Better Control Of Hypertension Research Articles

A prospective longitudinal approach to examine the association between social position in childhood, adolescence, and adulthood with the control of hypertension during adulthood.

Hypertension is one of the main concerns in public health, since it is related with increased morbidity, and potential years of life lost in addition to loss of quality of life. This study aimed to assess: (1) the distribution of indicators of life course SEP in a cohort of Colombian patients with hypertension and (2) to assess the association of life course SEP and control of hypertension among this cohort of patients. Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). Mother occupation and housing conditions were measured with the Event History Calendar. Mother educational level was measured with the questionnaire developed by the Project on Ethnicity and Race in Latin America (PERLA). Socioeconomic position during adulthood was measured using education, occupation, and income level based in the MacArthur Network. The group with a higher lifelong social position and the group of lower lifelong social position showed better control of hypertension (OR = 1.21; p <0.05; OR = 1.33; p < .05, respectively) compared to those whose social position throughout life varied the most. No statistical differences were found in the relations between single lifetime social position variables, and hypertension control in the three time points analyzed. These findings warrant further research to deeper our understanding on the role of a multidimensional and cumulative approach of social position in hypertension control.

Hypertension clinical pathway: Experience of Aseer region, Saudi Arabia.

Hypertension (HTN) is a common chronic health problem with many complications and high morbidity rates. This study aimed to describe the HTN pathway, to assess the performance of screening and registration programs, to explore the challenges and suggest solutions for those challenges. This study was conducted in primary care centers in the Aseer region, Saudi Arabia, at the end of 2022. The study consisted of three parts namely: Screening for HTN, registration of known hypertensive patients and opinions of representatives of Primary Healthcare Centers (PHCs) on challenges to the implementation of HTN pathway and suggestions for overcoming these challenges. Three Google forms were developed by the investigators to achieve the objectives of this study. The first two forms were completed by doctors and nurses at each PHC and reviewed by the leader of HTN pathway, and the third form completed by a representative of each PHC. SPSS version 26 was used for data management and analysis. Chi-square test was used to determine association between categorical variables; binary logistic regression analysis was performed to determine the correlates of being hypertensive and having good control of HTN. A total of 159,243 individuals were screened for HTN, 55% of whom were females and 94% were Saudis. The prevalence of HTN was 13%; 70% were overweight or obese and 14% had diabetes. The total registered number of patients was 55,628; 50% had good HTN control. Major challenges were inadequate health coaches, care coordinators, laboratory and radiology facilities, lack of coordination with hospitals, and ineffective appointment system. This study revealed that the current HTN pathway was successful with regard to screening and registration of patients with HTN. Many challenges need an executive plan with SMART objectives to optimize the care for HTN patients in the region.

A randomized controlled trial comparing the efficacy of nifedipine and enalapril in the postpartum period

Postpartum hypertension is a common medical complication of pregnancy and is associated with increased healthcare use, including unplanned interactions with the medical system and readmission, which can add significant stress to both a newly postpartum patient and the medical care delivery system. We currently do not know what the best antihypertensive treatment for postpartum hypertension is and tend to use antihypertensives commonly used during pregnancy. However, the mechanism of action of angiotensin-converting enzyme inhibitors may be well suited for the pathophysiology of hypertension in the postpartum period and may help to provide better control of hypertension and, in turn, decrease healthcare use. This study aimed to determine if enalapril is superior to nifedipine in preventing prolonged hospitalizations, unplanned medical visits, and/or readmission among women with postpartum hypertension. We performed an open-label, randomized controlled trial(ClinicalTrials.gov registered: NCT04236258)in which patients≥18 years with chronic hypertension, gestational hypertension, or preeclampsia were recruited to receive either 10 mg enalapril daily or 30 mg extended-release nifedipine daily as an initial antihypertensive agent in the period from delivery to 6 weeks postpartum. Recruitment occurred at a tertiary academic hospital from January 2020 to February 2021. Exclusion criteria included being on an antihypertensive when pregnancy started or requiring≥2 daily antihypertensives during pregnancy. The antihypertensive regimen was managed by the participants' obstetrical provider after the initial randomization. The primary outcome was a composite of prolonged hospitalization, unplanned clinic visits, triage visits, and/or readmission. A total of 40 patients in each arm were needed to detect a decrease in the primary outcome rate from 70% to 40% (α=0.05; power 0.80). Analyses were performed based on the intention-to-treat principal, and each arm was oversampled because of the risk for participant dropout. A total of 47 patients were randomized to each arm. Aside from the mode of delivery and twin gestation, the maternal demographics were similar between the 2 groups. The primary outcome occurred in 31 of 47 patients (66%) randomized to the nifedipine group and in 30 of 47 (64%) randomized to the enalapril group (P=.83). There was no significant difference in the primary outcome after controlling for mode of delivery and twin gestation. More patients in the enalapril arm had a second antihypertensive added during their primary hospitalization (16 vs 6) and more patients in the nifedipine arm were still on their antihypertensive at 2 weeks postpartum (42 vs 36). There were no adverse events in either group. Enalapril was not superior to nifedipine when used as an initial antihypertensive in the immediate postpartum period in terms of decreasing healthcare use.

