Antihypertensive Research Articles

Efficacy and Safety of Sacubitril/Valsartan Versus Amlodipine in Japanese Patients With Essential Hypertension: A Randomized, Multicenter, Open-Label, Noninferiority Study (PARASOL Study).

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has demonstrated a superior blood pressure-lowering effect compared with renin-angiotensin system inhibitors in several clinical trials. However, there has been no available evidence on the comparison between sacubitril/valsartan and calcium channel blockers (CCBs), a well-established class of antihypertensive drugs. In this open-label, multicenter study, we aimed to demonstrate the efficacy and safety of sacubitril/valsartan versus amlodipine, one of the most widely used CCBs, after 8 weeks of treatment. A total of 359 Japanese patients with essential hypertension (office systolic blood pressure [SBP] ≥150 to <180mmHg), aged 18-79, were randomly assigned to receive either once-daily sacubitril/valsartan 200mg or once-daily amlodipine 5mg in a 1:1 allocation ratio. The primary endpoint was the noninferiority of sacubitril/valsartan compared with amlodipine in mean change in 24-h SBP from baseline to Week 8, followed by a significance test as a secondary endpoint analysis. The mean change in 24-h SBP in sacubitril/valsartan was noninferior to that in amlodipine (between-treatment difference -0.62mmHg [95% confidential interval: -3.23 to 1.98; p = 0.003 for noninferiority; independent t-test with noninferiority margin 3.0mmHg]), with no significant difference observed (p=0.637). There was no significant difference in the incidence of adverse events (AEs). These results suggested that the blood pressure-lowering effect of sacubitril/valsartan is comparable to that of amlodipine, with no marked differences in tolerability between the two groups. Sacubitril/valsartan, a potent antihypertensive drug comparable to amlodipine, is expected to improve blood pressure control in clinical practice.

Development and Validation of a UHPLC-MS/MS Method for the Simultaneous Quantification of Candesartan and Bisoprolol Together with Other 16 Antihypertensive Drugs in Plasma Samples.

Antihypertensive pharmacological therapy is often characterized by a coadministration of different classes of drugs. Therefore, analytical methods allowing the simultaneous quantification of many drugs are needed for therapeutic drug monitoring (TDM) purposes in this context. In particular, TDM represents a useful tool to discriminate poor adherence from real cases of resistant hypertension. For this reason, the aim of this study is to validate, following the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) guidelines, an ultrahigh-performance liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS) method for the simultaneous quantification of 18 antihypertensive drugs in human plasma. A LX-50 coupled with a QSight 220 UHPLC-MS/MS system with electrospray ionization and multiple reaction monitoring mode was used, after a binary gradient separation (13 min) on a reverse-phase Acquity UPLC HSS T3 [1.8 μm, 2.1 mm × 150 mm] column. Method validation showed a stable and acceptable matrix effect, recovery, high accuracy, and precision, assessing the eligibility of this method for routine use in the clinical context.

Automated Text Message-Based Program to Improve Uncontrolled Blood Pressure in Primary Care Patients: A Randomized Clinical Trial.

Suboptimal control of BP is common, although safe and effective treatments are widely available. Conventional management relies on office visits, but this can be an inefficient path to medication optimization. To assess the effectiveness of an intensive, 6-month remote BP management program among patients with uncontrolled hypertension. A two-arm randomized clinical trial which ran from January to July 2023 at two primary care practices with an in-clinic BP measurement at the end of the intervention. Established adult patients (ages 21-80) of study practices with uncontrolled hypertension (two measurements > 140/90 in the prior 12months) and an active prescription for at least one anti-hypertensive agent. Participants received automated text messages prompting them to check their BP weekly for 6months. An RN and APP monitored BP data entered by the participant. The automated platform escalated any out-of-normal range readings or needs to the program staff. The primary outcome was change in SBP from baseline to the end-of-study measurement. Enrollment and engagement measures were collected for the intervention arm. Of the 300 participants, the mean (SD) age was 63 (± 12.2) years; 133 (44.3%) were male and 167 (55.7%) were female; 154 (51.5%) self-identified as Black and 120 (40.1%) White; and 119 (39.7%) were insured by Medicare and 41 (13.7%) by Medicaid. The change in SBP at 6months among those who completed the end-of-study measurement was - 14.66mmHg (95% CI - 19.95, - 9.36) in the intervention arm and - 10.87mmHg (95% CI - 18.04, - 3.69) in the control arm (p = 0.39). Within the intervention arm, 97 participants (64.7%) completed all enrollment steps, and these participants submitted BPs 72.8% of the weeks. Participants in the intervention arm had a greater number of medication changes (0.81 vs 0.57 in the control arm, p = 0.01) over the study period. In this randomized clinical trial of a 6-month automated text messaging program, there was no significant difference in the change in SBP among participants in each arm. ClinicalTrials.gov Identifier: NCT05571410.

