Antihypertensive Treatment Research Articles

Age- and sex-related reference values for central blood pressure parameters in middle-aged and older Japanese adults: the Wakayama study.

Central blood pressure (BP) is more strongly associated with cardiovascular events than brachial BP. Few studies have described age-related changes in central BP in the general Japanese population. This study aimed to provide reference values for central BP parameters according to the age and sex, using data from 2964 participants aged 40-89 years (mean age: 60 years) who had no history of overt cardiovascular or chronic kidney disease and had not received antihypertensive, lipid-lowering, or hypoglycemic treatments. The central aortic pressure waveform was measured noninvasively by pulse wave analysis using the SphygmoCor XCEL operating system. Central systolic BP (cSBP), pulse pressure (cPP), and augmentation pressure (AP) exhibited a curvilinear relationship with age, with men having significantly higher cSBP but lower cPP and AP than women (cSBP: 132 mmHg vs. 123 mmHg, P < 0.001; cPP, 50 mmHg vs. 55 mmHg, P = 0.001; and AP: 24 mmHg vs. 32 mmHg, P = 0.002). Reference percentiles for cSBP, cPP, and AP were determined for each 5-year age group using the LMS method. Multiple regression analyses showed that age-standardized z-scores for cSBP, cPP, and AP were significantly associated with hypertension, dyslipidemia, diabetes mellitus, abdominal obesity, and heavy smoking, after adjusting for potential confounders. In conclusion, this study provides age- and sex-specific percentiles of central BP parameters in middle-aged and older Japanese adults. These reference values allow a more accurate interpretation of results and may be useful for diagnosis and management of hypertension in clinical practice and for risk stratification in population studies.

Comparative Economic and Clinical Utility of Adding Candesartan for Hypertension Management

Introduction: Antihypertensive drugs require high costs because they are used over a long period. Therefore, consideration is needed in drug selection requirements, effectiveness, and price. This study aimed to see the beneficial results of hypertension therapy and the non-medical costs incurred by patients using cost-utility analysis (CUA). Method: This research was a prospective study. The incremental Cost-Utility Ratio (ICUR) of antihypertensive treatment was calculated using cost-utility data obtained through EQ-5D-5L questionnaires from outpatients at Universitas Andalas Hospital in January- March 2023 who met the inclusion and exclusion criteria. The costs used were from a patient perspective, consisting of direct medical and non-medical costs. This study compared standard treatment (amlodipine) with the addition of candesartan. Results: The number of respondents in this study was 67, consisting of 23 respondents (34.33%) using amlodipine alone and 44 respondents (65.67%) using the amlodipine-candesartan combination. The ICUR value obtained was IDR7,318,674/QALY. The difference in the average utility value of the amlodipine-candesartan combination with amlodipine alone is -0.02, and the difference in cost is -IDR12,224. Based on the cost-utility diagram, the amlodipine-candesartan combination group is included in the southwest quadrant (quadrant III), which illustrates that the cost required for the amlodipine-candesartan combination group is lower than the cost of the amlodipine single treatment group and the outcome is also not better (slightly lower or the same). Conclusion: It was recommended to prioritize using amlodipine alone for hypertension management, as it provides similar outcomes to the amlodipine-candesartan combination while incurring lower costs.

U-shaped association between blood pressure and all-cause mortality in older adults: the Shizuoka study.

Low blood pressure (BP) is suggested to be associated with all-cause mortality in older adults. The aim of this study is to validate the relationship in older adults and to examine the possible involvement of clinical characteristics, namely functional disability, comorbidities, antihypertensive treatment, and reverse causation, in the relationship using insurance claims data including annual health checkup data. The study participants were 337,975 individuals aged ≥65 years. The earliest day of participation in the annual health checkup from 2012 to 2020 was determined at baseline. Data on comorbidities, functional disability levels, prescribed antihypertensive medications, and incidence of stroke, myocardial infarction and all-cause mortality were obtained from the insurance claims. During a mean follow-up period of 5.3 years, there were 27,495 cases of all-cause mortality, 9000 cases of stroke and 1640 cases of myocardial infarction. A U-shaped association was observed between systolic BP and all-cause mortality in participants aged ≥75 years and the hazard ratio calculated systolic BP 120-129 mmHg as reference was 1.14 for <110 mmHg and 1.16 for ≥150 mmHg (all P < 0.001). The U-shaped association remained significant in the sub-analyses of individuals without severe comorbidities, antihypertensive treatment, or functional disability. Similar results were observed in the analysis excluding early-mortality cases. In contrast, the risk of stroke and myocardial infarction increased linearly with increasing BP. Low BP was associated with all-cause mortality in older adults. The U-shaped association may not be solely attributed to the previously suggested factors, including antihypertensive treatment, potential comorbidities, and functional disability.

