and also we noted the higher prevalence of the diastolic heart failure in comparison with patients who achieved target BP (16.9 vs 8.5 %). Conclusions: Not achievement of the target blood pressure levels was associated with the presence of the diastolic heart failure in patients with resistant hypertension

Identifying Targets to Improve the Management of Severe Hypertension in Pregnancy and Postpartum

ObjectivesTo (1) define quality indicators, (2) describe care gaps, and (3) identify process issues in severe hypertension (sustained systolic blood pressure [BP] ≥160 mm Hg or diastolic BP ≥110 mm Hg) management at our tertiary care centre. MethodsPregnant and postpartum persons diagnosed with a hypertensive disorder of pregnancy from 2018 to 2019 were identified. A retrospective cohort of patients with severe hypertension was constructed, and data were collected through chart review. Severe hypertension management was assessed according to defined quality indicators. Clinical characteristics were compared between participants with and without time-to-target BP within 60 minutes. Process issues were examined for each severe hypertension occurrence. ResultsOf 608 participants with a hypertensive disorder of pregnancy, 90 (15%) experienced severe hypertension. Median time-to-target BP was 76 minutes (interquartile range 47–123 minutes), and target BP (<155/105 mm Hg) was achieved within 60 minutes in 31/90 (34%) participants. Appropriate antihypertensives for severe hypertension were used in 55/90 (61%), and time-to-treatment initiation was within 30 minutes in 42/54 (78%). Chronic hypertension and oral labetalol use were associated with delays in achieving target BP. Process issues related to severe hypertension management included inappropriate treatment (n = 35/90; 39%), failure to recognize severe hypertension as an emergency (n = 21/90; 23%), and delayed treatment initiation (n = 12/54; 22%). ConclusionWe defined quality indicators for severe hypertension management. Time-to-target BP within 60 minutes was achieved in a minority of patients, and chronic hypertension was associated with delayed severe hypertension resolution. Process issues in severe hypertension management were described.

Does negative affectivity have an association with achieving target values in hypertensive patients: primary care perspective

ABSTRACT Objectives The current study aimed to seek the relationship between demographic characteristics, treatment compliance status, and type D personality characteristics to achieve target BP values. Methods This cross-sectional research was conducted on HT patients at three family medicine health-care services in Ankara, Turkey, between 1 February 2021, and 31 January 2022. The sociodemographic questionnaire survey, Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCHBPTS), and Type D Scale-14 (DS-14) were applied to 317 patients. HBCHBPTS consists of 14 items with three domains. DS-14 consists of 14 items assessing negative affectivity (NA) and social inhibition (SI). Results Patients with NA were less likely to achieve the SBP target values (62.20% vs 47.50, p = 0.011). NA scores were correlated with HBCHBPTS total scores and HBCHBPTS medication-taking domain scores. Living in a city center (β = −0.157, p = 0.017), not smoking (β = −0.114, p = 0.042), knowing the names of HT drugs (β = - 0.152, p = 0.005), having a Mediterranean-style diet (β = −0.182, p = 0.002), starting treatment immediately after diagnosis (β = −0.121, p = 0.029), older age (β = −0.164, p = 0.028), having less NA scores (β = 0.171, p = 0.029) were effective on better treatment adherence. Variables affecting the failure to achieve the SBP target values were not being in the extended family (p = 0.022, OR: 0.337), anti-HT drug side effects (p = 0.029, OR: 2.566), higher HBCHBPTS total scores (p = 0.001, OR: 1.178), higher DBP values (p < 0.001, OR: 1.141). Conclusion HBCHBPTS total and HBCHBPTS medication-taking domain indicators worsened as the NA and SI characteristics increased. Predictors, including those not living in an extended family, being affected by the side effects of anti-HT drugs, high HBCHBPTS total score, and high DBP values, were effective in failure to achieve the SBP target values.

