Decrease In Average Blood Pressure Research Articles

Exploring the impact of health education on medication adherence and health outcomes in low-income neighborhoods: An observational study

Background: Medication adherence and health outcomes are influenced by multiple factors, including patient education. Aims and Objectives: The aims and objectives of the study are to explore the impact of health education on medication adherence and various health outcomes in low-income neighborhoods. Materials and Methods: An observational study was conducted involving 100 participants from low-income neighborhoods, aged 18–65, who were prescribed at least one chronic medication. Participants underwent a comprehensive health education program focusing on medication adherence, potential side effects, dietary habits, and physical activity. Outcomes were measured using the Morisky Medication Adherence Scale (MMAS-8), biometric values (e.g., blood pressure, blood sugar levels, cholesterol, and body mass index [BMI]), self-reported health status, hospitalization records, medication side-effects awareness, and dietary habits. Results: Post-education, there was a significant improvement in MMAS-8 scores (5.3 pre to 6.8 post, P<0.001). Biometric outcomes revealed a decrease in average blood pressure (from 145/90 mmHg to 130/85 mmHg), fasting blood sugar (from 150 mg/dL to 130 mg/dL), cholesterol levels (from 210 mg/dL to 180 mg/dL), and BMI (from 28.5 to 27.3), all with a statistical significance of P<0.01. Participants reporting “Good” or “Very Good” health increased from 45% to 65%, and those reporting regular physical activity increased from 25% to 45% (P<0.05). Hospitalizations/medical visits decreased from an average of 2.1–1.3 over 6 months (P<0.01). The proportion of participants with awareness of their medication's side effects significantly increased from 30% before the health education program to 70% afterwards (P<0.001). In addition, participants reporting adherence to dietary guidelines rose from 20% to 50% (P<0.01). Conclusion: Health education appears to have a substantial positive impact on medication adherence, biometric health outcomes, and overall well-being in low-income neighborhoods. Structured health education interventions may play a pivotal role in improving community health.

New data from a subanalysis of the TRICOLOR study: antihypertensive effectiveness of the triple single-pill combination of amlodipine/indapamide/perindopril and predictors of effectiveness and blood pressure control in young patients

Aim. To describe the antihypertensive efficacy of triple fixed­dose combination of amlodipine/indapamide/perindopril and assess the predictors of efficacy in young patients (<50 years).Material and methods. The TRICOLOR study (NCT03722524) is an observational prospective study (n=1247) that demonstrated high antihypertensive effectiveness and good tolerability of the triple single­pill combination (SPC) of amlodipine/ indapamide/perindopril. This subgroup analysis was performed on 199 patients aged <50 years (16% of the total population), and the comparison group consisted of 925 patients (82,3% of the total population) aged 50 years or older.Results. In young patients, during triple therapy with SPC amlodipine/indapa­ mide/perindopril, a positive trend in blood pressure (BP) reduction was observed compared to the baseline: an average decrease in BP after 12 weeks was 32,6 (11,0)/14,8 (8,5) mm Hg (p<0,0001), comparable to patients over 50 years of age in terms of reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after 2, 4 and 12 weeks of follow­up. A greater number of young patients achieved a reduction in blood pressure <140/90 mm Hg after 2 weeks of therapy compared to patients 50 years of age and older (49,7% vs 38,8%, p=0,004), and blood pressure <130/80 mm Hg – after 4 and 12 weeks (51,3% vs 43,5% (p=0,041) and 74,9% vs 67,5% (p=0,038), respectively). Left ventricular hypertrophy was a significant negative predictor of SBP reduction by 12 weeks of therapy, and the presence of grade 2 hypertension (HTN) and statin use, on the contrary, were positive predictors of changes in SBP by the end of observation. More adherent younger patients were significantly more likely to have a decrease in DBP by 12 weeks of follow-up. In addition, in young patients, male sex and the presence of dyslipidemia significantly increased the chances of blood pressure control at the end of observation. Waist circumference, body mass index, and grade 2 HTN were negative predictors of achieving the target blood pressure level.Conclusion. Thus, in young patients, good antihypertensive effectiveness of amlodipine/indapamide/perindopril was observed, comparable in the degree of blood pressure reduction with the older age group of 50 years and older.