Blood pressure control and antihypertensive treatment in Swiss general practice: a cross-sectional study using routine data.

Arterial hypertension is a major global health risk. Global surveys indicate that only half of patients with arterial hypertension receive pharmacotherapy, and only a quarter achieve the primary blood pressure target recommended by guidelines. This study aimed to evaluate the achievement of the primary blood pressure target in Swiss general practice, provide insights into arterial hypertension treatment, and identify factors associated with achieving this goal. This cross-sectional study utilised data from a large Swiss primary care database. Patients with arterial hypertension, aged ≥18 years, who underwent blood pressure monitoring in 2021 were included. The primary observation was blood pressure control, defined as the achievement of the primary blood pressure target of systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Demographic data from physicians and patients, blood pressure measurements, comorbidities, cardiovascular risk factors, and pharmacotherapy were collected, and arterial hypertension stages were calculated. Unadjusted and multivariable-adjusted mixed logistic regression models were used to identify factors associated with blood pressure control. A total of 49,290 patients were included, of whom 23,933 (48.6%) were female. The median patient age was 71 years (interquartile range 61-80). Blood pressure control was observed in 23,022 patients (46.7%), and 36,692 patients (74.4%) had an antihypertensive pharmacotherapy prescription. In multivariable analysis, blood pressure control was positively associated with arterial hypertension stage, antihypertensive pharmacotherapy, the intensity of blood pressure monitoring, and the number of blood pressure-increasing drugs, but negatively associated with a long-standing arterial hypertension, female sex, and old age. While general practitioners appear to consider arterial hypertension stages in their treatment strategies, there is still room for improvement in arterial hypertension care by prescribing pharmacotherapy, especially in patients with long-standing arterial hypertension, female sex and old age.

Abstract 4137804: Associations between falls and other serious adverse events and antihypertensive medication in individuals with dementia: An observational cohort study

Background: The balance of benefits and risks associated with lowering blood pressure levels in individuals with dementia remains controversial with a lack of evidence for possible harms associated with antihypertensive treatment (AHT). Objectives: We examined the association between AHT and serious adverse events (SAEs) in individuals with dementia compared to those without. Methods: This was a retrospective analysis using nationally representative, UK general practice population between 1998 and 2018, using data from electronic health records (Clinical Practice Research Datalink, GOLD). Individuals included were age ≥40 years and not previously prescribed AHT. Diagnosis of dementia was based on standardised clinical codes. The primary outcome was the first hospitalisation or death from a fall within 10 years of the follow-up period. Secondary outcomes were first hospitalisation or death from hypotension, syncope, and fracture. Cox regression analyses, adjusted for propensity score were used to assess the risk of SAEs. Results: In a population of 1,219,732 individuals, 23,510 had dementia. Antihypertensive medications were newly prescribed in 4,062/23,510 (17.3%) individuals with dementia and 142,385/1,196,222 (11.9%) individuals without dementia in the 12 months exposure period. In individuals with dementia, AHTs were associated with an increased risk of hospitalisation or death from falls (adjusted hazard ratio [aHR] 1.15, 95% confidence interval [CI] 1.08, 1.22), hypotension (aHR 1.51, 95%CI 1.29, 1.78), syncope (aHR 1.34, 95%CI 1.11, 1.61), but not fracture (aHR 1.05, 95%CI 0.96, 1.15). In individuals without dementia, the association between AHT and SAEs was similar, with an increased risk of hospitalisation or death from falls (aHR 1.07, 95%CI 1.05, 1.10). However, absolute risk of falls with AHT per 10,000 individuals per year was significantly higher in individuals with dementia (47, 95%CI 26, 70) compared to those without (14, 95%CI 10, 18). The absolute risks of hypotension and syncope with AHT were also higher in the individuals with dementia compared to those without. Conclusions: AHT was associated with increased risk of SAEs in individuals with and without dementia, however, the absolute risk of harm from falls was more than double in individuals with dementia. Clinicians, patients, and their carers should consider these risks before starting new antihypertensive medications, particularly in the context of dementia, although they remain small.