Efficacy and Safety of Fixed-Dose Combination of Efonidipine and Telmisartan in Stage II Hypertensive Patients: Results from Randomized Clinical Trial

Aim: The aim of this study was to evaluate the anti-hypertensive efficacy of a fixed-dose combination (FDC) of Efonidipine 40 mg and Telmisartan 40 mg in Stage II hypertensive patients.&#x0D; Study Design: Multicentric, randomized, double-blind, parallel, comparative Phase III clinical trial.&#x0D; Methodology: This clinical trial was conducted at six geographically distributed sites across India and enrolled 240 Stage II hypertensive patients. They were randomized into two groups in a ratio of 1:1 using computer-generated block randomization to receive E+T (FDC of Efonidipine 40 mg + Telmisartan 40mg) or C+T (FDC of Cilnidipine 10 mg + Telmisartan 40 mg) group intervention once daily for a period of 90 days. The study site staff, investigator and patients were blinded to the treatment allocation. The primary endpoint of the study evaluated the mean reduction in sitting systolic BP (SBP) and diastolic BP (DBP) from baseline to day 90 whereas the secondary endpoints assessed were mean reduction in BP from baseline to day 30 &amp; 60, patients achieving target BP (&lt;140/90 mmHg) and the safety and tolerability of the investigational products based on the incidences of adverse events (AEs) reported.&#x0D; Results: A total of 118 subjects were randomized to the E+T group wherein the mean (±SD) SBP and DBP at baseline was 167.25 ± 4.68/107.26 ± 5.19 mmHg. After 30 days of treatment with the E+T group, the mean reduction in SBP/DBP of 29.37/18.06 mmHg was observed whereas at Day 60 reduction of 38.55/22.69 mmHg was seen from the baseline. At Day 90, SBP/DBP decreased to 119.41±14.99/81.67±4.29 mmHg with a mean reduction of 47.94/25.89 mmHg in the E+T group. During the study period, the difference in systolic blood pressure between the treatments with E+T and C+T was -0.48 mmHg, with the two-sided 95% confidence interval (CI) ranging from -4.54 to 3.58 mmHg. The corresponding difference in diastolic blood pressure was -0.77 (95% CI: -2.60 to 1.06) mm Hg. The upper boundary of the 95% CI was below the margin of 10 mmHg, confirming the non-inferiority of E+T to C+T. A total of 92% of patients who had been assigned to E+T treatment achieved their target BP goal. Only one patient reported an adverse event with E+T treatment. No unexpected AEs were reported in the E+T group suggesting its good safety and tolerability. Overall, the E+T treatment was effective, safe and well-tolerated by the patients for 90 days.&#x0D; Conclusion: It was concluded that the FDC of Efonidipine 40 mg and Telmisartan 40 mg was efficacious in the management of Stage II hypertension.

THE ROLE OF PHYSICAL ACTIVITY IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

The study aimed to assess the impact of physical activity on the dynamics of neurohumoral and cardio hemodynamic indicators in patients with arterial hypertension and concomitant obesity under different pharmacotherapy regimens. Materials and Methods: Two hundred patients with stage II arterial hypertension grade 2 and obesity grade I–II were examined using clinical-anamnestic, anthropometric, biochemical, automated immunological analysis, spectrophotometric and instrumental methods. Per the research objective, patients underwent a re-evaluation after six months of prescribed treatment. Non-pharmacological treatment included dietary therapy aimed at weight correction, with recommendations to increase physical activity primarily through brisk or moderately brisk walking for at least 45 minutes daily. Pharmacological treatment followed the European recommendations in 2018, involving dual antihypertensive therapy. The combination included perindopril and amlodipine. Patients who achieved target BP levels within 3 months of treatment continued to receive the prescribed therapy. For the rest of the patients, a third antihypertensive drug, indapamide, was additionally prescribed. In addition to assessing the achievement of target blood pressure levels after 6 months and at interim stages of the study, patients' adherence to recommendations regarding expanding physical activity was evaluated. Patients were divided into groups with sufficient and reduced physical activity accordingly. Statistical analysis of the obtained data was conducted using the SPSS 17 software package (IBM), Microsoft Office Excel-2003. The data are presented as mean values ± standard deviation. Significance was established at the level of p &lt; 0.05 in all cases. Results of the study: Patients who achieved target blood pressure levels on dual antihypertensive therapy and had sufficient physical activity after six months of treatment differed significantly from patients with low physical activity levels. They exhibited lower values of the pulse wave velocity in the carotid artery and abdominal aorta, a considerably higher degree of endothelium-dependent vasodilation, lower values of end-systolic and end-diastolic diameters, left ventricular mass, a lower E/e´ ratio, and showed better dynamics in metabolic and pro-inflammatory indicators. Additionally, they had a higher level of antioxidant protection. Patients who reached the target blood pressure levels on three-component antihypertensive therapy and engaged in sufficient physical activity after six months displayed significant differences compared to patients with low physical activity. These differences included a more substantial reduction in the pulse wave velocity in the carotid artery, an increase in endothelium-dependent vasodilation, lower indicators of carbohydrate metabolism, reduced levels of pro-inflammatory and pro-oxidant activity, lower levels of leptin, and a more pronounced increase in adiponectin. Conclusions: Physical activity is a crucial factor influencing the treatment outcomes for patients with arterial hypertension and obesity across different antihypertensive therapy regimens. Irrespective of the chosen antihypertensive therapy option, physical activity positively impacted cardiovascular remodelling, the dynamics of metabolic and pro-inflammatory indicators, and the equilibrium within the oxidative stress-antioxidant protection system and activity of the renin-angiotensin-aldosterone system.