Five-Finger Hypnosis and Murottal Therapy to Prevent Preeclampsia in Pregnant Women

The incidence of preeclampsia in Indonesia for the Southeast Asian continent is relatively high, with roughly 190 per 100,000 live births. According to the World Health Organization (WHO), the condition accounts for 12% of maternal deaths. Therefore, this study aimed to investigate the effectiveness of Five-Finger hypnosis and murottal therapy in stabilizing blood pressure, pulse, respiration, and activating endorphins. The study employed a quantitative method, specifically a quasi-experimental one-group pre and post-test design. Univariate data analysis was conducted to examine the characteristics of the sample, including age, education, and parity, and the Wilcoxon test was employed as the statistical test. The results showed that pregnant women were at risk of developing preeclampsia, as indicated by the age, education level, and parity of 9, 14, and 24 pregnant women. Furthermore, a significant difference was observed between the pretest and posttest, with an average decrease in blood pressure ranging from 2 to 6 mmHg (p=0.000). This result study provided that five-Finger hypnosis intervention and murottal therapy were effective in preventing preeclampsia. Consequently, the study strongly recommended the dissemination of the Five-Finger and murottal hypnotic intervention modules to a wider population as a preventive measure against preeclampsia.

ANALISIS ASUHAN KEPERAWATAN PADA NY. A DAN NY. SJ DENGAN PENERAPAN TERAPI RELAKSASI NAFAS DALAM TERHADAP PENURUNAN TEKANAN DARAH

Elderly is someone who has reached the age of 60 years and over which is identified with a period of helplessness and decline. Hypertension is the most common disease suffered by the community, especially in the elderly, because this disease cannot be cured, serious treatment is needed. In addition to pharmacological therapy, non-pharmacological therapy also needs to be carried out in this case modifying lifestyle, reducing sodium intake, reducing stress and avoiding smoking. Non-pharmacological therapy also consists of complementary therapies such as acupuncture, relaxation techniques (deep breathing exercises). The method in scientific work is the analysis of nursing care at PSTW Khusnul Khotimah. Subjects consisted of 2 participants with hypertension problems and the intervention given was deep breathing relaxation therapy. The results of the implementation of deep breathing relaxation therapy which was done once a day for 3 days proved that there was a decrease in blood pressure, with an average decrease in blood pressure in Grandma A aged 67 years, namely systolic blood pressure of 8 mmHg and 8 mmHg diastolic, and in Grandma SJ is 80 years old, systolic blood pressure is 8 mmHg and diastolic is 5 mmHg. The author recommends the nurse as the person in charge of the homestead to continue the implementation of deep breath relaxation therapy once a day with a duration of 15 minutes.

EFFECT OF CALCIUM AND VITAMIN D SUPPLEMENTATION IN PREGNANT WOMAN WITH HYPERTENSION AT SENTANI COMMUNITY HEALTH CENTER

Low calcium intake causes an increase in high blood pressure by stimulating the release of parathyroid hormone and renin, which causes an increase in intracellular calcium concentration in the smooth muscle cells of blood vessels and results in vasoconstriction. This study aims to determine the effect of giving calcium and vitamin D supplements to pregnant hypertension women on the anthropometric outcomes of newborns. The research design was quasi-experimental with two groups of post-test-only design. A respondent of 30 hypertension pregnant women at 28-32 weeks of gestation was selected by purposive sampling—data analysis using Mann Whitney. Calcium supplements (2 x 500 mg/day) and vitamin D3 (400 IU/day) were administered and monitored for eight weeks to 15 pregnant women as the intervention group and 15 pregnant women as the control group who were assumed to receive calcium supplements from the Health Service Program. Data on blood pressure and calcium levels were taken before and after eight weeks of intervention. The results showed that there was a significant difference in mean blood pressure between the control and intervention groups, with a p-value of systolic blood pressure (0.002) and a p-value of diastolic blood pressure (0.014), and the average decrease in blood pressure was more significant in the intervention group. There were differences in anthropometric results between the intervention group and the control group, with p-value s ​​for body weight (0.000), body length (0.000), and head circumference (0.000). The intervention group's average weight, length, and head girth were higher than the control group's. Thus, for eight weeks, calcium and vitamin D supplementation in hypertensive pregnant women can reduce blood pressure and result in better baby weight, body length, and head circumference. Keywords: Anthropometry, Calcium, Hypertension, Vitamin D

