Adjustment For Antihypertensive Treatment Research Articles

Improving Blood Pressure Control Using Digital Communication Methods in Serbia.

Background: The purpose of this study was to compare home and office BP in the adjustment of antihypertensive treatment. Methods: This study was an open, prospective, noninterventional, multicenter clinical trial that occurred between July 2019 and February 2020, in 34 cities in the territory of the Republic of Serbia, which monitored 1581 participants for 6 months. Depending on the used blood pressure monitoring method used, all patients were divided into control (office BP monitoring) and experimental (home BP telemonitoring) groups. We collected anamnestic data and data about systolic blood pressure (SP), in mmHg, diastolic blood pressure (DP), in mmHg, and heart rate (HR), in beats/minute, from all patients. Results: SP values were significantly different at baseline, and at the second, third, and fourth visits between the two tested groups. Home and office BP decreased significantly (p < 0.000) during the 6-month follow-up. We observed a statistically significant influence of the presence of diabetes mellitus and dyslipidemia on the dynamics of differences between SP monitoring values. Conclusions: Our study suggests that novel technologies in BP monitoring can be excellent alternatives for BP assessment in hypertensive patients with other cardiovascular risk factors such as diabetes and dyslipidemia.

Hypertension: novelties 2021

The past year has been particularly rich in the field of arterial hypertension. Our annual review covers the latest epidemiological studies which show that more than 1.2 billion people have high blood pressure, half of them are unaware of it and that only a quarter of treated patients reach the recommended targets. The impact of poor adherence in young hypertensive patients on cardiovascular events and the effects of intensive treatment in patients over 60 years of age will be discussed. Finally, the adjustment of anti hypertensive treatment in pregnant women with a history of pre-eclampsia according to hemodynamic parameters measured during pregnancy and the effects of potassium supplementation in table salt on cardiovascular events will be presented.

Blood pressure in relation to frailty in older adults: A population-based study.

In frail older adults, low blood pressure (BP) might be associated with worse health outcomes and hypertension management in this population is highly debated. Using data from a population-based study of older adults, we assessed the association between frailty and BP. We used data collected between 2014 and 2016 from 3157 participants aged between 67 and 80years in the Lausanne cohort Lc65+. BP was measured three times at one visit, and frailty status was assessed based on Fried's phenotype model. We analyzed the cross-sectional association between BP and frailty by computing mean systolic and diastolic BP stratified by sex, age, and frailty and by fitting regression models. The average age of the participants was 73.3 (standard deviation [SD]: 4.1) years, and 59.1% were women. 34.1% were pre-frail, and 3.3% were frail. Mean BP was 135.1/76.3mm Hg (SD 18.5/11.0). Age- and sex-adjusted systolic BP was on average lower by 2.8mm Hg (95% confidence interval [CI]: 1.4-4.2) and 6.7mm Hg (95% CI: 3.2-10.3) among pre-frail and frail compared to non-frail participants. Similar differences in mean diastolic BP across frailty status were found. Upon adjustment for antihypertensive treatment, the associations between frailty status and BP did not change substantially. Frail individuals had a substantially lower BP compared with non-frail older adults. Because low BP could be detrimental among frail older patients, our findings raise questions about hypertension management in this population and stress the need for additional evidence.

Adherence to renal function monitoring guidelines in patients starting antihypertensive therapy with diuretics and RAAS inhibitors: a retrospective cohort study.

Acute kidney injury (AKI) might complicate antihypertensive therapy. In The Netherlands, general practitioner clinical practice guidelines provide clear recommendations on monitoring of renal function to minimize this risk. Our objective was to investigate how day-to-day clinical practice corresponds to the guidelines. We conducted a retrospective cohort study in a dynamic population, using data on >9,000 adults that was retrieved from the Integrated Primary Care Information database. We investigated whether serum creatinine (SCR) was measured within 30 and 365days after the start of (combined) use of a diuretic, an angiotensin-converting enzyme inhibitor, and/or angiotensin receptor blocker. We also investigated the association between calendar year, sex, type of therapy, risk factors for AKI and practice and SCR measurement. Of 6,593 subjects who met the study criteria for single drug therapy, SCR was measured in 1,233 subjects within 30days and in 3,896 subjects within 365days. For combined drug therapy recipients (n=2,497), these were 545 and 1,687, respectively. Associated cumulative probabilities were 19% and 66% with single drug therapy, and 22% and 74% with combined drug therapy. Significant differences were observed between practices. SCR measurement was associated with other characteristics, except for sex. Within 365days, SCR increased >30% of baseline in 103 subjects (1.6%) after the start of single drug therapy, and in 85 (3.4%) subjects who initiated combined drug therapy. In the majority (>70%) of these subjects, this did not result in subsequent monitoring or adjustment of antihypertensive treatment. Results from this study suggest that, on average, renal function is not monitored as strictly as recommended by relevant clinical practice guidelines.

Abstract P403: Blood Pressure Differences Associated With OMNIHEART-like Lower Sodium Compared With Typical American Higher Sodium Nutrient Profile: INTERMAP USA

Background: The DASH-Sodium trial demonstrated beneficial effects on blood pressure (BP) of the DASH diet with lower sodium intake, compared to typical American diet with higher sodium. The subsequent OMNIHEART trial reported additional benefits for BP by replacing carbohydrate in the DASH diet with either protein or monounsaturated fats. Objective: Assess possible BP benefits of a lower sodium OMNIHEART-like diet in free-living Americans using two statistical methods: a linear OMNIHEART nutrient score, and a Bayesian approach comparing estimated BP levels with an OMNIHEART-like lower sodium nutrient profile (“OMNIHEART”) and with a typical American higher sodium profile (“Control”). Methods: Cross-sectional data include four 24-h dietary recalls, two timed 24-h urine collections, eight BP readings for 2,195 individuals ages 40-59 from the International Study on Macro/Micronutrients and Blood Pressure (INTERMAP). An OMNIHEART score (with 9 nutrient targets, based on the protein arm of the trial) was calculated for each participant and regressed on BP. For Bayesian profile regression, participants were assigned to clusters based on similarity of their nutrient profiles; pre-specified OMNIHEART and Control profiles were assigned to clusters. Posterior distributions were obtained for mean BP levels associated with OMNIHEART and Control profiles. Results: With adjustment for potential confounders, an OMNIHEART score higher by one point was associated with systolic/diastolic BP differences of 1.0/ 0.5 mmHg (both P&lt;0.001). Mean systolic/diastolic BPs were 111.3/68.4 and 115.2/70.6 mmHg for Bayesian OMNIHEART and Control profiles respectively; controlled for possible confounders, average BP differences were 3.9/ 2.2 mmHg (P(diff≥0) =0.98/0.96). Findings were comparable for men and women, for non-hypertensive participants, and with adjustment for antihypertensive treatment. Conclusions: These findings indicate broad generalisability of DASH and OMNIHEART trial results, and support recommendations for reduced sodium OMNIHEART-style diet for prevention/control of population-wide adverse BP levels.

Évaluation de l’équilibre tensionnel par la mesure ambulatoire de la pression artérielle et étude des facteurs associés à un mauvais contrôle tensionnel chez 300 diabétiques de type 2 hypertendus traités

Hypertension is frequently associated with type 2 diabetes and is often difficult to control. Aim Evaluate the frequency of controlled hypertension in our type 2 diabetic patients with known and treated hypertension and determine the factors associated with poor blood pressure control. Subjects and methods Prospective study concerning 300 type 2 diabetic patients with a known and treated hypertension, sex-ratio: 0.64, mean age: 61.2 ± 9.1 years (37–86). All subjects underwent physical examination, biological investigations and a 24 hours ambulatory blood pressure monitoring (ABPM). Results Hypertension was well controlled in 70 patients (23.3%). The concordance rate between clinical measure of blood pressure and ABPM was 70.3%. Subjects with uncontrolled hypertension were older (61.8 ± 8.9 vs 59.1 ± 9.3 years, P < 0.05), more frequently of male sex (sex-ratio: 0.77 vs 0.34, P < 0.01), smokers (36.4 vs 21.7%, P < 0.05) and with abdominal adiposity ( P < 0.05). Duration of diabetes, body mass index and the frequency of peripheral neuropathy, retinopathy and coronary insufficiency were not different between the two groups. Diabetic nephropathy was more frequent (29.8 vs 16.1%, P < 0.05) in the group with uncontrolled hypertension. Loss of circadian blood pressure rhythm was noted in 239 patients (79.6%) and it was more frequently observed in patients with uncontrolled hypertension (84 vs 66%, P < 0.001). Conclusion Our type 2 diabetic patients had a poorly controlled hypertension. Close monitoring of blood pressure with adjustment of antihypertensive treatment are necessary to improve cardiovascular prognosis of our patients.

A Comparison of Home Measurement and Ambulatory Monitoring of Blood Pressure in the Adjustment of Antihypertensive Treatment

The purpose of this study was to compare home and ambulatory blood pressure (BP) in the adjustment of antihypertensive treatment. After a 4-week washout period, patients whose untreated daytime diastolic ambulatory BP averaged > or = 85 mm Hg were randomized to be treated according to their ambulatory or home BP. Antihypertensive treatment was adjusted at 6-week intervals according to the mean daytime ambulatory diastolic BP or the mean home diastolic BP, depending on the patient's randomization group. If the diastolic BP stayed above 80 mm Hg, the physician blinded to randomization intensified hypertensive treatment. Ninety-eight patients completed the study. During the 24-week follow-up period both systolic and diastolic BP decreased significantly within both groups (P < .001). At the end of the study, the systolic/diastolic differences between ambulatory (n = 46) and home (n = 52) BP groups in home, daytime ambulatory, night-time ambulatory, and 24-h ambulatory BP changes averaged 2.6/2.6 mm Hg, 0.6/1.7 mm Hg, 1.0/1.4 mm Hg, and 0.6/1.5 mm Hg, respectively (P range .06 to .75) A nonsignificant trend to more intensive drug therapy in the ambulatory BP group and a nonsignificant trend to larger share of patients reaching (57.7% v 43.5%, P = .16) the target pressure in the home BP group was observed due to the 3.8 mm Hg difference in ambulatory and home diastolic BP at randomization. The adjustment of antihypertensive treatment based on either ambulatory or home BP measurement led to good BP control. No significant between-group differences in BP changes were seen at the end of the study. Additional research is needed to provide more conclusive results.

Seasonal variation of blood pressure in maintenance hemodialysis.

Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. Prospective, cohort study. Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). Sixteen patients with chronic renal failure undergoing hemodialysis. Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. The diastolic blood pressure was lower in summer than in fall and winter (95 +/- 8 vs 107 +/- 10 and 101 +/- 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 +/- 8 vs 130 +/- 11 and 124 +/- 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 +/- 1.6 vs 19.5 +/- 3.0 and 15.8 +/- 1.9 degrees C, respectively; p < 0.01). We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.