Цифрлық дәуірде артериялық гипертензиямен ауыратын науқастарды қашықтықтан бақылау және басқару

The use of active remote monitoring of patients with AH receiving antihypertensive therapy helps to achieve target BP values with subsequent monitoring of health indicators, as well as to provide timely medical care. Remote monitoring and treatment using information and communication technologies has been proposed to improve the quality of medical care. The introduction of remote BP monitoring will significantly improve the existing model of diagnostics and treatment of patients with chronic diseases, increase the number of observed patients at each therapeutic site without increasing the time for dispensary observation, as well as attract the working-age population to primary prevention of cardiovascular diseases. Taking into account modern trends in medical care for the working population and progress in information technologies, there is currently an opportunity to build a new model, which, while maintaining the main levels and stages of medical care, should ensure compliance with uniform standards of medical care, which can be ensured through the introduction of telemedicine and mobile components. The new elements of the system include: retrofitting medical stations of enterprises with medical and telecommunication equipment, connecting them to medical information systems; application of patient-oriented personal hardware and software systems for prevention, treatment monitoring and rehabilitation; use of mobile medical and telemedicine complexes; building up the material, technical and human resource capacity of emergency medical aid and medical evacuation services; development of digital communication systems between hospitals and medical centers in remote areas; and development of a new system of medical and telemedicine services. Organizational solutions in the field of digital and mobile medicine can serve as a basis for building a promising model of medical support for the working population in remote areas, ensuring proper quality and accessibility of medical care. The article considers the main aspects of using remote blood pressure monitoring as one of the methods of telemedicine health control. The regulatory and legal framework regulating the provision of medical care with the use of remote blood pressure monitoring is presented. The main technical aspects and technological models of telemedicine monitoring of BP in patients with arterial hypertension are analyzed. The review of publications devoted to clinical and economic efficiency of remote monitoring of blood pressure is given.

S-21-3: EFFECTIVENESS AND ACCEPTABILITY OF MOBILE PHONE TEXT MESSAGING INTERVENTION TO IMPROVE BLOOD PRESSURE CONTROL (TEXT4BP) AMONG HYPERTENSIVE PATIENTS IN NEPAL

Objectives: In LMICs, the rapid uptake and availability of mobile phones provide excellent opportunities for host of an intervention. However, research on the effectiveness and acceptability of mHealth in these settings remains limited. The main objective of this feasibility study was to assess the effectiveness and acceptability of a mobile phone text messaging intervention (TEXT4BP) to improve blood pressure control and treatment adherence among hypertensive patients in Nepal. Design and Methods: The TEXT4BP study was a two-arm, parallel-group, unblinded, randomized controlled pilot trial that recruited 200 clinically diagnosed hypertensive patients aged 18–69 years visiting at a tertiary referral hospital in Kathmandu, Nepal. We co-designed the contextual text messages informed by the formative qualitative studies that used COM-B (capability, opportunity, motivation, and behavior) model and Technology Acceptance Model (TAM) model. Patients in the intervention arm (n = 100) received text messages containing information on hypertension, diet, medication, and physical activity three times per week for three months. The control arm (n = 100) received standard care. Primary outcomes were changes in blood pressure and medication adherence at three months. Secondary outcomes included blood pressure control, medication adherence self-efficacy, and hypertension knowledge. Feasibility measures, such as attrition rate, was calculated. A nested qualitative study assessed the acceptability of the intervention. Results: Over the 12 weeks of follow-up, the retention rate was 77%. The intervention group had a greater reduction in systolic and diastolic BP vs usual care [-7.09/-5.86 (p = 0.003) vs -0.77/-1.35 (p = 0.28) mmHg] [adjusted difference: systolic B = -6.50 (95% CI, -12.6; -0.33) and diastolic BP B = -4.60 (95% CI, -8.16; -1.04)] (fig 1), coupled with a greater proportion achieving target BP (70% vs 48%, p = 0.006) at three months. The intervention arm showed an improvement in compliance to antihypertensive therapy (p &lt; 0.001), medication adherence (p &lt; 0.001), medication adherence self-efficacy (p = 0.023), and knowledge on hypertension and its treatment (p = 0.013). In addition, intervention participants expressed a high rate of acceptability and desire to continue the TEXT4BP intervention in the future too. Conclusion: The TEXT4BP study has generated promising evidence that text messaging intervention is feasible, acceptable, and effective in improving blood pressure control in low-resource settings like Nepal. The findings will inform further large-scale mHealth research and contribute to clinical practice with evidence-based hypertension guidelines in Nepal. Trial reg: ACTRN12619001213134

Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia.

BackgroundAccurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).MethodsA cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.ResultsParticipants (n=377) had a mean age of 53.61 ± 12.80-years, range (18–82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43–18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36–14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.ConclusionHypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.

EFFECTIVENESS AND TOLERABILITY OF BISOPROLOL/PERINDOPRIL SINGLE-PILL COMBINATION IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND CONCOMITANT HYPERTENSION WHO HAD A HISTORY OF MIOCARDIAL INFARCTION

Objective: To evaluate effectiveness and tolerability of bisoprolol/perindopril single-pill combination (Bis/Per SPC) in the subgroup with stable coronary artery disease (CAD) and concomitant hypertension (HTN) and a history of myocardial infarction (MI) Design and method: STYLE (NCT03730116) was a 3-month, multicenter, open-label, uncontrolled observational study conducted in Russia. Stable CAD patients (n = 1892) comorbid with HTN and treated with Bis/Per SPC were included from November 2018 to January 2019. Data were collected at 3 visits: V1 (inclusion visit), V2, V3 (1, 3 months). In this post-hoc analysis, the antihypertensive effectiveness of Bis/ Per SPC in the subgroup with a history of MI was assessed by mean change in systolic (SBP) and diastolic blood pressure (DBP) and antianginal effectiveness - by mean changes in number of angina attacks and short acting nitrates (SAN) intake. Treatment tolerability was assessed by investigators as excellent, good, or acceptable. Results: Subanalisis included 495 patients (26.2%) with a history of MI. At baseline (BL), mean age was 62.9 ± 8.5 years, 39.0% (n = 193) were women, mean SBP and DBP were 155.5 ± 16.2 mmHg and 92.1 ± 10.3 mmHg, respectively and mean heart rate (HR) was 80.2 ± 10.3 bpm. By V3, mean SBP/DBP significantly decreased by 29.6 ± 15.2/15.5 ± 10.0 mmHg respectively (p &lt; 0.0001 for both) and 86.9% (n = 430) of patients achieved target BP &lt; 140/90 mmHg. Mean HR decreased by 12.1 ± 8.5 bpm after 1 month and by 16.1 ± 9.6 bpm after 3 months (p &lt; 0.0001 for both) and 27.3% (n = 135) of patients reached target level of HR (55–60 bpm). The proportion of patients who achieved target BP (&lt;140/90 mmHg) with HR &lt; 60 bpm at V3 was 27,5 % (131 of 476). The number of angina attacks per week and intake of SAN decreased from 5.2 ± 14.5 and 5.0 ± 4.9 (at V1) to 0.8 ± 1.7 and 1.3 ± 1.7 (at V3), respectively (p &lt; 0.0001 for both). 97% of investigators rated tolerability of SPC as excellent or good at V3. Conclusions: In stable CAD patients with HTN and a history of MI treated with Bis/Per SPC for 3 months, significant improvement in BP and HR control, reduced angina attacks and SAN intake were observed, and treatment was well tolerated.

A Retrospective, Observational, EMR-Based Real-World Evidence Study to Assess the Incidence of Pedal Edema in Essential Hypertensive Patients on Amlodipine or Cilnidipine.