Genetic polymorphisms influencing antihypertensive drug responses.

Hypertension is a major contributor to cardiovascular disease and its associated morbidity and mortality. The low efficacy observed with some anti-hypertensive therapies has been attributed partly to inter-individual genetic variability. This paper reviews the major findings regarding these genetic variabilities that modulate responses to anti-hypertensive therapies such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, calcium channel blockers (CCBs) and β-adrenoceptor blockers. The importance of studying these genetic polymorphisms stems from the goal to optimise anti-hypertensive therapy for each individual patient, aiming for the highest efficacy and lowest risk of adverse effects. It is important to recognise that environmental and epigenetic factors can contribute to the observed variations in drug responses. Owing to the multigenic and multifactorial nature of drug responses, further research is crucial for translating these findings into clinical practice and the establishment of reliable recommendations.

Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study.

The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Of the 389 participants who enrolled in and completed the study, 380 (98%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1%) of the 239 participants entered full BP routines into the digital app 80% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as "excellent" for domains of perspicuity, efficiency, and dependability and "above average" for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension.

Losartan attenuates sex-dependent hypertension, neuroinflammation, and cognitive impairment in the aging male sprague-dawley rat.

The prevalence of hypertension increases with age and is the leading modifiable risk factor for cognitive impairment and dementia. At present, the neural mechanisms promoting hypertension across the lifespan are incompletely understood. Using the Sprague-Dawley (SD) rat as a model of normal aging, we hypothesized (1) blood brain barrier (BBB) disruption and neuroinflammation in the paraventricular nucleus (PVN) of the hypothalamus enhances sympathetic tone and contributes to age-dependent hypertension, (2) age-dependent hypertension is associated with cognitive impairment, and (3) lowering blood pressure in aged rats with established hypertension improves cognitive function. We found male, but not female, rats develop age-dependent hypertension with enhanced sympathetic tone, BBB disruption, and neuroinflammation in the PVN. Aged hypertensive male rats also showed impairments in recognition and spatial memory. Utilizing pharmacological interventions, blood pressure was lowered in male rats with established hypertension using either losartan (LOS) or hydrochlorothiazide. However, only losartan improved recognition memory. Further, LOS reduced BBB disruption, microglial activation, astrocyte reactivity, and proinflammatory cytokine expression in the PVN which we speculate contributes to a decrease in blood pressure. These data show SD rats develop age-dependent hypertension and cognitive impairment in a sex-dependent manner. However, not all antihypertensive agents improve cognitive function equally as only losartan, an angiotensin II type 1 receptor antagonist (AT1R) improved recognition memory. Thus, AT1R antagonists represent a potential therapeutic approach for treating cognitive decline in the aging population.

Pharmacological Nephroprotection in Chronic Kidney Disease Patients with Type 2 Diabetes Mellitus—Clinical Practice Position Statement of the Polish Society of Nephrology

Both chronic kidney disease (CKD) and type 2 diabetes (T2D) are modern epidemics worldwide and have become a severe public health problem. Chronic kidney disease progression in T2D patients is linked to the need for dialysis or kidney transplantation and represents the risk factor predisposing to serious cardiovascular complications. In recent years, important progress has occurred in nephroprotective pharmacotherapy in CKD patients with T2D. In the current position paper, we described a nephroprotective approach in CKD patients with T2D based on the five following pillars: effective antihyperglycemic treatment, SGLT2 inhibitor or semaglutide, antihypertensive therapy, use of RASi (ARB or ACEi), and in selected patients, finerenone, as well as sodium bicarbonate in patients with metabolic acidosis. We thought that the current statement is comprehensive and up-to-date and addresses multiple pathways of nephroprotection in patients with CKD and T2D.