NCOG-14. THE ROLE OF POSTOPERATIVE BLOOD PRESSURE MANAGEMENT IN EARLY POSTOPERATIVE HEMORRHAGE IN AWAKE CRANIOTOMY GLIOMA PATIENTS

Abstract INTRODUCTION Awake surgery is widely used to maximize the extent of resection and enhance neuro-oncological outcome in gliomas. Postoperative hemorrhage can severely deteriorate the patients’ neurological outcome. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage, but optimal perioperative patient and blood pressure management is unclear. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. MATERIAL &amp; METHODS In this retrospective analysis, we included all patients who underwent awake surgery between 2010 and 2023 at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 hours. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. RESULTS We included 48 patients with a median age of 39 years. 9 patients (19%) showed a preoperative history of arterial hypertension, 8 of them were on antihypertensive treatment. 23 patients (48%) showed signs of a hemorrhage on early postoperative MRI, of whom 9 (19%) required further treatment, which was surgery in 2 cases and conservative therapy in 7 cases. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p&amp;lt;0.05) as well as intraoperatively during the hours 1-5 (p&amp;lt;0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140 mmHg during the early postoperative course could be shown. DISCUSSION Postoperative hemorrhage is a serious complication in awake surgery glioma patients. However, with early treatment, no significant difference in Performance scores at follow-up could be found. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140 mmHg for the postoperative course.

Pharmacist interventions in the control of hypertension and adherence to anti-hypertensive treatment: A systematic review and meta-analysis of randomised controlled trials

Abstract Introduction Non-adherence to antihypertensive therapy is one of the major barriers for the achievement of blood pressure (BP) control and has a significant cost burden1. Non-adherence is also thought to be one of the leading factors leading to ethnic disparities in hypertension control in the UK2. Pharmacists have an important role in the management of hypertension and non-adherence due to their ideal position to promote optimal use of medication3. Many have advocated for pharmacist involvement in team-based hypertension management, however which pharmaceutical care interventions are most effective remains unclear. There have been many new studies in recent years exploring the effect of pharmacist interventions in hypertension and this meta-analysis provides an update of the current literature and quantification of the results. Aim This study aimed to systematically evaluate the efficacy of pharmacist-delivered interventions for adults with hypertension and examine the intervention characteristics associated with greater BP-lowering efficacy. The primary outcome was the change in BP and secondary outcomes were % achieving BP control. Methods Systematic review and meta-analysis of randomized controlled trials (RCTs). This review was registered on PROSPERO. Embase, CENTRAL, MedLine, Psychinfo and CINAHL were searched until February 2024. Eligible studies included adult patients with a diagnosis of essential hypertension where a pharmacist intervention (alone or collaborative care) targeting BP control was compared with control (usual care). Exclusion criteria included secondary hypertension, pregnancy, children and review articles/case studies. The risk of bias was assessed by the Cochrane risk-of-bias tool for RCTs. The primary outcome was change in BP. We extracted data on sample and intervention characteristics. Meta-analysis was performed using Comprehensive Meta-Analysis Software v4. Moderator analyses examined the association between intervention effects and intervention features. This study was a systematic review and meta-analysis of already completed trials and so ethical approval was not required. Results 2402 articles were retrieved. After removal of duplicates, 1538 were screened by title and abstract against the inclusion criteria. 88 studies with 25,516 participants were included. Mean intervention duration was 7.2 months (range 1-14 months). The overall pooled mean differences in systolic BP (SBP) and diastolic BP (DBP) between pharmacist intervention and control were -7.39 (-8.56, -6.23) mmHg and -3.99 (-4.61, -3.37) mmHg respectively, both P&amp;lt;0.001. With BP control, pharmacist interventions caused a significant increase in those achieving BP control compared to usual care (+21 (16.88, 25.27) %, P&amp;lt;0.001). Duration of intervention had no influence on change in SBP or DBP (both P&amp;gt;0.05). Discussion Pharmacists can make a significant impact in the management of hypertension in respect to increasing treatment adherence and improving BP control and this study highlights the importance of including them as part of the multidisciplinary team responsible for patient care. Limitations of the present study include the inability to extract individual patient data and stratification by ethnicity, socioeconomic status and gender. However, pharmacist interventions in hypertension significantly reduced SBP and DBP and improved BP control. Identifying the characteristics of the most effective interventions can lead to better treatment adherence and BP-lowering in patients with hypertension.