Introduction Calcium channel blockers have pedal edema as one of the confining factors of treatment. A real-world study may help evident reality of the situation in regular Indian clinical practice. The aim of the study is to assess effectiveness and incidence of pedal edema in essential hypertensive patients treated with amlodipine or cilnidipine monotherapy. Methods Retrospective EMR data of adult essential hypertensive patients, prescribed amlodipine (n = 800) or cilnidipine (n = 800) as monotherapy, were analyzed. Incidence of pedal edema from baseline visit was analyzed in terms of dose and duration of treatment. The changes in systolic (SBP) and diastolic blood pressure (DBP) from baseline and proportion of patients achieving target BP goals were assessed. Results In amlodipine and cilnidipine groups, mean changes in SBP and DBP from baseline to end of the study period were 28.4 and 15.1 mmHg and 24.3 and 13.5 mmHg, respectively (p value <0.05). More than 50% of patients in both groups achieved BP goal at the end of the study (p value 0.266). In amlodipine group, total 23.9% reported pedal edema, while in cilnidipine, 27.6% (p value 0.0863). At the end of the study, 3.5% and 8.2% of patients remain with pedal edema, respectively, in both groups (pvalue <0.005). Conclusion Amlodipine demonstrated greater BP reduction at a lower average dose, better efficacy, and tolerability in terms of pedal edema count as a lesser number of patients reported edema at the end of the study and a higher percentage of patients continued the prescribed baseline dosage regimen as compared to cilnidipine. Thus, the study established amlodipine as an effective and well-tolerated antihypertensive for Indians.

Real-world evidence on the strategy of olmesartan-based triple single-pill combination in Korean hypertensive patients: a prospective, multicenter, observational study (RESOLVE-PRO)

BackgroundIn this prospective, multicenter, non-comparative observational study, the effectiveness and safety of the triple single-pill combination (SPC) of olmesartan/amlodipine/hydrochlorothiazide (OM/AML/HCTZ) were evaluated in a real clinical practice setting in Korean patients with essential hypertension.MethodsA total of 3752 patients were enrolled and followed for 12 months after administration of OM/AML/HCTZ. Primary endpoint was change from baseline to month 6 in the mean systolic blood pressure (SBP). Secondary endpoints included changes from baseline in the mean SBP at month 3, 9, 12 and the mean diastolic blood pressure (DBP) at month 3, 6, 9, 12; changes in the mean SBP/DBP according to age and underlying risk factors; and blood pressure control rate (%) at different time points. Adherence to and satisfaction with OM/AML/HCTZ treatment among patients and physicians were assessed by medication possession ratio (MPR) and numeric rating scale, respectively, as exploratory endpoints. Safety was evaluated by the incidence and severity of adverse events (AEs) as well as the discontinuation rate due to AEs.ResultsOM/AML/HCTZ administration led to significant reductions in the mean SBP/DBP by 11.5/6.6, 12.3/7.0, 12.3/7.2, and 12.8/7.4 mmHg from baseline to month 3, 6, 9 and 12, respectively (P < 0.0001). The BP reductions were maintained throughout the 1-year observation period in all patients with different age groups and risk factors (diabetes mellitus, cardiovascular disease, and renal disease). The BP control rate (%) of < 140/90 mmHg was 65.9, 67.9, 68.9, and 70.6% at month 3, 6, 9, and 12, respectively. The mean MPR during the observation period was 0.96. The safety results were consistent with the previously reported safety profile of OM/AML/HCTZ.ConclusionsTreatment with the triple SPC of OM/AML/HCTZ demonstrated significant effectiveness in reducing SBP/DBP and achieving target BP control with high adherence over the 1-year observation period in Korean hypertensive patients and was well-tolerated.Trial registrationCRIS, KCT0002196, Registered 3 May 2016.

An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension.

Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM’s inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339–0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209–0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107–1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.

Изменения офисного артериального давления и приверженность к лечению у пациентов с артериальной гипертензией в исследовании ТРИМАРАН (эффективность генерических препаратов Комбисарт Н и Комбисарт (фиксированная комбинация валсартана и амлодипина))