Captopril Polyvinyl Alcohol/Sodium Alginate/Gelatin-Based Oral Dispersible Films (ODFs) with Modified Release and Advanced Oral Bioavailability for the Treatment of Pediatric Hypertension.

Hypertension can begin in childhood; elevated blood pressure in children is known as pediatric hypertension. Contrary to adult hypertension, there is a scarcity of commercial medications suitable for the treatment of pediatric hypertension. The aim of this study was to develop orally dispersible films (ODFs) loaded with captopril for the treatment of hypertension in children. Captopril-loaded ODFs were composed of different blends of synthetic polymers, such as polyvinyl alcohol (PVA) and polyvinyl pyrrolidone, and natural polymers, such as sodium alginate (SA) and gelatin. The ODFs were characterized based on their mechanical and thermal properties, drug content, surface morphology, in vitro disintegration, in vitro release, and bioavailability. A novel HPLC method with precolumn derivatization was developed to precisely and selectively determine captopril levels in plasma. A low concentration of PVA and a high concentration of SA generated ODFs with faster hydration and disintegration rates. SA-based films exhibited fast disintegration properties (1-2 min). The optimized modified-release film (F2) showed significant (p < 0.05) enhancement in bioavailability (AUC = 1000 ng min/mL), with a value 1.43 times that of Capoten® tablets (701 ng min/mL). While the plasma concentration peaking was in favor of the immediate-release tablet, Tmax was significantly prolonged by 5.4 times for the optimized ODF (3.59 h) compared with that of the tablets (0.66 h). These findings indicate uniform and sustained plasma concentrations, as opposed to the pulsatile and rapid plasma peaking of captopril from the immediate-release tablets. These findings suggest that the modified release of oral films could offer more favorable plasma profiles and better control of hypertension than the conventional release tablets.

Relationship between the Level of Spirituality and Medication Adherence among Adult Hypertensive Patients in Rural South Western Nigeria

Background: Spirituality has been found to drive the motivational component of the Behavioural Wheel of the Theory of Change Approach in adaptation mechanisms. Effective medication adherence has been strongly associated with good hypertension control and one way to achieve this is to leverage spirituality as a strong coping mechanism in hypertensive patients. Method: Selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of Spirituality was assessed using the Spiritual Perspective Scale and medication adherence was assessed using the Morisky Medication Adherence Scale 8. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p ≤ 0.05. Results: The mean age of the respondents was 61.1±11.1 years. More than half (52.6% and 61.2%) had high level of spirituality and good medication adherence respectively. Respondents with high level of spirituality (99.4%) had good medication adherence and this was statistically significant with p&lt;0.001. Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients’ holistic care with the aim of achieving better blood pressure control among hypertensive patients.