Association between alpha blocker use and the risk of fractures in patients with chronic kidney disease: a cohort study

BackgroundAlpha blockers (ABs) are frequently prescribed to patients with chronic kidney disease (CKD), which is often complicated by refractory hypertension (HT). Although there have been several reports on the association between AB use and the risk of fractures, their conclusions have not yet been drawn. Therefore, this study aimed to investigate the association between AB use and the risk of fractures in patients with CKD.MethodThis population-based cohort study used patient data obtained between April 2008 and August 2021 from a large-scale Japanese medical claims database. Consecutive patients with CKD who were newly prescribed ABs or non-AB antihypertensive drugs were included; males and females were analysed separately. The AB group was then divided into AB for HT and voiding dysfunction (VD) groups according to the drug approval in Japan. The primary outcome was the first hospitalisation due to fracture, and the variables were evaluated with weighted Cox proportional hazard model using overlap weights.ResultsA total of 65,012, 4,723, and 10,958 males constituted the non-AB, AB for HT (doxazosin), and AB for VD (naftopidil, silodosin, tamsulosin, or urapidil) groups, respectively. A total of 31,887, 2,409, and 965 females constituted the non-AB, AB for HT (doxazosin or guanabenz), and AB for VD (urapidil) groups, respectively. In males, hazard ratio (HR) for primary outcome was not increased in the non-AB and AB for VD groups compared with the AB for HT group (HR, 0.70; 95% confidence interval [CI], 0.38–1.28 and HR, 1.33; 95% CI, 0.67–2.66, in the non-AB and AB for VD groups, respectively). Whereas, in females, although HR for the primary outcome was not increased in the non-AB group (HR, 1.06; 95% CI, 0.56–1.99), it was significantly increased in the AB for VD group (HR, 2.28; 95% CI, 1.01–5.16) compared with the AB for HT group.ConclusionAB use in patients with CKD did not increase the risk of fractures when used for the treatment of HT; however, it increased the risk of fractures when used for the treatment of VD in females. These results suggest that ABs should be used with caution in these patients.

Design, In silico Screening, Synthesis, Characterisation and DFT-based Electronic Properties of Dihydropyridine-based Molecule as L-type Calcium Channel Blocker.

People of all nationalities and social classes are now affected by the growing issue of hypertension. Over time, there has been a consistent rise in the fatality rate. A range of therapeutic compounds, on the other hand, are often used to handle hypertension. The objectives of this study are first to design potential antihypertensive drugs based on the DHP scaffold, secondly, to analyse drug-likeness properties of the ligands and investigate their molecular mechanisms of binding to the model protein Cav1.2 and finally to synthesise the best ligand. Due to the lack of 3D structures for human Cav1.2, the protein structure was modelled using a homology modelling approach. A protein-ligand complex's strength and binding interaction were investigated using molecular docking and molecular dynamics techniques. DFT-based electronic properties of the ligand were calculated using the M06-2X/ def2- TZVP level of theory. The SwissADME website was used to study the ADMET properties. In this study, a series of DHP compounds (19 compounds) were properly designed to act as calcium channel blockers. Among these compounds, compound 16 showed excellent binding scores (-11.6 kcal/mol). This compound was synthesised with good yield and characterised. To assess the structural features of the synthesised molecule quantum chemical calculations were performed. Based on molecular docking, molecular dynamics simulations, and drug-likeness properties of compound 16 can be used as a potential calcium channel blocker.

Correlation between Blood Pressure and Left Ventricular Function in Neonates: A Retrospective Observational Study