An Evaluation of Drug Prescribing Patterns and Prescription Completeness.

Background/Objectives: The rational use of medicines, in accordance with the World Health Organization (WHO) guidelines, is crucial for optimizing healthcare outcomes. This cross-sectional study aimed to evaluate drug prescribing patterns and assess prescription completeness based on the WHO core drug use criteria. A comprehensive analysis was conducted at the University Clinic in the Northern region, Kingdom of Saudi Arabia (KSA). Methods: The study assessed drug prescribing patterns and examined prescription completeness by analyzing various parameters recommended by the WHO core drug use criteria. Results: Upon analyzing the 615 prescriptions, it was observed that each prescription had a mean of 2.56 prescribed drugs. Multiple medicines per prescription were prevalent in 71.4%, whereas polypharmacy was evident in 2.9%. Analgesics were the most frequently prescribed medication, accounting for 50.4% of the prescriptions, followed by supplements (31.7%), decongestants (16.1%), cough syrup (12%), and antihypertensive and diabetes treatments at 17%. Furthermore, antimicrobials were prescribed in 21.5% of the prescriptions. During the evaluation, it was found that 19.8% of the prescriptions were incomplete, lacking important information on dosing, duration, and drugs not suited to the diagnosis. Conclusions: Most of the parameters evaluated in this study were determined to fall outside the range of recommended guidelines criticized by the WHO. As a result, the implementation of efficient intervention programs, such as education initiatives, is recommended to enhance the practice of rational drug use. Contribution: This study highlights the importance of improving prescription indicators at the national level, focusing on both medication prescribing characteristics and prescription quality as a practice.

Mechanistic insights into antihypertensive activity of mushroom-derived protein-peptides via metabolomic and proteomic approaches

Stropharia rugosoannulata mushroom peptides have well-defined sequences, specific structures, and excellent antihypertensive activity. In this study, metabolomic and proteomic analyses revealed the antihypertensive mechanism of mushroom-derived protein-peptides, GQEDYDRLRPL (GL-11P) and KSWDDFFTR (KR-9P), to demonstrate their potential antihypertensive buck-regulation systems and pathways. Protein-peptides were predominantly down-regulated expression of endogenous metabolites in antihypertensive regulation, and bile acid analogs were key endogenous differentially expressed metabolic markers. Antihypertensive treatment with protein-peptides activated the immune and signal transduction systems, affected extracellular regions, metal ion binding, and receptor binding ability. The ECM-receptor interaction pathway, with differentially expressed proteins in antihypertensive treatment, distinguished the protein-peptides from blank control and was also a critical pathway that distinguished the two protein-peptides. Up-regulatory pathways of protein expression dominated by GL-11P's antihypertensive regulation, while down-regulatory pathways of protein expression dominated by KR-9P's antihypertensive regulation. Protein-peptides exerted antihypertensive regulatory effects by enhancing immune responses, up-regulating protein and enzyme binding capacity, and down-regulating inflammatory mediator release. Differentially expressed protein interactions produced in protein-peptides antihypertensive therapy mostly up-regulated the Reactome pathway and were dominated by immune system regulation. This study provided data support for utilizing mushroom-derived protein-peptides in antihypertensive therapy, and enriched the theoretical basis of protein-peptides' antihypertensive regulation mechanisms.