THE IMPACT OF OBESITY ON THE CONTROL OF TREATED HYPERTENSIVE PATIENTS

Objective: Obesity is as a risk factor for hypertension, but there are few studies evaluating its impact on the response to antihypertensive drug and on the control of hypertensive patients. The aim of our study was to determine the effect of obesity on the control of treated hypertension. Design and method: We analyzed recordings of ambulatory blood pressure measurement (ABPM) in 84 treated hypertensive patients aged &gt; 18 years, in the cardiology department of Mohamed Taher Maamouri University hospital in Nabeul. Patients were stratified into two groups: obese (Body Mass Index (BMI) &gt;30 kg/m2) and non-obese. Hypertension control is defined by 24-hour ambulatory blood pressure (BP) = &lt; 130/80 mmHg, daytime = &lt; 135/85 mmHg and nighttime = &lt; 120/70 mmHg. The comparisons of percentages were carried out by the Chi-square test. Results: Our Population was composed of 33 obese and 51 non-obese patients. The mean age of our population was 59.37±13.1 years. BMI in obese was significantly higher than in non-obese (34.47±5.4 versus 25.36±2.5; p&lt;0.001). The prevalence of uncontrolled patients was significantly higher in obese patients detected in 24-hour ABPM (75.8% versus 51%; p = 0.039), in daytime ABPM (69.7% versus 41.2%; p = 0.014) and in night-time ABPM (90.9% versus 68.6%; p = 0.018) than in normal weight patients. Conclusions: Prevalence of uncontrolled hypertension was higher with higher BMI values. The level of blood pressure control in our sample remains relatively insufficient. To achieve a better control of hypertension, we must insist on therapeutic compliance and on the correction of risk factors, particularly obesity, which is significantly associated with an increase in BP.

THE PROFILE OF HYPERTENSION IN TYPE 2 DIABETICS PATIENTS

Objective: Hypertension (HT) is associated with type 2 diabetes (T2D) in 80% of cases. This association is explained by the same risk factors shared by these two pathologies, essentially obesity, lack of physical activity and smoking. The aim of our work is to study the epidemiological, clinical and therapeutic characteristics of hypertension in type 2 diabetes patients at the first nephrology consultation. Design and method: It's a retrospective study of 42 patients with type 2 diabetes followed at the nephrology consultation of Mongi Slim Hospital over a period of three years (January 2013 - December 2016). HT was classified according to the ESH / ESC recommendations of 2021. Results: The study included 25 men and 17 women with a mean age of 63.3 [31-80]. At the first consultation, 88% of our patients had hypertension with a sex ratio M/F of 1.3. The duration of the HT was 98 months [0-300] and that of the T2D was 170 months [2-480]. The diagnosis of HT and T2D was made at the same time in 7 patients (16.6%). In 8 patients (19.04%), HT preceded T2D. HT was classified as grade 1 in 8 patients (19%), grade 2 in 12 patients (28.6%), grade 3 in 6 patients (14.3%) and systolic HT in 9 patients (21.4%). Fourteen patients were on dual therapy, 12 patients were on triple therapy including a renin angiotensin system blocker and 2 were on quadruple therapy including a loop diuretic. The mean systolic blood pressure was 161.78 mm Hg, 152.91 mm Hg and 175 mm Hg respectively and the mean diastolic pressure was 80.35 mm Hg, 68.75 mm Hg and 85 mm Hg respectively. Conclusions: Hypertension is frequently associated with type 2 diabetes. It increases the cardiovascular risk of type 2 diabetes patients. Thus, early diagnosis and good control of hypertension are of paramount importance.

A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran.

Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.

Hypertension Medication from Guidelines to Practice: A Cohort study in western Iran.

Hypertension (HTN) is one of the most common risk factors for non-communicable chronic diseases. The aim of the current study is to evaluate the prescribing patterns of antihypertensive medications in Kermanshah Province, west of Iran. The Ravansar Non-Communicable Diseases (RaNCD) cohort study is the first Kurdish community-based study; subjects' age ranged from 35-65 years. In order to examine the use of medications to control blood pressure, participants were asked to bring all prescribed medications to the study center. Treatments were compared with 2013 European Society of Hypertension (ESH) / European Society of Cardiology (ESC) Guidelines for the management of arterial HTN RESULTS: From a total of 10,040 participants in RaNCD cohort, 1,575 (15.7%) individuals were hypertensive, of whom, 1271 ((80.7%) people were aware of their condition. From 1,153 (73.20%) people under treatment, 840 (72.8%) had their HTN properly controlled. The most common medications used to treat HTN were losartan (27.5%), metoprolol (14.3%), and captopril (11.9%). Regardless of type of treatment, 49.3% of all patients have received the medication for l 6≥years. The most commonly used drugs were β-Blockers and Angiotension receptor blockers as 620 (31.0%) and 612 (30.6%), respectively. Multivariable analysis showed that female gender, those receive ≥3 antihypertensive agents, and using preferred combinations were associated with a better blood pressure control. In addition, the chance of hypertension control was less likely with duration of treatment and in obese patients with BMI ≥ 35 kg/m2 . Even though adherence to the international guidelines was acceptable, improvements can be made for better control of HTN. Therefore, it is imperative to educate healthcare professionals on improving their selection of antihypertensive medications and combination therapy for hypertensive patients. This article is protected by copyright. All rights reserved.