Актуальность. Несмотря на широкие возможности медикаментозного лечения, контроль артериальной гипертензии остается не очень хорошим во всем мире. Многие пациенты имеют хороший результат при применении комбинированной терапии и достигают целевого уровня артериального давления. Однако около 2/3 из них принимают многокомпонентную антигипертензивную терапию. Наиболее эффективные фиксированные комбинации антигипертензивных препаратов включают блокаторы ренин-ангиотензин-альдостероновой системы (блокаторы рецепторов к ангиотензину II или ингибиторы ангиотензинпревращающего фермента) в комбинации с антагонистами кальция и/или диуретиками. Цель: оценить терапевтическую эффективность генерической фиксированной тройной комбинации валсартана/амлодипина/гидрохлортиазида и двойной фиксированной комбинации валсартана/амлодипина в лечении пациентов с артериальной гипертензией II–III степени. Материалы и методы. В исследование включались пациенты с умеренной и тяжелой артериальной гипертензией без сахарного диабета. Пациенты были разделены на 2 группы. Первой группе (n = 25) было назначена фиксированная тройная комбинация 160 мг валсартана/5 мг амлодипина/12,5 мг гидрохлортиазида один раз в сутки утром в течение 1 месяца. Пациенты второй группы (n = 25) получали по аналогичной схеме двойную фиксированную комбинацию 160 мг валсартана/5 мг амлодипина один раз в сутки утром в течение 1 месяца. Если через 1 месяц терапии был достигнут целевой уровень офисного АД, то пациенты продолжали принимать назначенную терапию в прежней дозе. Если через 1 месяц лечения не был достигнут целевой уровень офисного АД &lt; 140/90 мм рт.ст., пациентам первой группы назначалась таблетка препарата Комбисарт Н в дозе 160 мг валсартана/10 мг амлодипина/12,5 мг гидрохлортиазида еще на 1 месяц. Пациентам второй группы назначалась 1 таблетка препарата Комбисарт — 160 мг валсартана/10 мг амлодипина еще на 1 месяц. Если через 2 месяца терапии достигнут целевой уровень офисного АД, то пациенты продолжали принимать назначенную терапию в прежней дозе. Если через 2 месяца лечения не было достижения целевого уровня офисного АД &lt; 140/90 мм рт.ст., пациентам первой группы назначалась дополнительно таблетка препарата Комбисарт (160 мг валсартана/5 мг амлодипина) на вечерний прием еще на 1 месяц. Пациентам второй группы назначалась дополнительно таблетка препарата Комбисарт Н в дозе 160 мг валсартана/10 мг амлодипина/12,5 мг гидрохлортиазида на 1 месяц. Через 3 месяца лечения происходил контроль терапии. Результаты. В исследование было включено 50 пациентов с умеренной и тяжелой артериальной гипертензией. Средний возраст больных составил 54,9 ± 1,8 (25–75) года. Средняя масса тела составляла 92,4 ± 2,6 кг. Средний индекс массы тела — 31,2 ± 0,7 кг/м2. Средние цифры офисного систолического (САД) и диастолического АД (ДАД) в начале исследования составили 161,7 ± 1,8 мм рт.ст. и 98,5 ± 1,4 мм рт.ст. соответственно. Средняя офисная частота сердечних сокращений — 70,7 ± 1,4 уд/мин. Средние уровни АД при амбулаторном мониторировании составляли: САД — 140,8 ± 1,1 мм рт.ст., ДАД — 84,4 ± ± 1,2 мм рт.ст. Средняя суточная частота сердечних сокращений — 71,5 ± 1,5 уд/мин. Только 5 (10 %) пациентов имели нормальный вес тела, 17 (34 %) пациентов имели избыточный вес тела, 19 (38 %) пациентов имели ожирение I степени, 6 (12 %) пациентов — ожирение II степени, 3 пациента (6 %) имели ожирение III степени. Снижение офисного АД составило 35,6/22,5 мм рт.ст. (Р &lt; 0,05) в целом по группе, 35/19 мм рт.ст. (Р &lt; 0,05) и 42/26 мм рт.ст. (Р &lt; 0,05) — при применении двойной и тройной комбинации соответственно. Целевого АД при офисном измерении достигли 93,3 % пациентов во всей группе, 90,9 % — на двойной комбинации и 95,7 % — на тройной комбинации. Тройная комбинация была более эффективной в снижении офисного артериального давления по сравнению с двойной комбинацией, и ее применение не сопровождалась увеличением побочных эффектов. Отмена препарата наблюдалась у 7 (14 %) пациентов, преимущественно за счет побочного действия в виде сердцебиения и отеков голеней на фоне приема амлодипина. В группе двойной комбинации отмена была у 3 (6 %) пациентов, в группе тройной комбинации — у 4 (8 %) пациентов. Прием двойной и тройной фиксированной комбинации способствовал улучшению приверженности пациентов к лечению по опроснику Мориски — Грина. Выводы. Фиксированные генерические комбинации валсартана/амлодипина и валсартана/амлодипина/гидрохлоротиазида были эффективны в снижении офисного артериального давления у пациентов с умеренной и тяжелой гипертензией, способствовали улучшению приверженности к лечению и хорошо переносились больными.