Dendritic cell mineralocorticoid receptor controls blood pressure by regulating T helper 17 differentiation: role of the Plcβ1/4-Stat5-NF-κB pathway.

Dendritic cells (DCs) are closely related to blood pressure (BP) regulation. Mineralocorticoid receptor (MR) is an important drug target for antihypertensive treatment. However, the role of DC MR in the pathogenesis of hypertension has not been fully elucidated. This study aimed to determine the role of DC MR in BP regulation and to explore the mechanism. Renal biopsy and peripheral blood samples were collected from hypertensive patients (HTN) for immunostaining and flow cytometry. Dendritic cell MR knockout (DCMRKO) mice, DC MR overexpressing (DCMROV) mice, DCMROV/IL-17A knockout (DCMROV/IL-17AKO) mice and finerenone-treated C57BL/6 mice were infused with angiotensin II (Ang II) to establish hypertensive models. Western blotting, chromatin immunoprecipitation, co-immunoprecipitation, and in vivo DC depletion or adoptive transfer were used to delineate the functional importance of DC MR in hypertension development. Mineralocorticoid receptor antagonists (spironolactone and finerenone) suppressed DC aggregation and activation, as well as hypertension in HTN and mice. Compared with littermate control (LC) mice, dendritic cell MR knockout mice had strikingly decreased BPs and attenuated target organ damage after Ang II infusion. Flow cytometry showed that DC MR deficiency mitigated Ang II-induced DC activation and T helper 17 (Th17) cell differentiation. RNA sequencing revealed that MR-deficient DCs had elevated expression of Plcβ1 and Plcβ4, knockdown of which reversed the inhibitory effect of MR deficiency on DC activation and Th17 differentiation. Adoptive transfer of MR-deficient DCs protected Ang II-induced hypertension, whereas knockdown of Plcβ1/4 eliminated the protective effects. At the molecular level, MR negatively regulated Plcβ1/4, which recruited SHP-1 to inactivate of Stat5 activity, resulting in enhanced NF-κB activation and Th17 polarization. Furthermore, DCMROV mice manifested more elevated BPs and target organ damage than control mice after Ang II infusion, and these differences were abolished in DCMROV/IL-17AKO mice. Finally, MR antagonists decreased the aggregation of Th17 in HTN and mice. Dendritic cell MR plays important roles in the pathogenesis of hypertension by regulating Th17 through Plcβ1/4-Stat5-NF-κB signalling, and blockade of DC MR is beneficial for treating hypertension.

An earthquake reality: fasciotomy wounds and treatments

Earthquake-induced Crush Syndrome and subsequent acute kidney injury are important issues that affect morbidity and mortality. Fasciotomies prolong the length of stay in intensive care unit in patients with Compartment Syndrome due to the complications it causes. Infections and delayed wound healing are two common complications among these. Therefore, early closure of fasciotomy wounds is recommended. Although different treatments can be applied for treatment of wounds, data on this subject in pediatric patients are insufficient. We report the case of a 15-year-old girl who developed acute renal failure due to crush syndrome after being trapped in the wreckage for 9 hours and undergoing fasciotomy procedures for four locations, in the left extremity, two in the thigh and two in the cruris. Hemodialysis, antihypertensive, and antibiotic treatment were administered during the intensive care follow-up due to acute kidney injury, hypertension, and sepsis. With negative pressure therapy, silver alginate wound dressing, and hyperbaric oxygen therapy, all wounds epithelialized within two months. However, rehabilitation for drop foot syndrome caused by nerve cuts in the left extremity continues.

Etiology and Medication of Hospitalized Children With Hypertension: A Retrospective Study.