Pengaruh Pemberian Ekstrak Black Garlic Terhadap Tekanan Darah Pada Penderita Hipertensi di UPTD Puskesmas Rowobungkul

Introduction: Hypertension sufferers in Central Java experienced an increase of 12.9% from the results of the Basic Health Research in 2018. In Blora Regency, there were ± 36% of the population aged ≥18 years suffering from hypertension. Objectives: The research objective was to determine the effect of black garlic extract on blood pressure in hypertension sufferers at Rowobungkul Public Health Center. Methods: The research method was a quantitative study with a quasi-experimental approach two groups pre-posttest design. The samples of this research were 20 people with hypertension in Rowobungkul Health Center UPTD. The sampling technique used purposive sampling. The instrument used was a digital sphygmomanometer. Normality test data was calculated by using the Shapiro Wilk test with normally distributed data results, the difference with the paired sample t-test, and the 2-group difference test with the independent t-test. Results: The results showed that the average decrease in blood pressure after being given black extract is 33.20 mmHg and white garlic is 36.00 mmHg for systole, while black garlic extract diastole is 6.70 mmHg and white garlic extract is 7.40 mmHg. The results of the analysis of the effect of reducing blood pressure in patients with hypertension after giving black garlic and white garlic extracts with a p-value (systole) of 0.354 and a p-value of diastole (0.755). Conclusion: The conclusion is that there is no significant effect on black garlic extract compared to white garlic on blood pressure, meaning that the effectiveness of black garlic and white garlic extracts on blood pressure is the same.

Effect of diuretics on plasma renin activity in primary hypertension: A systematic review and meta-analysis.

Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta-analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and/or other biomarkers of fluid homeostasis were measured before and after treatment. Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials. Titles were firstly screened by title and abstract for relevancy before full-text articles were assessed for eligibility according to a predefined inclusion/exclusion criteria. A total of 1684 articles were retrieved of which 61 met the prespecified inclusion/exclusion criteria. PRA was measured in 30/61 studies. Diuretics led to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference [95% confidence interval] 0.481 [0.362, 0.601], 0.729 [0.181, 1.28], 0.541 [0.253, 0.830] and 0.548 [0.159, 0.937] for thiazide, loop, mineralocorticoid receptor antagonists/potassium-sparing and combination diuretics respectively, Q = 0.897, P = .826), and did not relate to the average decrease in blood pressure. In antihypertensive drug trials, diuretics lead to a sustained increase in average PRA, which is similar across different classes of diuretic and unrelated to the average reduction in blood pressure.

Study in vitro and in silico on effectiveness noni fruit extract (Morinda Citrifolia) to reducing hypertension

Hypertension is one of the major causes of stroke. Stroke can be prevented by controlling hypertension. Noni fruit proved to have antihypertensive effect. Noni Fruit contains scopoletin and xeronin compounds that play a role in antihypertensives. This study aims to determine the effectiveness of noni fruit extract to controlling hypertension. The research method used is pre-test and post-test matched control group. The 6 Wistar rats were divided into 3 groups consisting of 1 treatment group and 2 control groups. Group P1 was induced by using ketamine 0.05 ml + epinephrine 0.2 ml + 6 ml noni fruit extract, group K (-) induced by ketamine 0.05 ml + epinephrine 0.2 ml without extract, and group K (+) induced by using ketamine 0.05 ml + epinephrine 0.2 ml + captopril 2.5 mg. The results showed that epinephrine can be used as a hypertensive inducer. Noni fruit extract as much as 6ml can provide antihypertensive effects. In Vitro, test result showed that noni fruit extract can reduce blood pressure by an average decrease in blood pressure of 58,5 mmHg While captopril 25,5 mmHg. in addition to the in vitro test, the results of the in-silico test showed that the noni fruit extract can significantly reduce blood pressure compared to anti-hypertensive drugs (captopril). the value of scopoletin in noni fruit is -7.6. and captopril only -5.7.