Purpose: Ejection fraction, measured as the fraction of blood ejected from the ventricle in each heartbeat using M-mode echocardiography, serves as a primary indicator of left ventricular systolic function. This study explores the correlation between blood pressure and left ventricular systolic function in neonates using M-mode echocardiography.Methods: Neonates who underwent echocardiography in the neonatal intensive care unit between January 2011 and December 2020 were retrospectively studied.Results: Our analyses showed a significant association between ejection fraction and systolic blood pressure, but not with diastolic or mean blood pressure—both of which are more sensitive to hypotension. Ejection fraction was also not significantly associated with heart rate, urine output, or inotropic support in this study, suggesting that factors influencing urine output may not directly relate to ejection fraction. Additionally, we found that higher systolic blood pressure was correlated with advanced gestational age, the absence of patent ductus arteriosus, and no need for fentanyl administration. Notably, lower gestational age and lack of mechanical ventilation were both associated with increased hourly urine output, suggesting that developmental maturity and respiratory stability may influence renal function.Conclusion: Neonatal hypotension occurred secondary to decreased systolic cardiac function and peripheral vascular resistance. Neonatologists should carefully monitor the individual components of blood pressure and prescribe medications accordingly, considering that systolic blood pressure is correlated with ejection function.

Kombinasi Senam Lansia dan Obat Hipertensi Berpengaruh terhadap Tekanan Darah Lansia Penderita Hipertensi

Hypertension management can be done pharmacologically or by administering drugs and non-pharmacologically, one of which is elderly gymnastics. Hypertension if not given proper management can lead to heart disease, stroke and kidney failure. The purpose of this study was to determine the effect of a combination of elderly gymnastics and antihypertensive drugs on blood pressure in elderly people with hypertension. This research method uses a quasi-experimental design with a pre-post test nonequivalent control group design approach. The sample of this study was 39 respondents with a total sampling technique, the intervention group consisted of 20 respondents and the control group consisted of 19 respondents. The hypothesis test of this study used the T-test because the data was normally distributed with a p-value&gt; 0.05. The results of this study obtained a significance value of systolic and diastolic pressure in the intervention group p-value = 0.000, while in the control group the significance value of systolic blood pressure p-value = 0.000 and diastolic pressure p-value = 0.048. So it can be stated that the decrease in blood pressure in the intervention group was more optimal than in the control group. Conclusion: There is an effect of giving a combination of elderly exercise and antihypertensive drugs on the blood pressure of elderly people with hypertension

Breaking barriers: enhancing solubility and dissolution of efonidipine using co-amorphous formulations.

The study aims to enhance the solubility and dissolution characteristics of efonidipine hydrochloride ethanolate (EFD), an antihypertensive drug, through the co-amorphous approach. Hypertension is a prevalent chronic condition characterized by consistently elevated blood pressure. Efonidipine, a BCS class II drug, has high permeability but low solubility, limiting its therapeutic effectiveness. Amorphization, which disrupts the crystal lattice of crystalline medications, can significantly enhance drug solubility and dissolution rates. Co-amorphous systems of EFD were prepared using solvent evaporation, ball milling, and liquid-assisted grinding methods. The drug and co-former were used in a different ratio, a stoichiometric proportion known for forming stable amorphous phases. The in vitro dissolution of the co-amorphous form was evaluated and compared with the pure crystalline form of EFD. The co-amorphous system of EFD with benzoic acid demonstrated significantly higher dissolution rates in vitro compared to the pure drug. PXRD analysis confirmed the transformation from a crystalline to an amorphous state, indicated by the disappearance of sharp peaks characteristic of the crystalline form. The resultant co-amorphous system exhibited dissolution properties. The co-amorphous approach effectively improved the solubility and dissolution of efonidipine hydrochloride ethanolate. Benzoic acid, as a co-former, facilitated the formation of a stable amorphous phase, thereby enhancing the drug's dissolution rate. The developed a co-amorphous system of EFD with benzoic acid, significantly enhancing its dissolution characteristics. PXRD analysis confirmed the amorphous nature and improved stability of the co-amorphous form, indicating its potential for better therapeutic efficacy in hypertension management.

Identification of potentially causative drugs associated with hypotension: A scoping review.

Drug-induced hypotension can be harmful and may lead to hospital admissions. The occurrence of hypotension during drug therapy is preventable through increased awareness. This scoping review aimed to provide a comprehensive overview of antihypertensive and nonantihypertensive drugs associated with hypotension in adults. A systematic literature search was conducted using MEDLINE, Embase and Cochrane Library, focusing on studies from January 2013 to May 2023. Search terms were developed to capture key concepts related to hypotension and adverse drug events in adults while excluding terms related to allergic reactions, phytotherapy and studies involving paediatric, pregnant or animal populations. The eligibility criteria included a wide range of study types evaluating hypotension as an adverse drug event across all healthcare settings. Relevant information was extracted from the included studies, while identified drugs associated with hypotension were categorised into drug classes. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. In 97 eligible studies, we identified 26 antihypertensive drugs grouped into nine different antihypertensive classes and 158 other drugs grouped into 22 other drug classes. Common antihypertensive classes were angiotensin-converting enzyme inhibitors, beta blockers and diuretics. Frequently reported nonantihypertensive classes were neuroleptics, alpha-1 blockers for benign prostatic hyperplasia, benzodiazepines, opioids and antidepressants. The results highlight the importance of healthcare professionals being aware of nonantihypertensive drugs that can cause hypotension. This review provides a basis for future systematic reviews to explore dose-dependence, drug-drug interactions and confounding factors.

Exploring the association of adverse drug reactions with medication adherence and quality of life among hypertensive patients: a cross-sectional study.

Effective hypertension management requires medication adherence to prevent complications. However, adverse drug reactions (ADRs) can undermine adherence and negatively affect patients' quality of life. Limited research has explored the association between ADRs, medication adherence, and health-related quality of life (HRQoL) in individuals with hypertension. To investigate the association between ADRs, medication adherence, and HRQoL among patients with hypertension. A cross-sectional study using telephone interviews and medical record reviews was conducted in 11 primary care facilities in Indonesia. The causality of reported ADRs was assessed using the Naranjo algorithm, validated by a panel of experts in pharmacy practice and medication safety. The severity of ADRs was classified using the Hartwig scale. Adherence to antihypertensive drugs was estimated using the Medication Adherence Report Scale-5 (MARS-5). The EuroQoL EQ-5D-5L was used to measure HRQoL. The association between ADRs and medication adherence was assessed using multivariate logistic regression, while the association with HRQoL was evaluated through the Tobit regression model. A total of 507 patients were included in this study. We found that 20.32% (n = 103) of the patients experienced ADRs, with the most commonly reported ADRs being polyuria and urgency, gastrointestinal symptoms, leg swelling, dizziness/hypotension, palpitations, and dry cough. The majority experienced mild ADRs (n = 75, 72.82%), while 27.18% (n = 28) had reactions of moderate severity. Experiencing ADRs was associated with reduced medication adherence (adjusted odds ratio (OR) 7.15, 95% CI 4.07-12.55) and decreased HRQoL (coefficient: - 0.037). Patients experiencing ADRs were seven times more likely to be non-adherent to their medication regimen and reported a reduced quality of life compared to those without ADRs, placing them at a higher risk of suboptimal treatment outcomes. This finding highlights the need for additional monitoring and education for patients affected by ADRs, particularly through more frequent clinical and laboratory assessments, timely management of ADRs, and personalized education on the importance of adherence to prevent hypertension-related complications.

Oxygenation Effects of Antihypertensive Agents in Intensive Care: A Prospective Comparative Study of Nicardipine and Urapidil.

Acute arterial hypertension within the critical care context may necessitate the administration of intravenous antihypertensive agents. Nicardipine and urapidil are notable for their application in intensive care units. Nonetheless, dihydropyridine calcium channel inhibitors (DCCIs) such as nicardipine are implicated in the impairment of hypoxic pulmonary vasoconstriction, potentially disrupting oxygenation. This study aimed to assess the differences in patient oxygenation when these antihypertensive agents are administered intravenously. This bicentric, prospective, observational investigation spanning five intensive care units evaluated patients requiring intravenous nicardipine or urapidil. Oxygenation data were recorded from the start of therapy until the 12th hour. Comparative analysis was performed between patient groups based on the antihypertensive agent administered, along with subgroup investigations to identify populations with an elevated risk of hypoxemia. From November 2021 to November 2023, 197 patients were included: 98 (50%) were treated with nicardipine, and 99 (50%) were treated with urapidil. Hypoxemia occurred in 97 (49%) patients and was more prevalent in the nicardipine cohort, affecting 65 (66%) patients, as opposed to 32 (32%) patients in the urapidil cohort (RR 2.05, 95% CI [1.48-2.82], P < 0.001). Subgroup analysis revealed a significant association between patients with pulmonary atelectasis (RR 2.30, 95% CI [1.4-3.7], P < 0.001) and obesity (RR 2.7, 95% CI [1.5-4.6], P < 0.001). Considering these findings, cautious consideration of the patient's respiratory status should be exercised when initiating intravenous DCCI treatment. However, given the limitations of this study, a controlled trial on hypertension management in the ICU is needed.