Specifičnosti u lečenju hipertenzije kod bolesnika sa hroničnim bubrežnim oboljenjem

Today, it is believed that all over the world about 10% of the population has a kidney lesion, most often chronic kidney disease (CKD). Hypertension and diabetes mellitus are the most common causes of chronic kidney damage, and in everyday clinical practice, we often wonder whether hypertension is a consequence of a lesion of the kidney parenchyma and vasculature or is its cause. Patients with CKD have high cardiovascular (CV) morbidity and most often die from CV disease. The specificity of blood pressure treatment in patients with chronic kidney damage is that good control of hypertension not only leads to a reduction of CV risk but also to a slowing of the progression of chronic to terminal renal failure. There is no doubt that the first line of treatment for hypertension in patients with CKD is angiotensinconverting enzyme inhibitors (ACEi) and angiotensin-2 receptor blockers (ARB). They are recommended especially for those patients with diabetic nephropathy because, in addition to their antihypertensive effect, they reduce proteinuria, slow down the progression of chronic kidney failure, especially if given in the early stages of CKD, and reduce CV risk. However, for a long time, there have been controversial opinions about whether in the advanced stages of renal failure, when the glomerular filtration rate (GFR) is &lt; 30 mL/min/1.73 m2, these drugs should be excluded. According to the latest KDIGO guidelines in 2021, renin-angiotensinaldosterone (RAAS) blockers are the first line in the treatment of proteinuric CKD patients, with and without diabetes mellitus, and in stage 4, with a note that these drugs should be continued in therapy unless there is marked hyperkalemia (potassium &gt; 6 mmol/L), acute kidney damage or decrease in estimated glomerular filtration rate &gt; 30%. The most important thing is to individualize the optimal therapy for each patient. In the guidelines for the treatment of hypertension in patients with CKD, there are no clear recommendations for the treatment of unregulated hypertension when target pressures cannot be achieved with RAAS blockade and when there are contraindications for the administration of this group of drugs. The addition of calcium channel blockers, diuretics, and beta blockers is based on expert opinion.

Adaptation, implementation, and evaluation of the HEARTS technical package in primary health care settings in Jordan to improve the management of hypertension: a pilot study.

The majority of patients with hypertension in Jordan have uncontrolled blood pressure. This study aimed to adapt and implement the hypertension management protocol (a module in the HEARTS technical package) in health care centers in Jordan and evaluate its effectiveness on hypertension management and control. The hypertension management protocol was adapted and implemented in six health centers followed by training of the healthcare staff on the adapted protocol. Patients above 18 years old who attended health centers during the study period were recruited consecutively. The blood pressure of 852 patients was monitored over 4 months, using an individual patient treatment card. At the baseline visit, the proportion of patients with uncontrolled blood pressure was 71.5%. After 4 months of the implementation of the protocol, the proportion of patients with uncontrolled blood pressure decreased to 29.1%. Of all studied characteristics, age was the only significant predictor of achieving blood pressure control. Patients aged ≤50 had a higher rate of controlled blood pressure readings after 4 months of implementation of the protocol compared to patients older than 60 years (OR = 1.98, 95% CI: 1.07, 3.67; P value = 0.028). In conclusion, the implementation of the HEARTS hypertension management protocol has successfully achieved better control of the blood pressure of the enrolled patients after 4 months of implementation. To achieve better control of hypertension in the general population, integrating evidence-based strategies for hypertension control that are listed in the HEART technical package into routine care is strongly recommended.

Automated adjustment of dialysate sodium by the hemodialysis monitor: Rationale, implementation, and clinical benefits.

Prescribing dialysate sodium is the responsibility of the physician, but there are currently no clear guidelines for this prescription. Furthermore, there is quite frequently a significant difference between prescribed and measured dialysate sodium. Several arguments, both theoretical and experimental, suggest that dialysate sodium should be adjusted individually in such a way as to result in a decreasing sodium profile that takes into account the patient's predialytic natremia. The generalization in clinical routine of this strategy requires the integration into the hemodialysis monitor of software making the machine capable to automatically adjust the dialysate sodium at each session. The only three such softwares that have been integrated into hemodialysis machines for routine clinical use are discussed. All three work with conductivity measurements as a surrogate for sodium concentrations. Although there are only a few publications on the use of these softwares in clinical practice, they appear to result in improved intradialytic tolerance to the dialysis treatment, better control of hypertension, and reduced thirst, leading to decreased interdialytic weight gain.