Pengaruh Aplikasi Akupuntur Pada Pasien Hipertensi di Puskesmas Sentani Kabupaten Jayapura

Hypertension is blood pressure that exceeds normal limits divided into three categories. Hypertension is dubbed as a silent killer with symptoms of feelings of bending, headaches, palpitations, blurred vision, ringing in the ears, fatigue, vertigo, and nosebleeds. In addition, trends in treatment using alternative and complementary therapies are starting to appeal to the community, one of which is acupuncture. Acupuncture is a method of treatment by attaching needles to certain points on the body to reduce blood pressure or relieve symptoms of hypertension. This study aims to determine the application of acupuncture at points: LV3, HT7, PC6, and LU9 in hypertensive patients. This research was an experimental pretest-posttest without a control group with a time series approach, in 15 people with blood pressure criteria ≥130mmHg. This research was conducted from November 2018 to February 2019 using the analysis of the repeated ANOVA test. The results of the comparative output mean it is known that average hypertension before the acupuncture application was 172.93 mmHg, and after the acupuncture application 155.87 mmHg at the first meeting, hypertension before the acupuncture application was 154.50 mmHg and after the acupuncture application was 135.73 mmHg at the second meeting with the results of the in-action effect test revealed a Greenhouse-Geisser sig value of 0,000, so it can be concluded that there is a difference in the decrease in average blood pressure in hypertensive patients. Efforts that can be done are monitoring the continuity of hypertensive patients in carrying out acupuncture therapy.

Human clinical trial to assess the effect ofconsumption ofmultigrain Indian bread on glycemic regulation intype 2 diabetic participants.

The efficacy of multigrain flatbread in regulating the lipid profile and carbohydrate homeostasis among type 2 diabetic patients was studied in 100 type 2 diabetic participants. The results revealed that the anthropometric parameters remained unaltered in both test and control groups. The fasting blood glucose levels (140.70±8.43 versus 132.89±5.63mg/dl) did not significantly decrease. In contrast, the insulin levels (12.96±1.06 versus 10.83±1.03 μIU/ml) and HbA1c levels (8.01±0.27 versus 7.40±0.21%) in the test group decreased significantly, and it was associated with a decrease in insulin resistance. The LDL levels in the test group decreased after the intervention (116.0±5.67 versus 98.7±5.68mg/dl), while triglycerides and VLDL increased significantly and HDL levels remained unaltered. A significant decrease in average blood pressure (systolic/diastolic) was noticed among the test group participants. The human RBP4 and hs-CRP remained unaltered. PRACTICAL APPLICATIONS: Millets are rich in fibers, has complex carbohydrate, protein, and is lower in fat content. Millets provide a wide range of nutrients, phytochemicals, and are gluten-free with low glycemic nature. Their intake can reduce factors such as insulin resistance and oxidative stress responsible for the pathogenesis of type 2 diabetes and cardiovascular diseases. Our study indicated the use of multigrain flatbreads prepared from millets helped reduce serum insulin, LDL cholesterol, HbA1c levels, and incidentally blood pressure levels with a significant increase in insulin sensitivity in type 2 diabetes participants. The results suggest using the multigrain flatbread meal as a food supplement or meal replacer in diabetic participants in terms of glucose control and insulin sensitivity.

Aortic Arch Baroreceptor Stimulation in an Experimental Goat Model: A Novel Method to Lower Blood Pressure.

The effect of aortic baroreceptor stimulation on blood pressure manipulation was assessed using the goat species Capra aegagrus hircus. The aim of this study was to manipulate blood pressure with future intention to treat high blood pressure in humans. The ages of the animals ranged from 6 months to 2 years. A standard anesthesia protocol was used. A lateral thoracotomy was performed to gain access to the aortic arch. Data was collected with the Vigileo system. Pre stimulation blood pressure was compared with maximum post stimulation blood pressure values. Results were analyzed with the Wilcoxon signed rank test. In the study 38 animals were enrolled. Baroreceptor stimulation was performed for each animal using 3 different electrodes each of which emits an electrical impulse. In the pilot phase of the study, the median baseline blood pressure prior to stimulation of the baroreceptors was 110.8 mmHg. After stimulation the median blood pressure decreased to 88 mmHg. The average decrease in blood pressure was 22.8 mmHg. This decrease of blood pressure after stimulation of the baroreceptors is statistically significant (p < 0.0001) and the proof of concept was shown. During the extended phase all three probes had a significant effect on blood pressure lowering (p < 0.0001). The study confirmed that aortic baroreceptor stimulation has an effect on blood pressure lowering. This is a novel field of blood pressure manipulation. The hemodynamic effects of long-term aortic baroreceptor stimulation are unknown. Further investigations need to be done to determine whether a similar effect can be induced in different species such as primates and humans.

