Treatment Of Arterial Hypertension Research Articles

A Single Center Experience of Pulmonary Arterial Hypertension Management in Korea: A 25-Year Comparative Analysis Following the Introduction of Targeted Therapy.

The transformation of pulmonary arterial hypertension (PAH) treatment in Korea, ushered by targeted therapy's advent, prompted our analysis of baseline attributes, treatment trends, and survival shifts within our single-center registry. We examined 230 patients (72.6% female, mean age 40.6±17.4 years) diagnosed and/or treated between 1980 and 2021 in our PAH clinic. Given targeted therapy's introduction and active use since 2007, we compared diagnostic classification, demographics, and treatment patterns at that juncture. Survival analysis encompassed PAH types and the overall population. For historical survival comparison, 50 non-registry patients were retrospectively added, and age-sex matching enabled pooled analysis. Congenital heart disease-associated pulmonary arterial hypertension (CHD-PAH) constituted the largest subset (43.0%), trailed by connective tissue disease-associated PAH (CTD-PAH, 29.6%) and idiopathic PAH (IPAH, 19.1%). Post-2007, CTD-PAH proportions surged, notably with an elevated initiation rate of targeted therapy (95.4%). Overall survival rates at 1, 5, and 10 years stood at 91.3%, 77.4%, and 65.8%, respectively, with CHD-PAH exhibiting superior survival to idiopathic or CTD-PAH. Age-sex matching analysis indicated survival disparities between those starting immediate targeted therapy vs. conservative treatment upon diagnosis, especially driven by IPAH. In the post-introduction of the targeted therapy era, patients with PAH promptly started treatment right away, and higher survival rates of patients who started initial PAH-targeted therapy were demonstrated. The transition towards early treatment initiation might have likely contributed to the elevated survival rates observed in Korea's PAH patient cohort.

Sotatercept: First Approval.

Sotatercept (sotatercept-csrk; WINREVAIRTM) is an activin signalling inhibitor that is being developed by Merck and Co., Inc. (Rahway, NJ, USA) for the treatment of pulmonary arterial hypertension. Sotatercept recently received approval in the USA for the treatment of adults with pulmonary arterial hypertension [World Health Organisation (WHO) Group 1] to increase exercise capacity, improve WHO functional class and reduce the risk of clinical worsening events. This article summarizes the milestones in the development of sotatercept leading to this first approval for pulmonary arterial hypertension.

Therapeutic approaches for pulmonary hypertension in patients with chronic kidney disease.

Pulmonary hypertension is a common comorbidity in patients with chronic kidney disease (CKD), but therapeutic options are limited. We discuss the epidemiology of pulmonary hypertension in patients with CKD and review therapies for pulmonary hypertension with a focus on emerging treatments for pulmonary arterial hypertension (PAH). The definition of pulmonary hypertension has been updated to a lower threshold of mean pulmonary artery pressures of more than 20 mmHg, potentially leading to more patients with CKD to qualify for the diagnosis of pulmonary hypertension. Endothelin receptor antagonists, a class of medications, which demonstrated efficacy in patients with PAH, have been shown to slow progression of CKD, but their efficacy in lowering pulmonary artery pressures and their effects on reducing cardiovascular mortality in this population remains unproven. Sotatercept, a novel activin signaling inhibitor, which was previously studied in dialysis patients has been shown to increase exercise capacity in patients with PAH. These studies may lead to new specific therapies for pulmonary hypertension in patients with CKD. Pulmonary hypertension is common in patients with CKD. Although our understanding of factors leading to pulmonary hypertension in this population have evolved, evidence supporting disease-specific therapy in CKD is limited arguing for larger, long-term studies.

Aprocitentan (Tryvio) for hypertension.

The FDA has approved the dual endothelin receptor antagonist aprocitentan (Tryvio – Idorsia) for use in combination with other antihypertensive drugs to treat hypertension in adults whose blood pressure is not adequately controlled on other drugs. Three other dual endothelin receptor antagonists, ambrisentan (Volibris, and generics), bosentan (Tracleer, and generics), and macitentan (Opsumit), are available in the US for treatment of pulmonary arterial hypertension.