With the increasing incidence of hypertension in children, the lack of high-quality research data on antihypertensive drugs in pediatric patients restricts treatment options for clinicians and can lead to suboptimal outcomes. We conducted a retrospective analysis of clinical data from hospitalized pediatric patients diagnosed with hypertension and treated with antihypertensive drugs in the past 3years. The study included 203 pediatric patients (119 males and 84 females), with an average age of 8.9±4.7years (range: 0.1-17years). Clinical symptoms of hypertension were observed in 132 participants (65.0%), and the conditions in all cases were classified as primary or secondary hypertension. Renal causes (71 patients, 35.0%) and drug-induced factors (39 patients, 19.2%) were the main causes of secondary hypertension. Nifedipine (137 patients, 67.5%) was the most commonly prescribed medication, followed by captopril (84 patients, 41.4%). Multiple antihypertensive medications were prescribed to 99 participants (48.8%), and blood pressure returned to normal in 111 patients (54.7%). Hypertension-related organ damage was observed in 47 patients (23.2%). Timely diagnosis and treatment of hypertension are critical to prevent organ damage in pediatric patients. Although nifedipine was widely used in this pediatric cohort, the appropriateness of this treatment remains unclear. Emphasis should be placed on monitoring target organs affected by pediatric hypertension, and post-discharge antihypertensive treatment should include thorough follow-ups and documentation.

Inflammatory Risk Factors for Chronic Subdural Hematoma in a Nationwide Cohort.

The discovery of biomarkers in chronic subdural haematomas (CSDH) suggests that inflammation is part of CSDH pathophysiology. It is unknown whether inflammation reflects an independent CSDH driver or haematoma degeneration. This knowledge holds a potential target for anti-inflammatory treatment in patients at risk of CSDH. This study investigated the association of pro- and anti-inflammatory factors with CSDH development. This cohort study included all individuals in Denmark over 50 years between 2007-2018. The outcome was first-time CSDH surgery. Hazard ratios (HR) according to potential risk factors were estimated using Cox regression, with age as underlying time scale. Among the 2,391,853 individuals, head trauma was registered in 427,612 individuals (17%), and among these, only 812 were operated for CSDH (0.18%). Among individuals without registered head trauma, the pro-inflammatory conditions of alcohol addiction, diabetes, anti-hypertensive treatment, and chronic hepatic disease were significantly associated with CSDH among individuals (50-74 years). The use of glucocorticoids displayed a decreased risk in cohort members aged 75 and older. Non-steroid anti-inflammatory drugs and statins appeared to be risk factors for CSDH in individuals between the ages of 50-64 and 65-74. Although head trauma was a risk factor for CSDH, the absolute risk was low (0.18%), which does not support preventive measures after emergency room contacts for head trauma. Interestingly, pro-and anti-inflammatory factors were significantly associated with CSDH in patients without registered head trauma, and the pronounced age-dependency of the associations suggests that the pathophysiological mechanisms vary with age.

Prescribing Pattern and Effectiveness of Antihypertensives in Patients Suffering from Hypertension to Diabetes Mellitus with and without Compelling Indications in Tertiary Care Hospital.

Aim: The prevalence of hypertension (HTN) and diabetes mellitus (DM) is increasing worldwide, and their coexistence is well-documented. Managing both conditions is challenging due to shared pathophysiological mechanisms and the need to balance blood pressure (BP) control with glycemic management. The objective of this protocol was to consider the prescribing pattern and effectiveness of antihypertensive agents in hypertensive and diabetic patients, with and without compelling indications, at tertiary care hospital. Materials and methods: A prospective, observational study was conducted over 6 months in total 226 diabetic hypertensive patients from a tertiary care hospital. Demographic and medication history data were collected using a self-designed patient profile form. Descriptive statistics were used to analyze the data, and the results were expressed as percentages or means with standard deviations. Results: A total of 226 patients were included in the study, with 62% males and 38% females. 73% of patients were classified as stage 1 and 27% as stage 2 HTN. Among the prescribed antihypertensive agents, β-blockers (BBs) were the most prescribed, followed by angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), diuretics, and other classes. Combination therapy was predominantly used, with dual-drug therapy being the most common. Compelling indications for antihypertensive treatment included ischemic heart disease (IHD) (38.49%), chronic kidney disease (CKD) (12.38%), and stroke (6.63%). The choice of antihypertensive agents varied based on the presence of compelling indications, with BBs and ARBs being frequently prescribed. BP control was achieved in 93% of the patients, with 85.96% of patients with HTN + DM, and 82.84% of patients with additional compelling indications having controlled BP. Conclusion: Therefore, it can be concluded that the antihypertensive medications prescribed to the study adhered to guidelines and that long-term use of these combinations proved to be more effective, safe, and well-tolerated for patients with HTN and DM with or without convincing indications. Adopting the best approach to managing HTN in people with diabetes is crucial for ameliorating patient outcomes and enhancing overall quality of life.