PENGARUH TERAPI BEKAM TERHADAP TEKANAN DARAH PADA PASIEN HIPERTENSI DI KLINIK SEHAT MUGI BAROKAH KARAKAN GODEAN SLEMAN YOGYAKARTA

Background: Hypertension is a degenerative disease that becomes a serious problem but one way to reduce hypertension by means of cupping therapy.Objective: To know the effect of bruise therapy on blood pressure in hypertensive patients in healthy clinic Mugi Barokah Karakan, Godean, Sleman, Yogyakarta Method: This research is a quantitative research, using quasi experimental (quasi experiment) with pre and posttest without control. The population of this study were hypertensive patients who performed bruise therapy with population taking at the clinic of bruise therapy as much as 15 respondents. The sampling technique used incidental samples, with a sample size of 15 people. Data collection tool using check list.Results: The results showed the value of bivariate analysis with the wilxocon test formula that there was an effect of bruise therapy on blood pressure in hypertensive patients after bruise. That there was an average decrease in blood pressure on 15 respondents of hypertension before and after cupping therapy showed with p = 0,000 and p = 0.003 where p &lt;0.005 Conclusion: There is infl uence of bruise therapy to blood pressure in hypertension patient at Healthy Clinic Mugi Barokah Karakan Godean Sleman Yogyakarta

European Society of Hypertension position paper on renal denervation 2018.

: This ESH update was deemed necessary with the publication of new results of sham-controlled randomized blinded prospective trials with renal denervation (RDN). Proof of concept studies and first randomized trials (some were sham-controlled) displayed discrepant results about the efficacy of RDN. Three sham-controlled randomized trials of the 2.0 generation yielded now similarity in the average blood pressure decrease following RDN. Reduction of ambulatory blood pressure was approximately 5 to 7 mmHg and of office blood pressure 10 mmHg. Such a decrease in blood pressure by pharmacologic therapy has been found to be associated with lower incidence of cardiovascular events in particular with respect to heart failure and stroke by roughly 25%. Nevertheless, some questions about renal denervation are unanswered. The heterogeneity of the blood pressure-lowering response point to the clinical need to identify predictors for efficacy, and questions on long-term safety could not have been answered due to the short duration of the sham-controlled randomized clinical trials.

2198 Cognitive and behavioral side effects in patients treated with droxidopa for neurogenic orthostatic hypotension

OBJECTIVES/SPECIFIC AIMS: To describe adverse behavioral symptoms attributed to droxidopa therapy for neurogenic orthostatic hypotension (nOH). METHODS/STUDY POPULATION: BACKGROUND: Droxidopa, a norepinephrine (NE) precursor, improves symptoms of nOH by replenishing NE levels. Central NE effects are poorly described but may offer potential benefits given the pathophysiologic progression of α-synuclein-related disorders. Here we report a series of cognitive and behavioral side effects linked to droxidopa therapy. METHODS: We identified 5 patients treated at Vanderbilt University who developed behavioral symptoms including mania, irritability, and disorientation shortly after the initiation of droxidopa for nOH. Comprehensive chart reviews were performed for all patients, including analysis of droxidopa titration schedule and dosing, medical comorbidities, clinical course, and outcome. All patients had symptoms of synucleinopathy, manifesting with autonomic failure, REM behavior disorder, and parkinsonism. Four met criteria for idiopathic PD, and one was diagnosed with pure autonomic failure but had concomitant symptoms of parkinsonism and REM sleep behavior disorder. RESULTS/ANTICIPATED RESULTS: Our patients had no significant cognitive or behavioral symptoms before the initiation of droxidopa. The average decrease in blood pressure upon standing was 27 mmHg systolic and 17 mmHg diastolic. Behavioral disturbances were observed early in the titration period and at relatively low doses of droxidopa (total daily doses ranging from 300 to 800 mg/day; droxidopa therapeutic dose range 900–1800 mg/d). The most common symptoms reported were mania, irritability, and confusion. Symptoms resolved with dose reduction in 4 patients, and droxidopa was discontinued in 1 patient due to persistent irritability. No other medical comorbidities or alternative etiologies were identified to explain these effects. DISCUSSION/SIGNIFICANCE OF IMPACT: Droxidopa is a prodrug designed to act peripherally, but may also have important, yet poorly described, central effects. We hypothesize that these behavioral manifestations result from an “overdose” of key NE networks linking orbitofrontal and mesolimbic regions. Further studies are warranted to better characterize central NE effects in patients treated with droxidopa.