Mechanisms of cordycepin in the treatment of pulmonary arterial hypertension in rats based on metabonomics and transcriptomics

Pulmonary arterial hypertension (PAH) is a fatal disease featured by high morbidity and mortality. Although Cordycepin is known for its anti-inflammatory, antioxidant and immune-enhancing effects, its role in PAH treatment and the underlying mechanisms remain unclear. The therapeutic effects of Cordycepin on rats with PAH were investigated using a monocrotaline (MCT)-induced rat model. The metabolic effects of Cordycepin were assessed based on the plasma metabolome. The potential mechanisms of Cordycepin in PAH treatment were investigated through transcriptome sequencing and validated in pulmonary artery smooth muscle cells (PASMC). Evaluations included hematoxylin and eosin staining for pulmonary vascular remodeling, CCK-8 assay, EDU, and TUNEL kits for cell viability, proliferation, and apoptosis, respectively, and western blot for protein expression. Cordycepin significantly reduced right ventricular systolic pressure (RVSP) and right ventricular hypertrophy index (RVHI) in PAH rats, and mitigated pulmonary vascular remodeling. Plasma metabolomics showed that Cordycepin could reverse the metabolic disorders in the lungs of MCT-induced PAH rats, particularly impacting linoleic acid and alpha-linolenic acid metabolism pathways. Transcriptomics revealed that the P53 pathway might be the primary pathway involved, and western blot results showed that Cordycepin significantly increased P53 and P21 protein levels in lung tissues. Integrated analysis of transcriptomics and metabolomics suggested that these pathways were mainly enriched in linoleic acid metabolism and alpha-linolenic acid metabolism pathway. In vitro experiments demonstrated that Cordycepin significantly inhibited the PDGFBB (PD)-induced abnormal proliferation and migration of PASMC and promoted PD-induced apoptosis. Meanwhile, Cordycepin enhanced the expression levels of P53 and P21 proteins in PD-insulted PASMC. However, inhibitors of P53 and P21 eliminated these effects of Cordycepin. Cordycepin may activate the P53–P21 pathway to inhibit abnormal proliferation and migration of PASMC and promote apoptosis, offering a potential approach for PAH treatment.

Aprocitentan: a novel option for treatment of resistant arterial hypertension.

Aprocitentan: a novel option for treatment of resistant arterial hypertension.

The prognosis and management of reclassified systemic lupus erythematosus associated pulmonary arterial hypertension according to 2022 ESC/ERS guidelines.

The 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guideline has recently revised the hemodynamic definition of pulmonary arterial hypertension. However, there is currently limited research on the prognosis and treatment of system lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH) patients that have been reclassified by the new hemodynamic definition. This study aims to analyze the prognosis of newly reclassified SLE-PAH patients and provide recommendations for the management strategy. This retrospective study analyzed records of 236 SLE-PAH patients who visited Peking Union Medical College Hospital (PUMCH) from 2011 to 2023, among whom 22 patients were reclassified into mild SLE-PAH (mean pulmonary arterial pressure (mPAP) of 21-24mmHg, pulmonary vascular resistance (PVR) of 2-3 WU, and PAWP ≤ 15mmHg) according to the guidelines and 14 were defined as unclassified SLE-PAH patients (mPAP 21-24mmHg and PVR ≤ 2 WU). The prognosis was compared among mild SLE-PAH, unclassified SLE-PH, and conventional SLE-PAH patients (mPAP ≥ 25mmHg and PVR > 3WU). Besides, the effectiveness of pulmonary arterial hypertension (PAH)-specific therapy was evaluated in mild SLE-PAH patients. Those mild SLE-PAH patients had significantly longer progression-free time than the conventional SLE-PAH patients. Among the mild SLE-PAH patients, 4 did not receive PAH-specific therapy and had a similar prognosis as patients not receiving specific therapy. This study supports the revised hemodynamic definition of SLE-PAH in the 2022 ESC/ERS guideline. Those mild and unclassified SLE-PH patients had a better prognosis, demonstrating the possibility and significance of early diagnosis and intervention for SLE-PAH. This study also proposed a hypothesis that IIT against SLE might be sufficient for those reclassified SLE-PAH patients.