Treatment Effect Heterogeneity in Acute Kidney Injury Incidence Following Intravenous Antihypertensive Administration for Severe Blood Pressure Elevation During Hospitalization

Severe hypertension (sHTN) that develops after hospital admission is prevalent in 10% of patients admitted for reasons other than HTN. sHTN is commonly treated with intravenous (IV) antihypertensives and is associated with a greater risk of acute kidney injury (AKI). Our goal was to explore whether there is heterogeneity in IV antihypertensives' effect on AKI incidence among patients who develop sHTN during hospitalization. Heterogeneity of treatment effect analysis. Patients who developed sHTN, systolic blood pressure (BP) >180, or diastolic BP >110 mmHg during hospitalization and did not have kidney failure. Treatment with IV antihypertensives within 3 hours of BP elevation. Time to develop AKI. An accelerated failure time Bayesian Additive Regression Trees (BART) model to capture the association between the time to develop AKI and predictors. Individual treatment effects estimated for each participant using a counterfactual outcome framework and these estimates were used to identify patient characteristics associated with treatment effect heterogeneity in response to IV antihypertensives. We included 11,951 patients who developed sHTN, 741 were treated with IV antihypertensives, and 11,210 were not, of which 18% and 13% developed AKI, respectively. Most patients would have been harmed from IV antihypertensive treatment except for a small subset of 317 patients who were White, had an SBP on admission ≥156 mmHg, an eGFR ≥70.7 ml/min/1.73m2, and a serum bicarbonate <21.7 mmol/L. Data-driven, hypothesis-generating approach. Findings were not validated with external data sources. These exploratory findings suggest that most patients who develop sHTN will not benefit from IV antihypertensive treatment. Future studies should assess for heterogeneity when identifying treatment options, if any are needed, for sHTN.

Molecular Imaging of Renin Activity using Fluorogenic Nanoprobes for Precision Antihypertensive Therapy

AbstractLife‐threatening hypertension remains inadequately controlled in clinics due to its heterogeneous renin levels. Rapid stratification of hypertension through renin analysis is crucial for effective personalized treatment, yet an ultrasensitive detection approach is currently lacking. Here, we report activatable renin nanoprobes (ARNs) for non‐invasive and ultrasensitive profiling of renin activity and guiding antihypertensive treatment decision through near‐infrared fluorescence (NIRF) in vivo imaging and in vitro urinalysis. ARNs are intrinsically non‐fluorescent due to NIRF reporter connected to a gold nanocluster through a renin‐responsive peptide. In hyperreninemia mouse models, ARNs specifically react with renin to liberate the renal clearable NIRF reporter for accurate renin detection that outperforms the gold standard radioimmunoassay. Such specific and sensitive detection also enables imaging‐based high‐throughput screening of antihypertensive drugs. In hypertensive rat models, ARNs enable ultrasensitive detection of both plasma and urinary renin, facilitating renin‐guided precision treatment and significantly improving hypertension control rate (90 % versus 58 %). Our nanoprobe platform holds great potential for assisting clinicians in rapidly and accurately classifying hypertensive patients and improving outcomes through tailored treatment selection.