Pengaruh Kepatuhan Suplementasi Tablet Kalsium Modifikasi terhadap Kadar Kalsium dan Tekanan Darah Pada Ibu Hamil

A low intake of calcium leads to an increase in high blood pressure by stimulating the release of paratiroid and renin hormones that lead to increase in intracellular calcium concentration in the vasculer smooth muscle cells and result in vasocontriction. This study aims to determine the influence of compliance to supply modified calcium tablet toward calcium level and blood pressure in pregnant mothers. This research was conducted at RSIA Sitti Khadijah I Maternity Hospital Makassar with research design of quasy experiment with prepost test group control design. There were 30 pregnant mother sampels of prehypertension in gestational age&gt; 20 weeks, 12 pregnant women were given normal calcium tablets and 18 pregnant women given modified calcium tablets for 8 weeks each. Data analysis use paired t test. The results indicate that there is a different changes of calcium level and blood pressure between pregnant mothers of intervention group and control group with the value of p = 0.000 (p&lt;0.05). After intervention averagely the calcium level increase in intervention group 0.4 mg/dl while in control group 0.1 mg/dl, followed by the average decrease in blood pressure of systole and dyastole in the intervention group 15.4/9.6 mmHg while in the control group 3.5/4.5 mmHg.

Cardiotropic action of oxacom in experimental heart failure

Prolonged hypotensive effect of oxacom (dinitrosyl iron complexes with ligand glutathione) has been well documented in animals and healthy volunteers, but effect on the heart is not defined. In this work, the blood pressure (BP), and the pressure in the left ventricle (LV) were recorded in rats. Intravenous bolus injection of oxacom (10 mg/kg) caused an immediate average BP decrease by 20-30 mm Hg followed by a slow recovery. The LV systolic and diastolic pressures did not change, but the maximal speed of pressure development, and contractility index at peak action of oxacom increased by 26-33%, while isovolumic relaxation constant fell by 30%. These changes gradually normalized within 10-15 minutes. Effect of oxacom on hearts with isoproterenol-induced diffuse ischemic myocardial lesions and diastolic heart failure was similar to that observed in the control group except the isovolumic relaxation constant rose 1.5-fold while elevated LV diastolic pressure fell. Results suggest that oxacom exerts the positive cardiotropic action especially at heart failure.

The protective effect of the RAS inhibitor on diabetic patients with nephropathy in the context of VEGF suppression

The aim of the present study was to explore whether renin angiotensin system (RAS) inhibitor can reduce the production of vascular endothelium growth factor (VEGF). Further, we sought to elucidate the correlation between VEGF level and certain clinical parameters, such as albumin excretion rate (AER), before and after treatment with angiotensin type 1 receptor blocker. We recruited 166 type 2 diabetic patients at various stages of diabetic nephropathy (DN) and 46 healthy control subjects for a cross-sectional study. We recruited another 42 hypertensive type 2 diabetic patients with microalbuminuria for a longitudinal study involving a 6-month irbesartan treatment protocol. Urinary VEGF (uVEGF) levels were determined using ELISA. In the cross-sectional study, hypertensive type 2 diabetic patients who received RAS inhibitor presented lower uVEGF levels than those who did not receive the RAS inhibitor. Statistical analysis indicated that uVEGF level was independently correlated with the AER. In the longitudinal study involving the 6-month irbesartan treatment, we demonstrated that uVEGF levels decreased significantly in patients who achieved a 50% AER reduction (remission group, n=32). In contrast, uVEGF levels remained unchanged in patients who did not exhibit a 50% AER reduction (nonremission group, n=10). Furthermore, the change in uVEGF was significantly correlated with the change in AER (r=0.65, P<0.01) before and after 6 months of irbesartan treatment. This result held true even after we had adjusted for the decrease in average blood pressure. The protective effect of the RAS inhibitor in DN patients is associated with the suppression of VEGF. Accordingly, it may be possible to use uVEGF as a marker of DN progression. We suggest that uVEGF may be an important target for therapeutic intervention in the context of DN.