Association between social participation and hypertension control among older people with self-reported hypertension in Japanese communities.

Hypertension control remains poor worldwide despite well-established strategies for lowering blood pressure. Social participation has been associated with a lower prevalence of hypertension, but evidence is scarce regarding hypertension control. The aim of this study was to examine the relationship between social participation and hypertension control among older people. We used cross-sectional data from participants of the 2019 wave of the Japan Gerontological Evaluation Study (JAGES; n = 13,629). Social participation was defined as no participation, participation in one group, or participation in two or more groups. After adjusting for covariates, modified Poisson regression analysis showed that participation in two or more groups (prevalence ratio [95% confidence interval]: 1.08 [1.03-1.13]) was associated with better control of hypertension than no participation, but participation in one group (1.02 [0.96-1.08]) was not. Social participation in multiple groups was associated with better control of hypertension among older people in Japan.

Cardiovascular risk factors in pediatric kidney transplant recipients

Introduction: Cardiovascular risk factors decrease after kidney transplantation, however cardiovascular disease remains one of the most common causes of death in children and young adults. The authors performed a comprehensive analysis of cardiovascular risk factors before and after kidney transplantation. Methods: Retrospective study, from 2007 to 2017, that included children and adolescents with a minimum of six months follow -up after kidney transplant. Demographic profile, chronic kidney disease characteristics and family and personal cardiovascular risk factors (hypertension, left ventricular hypertrophy, anemia, overweight/obesity, dyslipidemia, hypoalbuminemia and new onset diabetes after transplant) were assessed. Pre - and post -transplant cardiovascular risk factors were compared using the McNemar test. Results: We included 49 patients, with a mean age at the time of transplantation of 9.3 ± 4.2 years. Congenital anomalies of kidney and urinary tract (37.7%) and glomerulopathies (32.7%) were the most frequent causes of stage 5 chronic kidney disease. Transplantation was preemptive in five patients. Living donor transplant was performed in six cases. The immunosuppression regimen was identical in all patients and there were nine acute rejection episodes. The most frequent pre -transplant cardiovascular risk factors were dyslipidemia (90.3%), hypertension (70.8%) and anemia (61.9%). After transplant there was a decrease of all cardiovascular risk factors except for overweight/obesity. Although a better control of hypertension was granted, the decrease was not significant. Hypoalbuminemia and dyslipidemia decreased from the 6 -month evaluation on (p&lt;0.001) and left ventricular hypertrophy and anemia from the second year on (p&lt;0.05). Conclusions: We aimed to evaluate the evolution of cardiovascular risk factors in pediatric patients before and after kidney transplant. In our cohort there was a decrease in all studied cardiovascular risk factors after kidney transplant, except for overweight/obesity. This could mean that chronic kidney disease related factors decrease with time, but traditional risk factors may persist or increase, and need active prevention.

Abstract TP73: Use Of A Novel Patient Simulation Application To Assess Physicians’ Knowledge In The Management Of Atrial Fibrillation And Stroke Prevention

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia that contributes to over 150,000 deaths each year. Hypertension, ischemic heart disease, and smoking are among the leading risk factors for AF. Historically, it is well-accepted that AF is treated by cardiologists and frequently by specialists of heart electrophysiology. However, an overwhelming majority of patients with AF initially present to their primary care physicians (PCP). Yet, the assessment of PCP skills in the management of AF has not been well studied. We used the Edocate® virtual patient simulation platform and smartphone application to test the skills of physicians in a “virtual” clinic where their decisions in selecting diagnostic and management steps over several encounters were used for analysis of their knowledge and as a learning tool. We applied this application to assess the level of knowledge in managing AF in 25 PCP. The virtual patient was a 68-year-old man (an active smoker) with hypertension, hyperlipidemia, myocardial infarction 5 years ago, presenting with a 30-day history of palpitations and shortness of breath. On presentation, his blood pressure was 145/93 mmHg, ECG showed AF with a ventricular rate of 132 bpm. He was on atorvastatin 40 mg/d, aspirin 100 mg/d, and ramipril 5 mg/d. Total cholesterol was 155 mg/dl and LDL 85 mg/dl. Comprehensive analysis of the PCP choices via the Edocate platform revealed that only 62% of the participants elected to refer this patient to cardiology. While 65% addressed smoking cessation, only 38% achieved LDL levels of &lt;75 mg/dl and none achieved better control of hypertension. Eighteen percent started anti-arrhythmic drugs within 3 weeks, (89% amiodarone, while 1 PCP started propafenone and 1 sotalol) and 82% started novel oral anticoagulants (dabigatran, rivaroxaban or apixaban - in approximately equal numbers). These results, albeit in a small sample size, clearly show a superb utility of the Edocate patient simulation application to reveal the level of competency of participating physicians. In the case of AF and stroke prevention, the data demonstrated a significant gap in the guideline-based knowledge in participating PCP and indicated that educational effort must be increased substantially among this group of providers.