Renal denervation for the management of refractory ventricular arrhythmias

Abstract Background While catheter ablation (CA) has proven effective in managing ventricular arrhythmias (VA) associated with structural heart disease, a portion of patients continue to experience refractory VA despite medical treatment and multiple CA procedures. In such cases, additional techniques, such as autonomic neuromodulation, have been explored. Renal denervation (RDN), traditionally performed for the treatment of resistant arterial hypertension, inhibits the afferent renal sympathetic pathway, leading to reduced efferent sympathetic overactivation on a systemic level. Due to this mechanism, it has also been studied for the management of arrhythmias, including atrial fibrillation and VA, with favorable results. Objective To assess the effectiveness and safety of RDN for the management of refractory VA storms in high-risk patients. Methods A retrospective analysis of RDN procedures for electrical storms, conducted at a tertiary center between February 2020 and September 2023. We analyzed baseline patient characteristics, procedural details, and acute complications. Recurrence of VA after RDN was assessed at one and six months. Results A total of 7 patients underwent RDN for the treatment of refractory VA. The mean age was 56 ± 10 years (6 male). The primary diagnosis was ischemic cardiomyopathy (n=5), with a mean left ventricular ejection fraction (LVEF) of 20 ± 5%, and no history of resistant arterial hypertension. All patients had an implantable cardioverter-defibrillator (ICD) (two with concomitant resynchronization therapy). Five patients had undergone previous endocardial VA ablation. Of the two patients without prior VA ablation, one had a contraindication because of a large left ventricle thrombus, and the other was submitted to an electrophysiological study, but without inducible ventricular tachycardia. In the four weeks before RDN, patients exhibited a mean of 12 ± 18 sustained VA episodes, meeting the criteria for electrical storm (3 ≥ episodes in 24h). During the procedure, there was a mean of 7 ± 8 radiofrequency applications in the right renal artery and 6 ± 10 in the left renal artery. No acute complications were observed. One month after the procedure, VA episodes were reduced to a mean of 0 ± 1, with only two patients experiencing recurrent VA. After six months, the absence of VA recurrence remained consistent, with only one patient experiencing new episodes. There were no deaths during this period. Conclusion In our pilot study, RDN appeared to be a safe and effective treatment for the management of VA.VA episodes before and after RDN

Pulmo-protection of long-term swimming exercise via improving insulin sensitivity in monocrotaline-induced pulmonary hypertensive rats

Exercise has been recognized as an effective intervention in the treatment of pulmonary arterial hypertension (PAH), supported by numerous studies. However, the precise effects of exercise on pulmonary function remain to be fully elucidated. In this study, using a rat model of swimming exercise training and monocrotaline-induced PAH, we aimed to explore its impact on pulmonary morphology and function. Our investigations revealed that MCT-treated rats exhibited augmented mean pulmonary arterial pressure (MPAP) and pulmonary vascular remodeling, which can be attenuated by 4 weeks of swimming exercise training (60 min/day, 5 days/week). Notably, MCT-treated rats showed impaired pulmonary function, as manifested by decreased tidal volume and dynamic compliance, which were reversed by exercise training. Assessment of pulmonary substrate in PAH rats indicated a prominent pro-inflammatory substrate, evidenced by macrophage accumulation through quantitative immunohistological analysis of macrophage-like cell expression (CD68), and extracellular matrix remodeling, evaluated by Masson staining. Importantly, both the pro-inflammatory substrate and extracellular matrix remodeling were ameliorated by swimming exercise training. Additionally, serum biochemical analysis demonstrated elevated levels of low-density lipoprotein cholesterol and Apolipoprotein B following MCT treatment, which were reduced with exercise intervention. Moreover, exercise enhanced systemic insulin sensitivity in both MCT-treated and untreated rats. Notably, MCT and exercise treatment both decreased fasting blood glucose (FBG) levels in rats, whereas exercise training reinstated FBG levels to normal in MCT-treated rats. In summary, our study suggests that swimming exercise confers a pulmonary protective effect in MCT-induced PAH rats, highlighting the potential importance of exercise-based rehabilitation in the management of PAH.

Preparation of the new peptide drug ACTY116-loaded in situ forming implants and evaluation of its efficacy in pulmonary arterial hypertension and right ventricular hypertrophy induced by SU5416/hypoxia in mice.