Incidence and Predictors of Development of Acute Renal Failure Related to Treatment of Congestive Heart Failure with ACE Inhibitors

Background/Aims: Recent studies have shown high rates of morbimortality associated with hyperkalemia in congestive heart failure (CHF) patients treated with angiotensin-converting enzyme inhibitors (ACEI) plus spironolactone and the best predictor of this electrolytic disorder was a decrease in renal function. We aim to identify the incidence and predictors of acute renal failure (ARF) related to treatment with ACEI associated or not with spironolactone. Methods: We conducted a cohort study and followed 114 consecutive cases of CHF patients treated with ACEI at admission to a University Hospital. We performed measurements of serum creatinine and potassium levels three times a week, and systolic and diastolic blood pressures every 8 h, daily. Results: Among 114 patients, 25% developed ARF, 15% hyperkalemia and 3% severe hyperkalemia. Predictors of ARF were a decrease in average blood pressure 25 mm Hg (OR 18.2; 95% CI: 6.2, 53.5); class IV CHF (OR 4.7; 95% CI: 1.7, 12.7), diabetes (OR 2.6; 95% CI: 1.1, 6.4) and hypertension (OR 3.0; 95% CI: 1.2, 7.4). Conclusions: ARF and hyperkalemia are common complications in CHF patients after treatment with ACEI. Diabetic, hypertensive and class IV CHF patients who experienced a decrease in average blood pressure 25 mm Hg were more susceptible to ARF.

Dietary Sodium and Blood Pressure

<h3>To the Editor.</h3> —Dr Midgley et al¹suggested that a 100-mmol/d reduction in sodium intake would yield an average decrease in blood pressure of 3.7 mm Hg (systolic) and 0.9 mm Hg (diastolic) in hypertensive individuals and 1.0 mm Hg (systolic) and 0.1 mm Hg (diastolic) in normotensive individuals and then questioned the wisdom of current recommendations for moderation in sodium intake in the general population. As the authors point out, many of the 56 trials that formed the basis for their meta-analysis were of questionable quality. Furthermore, the median length of intervention was only 14 days, which is considerably less than desirable for implementation of a behavior change intervention and too short to observe the full effects of a meaningful reduction in sodium intake on blood pressure. As a consequence, the analysis is heavily weighted by results from studies of doubtful relevance to the question at hand. Greater reliance should be

Efficacy and safety of atenolol, enalapril, and isradipine in elderly hypertensive women

purpose: This trial was designed to evaluate the efficacy and safety of three different classes of antihypertensive agents in elderly women. patients and methods: The trial had three phases: 4 to 8 weeks of placebo, 6 weeks of titration, and 16 weeks of maintenance. White women between 60 and 80 years old with sitting diastolic blood pressures (DBPs) from 95 through 114 mm Hg treated with placebo were evaluated by history, physical examination, laboratory studies, and quality-of-life interview. After double-blind randomization with low-dose atenolol, enalapril, or isradipine, the dose was increased stepwise and hydrochlorothiazide added as needed to achieve goal DBP (less than 90 mm Hg and greater than 10 mm Hg below baseline). During maintenance, patients not at goal were “stepped up” and patients with uncontrolled DBP at maximum dosage were removed from the study. The pretreatment (baseline) blood pressure of the 315 randomized participants averaged 161 100 mm Hg; 92% had been treated previously for hypertension, 15% had diabetes mellitus, 11% smoked, and 38% consumed alcohol. results: For 245 patients completing the trial, the average decrease in blood pressure during treatment was 18.2 15.6 mm Hg. Antihypertensive efficacy was similar for the monotherapy drug regimens, with 84%, 71%, and 80% of patients receiving atenolol, enalapril, and isradipine, respectively, achieving DBP goal. Of the 70 patients who did not complete the trial, 42 left because of symptoms and 19 because of uncontrolled DBP. No important, unexpected drug-induced changes in symptoms or blood chemistries were noted. Symptom frequency differed little among the three dosage levels, becoming maximal by the second visit at the same dosage level. conclusion: All three drugs lowered DBP comparably, and none produced alarming effects. Thirteen percent of patients left the study because of symptoms.