Duration of hypertension and prevalence of end-organ damage in hypertensive patients

The objective of this study is to determine the prevalence of end-organ damage in hypertensive patients in a tertiary care hospital in Azad Kashmir. The study was conducted in a public sector teaching hospital of AJK-Medical College between March 2019 and Feb 2020. Adult hypertensive patients above the age of 27 years were included in the study from out-patient and in-patient departments. A standard Performa was used to collect and document the demographic information, medical history and physical examination of patients. The age, sex, residential area, marital status, education, profession, presenting complaints, smoking, addictions, functional status, and physical activity were recorded. The measurement of Blood Pressure (BP) was performed with a mercury sphygmomanometer and end-organs damage (Retinopathy, Nephropathy, Cardiovascular and cerebrovascular disease) was assessed by clinical evaluation and relevant investigations. A total of 100, hypertensive patients were enrolled in the study between the ages of 27 to 96 years. The mean age of the participants was 57 years (Std. deviation 17.8). 55% of patients were male while 45% of patients were female. 23% had good control of hypertension while 77% had poor control. 7% of participants were monitoring their BP on daily basis, 32% weekly, 39% once a month while 22% never had any schedule of monitoring their Blood Pressure. A family history of hypertension was present in 61%. Overall, 91% of the participants had retinopathy, 48% had nephropathy, 48% had cardiovascular disease and 19% had evidence of stroke. In conclusion, there is a high prevalence of End-Organ damage in middle age and elderly hypertensive patients. Keywords: Hypertension, hypertensive end-organ damage.

Control of Blood Pressure in District Dehradun, India: is Rule of Halves Still Valid?

Background: Hypertension is one of the most important causes for cardiovascular disease (CVD) which poses a major public health challenge. Rule of Halves in hypertension has long been used as a standard referral point for level of awareness, treatment&amp; control of blood pressure in general population considering it to be 50 percent at each level. Aim and Objectives: To validate “Rule of Halves”, for updated teaching to medical and nursing students and formulation of appropriate strategies for prevention and control of Hypertension at community level. Methodology: A cross section survey was conducted covering all households in the randomly selected 30 villages of district Dehradun, Uttarakhand by house-to-house visit. A pre-validated, structured questionnaire was used for capturing data.Hypertension was defined as Systolic Blood pressure -140mmHg or greater &amp;/or Diastolic Blood pressure of 90mm Hg or greater or both or treatment with antihypertensives.Result: Out of 1946 screened, 39 percent (749) were found hypertensive. Out of them, less than half (43.5%) were aware,more than 2/3rd(87.1%) were under treatment and approximately one third were well controlled (36.2%) with given treatment.Age more than 40 years, female gender and self-employment were found significant factors after adjusting the confounding factors for hypertension in binary logistic regression analysis.Conclusion: Hypertension was more among younger age group and females had better control of Hypertension. Awareness regarding hypertensive status is still less than fifty percent, but those who are aware, majority of them are on treatment, but control on given treatment is far from optimal.

Progression of Beat-to-Beat Blood Pressure Variability Despite Best Medical Management.

Beat-to-beat variability in blood pressure (BP) is associated with recurrent stroke despite good control of hypertension. However, no study has identified rates of progression of beat-to-beat BP variability (BPV), its determinants, or which patient groups are particularly affected, limiting understanding of its potential as a treatment target. In consecutive patients one month after a transient ischaemic attack or nondisabling stroke (Oxford Vascular Study), continuous noninvasive BP was measured beat-to-beat over 5 minutes (Finometer). Arterial stiffness was measured by carotid-femoral pulse wave velocity (Sphygmocor). Repeat assessments were performed at the 5-year follow-up visit and agreement determined by intraclass correlation coefficient. Rates of progression of systolic BPV (SBPV) and diastolic BPV (DBPV) and their determinants were estimated by mixed-effect linear models, adjusted for age, sex, and cardiovascular risk factors. One hundred eighty-eight of 310 surviving, eligible patients had repeat assessments after a median of 5.8 years. Pulse wave velocity was highly reproducible but SBPV and DBPV were not (intraclass correlation coefficient: 0.71, 0.10, and 0.16, respectively), however, all 3 progressed significantly (pulse wave velocity, 2.39%, P<0.0001; SBPV, 8.36%, P<0.0001; DBPV, 9.7, P<0.0001). Rate of progression of pulse wave velocity, SBPV, and DBPV all increased significantly with age (P<0.0001), with an increasingly positive skew and were particularly associated with female sex (pulse wave velocity P=0.00035; SBPV P<0.0001; DBPV P<0.0001) and aortic mean SBP (SBPV P=0.037, DBPV P<0.0001). Beat-to-beat BP variability progresses significantly in high-risk patients, particularly in older individuals with elevated aortic systolic pressure. Beat-to-beat BPV and its progression represent potential new therapeutic targets to reduce cardiovascular risk.

Comparing blood pressure measurements between a photoplethysmography-based and a standard cuff-based manometry device

Repeated blood pressure (BP) measurements allow better control of hypertension. Current measurements rely on cuff-based devices. The aim of the present study was to compare BP measurements using a novel cuff-less photoplethysmography-based device to a standard sphygmomanometer device. Males and females were recruited from within the general population who arrived at a public BP screening station. One to two measurements were taken from each using a sphygmomanometer-based and the photoplethysmography-based devices. Devices were considered equal if the mean difference between paired measurements was below 5 mmHg and the Standard Deviation (SD) was no greater than 8 mmHg. Agreement and reliability analyses were also performed. 1057 subjects were included in the study analysis. There were no adverse events during the study. The mean (± SD) difference between paired measurements for all subjects was -0.1 ± 3.6 mmHg for the systolic and 0.0 ± 3.5 mmHg for the diastolic readings. We found 96.31% agreement in identifying hypertension and an Interclass Correlation Coefficient of 0.99 and 0.97 for systolic and diastolic measurements, respectively. The photoplethysmography-based device was found similar to the gold-standard sphygmomanometer-based device with high agreement and reliability levels. The device might enable a reliable, more convenient method for repeated BP monitoring.

Area Deprivation and Risk of Death and CKD Progression: Long-Term Cohort Study in Patients under Unrestricted Nephrology Care

Background: Area deprivation index (ADI) associates with prognosis in non-dialysis CKD. However, no study has evaluated this association in CKD patients under unrestricted nephrology care. Methods: We performed a long-term prospective study to assess the role of deprivation in CKD progression and mortality in stage 1–4 CKD patients under regular nephrology care, living in Naples (Italy). We used ADI calculated at census block levels, standardized to mean values of whole population in Naples, and linked to patients by georeference method. After 12 months of “goal-oriented” nephrology treatment, we compared the risk of death or composite renal outcomes (end-stage kidney disease or doubling of serum creatinine) in the tertiles of standardized ADI. Estimated glomerular filtration rate (eGFR) decline was evaluated by mixed effects model for repeated eGFR measurements. Results: We enrolled 715 consecutive patients (age: 64 ± 15 years; 59.1% males; eGFR: 49 ± 22 mL/min/1.73 m²). Most (75.2%) were at the lowest national ADI quintile. At referral, demographic, clinical, and therapeutic features were similar across ADI tertiles; after 12 months, treatment intensification allowed better control of hypertension, proteinuria, hypercholesterolaemia, and anaemia with no difference across ADI tertiles. During the subsequent long-term follow-up (10.5 years [interquartile range 8.2–12.6]), 166 renal events and 249 deaths were registered. ADI independently associated with all-cause death (p for trend = 0.020) and non-cardiovascular (CV) mortality (p for trend = 0.045), while CV mortality did not differ (p for trend = 0.252). Risk of composite renal outcomes was similar across ADI tertiles (p for trend = 0.467). The same held true for eGFR decline (p for trend = 0.675). Conclusions: In CKD patients under regular nephrology care, ADI is not associated with CKD progression, while it is associated with all-cause death due to an excess of non-CV mortality.