Prevalence of non-compliance to prescribed antihypertensive medication among hypertensive middle-aged adults at a tertiary care hospital, Faisalabad, Pakistan: a descriptive cross-sectional study.

ABSTRACT BACKGROUND &amp; OBJECTIVE: Uncontrolled hypertension due to non-compliance with prescribed treatment is one of the main reasons for premature illness and mortality in Pakistan. There is a lack of data on the prevalence of non-compliance with prescribed antihypertensive therapy among hypertensive middle-aged adults in Pakistan. To determine the overall prevalence of non-compliance with prescribed antihypertensive medication among middle-aged hypertensive patients at a tertiary care hospital in Faisalabad, Pakistan. METHODOLOGY: A Descriptive cross-sectional study was conducted over six months from December 2023 to May 2024. All hypertensive patients aged between 40 and 59 years who are conveniently available are included in this study. Data were directly collected from participants by using a structured questionnaire Hill-Bone Medication Adherence Scale. Informed consent was obtained, and participants were briefed on the research topic. The researcher explained the questionnaire in Urdu, which was completed in their presence, ensuring confidentiality to respect participants' ethical rights. RESULTS: A non-compliance score below 25 suggests a low non-compliance rate of 1.56%. Scores between 25-35 indicate moderate non-compliance at 8.31%. Scores of 35-45 show substantial non-compliance with a rate of 62.86%. Severe non-compliance, with scores above 45, results in a high rate of 27.27%. CONCLUSION: The study reveals varying compliance levels among hypertensive patients, highlighting minimal to severe non-compliance, necessitating targeted interventions to reduce non-compliance rates.

Postoperative Blood Pressure Goals After Craniotomy for Tumor Resection: A National Survey.

Acute hypertension can occur in 90% of postcraniotomy patients for tumor resection, and 60% to 90% of patients require treatment with antihypertensive agents. Postoperative intracranial hemorrhage is a major driver of morbidity and mortality after craniotomy for tumor resection, and perioperative hypertension is believed to be a risk factor. Many neurosurgeons impose postoperative blood pressure (BP) goals to mitigate this risk, but there is little evidence to guide the selection of a specific target BP, leading to a wide variation in patient care. In this article, we have conducted a national survey to report the current practices regarding postoperative BP management. We conducted a cross-sectional survey of academic neurosurgical programs by distributing a 10-item questionnaire to neurosurgical residents of each accredited national neurosurgical residency training program (n = 117). Responses were collected over 3 months, from July 2023 to September 2023. Analysis was performed at the program level; for programs with multiple responding residents, the responses of the senior residents were retained. Responses were received from 66 residents at 45 institutions. Forty-two programs set postoperative BP goals using systolic blood pressure (SBP) as a parameter, and 2 used mean arterial pressure. Among programs using an SBP goal, most programs kept a goal SBP of <140 mm Hg (41%-43% depending on the tumor type), followed by SBP <160 mm Hg (36%-39%). Most programs maintained this goal until the morning of the first postoperative day. Intravenous nicardipine (n = 12, 27%) and labetalol (n = 12, 27%) were the most frequently administered medications to maintain BP goals. Most of the academic neurosurgical programs use a postoperative SBP goal after craniotomy for tumor resection. Programs are evenly divided between goals of SBP <140 mm Hg and SBP <160 mm Hg. The variability among programs indicates clinical equipoise between these 2 approaches in the context of a future clinical trial.

Determining optimal timing of birth for women with chronic or gestational hypertension at term: The WILL (When to Induce Labour to Limit risk in pregnancy hypertension) randomised trial.