Вплив фіксованих комбінацій на артеріальну жорсткість та еректильну функцію в пацієнтів з артеріальною гіпертензією

Мета роботи – оцінити терапевтичну ефективність, вплив на жорсткість судин (за допомогою визначення серцево-гомілкового судинного індексу (CAVI)) та еректильну функцію в чоловіків фіксованої потрійної комбінації валсартан/амлодипін/гідрохлоротіазид та подвійної фіксованої комбінації валсартан/амлодипін у лікуванні пацієнтів із артеріальною гіпертензією 2–3-го ступеня. Матеріали і методи. У дослідження залучили 50 пацієнтів з помірною та тяжкою артеріальною гіпертензією без цукрового діабету, віком 25–75 років (у середньому (54,9±1,8) року). Пацієнти були розділені на дві групи методом конвертів по 25 осіб у кожній. Хворим першої групи (n=25) було призначено фіксовану потрійну комбінацію валсартан/амлодипін/гідрохлоротіазид – по 1 таблетці (160 мг валсартану/5 мг амлодипіну/12,5 мг гідрохлоротіазиду) один раз на добу, вранці протягом 1 міс. Пацієнти другої групи (n=25) отримували за аналогічною схемою подвійну фіксовану комбінацію препарату валсартан/амлодипін – по 1 таблетці (160 мг валсартану/5 мг амлодипіну) один раз на добу, вранці протягом 1 міс. За необхідності, якщо не було досягнуто цільового рівня офісного артеріального тиску (АТ) менше 140/90 мм рт. ст., дозу титрували до добової 320/10/12,5 мг (валсартан/амлодипін/гідрохлоротіазид) для фіксованої потрійної комбінації та до 320/10 мг (валсартан/амлодипін) для фіксованої подвійної комбінації. Через 3 міс лікування здійснювали контроль терапії.Результати та обговорення. Індекс маси тіла пацієнтів становив у середньому (31,2±0,7) кг/м2. Офісний систолічний і діастолічний АТ на початку дослідження становив у середньому відповідно (161,7±1,8) та (98,5±1,4) мм рт. ст., офісна частота скорочень серця – 70,7±1,4 за 1 хв. Офісний АТ знизився на 35/19 мм рт. ст. (р&lt;0,05) при застосуванні подвійної фіксованої комбінації та на 42/26 мм рт. ст. (р&lt;0,05) при застосуванні потрійної комбінації. Цільового офісного АТ вдалося досягти у 90,9 % пацієнтів при застосуванні подвійної фіксованої комбінації та у 95,7 % – при застосуванні потрійної комбінації. У групі лікування подвійною фіксованою комбінацією препарат відмінили у 3 (6 %) пацієнтів, у групі застосування потрійної фіксованої комбінації – у 4 (8 %) пацієнтів. Не виявлено статистично значущих змін показника CAVI та змін еректильної функції в чоловіків. CAVI справа при застосуванні подвійної фіксованої комбінації становив (8,68±0,57) ум. од. до лікування та (8,30±0,55) ум. од. – після лікування. CAVI зліва при застосуванні подвійної фіксованої комбінації становив (8,49±1,49) ум. од. до лікування та (8,17±1,49) ум. од. – після лікування. CAVI справа при застосуванні потрійної комбінації становив (8,86±0,39) ум. од. до лікування та (8,50±0,40) ум. од. – після лікування. CAVI зліва при застосуванні потрійної комбінації становив (8,09±0,53) ум. од. до лікування та (8,27±0,36) ум. од. – після лікування (р&gt;0,05 для всіх значень).Висновки. Використані варіанти подвійної (валсартан/амлодипін) та потрійної (валсартан/амлодипін/гідрохлоротіазид) фіксованої комбінації виявили високу антигіпертензивну ефективність, не посилювали метаболічні порушення, не впливали негативно на еректильну функцію в чоловіків та сповільнювали прогресування жорсткості артерій.

MO856IMPACT OF HEMODIALYSIS TIME PROLONGATION ON BLOOD PRESSURE CONTROL IN PREVALENT HEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium &amp; volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.We aim to study the effect of increasing hemodialysis session time on blood pressure control. Method This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study.Patients were divided into 2 groups:(A) 25 patients who received longer session hemodialysis session (4.5hour) and (B) 25 patients HD who received the usual 4 hours session. Revision of antihypertensive medications&amp;dosages,dry weight was reassessed regularly, andthey were instructed to restrict their salt intake as much as possible aiming at BP &amp;lt;140/90mmHg.they werefollowed up for a period of 6 months assess changes of pre-dialysis blood pressure to monitor response. Results Patients in both groups were age matched, with male sex predominance (64%in groupA&amp;56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value &amp;lt;0.001 vs 0.523). Longer HD session time session was associated with highly significant decline in mean SBP, (p-value &amp;lt;0.001). Longer HD session time session was associated with highly statistically significant decline in mean DBP, (p-value &amp;lt;0.001). The decline in mean perdialysis SBP &amp; DBP was -17.27 &amp;-9 mmHg, respectively and the rate of decline of postdialysis SBP &amp; DBP was -6.45 &amp; -12.38 mmHg, respectively at 6th month compared to values in 1st month of follow up period. Conclusion Longer HD session duration is associated with better improvement in UF volume, mean SBP&amp;DBP, pre-dialysis SBP&amp;DBP and post-dialysis SBP&amp;DBP as well.

Oral Nifedipine Versus Intravenous Labetalol in the Management of Severe Pregnancy Induced Hypertension: A Randomized Control Trial

Background : Pregnancy-also known as gestation is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can occur through assisted reproductive technology protedures. To assess the efficacy of oral Nifedipine and I/V Labetalol for lowering BP in severe PIH after 28 weeks of pregnancy.&#x0D; Materials and methods: In this study 100 subjects were selected with severe pregnancy induced hypertension as per inclusion criteria. After taking informed written consent they were randomly allocated into two groups, A &amp; B. Group A received initially tablet nifedipine 10 mg orally with repeated doses of 20 mg every 20 minutes upto five doses while Group B received intravenous labetalol 20 mg initially followed by escalating doses of 40, 80, 80 and 80 mg every 20 minutes until the therapeutic goal blood pressure Systolic £ 150 mmHg &amp; diastolic £ 100 mmHg was achieved. Primary outcomes were the time interval and the number of doses needed to achieve a blood pressure of £ 150/100 mmHg, Secondary outcomes were fetomaternal safety, efficacy and side effects of both drugs. The outcomes were recorded in a preformed data collection sheet. All the data were analyzed by computer based software SPSS version 19 (SPSS Inc, Chicago, IL, USA). P &lt;0.05 at 95% level was taken as statistically significant.&#x0D; Results: A total of 100 patients of different ages with mean age of 27.41 years were taken in the study. Primi patients were more in Group A the Group B and mode of delivery was commonly caesarian section (66% vs 78%) in both groups. Proportion of target BP achievement were 100% in Group A and it was 72% in Group B. Need of drug dose and time of reduction was found significantly less among Group A women. Change of mean ± SD, SBP was more rapid in Group A ( 174.90 ± 20.01 vs 158.40 ± 11.13) women who were on Group A oral nifedipine than Group B ( 179.80 ± 16.54 vs 167.40 ± 15.02) i/v labetalol group after first dose. It was same for DBP also. Need of mean dose were less in group A than Group B (1.72 vs 3.30) also total time needed to achieve target BP was less in Group A (34.40 vs 66.0 mins). There was no need of doses exceeding third dose who were on oral nifidipine than i/v labetolol. Both maternal and fetal heart rate was not influenced by both the drugs. Side effects of drugs were found more in Group B (8% vs 4%) and fetal death also more common in there (8% vs 16%). Value of APGAR scores was found higher both at 1 minute and at 5 minutes among Group A neonates than Group B. Significant urine output volume was found in Group A patients than Group B at first hour.&#x0D; Conclusion: Oral nifedipine and intravenous labetalol both the regimens are found to be effective in the management of severe PIH. But Nifidipine lowers blood pressure more rapidly with fewer doses with minimum fetomaternal side-effects.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 55-61

Impact of Hemodialysis Time Prolongation on Blood Pressure Control

Introduction: Hypertension prevalence among end-stage renal disease (ESRD) patients range from 76% to 90%. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours. Objective: We aimed to study the effect of increasing hemodialysis session time on blood pressure control. Methods: This observational study was conducted on 50 hypertensive prevalent HD patients on thrice-weekly maintenance HD. Patients were divided into 2 groups: (A) 25 patients who received longer hemodialysis session (4.5 hours) and (B) 25 patients HD who received the usual 4 hours session. They were followed up for a period of 6 months to assess changes of pre-dialysis blood pressure to monitor response. Results: Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value < 0.001 versus 0.523). Longer HD session time group was associated with highly significant decline in mean SBP, (p-value < 0.001). Moreover, longer HD session time group was associated with highly statistically significant decline in mean DBP, (p-value < 0.001). The decline in mean perdialysis SBP & DBP was -17.27 & -9 mmHg respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg respectively at 6th month compared to values in 1st month of follow up period. Conclusion: Longer HD session duration is associated with better improvement in UF volume, mean SBP & DBP, pre-dialysis SBP & DBP and post-dialysis SBP & DBP as well.