There is a lack of effective therapeutic drugs for pulmonary arterial hypertension. Previous studies have demonstrated the positive cardiovascular system protective effects of the new peptide ACTY116. However, its stability in ordinary aqueous solution injections is poor and its half-life in the body is short, which has hindered the development of preparations. This study aimed to prepare in situ forming implants (ISFIs) of the peptide ACTY116 and investigate its impact on pulmonary arterial hypertension. We prepared ISFIs using NMP/TA as a solvent and PLGA as a polymer. These ISFIs exhibited low viscosity, low toxicity and sustained release properties. In a mouse model of pulmonary hypertension induced by SU5416/hypoxia, both ISFIs and ACTY116 peptides effectively reduced pulmonary hypertension, cardiac hypertrophy and pulmonary blood vessel wall thickness. In conclusion, this study highlights the potential of ACTY116 as a treatment for pulmonary arterial hypertension and suggests that incorporating it into an in-situ gel implant could be a promising option.

Right ventricular strain to systolic pulmonary artery pressure ratio in response to treatment of pulmonary arterial hypertension.

The RVFWLS/PASP ratio, a novel surrogate for ventriculoarterial coupling, showed sensitivity to afterload-lowering treatment and the magnitude of change informed on long-term outcomes in PAH https://bit.ly/4cRtREC.

After 30 years, the first endothelin-receptor antagonist (Aprocitentan) is approved for the treatment of arterial hypertension.

After 30 years, the first endothelin-receptor antagonist (Aprocitentan) is approved for the treatment of arterial hypertension.

European guidelines for the treatment of arterial hypertension 2023: new trends

The treatment strategy for arterial hypertension is aimed at controlling blood pressure levels, as well as preventing serious cardiovascular complications and affecting the prognosis of the disease. Therefore, pharmacotherapy of arterial hypertension is given great importance as a guide to the treatment of patients in real practice. The new 2023 European Society Guidelines for the diagnosis and treatment of hypertension were developed after a thorough analysis of studies in the field of arterial hypertension, and were not limited to RCTs only, but also included realistic studies (observational, cohort, administrative databases). The 2023 Guidelines support the proven value of five major classes of antihypertensive drugs: thiazide/thiazide-like diuretics, ACEIs, ARBs, calcium antagonists, and β-blockers. New data from meta-analyses support the greater clinical relevance of RAS blockers, calcium channel blockers, and thiazide/thiazide-like diuretics in preventing hypertension-related outcomes, leading to their preferred use in the pharmacotherapy of arterial hypertension, including various combinations of drugs. A new trend in the pharmacotherapy of arterial hypertension has been the inclusion of β-blockers among the main antihypertensive drugs, including their preferred use for a number of clinical conditions. New classes of drugs, such as SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, are cited as having BP-lowering effects and with strong evidence of reduced cardiovascular and renal outcomes in patients with type 2 diabetes and, in the case of SGLT2 inhibitors, in non-diabetic patients. The 2023 Guidelines significantly updated information on available combination strategies for the treatment of arterial hypertension, and added data on the effectiveness of fixed combinations, including quadropills and polypills.

DOPAMINE-DEPENDENT FORM OF ARTERIAL HYPERTENSION IN PATIENTS WITH A HIGH DEGREE OF NUTRITIONAL-CONSTITUTIONAL OBESITY

Objective: Despite significant advances in the study of the pathogenesis, clinical picture and treatment of arterial hypertension (AH), the role of the dopaminergic system in obese patients remains insufficiently studied. Aim: To evaluate the effectiveness of the use of D2 receptor agonists in patients with arterial hypertension (AH) and nutritional-constitutional obesity (NCO) of the 3rd degree. Design and method: We examined 151 patients aged 30-60 years (65 men, 86 women) with AH and NCO. The control group (CG) consisted of 78 hypertensive patients. Daily monitoring of blood pressure (BP), body mass index (BMI), daily excretion of dopamine, plasma levels of aldosterone, prolactin, leptin, adrenaline, creatinine, lipid spectrum - obese patients were divided into two groups. In addition to basic antihypertensive therapy, patients 1 group (n=74) were prescribed bromocriptine (0.08 mg/kg in three doses), patients 2 group (n=71) – pramipexole (0.125 mg 3 times/day). Results: During the baseline examination, daily dopamine excretion in obese patients was 1.6 times lower (p<0.001) than in control group patients. A negative correlation was found between dopamine excretion and BMI (r=-0.6; p<0.001). In patients with hypertension and NCO, a basic examination revealed a significant (p<0.001) increase in the plasma concentrations of prolactin (2.5 times), aldosterone (1.5 times), leptin (3.4 times) and adrenaline (by 1.3 times) compared to CG. Taking bromocriptine for 8 weeks in patients 1 group led to a decrease in blood pressure, BMI and plasma levels of prolactin and aldosterone. In 41.9% of patients 1 group with dopamine excretion levels less than 300 nmol/day, normalization of blood pressure was observed. In patients 2 group pramipexole was discontinued due to side effects. Conclusions: In the majority of patients with hypertension and NCO (58.1%), the main pathogenetic factor in increasing blood pressure is a low level of dopamine and a compensatory increase in prolactin, aldosterone, and adrenaline in plasma. The use of the D2-dopamine receptor agonist bromocriptine helps to normalize the daily excretion of dopamine, reduce the levels of prolactin, aldosterone and adrenaline, blood pressure and BMI. The use of pramipexole in patients with hypertension and NCO seems inappropriate

ARE THERE ANY ADVANTAGES TO USING A POLYPILL OR FREE PILL COMBINATION TO PROTECT PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA?

Objective: Arterial hypertension (AH) has been acknowledged as a leading cause of death. Treating AH alone may provide only limited benefits while it is recommendable to manage the total cardiovascular risk. The aim was to assess the treatment of AH and dyslipidemia (DLP) in patients in specialists’ offices. Design and method: This project was conducted from April to June 2023 in 51 specialists’ offices (SPO) (33% cardiology, and 67% internal medicine) in Slovakia. We have enrolled all 18-year-old pts who are willing to complete a short questionnaire and take office BP. Results: We enrolled 514 pts with AH (42% women), mean age 61,5 ± 17,2 years from SPOs. The mean OBP was 134,9 ± 10,9/ 80,3 ± 7,2 mmHg. The average total cholesterol (TC) was 5,7 mmol/l, LDL-C 3,0 mmol/l. TC (6,12 vs 5,15 mmol/l, p<0,01) was higher in male patients, and LDL-C was higher in female patients (3,05 vs 2,91 mmol/l). 76% pts experienced both AH and DLP simultaneously. In comparison to those without HLP, AH patients with HLP were given 0.5 active substances and 0.8 pills more. In total 79% pts with AH and HLP were treated with a free pill combination with a statin, while only 16% were treated with polypill. The use of polypill was more frequent in female pts (18%) vs male pts (14%). Target BP lower than 140/90 mmHg was reached in 68% pts with polypill, and in 53% pts without polypill. Non-HDL- C was lower in pts with polypill (3,6 vs 4,03 mmol/l). The current BP and non-HDL targets were reached more frequently in pts with polypill 56% vs 44% pts. Conclusions: Adherence to medications is important to achieve the full effect of antihypertensive and lipid-lowering drugs. We demonstrated that the use of polypill compared to a free pill combination of statin and AH therapy is more effective. 27% of patients reached BP and LDL targets when were treated by polypill. Using polypill in our pts we aim to reach a higher rate of BP and cholesterol control in Slovakia to meet the objectives of the Charter 70/2023 initiative.

Management of pulmonary vascular disease associated with congenital left-to-right shunts: A single-center experience

ObjectiveThe study objective was to describe the course and outcomes of children under 18 years of age, with left-to-right shunts and pulmonary arterial hypertension undergoing 1 of 2 management approaches: pulmonary arterial hypertension treatment before left-to-right shunt repair (Treat First) and left-to-right shunt repair first with or without subsequent pulmonary arterial hypertension treatment (Repair First). MethodsWe performed a retrospective single-center study, conducted from September 2015 to September 2021, of children with left-to-right shunts and pulmonary arterial hypertension (defined as indexed pulmonary vascular resistance ≥ 4 Wood units [WU]∗m2) but without Eisenmenger physiology. Patient characteristics, longitudinal hemodynamics data, pulmonary arterial hypertension management, left-to-right shunt repair, and outcomes were reviewed. ResultsOf 768 patients evaluated for left-to-right shunt closure, 51 (6.8%) had left-to-right shunts associated with pulmonary arterial hypertension (median age 1.1 [0.37-5] years, median indexed pulmonary vascular resistance 6 [5.2-8.7] WU∗m2). In the "Treat First" group (n = 33, 65%), 27 patients (82%) underwent left-to-right shunt closure and 6 patients (18%) did not respond to pulmonary arterial hypertension therapy and did not undergo left-to-right shunt closure. In the "Repair First" group (n = 18, 35%), 12 patients (67%) received pulmonary arterial hypertension therapy and 6 patients (33%) did not. Mortality rates were 6% in the "Treat First" group and 11% in "Repair First" group with follow-ups of 3.4 and 2.5 years, respectively. After left-to-right shunt closure, there was no significant change in indexed pulmonary vascular resistance over a median follow-up of 2 years after surgery (P = .77). ConclusionsIn children with left-to-right shunts and associated pulmonary arterial hypertension, treatment with pulmonary arterial hypertension–targeted therapy before defect repair does not appear to endanger the subjects and may have some benefit. The response to pulmonary arterial hypertension–targeted therapy before shunt closure persists 2 to 3 years postclosure, providing valuable insights into the long-term management of these patients.

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

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

Controlling blood pressure and progression of hypertension-dependent cardiovascular continuum by amlodipine and perindopril A single pill fixed‑dose combination: focus on endothelial dysfunction and metabolic risks

Due to its broad spectrum of pathogenic target points, fixed-dose combination therapy is considered a benchmark approach to successful treatment of arterial hypertension (HTN) and HTN-associated cardiovascular conditions. This results from endothelium insufficiency of various origin, so the use of combination of angiotensinconverting enzyme inhibitors and calcium channel blockers is an optimal treatment choice. The review highlights key points of single pill amlodipine and perindopril A combination use and its key position in modern concept of hypertension management. We have focused on the metabolic neutrality of fixed-dose amlodipine and perindopril A combination, its ability to delay rapid progression of already acquired metabolic changes. We briefly highlight fundamental observational and randomized studies, in particular, those regarding effectiveness of the drug components and its effect on the end points as a fixed-dose combination. The last but not least, we emphasize vasoand cardioprotective properties of the drug as well as its safety profile.

Switching from Beraprost to Selexipag in the Treatment of Pulmonary Arterial Hypertension: Insights from a Phase IV Study of the Japanese Registry (The EXCEL Study: EXChange from bEraprost to seLexipag Study).

Pulmonary arterial hypertension (PAH) remains a significant challenge in cardiology, necessitating advancements in treatment strategies. This study explores the safety and efficacy of transitioning patients from beraprost to selexipag, a novel selective prostacyclin receptor agonist, within a Japanese cohort. Employing a multicenter, open-label, prospective design, 25 PAH patients inadequately managed on beraprost were switched to selexipag. Key inclusion criteria included ongoing beraprost therapy for ≥3 months, a diagnosis of PAH confirmed by mean pulmonary artery pressure (mPAP) ≥ 25 mmHg, and current treatment with endothelin receptor antagonists and/or phosphodiesterase type 5 inhibitors. Outcomes assessed were changes in hemodynamic parameters (mPAP, cardiac index, pulmonary vascular resistance) and the 6 min walk distance (6-MWD) over 3-6 months. The study found no statistically significant changes in these parameters post-switch. However, a subset of patients, defined as responders, demonstrated improvements in all measured hemodynamic parameters, suggesting a potential benefit in carefully selected patients. The transition was generally well-tolerated with no serious adverse events reported. This investigation underscores the importance of personalized treatment strategies in PAH, highlighting that certain patients may benefit from switching to selexipag, particularly those previously on higher doses of beraprost. Further research is needed to elucidate the predictors of positive response to selexipag and optimize treatment regimens for this complex condition.

Access to health services and its influence on adherence to treatment of arterial hypertension during the COVID-19 pandemic in a Hospital in Callao, Peru: A cross-sectional study

Background Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. Methods We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Results Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Conclusion Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.