Chronic or gestational hypertension complicates approximately 7% of pregnancies, half of which reach 37 weeks' gestation. Early term birth (at 37 to 38 weeks) may reduce maternal complications, cesareans, stillbirths, and costs but may increase neonatal morbidity. In the WILL Trial (When to Induce Labour to Limit risk in pregnancy hypertension), we aimed to establish optimal timing of birth for women with chronic or gestational hypertension who reach term and remain well. This 50-centre, open-label, randomised trial in the United Kingdom included an economic analysis. WILL randomised women with chronic or gestational hypertension at 36 to 37 weeks and a singleton fetus, and who provided documented informed consent to "Planned early term birth at 38+0-3 weeks" (intervention) or "usual care at term" (control). The coprimary outcomes were "poor maternal outcome" (composite of severe hypertension, maternal death, or maternal morbidity; superiority hypothesis) and "neonatal care unit admission for ≥4 hours" (noninferiority hypothesis). The key secondary was cesarean. Follow-up was to 6 weeks postpartum. The planned sample size was 540/group. Analysis was by intention-to-treat. A total of 403 participants (37.3% of target) were randomised to the intervention (n = 201) or control group (n = 202), from 3 June 2019 to 19 December 2022, when the funder stopped the trial for delayed recruitment. In the intervention (versus control) group, losses to follow-up were 18/201 (9%) versus 15/202 (7%). In each group, maternal age was about 30 years, about one-fifth of women were from ethnic minorities, over half had obesity, approximately half had chronic hypertension, and most were on antihypertensives with normal blood pressure. In the intervention (versus control) group, birth was a median of 0.9 weeks earlier (38.4 [38.3 to 38.6] versus 39.3 [38.7 to 39.9] weeks). There was no evidence of a difference in "poor maternal outcome" (27/201 [13%] versus 24/202 [12%], respectively; adjusted risk ratio [aRR] 1.16, 95% confidence interval [CI] 0.72 to 1.87). For "neonatal care unit admission for ≥4 hours," the intervention was considered noninferior to the control as the adjusted risk difference (aRD) 95% CI upper bound did not cross the 8% prespecified noninferiority margin (14/201 [7%] versus 14/202 [7%], respectively; aRD 0.003, 95% CI -0.05 to +0.06), although event rates were lower-than-estimated. The intervention (versus control) was associated with no difference in cesarean (58/201 [29%] versus 72/202 [36%], respectively; aRR 0.81, 95% CI 0.61 to 1.08. There were no serious adverse events. Limitations include our smaller-than-planned sample size, and lower-than-anticipated event rates, so the findings may not be generalisable to where hypertension is not treated with antihypertensive therapy. In this study, we observed that most women with chronic or gestational hypertension required labour induction, and planned birth at 38+0-3 weeks (versus usual care) resulted in birth an average of 6 days earlier, and no differences in poor maternal outcome or neonatal morbidity. Our findings provide reassurance about planned birth at 38+0-3 weeks as a clinical option for these women. isrctn.com ISRCTN77258279.

Integrating the health belief model into health education programs in a clinical setting.

The article demonstrates that health belief model (HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months. The HBM addresses perceived barriers, benefits, susceptibility, severity, and self-efficacy, leading to better health behaviors. HBM-based education has been effective in various contexts, including managing chronic diseases, promoting cancer screenings, and preventing infectious diseases. However, the model has limitations, such as cultural applicability and addressing complex health behaviors influenced by environmental factors. Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts. Despite these limitations, HBM-based education significantly improves patient outcomes, highlighting its potential in health education and promotion when appropriately adapted and implemented. This reinforces the model's value in designing effective health interventions and advancing public health.

Effectiveness and Monitoring of Side Effects of Hypertension Drugs in the Elderly in Kalijaga Village

Hypertension is the disease with the highest prevalence in Indonesia. Prevalence of hypertension in the elderly aged 55-75 years and above, which is 62.63% of the overall percentage of people with hypertension. However, many elderly people are not aware and responsive to the treatment of hypertension. The use of anti-hypertensive drugs is often not taken with good procedures. The purpose of this study was to determine the effectiveness and side effects of anti-hypertensive drugs consumed by the elderly in Kalijaga. Sampling using purposive sampling technique with a sample of 30 respondents with blood pressure criteria ≥140/90 mm Hg. Data analysis used wilcoxon and chi-square tests. The results showed a significant effectiveness after the administration of anti-hypertensive drugs as shown by 26 people reaching the target blood pressure therapy. Many of the side effects felt were derived from the use of anti-hypertensive drugs.