Effect of antihypertensive drug classes in metabolic syndrome

Background: Metabolic syndrome (MetS) affects approximately 35% of the adult population of United States as well as categorized by the synchronized existence of hypertension, hyperglycemia, obesity and dyslipidemia. Now a days, this is the main cause of leading CVD (cardiovascular disease) risk in an individual. Raised blood pressure is the record common component of this syndrome and this incidence increases with age. Objective: This research was carried out to recommend the characterizations for the metabolic syndrome along with the occurrence of hypertension in this disorder. Additionally, indications concerning the properties of metabolic of the diverse antihypertensive drug modules and their consequence on metabolic syndrome will be demonstrated. Methods: A comprehensive trial in different patients were performed to identify data from clinical investigations for the occurrence, patho-physiology and treatment of hypertension in MetS. Results: Hypertension existing in almost 79% Pakistani patients alon with metabolic syndrome. The usage of thiazide diuretics, and beta-blockers salts, is dejected in the present community; though, latest signs recommend its use under precise circumstances. The Ca. channel inhibitors appear to apply a unbiased outcome on Metabolic syndrome. Whereas, renin angiotensin scheme inhibitors are supposed to be of the utmost advantage. Even though, variances occur among various agents of this class. Conclusion: Debate still exists about the ideal anti-hypertensive treatment in Metabolic syndrome. Due to the huge occurrence of hypertension in Pakistani community, still, further investigations and data is in dire need for this treatment.

Significant regression of left ventricular hypertrophy in patient with arterial hypertension during antihypertensive treatment with perindopril and atorvastatin

Left ventricular hypertrophy (LVH) in arterial hypertension (AH) is one of the modifiable risk factors for cardiovascular events and serves as a justified goal for antihypertensive therapy. The article presents follow-up of a 60-year-old female with AH, hyperlipidemia, and discovered of LVH on the data of electrocardiography and echocardiography. In addition to the SokolowLyon and Cornell voltage criteria, the baseline echocardiographic examination revealed and increase in thickness of the ventricular septum and the left ventricular (LV) posterior wall, an increase in LV myocardial mass and LV myocardial mass index. The patient was recommended to take a drug of the class of angiotensin converting enzyme inhibitors perindopril and atorvastatin. The patient regularly received therapy and periodically underwent repeated echocardiographic examinations. After 40 months follow-up there are a significant decrease in septal hypertrophy (from 1.22 to 0.76 cm, -37.7%), LV posterior wall (from 1.05 to 0.49, -53.3%), as well as LV myocardial mass (from 197.9 to 96 g, -51.5%) and LV myocardial mass index (from 111.18 to 59.11 g/ m2, -51.5%). Thus, during the entire period of follow-up, the LV mass decreased almost twice. There was a decrease in the size of the left atrium, the relative wall thickness, with the same parameters of LV volumes, characteristics of systolic and diastolic function. Among the favorable factors contributing to significant LVH regression, high adherence to treatment, the efficacy of angiotensin converting enzyme inhibitors and the possible antihypertrophic influence of atorvastatin are discussed.

Psychometric Properties of the TWente Engagement with Ehealth Technologies Scale (TWEETS) Among Patients with Hypertension in Italy.

Engagement with mobile health (mHealth) technologies among patients with hypertension is linked to reduced blood pressure and improved patient understanding of the condition. This study aimed to evaluate the psychometric properties (validity and reliability) of the TWente Engagement with Ehealth Technologies Scale (TWEETS) in an Italian cohort with hypertension. This study is the first attempt to evaluate the psychometric characteristics of the TWEETS in this population. The study was conducted in three phases. The first phase encompassed the translation and cultural adaptation of the TWEETS to the Italian setting. The second phase involved an expert panel evaluating the instrument's face and content validities. The third phase wasa cross-sectional study aiming to test construct validity and reliability. Adults diagnosed with hypertension were eligible for participation. Additional inclusion criteria included stable antihypertensive treatment for at least 2 weeks before enrolment and the provision of written informed consent. Patients were taught how to use two mHealth devices using the teach-back method. A total of 131 patients were enrolled. Exploratory and confirmatory factor analyses revealed that the TWEETS had a one-factor structure and a good level of fit. Cronbach's alpha coefficients suggested good internal consistency. The findings indicate that the TWEETS is a valuable tool for assessing the engagement of patients with hypertension with mHealth devices. Further assessment is needed in various cohorts to confirm the psychometric equivalence of the construct across different groups with hypertension.

Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults.

Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination. We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained. Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses. In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings.