Blood Pressure Control In Patients Research Articles

BLOOD PRESSURE CONTROL AMONG AN ELDERLY NORTHERN-ITALIAN POPULATION, EFFECT OF BETA-ADDUCIN POLYMORPHISMS. A CROSS-SECTIONAL STUDY

Objective: Evaluate role of nvironmental and genetic factors on Blood Pressure (BP) control among an Italian elderly population. Design and method: Cross-sectional study on 1250 elderly subjects of north Italy aged over 65y, recruited in recreative centers. BP was measured with an automated device (Omron) and the average of 2nd and 3rd measure was recorded. According to ESC-ESH-2018 guidelines we defined suboptimal BP control for patients presenting with systolic BP>140 or diastolic BP>80 mmHg. Anthropometric measurements were taken, blood and urines samples for biochemical and targeted genetic analysis were acquired. Genotyping was performed by OpenArray system. All participants signed informed consent. The protocol was approved by the Ethical Committee. Results: 746 subjects (59.9%) were on antihypertensive therapy. 385 (51.6%) had a systolic BP over 140 mmHg, and 419 (56.2%) had a diastolic BP over 80 mmHg, thus classified as on suboptimal BP control. Among those, 153 (20.4%) presented SBP> 160 or DBP > 100 (stage 2 hypertension) despite treatment. 28.6% were on optimal BP control. Factors associated with poor BP control on univariate analysis showed gender (p = 0.002), higher waist circonference (p = 0.014), high visceral fact index (p < 0.01) and minor number of total medications (p < 0.01). Age, eGFR, and urine albumin/creatinine ratio were non significantly different between the two groups. Inferential tree analysis showed that urine sodium is relevant on BP level in ‘younger’ and untreated subjects (p < 0.001). Among genetic variants, rs4984 T allele in beta-adducin gene (ADD2) was associated with poor BP control (17.3% vs 11.4%; p = 0.016). Similarly, T allele in the overall elderly subjects showed a high frequency compared to general population (EUR - 1000 Genome Project) (16% vs 12.5%; p = 0.023). Conclusions: Gender, visceral fat and therapies are associated with poor BP control, suggesting the relevant role of clinical management. Surprisingly, even in this elderly population, a genetic factor already associated with salt-sensitive hypertension and response to anti-hypertensive therapy as ADD2 was found related to poor BP control. Most of of elderly patients treated for hypertension have suboptimal control of BP. Moreover, genetic factors besides environmental factors, seem to play a role in BP control even in elderly.

Intensive or standard blood pressure control in patients with a history of ischemic stroke: RESPECT post hoc analysis.

The Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study and its pooled analysis showed that intensive blood pressure (BP) lowering reduced recurrent stroke risk by 22% in patients with a history of stroke. Here, we report the effect of intensive BP lowering on the risk of recurrent stroke subtypes in patients with a history of ischemic stroke. RESPECT was a randomized clinical trial among 1280 people with a history of cerebral infarction or intracerebral hemorrhage. Participants were assigned to the intensive blood pressure control group (blood pressure < 120/80 mmHg) or standard blood pressure control group (blood pressure < 140/90 mmHg). In this post hoc analysis, we analyzed 1074 patients with a history of cerebral infarction. The mean BP at baseline was 140.7/81.4 mmHg. Throughout the follow-up period, the mean BP was 133.4/77.5 (95% CI, 132.7-134.1/76.9-78.2) mmHg in the standard group and 126.7/74.1 (95% CI, 126.0-127.4/73.5-74.8) mmHg in the intensive group. During a mean follow-up of 3.9 years, 78 first recurrent strokes occurred. Intensive treatment tended to reduce overall annual stroke recurrence (1.74% in intensive vs. 2.17% in standard; P = 0.351 by log-rank test) and did not change the risk of ischemic stroke (1.74% vs. 1.75%, P = 0.999) but markedly reduced the risk of hemorrhagic stroke (0.00% vs. 0.39%, P = 0.005). Beneficial effects of intensive BP control were observed for the risk of hemorrhagic stroke in patients with a history of ischemic stroke. The findings of this study indicate the benefit of intensive BP control for patients with a history of ischemic stroke at high risk of hemorrhagic stroke.

Effects of Continuous Exercise on Physiological Indexes Among Middle-Aged and Elderly Chronic Patients in Northwest China

With the increase of aging population, accompanied by a series of aging problems, the study showed that the probability of chronic disease in the elderly population is 92.1%, and further research shows that the probability of having two or more chronic diseases is 70.0%. Therefore, understanding of the distribution and spatial-temporal variation trend of risk factors related to chronic diseases can provide scientific basis for the formulation of policies and intervention strategies for the prevention and treatment of chronic diseases. It is of urgent practical significance to improve the quality of life of the elderly and reduce the social medical burden. Analysis of the data indicated that after 1 year of continuous exercise intervention, the experimental group’s blood pressure was controlled at a normal level in nearly 2 months [90 ~ 140mmHg/100 ~ 160mmHg(SBP/DBP)]. The results showed that moderate physical activity can reduce stress and help control blood pressure in patients with high blood pressure. After 1 year of targeted exercise intervention, the experimental group significantly improved fasting blood glucose (controlled under 7.2mmol/liter) in nearly 2 months after the second questionnaire survey. After the exercise, the blood glucose was controlled within the normal range and gradually increased. After one year of exercise intervention, the blood lipid index of the experimental group was significantly different from that of the control group, indicating that physical exercise has a positive effect on the elderly with hyperlipemia.

Blood pressure control in patients with chronic kidney disease.

Uncontrolled blood pressure (BP) in patients with chronic kidney disease (CKD) can lead to serious adverse outcomes. To prevent the occurrence of cardiovascular events (CVEs), and end-stage kidney disease, achieving an optimal BP level is important. Recently, there has been a paradigm shift in the management of BP largely as a result of the Systolic Blood Pressure Intervention Trial (SPRINT), which showed a reduction in CVEs by lowering systolic BP to 120 mmHg. A lower systolic blood pressure (SBP) target has been accepted by the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 guidelines. However, whether intensive control of SBP targeting < 120 mmHg is also effective in patients with CKD is controversial. Notably, this lower target SBP is associated with a higher risk of adverse kidney outcomes. Unfortunately, there have been no randomized controlled trials on this issue involving only patients with CKD, particularly those with advanced CKD. In this review, we discuss the optimal control of BP in patients with CKD in terms of reduction in death and CVEs as well as attenuation of CKD progression based on the evidence-based literature.

Effect of Sleep Disturbances on Blood Pressure.

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension: A Systematic Review and Meta-Analysis.

Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve adherence and BP control. This systematic review assessed whether single-pill combination (SPC) therapy led to improved adherence, persistence, and better BP control compared with free-equivalent combination (FEC) therapy in patients with hypertension. PubMed, Medline, Embase, and the Cochrane Library were searched until July 2020, in addition to manual searching of relevant congress abstracts from 2014 to 2020 for studies including adults with hypertension aged ≥18 years receiving SPC or FEC antihypertensive therapy measuring any of the following: adherence, persistence, and reductions in systolic BP and/or diastolic BP. Adherence and persistence were summarized in a narrative analysis; direct pair-wise meta-analysis was conducted to compare BP reductions with SPC therapy versus FEC therapy using fixed-effect and random-effects models. Following screening, 44 studies were included. The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus FECs. Overall, 16 studies measured persistence, of which 14 showed that patients receiving SPCs had significantly improved persistence or were significantly less likely to discontinue therapy than patients receiving FECs. Systolic BP (mean difference, -3.99 [95% CI, -7.92 to -0.07]; P=0.05) and diastolic BP (-1.54 [95% CI, -2.67 to -0.41]; P=0.0076) were both significantly reduced with SPC therapy compared with FEC therapy at week 12. SPC therapy leads to improved adherence and persistence compared with FEC therapy and may lead to better BP control in patients with hypertension.

Prescription pattern and blood pressure control among patients on antihypertensive medications attending a tertiary hospital in Lagos: A cross-sectional study

Context: Hypertension is a disease of global public health importance affecting an estimated 1 billion people worldwide. Hypertension accounts for about 10.4 million deaths in 2017. Many guidelines are available for the management of hypertension, but despite this, there are wide variations in physicians' choice of antihypertensive medications for blood pressure (BP) control. Aims: We reviewed the prescription pattern of antihypertensive medication and the level of BP control in patients with hypertension. Settings and Design: This is a cross-sectional study among hypertensive patients attending follow-up clinics of a tertiary hospital. Methodology: Structured questionnaires were used to collect information on the antihypertensive medications and clinical profiles of the study participants. Questionnaires were administered to participants during the attendance of the follow-up clinic to capture information relevant to the study. Information retrieved from patients includes details about their baseline demographic characteristics, clinical history, antihypertensive drug history and blood BP recordings. The study protocol was reviewed and approved by the institutional ethics committee. Statistical Analysis: Data were analysed using Microsoft Excel 2003 and the Statistical Package for the Social Sciences version 22.0 software. Results: A total of 489 hypertensive patients took part in the study. The study found that the rate of BP control was 44.6% among the participants. Calcium channel blockers (CCBs) are the most common antihypertensive medication prescribed in our clinics. There was no significant relationship between how long a patient had been attending the follow-up clinic and the level of BP control in patients who have attended the clinic for a minimum period of 3 months. Conclusion: BP control was less than optimal in more than half of the participants, and the most commonly prescribed antihypertensive medication were CCBs.

Compliance of Secondary Prevention Strategies in Coronary Artery Disease Patients with and without Diabetes Mellitus - A Cross-Sectional Analytical Survey from Kerala, India.

Context:There is limited data related to compliance of secondary prevention strategies for coronary artery diseases (CAD) among patients with and without diabetes.Objectives:The objective was to compare compliance to secondary prevention strategies for CAD including smoking cessation, weight management, blood pressure (BP) control, Low density lipoprotein (LDL) cholesterol control and adequate physical activity between patients with and without diabetes.Settings and Design:This is a hospital-based cross-sectional analytical study.Methods and Materials:The study questionnaire was used to collect data through interviews of CAD patients. Compliance to secondary prevention strategies was documented using European Society of Cardiology guidelines.Statistical Analysis:We used modified Poisson model to estimate adjusted prevalence ratios (Adj. PR) for estimating compliance.Results:Among 1,206 participants with CAD, 609 (50.5%) had diabetes. The Adj. PR s for three targets – smoking cessation (Adj. PR 1.01, 95% CI 0.97, 1.06, P 0.50), ideal BMI (Adj. PR 0.99, 95% CI 0.92, 1.09, P 0.99) and adequate physical activity (Adj. PR 1.12, 95% CI 0.97, 1.29, P 0.12) showed no significant difference between the groups. There was poor BP control in patients with diabetes compared to those without the same (Adj. PR 0.19, 95% CI 0.15, 0.23, P < 0.0001). LDL cholesterol control was better in patients with diabetes in comparison to those without the same (Adj. PR 1.19, 95% CI 1.08, 1.31, P 0.0005).Conclusion:The compliance for secondary prevention of CAD among patients with diabetes is similar to those without diabetes except for poor control of hypertension and better control of LDL cholesterol.

Abstract 13760: Intensive versus Standard Blood Pressure Control in Patients With Peripheral Artery Disease: The Systolic Blood Pressure Intervention Trial (SPRINT)

Background: High blood pressure (BP) is the strongest modifiable risk factor for cardiovascular (CV) disease and is highly prevalent among individuals with peripheral artery disease (PAD). Purpose: To assess the efficacy and safety of intensive versus standard BP control in patients with PAD, and to assess if the presence of PAD modified treatment effect. Methods: SPRINT was a randomized, controlled, open-label trial in which individuals aged ≥50 years, at high CV risk, and with a systolic BP 130-180 mmHg were randomized to intensive (systolic BP target &lt;120mmHg) or standard BP control (systolic BP target 135-139 mmHg). The primary outcome was the composite of acute coronary syndromes, stroke, heart failure, or CV death. Safety outcomes included serious adverse events, such as hypotension, syncope, electrolyte abnormalities, acute kidney injury or failure, or injurious falls. We assessed the risk of events in patients with PAD versus those without and assessed the efficacy and safety of intensive BP in patients with PAD. Subgroup heterogeneity was evaluated using interaction analyses. Results: Of 9361 participants, 503 (5.3%) had baseline PAD (intensive group 250 (5.3%) versus standard group 253 (5.4%); P=0.90). Median follow-up duration was 3.2 years (range 0-4.6 years). PAD was independently associated with a higher risk of both the primary outcome (hazard ratio (HR) 1.61, 95% confidence interval (CI): 1.23-2.12; P&lt;0.001) and composite serious adverse events (HR 1.49, 95% CI: 1.32-1.69; P&lt;0.001). The presence of PAD did not modify the efficacy and safety of intensive versus standard BP control (P≥0.05). However, due to the higher baseline risk in PAD patients, the absolute risk reduction of the primary outcome with intensive treatment was larger compared with patients without PAD (1.8% versus 1.6%), as was the risk of death from any cause (2.3% versus 1.1%) (Figure) . Conclusion: Intensive BP control reduced CV events and death in patients with hypertension and PAD.

Impact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta-analysis of randomized clinical trials.

Hypertension (HTN) and chronic kidney disease (CKD) are recognized as silent killers because they are asymptomatic conditions that contribute to the burden of multiple comorbidities. The achievement of a blood pressure (BP) goal can dramatically reduce the risks of CKD. In this study, we aimed to assess the effectiveness of pharmacist intervention on BP control in patients with CKD and evaluate the usefulness of home-based BP telemonitoring. The terms "chronic kidney disease," "pharmacist," "BP" and "randomized controlled trial (RCT)" were used five databases to search for information regarding pharmacist intervention on BP control in patients with CKD. The inclusion criteria were as follows: (a) studies for adult patients with uncontrolled HTN and (b) studies with adequate data for meta-analysis. The primary outcome was an evaluation of achievement of BP goal in patients with CKD. The secondary outcome was usefulness of home-based BP telemonitoring by pharmacists in patients with CKD. Six RCTs were identified and included in the meta-analysis with a total of 2573 patients (mean age 66.0years and 63.9% male). Pharmacist interventions resulted in significantly better BP control vs usual care (OR=1.53, 95% CI=1.15-2.04, P<.01). Pharmacist interventions using home-based BP telemonitoring were significantly superior to control/usual care (OR=2.03, 95% CI=1.49-2.77, P<.01), whereas pharmacist interventions without home-based BP telemonitoring did not significantly improve BP control compared to that with control/usual care (OR=1.30, 95% CI=0.97-1.75, P=.08). Home-based BP telemonitoring supported team-based care for HTN in these studies. In addition, patient self-monitoring with telemedicine devices might enhance patients' abilities to manage their condition by pharmacist instruction. The findings of this meta-analysis showed that pharmacist interventions with home-based BP telemonitoring improve BP control among adult patients with CKD.

Resistant Hypertension in Chronic Kidney Disease (CKD): Prevalence, Treatment Particularities, and Research Agenda.

To explore the prevalence, treatment particularities, and research agenda in the management of resistant hypertension among patients with chronic kidney disease (CKD). The prevalence of resistant hypertension is reported to be 2-3 times higher in patients with CKD than in the general hypertensive population. Based in part on the results of the PATHWAY-2 trial showing add-on spironolactone to be superior to placebo or active treatment with an α- or β-blocker in reducing BP, international guidelines recommend the use of spironolactone as fourth-line agent in pharmacotherapy of resistant hypertension. Despite the several-fold higher burden of resistant hypertension among patients with stage 3b-4 CKD, the use of spironolactone in this population has been restricted, mainly due to the risk of hyperkalemia. The recently reported AMBER trial showed that among patients with uncontrolled resistant hypertension and an estimated glomerular filtration rate of 25-45ml/min/1.73m2, the newer potassium-binder patiromer prevented the development of hyperkalemia and increased the proportion of participants who remained on add-on spironolactone over 12weeks of follow-up. Administration of spironolactone was associated with a clinically meaningful reduction of 11-12mmHg in unattended automated office systolic blood pressure (BP) over the course of the AMBER trial. Newer potassium-binding therapies overcome the barrier of hyperkalemia and facilitate the persistent use of spironolactone, which is an effective add-on therapy to control BP in patients with resistant hypertension and advanced CKD. Future trials are now warranted to explore whether this strategy confers benefits on "hard" clinical outcomes in this high-risk population.

Blood pressure control in patients with chronic kidney disease according to office and home blood pressures.

The aim of this study was to assess blood pressure (BP) control in patients with chronic kidney disease (CKD) according to office and home BP and to assess the prevalence of normal BP, white-coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and elevated BP. Patients with renal failure with or without proteinuria were included in this multicenter observational study. Office BP was first measured by the physician using a self-monitoring BP device (three automatic readings), then by the patient at home (morning and evening) over 3 consecutive days. WUCH was defined as a systolic BP (SBP)/diastolic BP (DBP) ≥140/90 mmHg in the clinic and SBP/DBP<135/85 mmHg at home. MUCH was defined as SBP/DBP <140/90 mmHg in the clinic and SBP/DBP ≥135/85 mmHg at home. Among the 243 included subjects, data of 225 patients were analyzed. Mean estimated glomerular filtration rate was 37.7 ± 15.7 mL/min/1.73 m and mean office SBP/DBP was 154 ± 19/83 ± 13 mmHg. Mean office SBP/DBP was significantly higher than home SBP/DBP (+9.0 ± 15.1/+7.0 ± 10.0 mmHg, P < 0.01). Normal BP (office and home BP), WUCH, MUCH and elevated BP (office and home BP) rates were 12.0, 14.2, 6.7 and 67.1%, respectively. The patients were taking, on average, 2.8 ± 1.5 antihypertensive drugs/day. BP control in patients with CKD was poor. Routine use of 'out-of-office' BP measurement, in addition to office BP by which we can identify patients with WUCH or MUCH, should be recommended based on the current findings.

Relationship between health-related quality of life and blood pressure control in patients with uncontrolled hypertension.

We sought to investigate the psychosocial characteristics of patients with uncontrolled hypertension and examine factors that influence blood pressure (BP) control. A total of 1011 patients with uncontrolled hypertension were enrolled in 13 tertiary hospitals. Uncontrolled hypertension was defined as systolic BP ≥140mmHg or diastolic BP ≥90mmHg despite on antihypertensive therapy. Socio-demographics, anthropometrics, behavioral risk factors, medication pattern, adherence, and measures of health-related quality of life (HRQoL; EuroQol 5D visual analog scale [EQ-5D VAS]) were assessed at baseline and during follow-up visits (3 and 6months). Patients were divided into 2 groups based on BP control status at 6months (controlled group [n=532] vs uncontrolled group [n=367]). There were no differences in clinical characteristics except the proportion of smokers and baseline BP between patients with controlled BP and uncontrolled BP. At 6months, the adherence of antihypertensive medication did not differ between the groups but the proportion of combination therapy with ≥3 antihypertensives was significantly higher in patients with uncontrolled BP. EQ-5D VAS at follow-up was significantly lower in patients with uncontrolled BP despite similar baseline values. Multivariate logistic regression analysis revealed that EQ-5D VAS at follow-up significantly correlated with BP control. Patients with worse HRQoL had higher Charlson Comorbidity Index and higher proportion of taking ≥3 antihypertensives, but medication adherence was similar to those with better HRQoL. These findings suggest that along with pharmacologic intervention of hypertension, management of comorbid conditions or psychological support might be helpful for optimizing BP control in patients with uncontrolled hypertension.

Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study.

High blood pressure (BP) is the major cardiovascular-risk factor for coronary artery disease (CAD), principally in young patients who have an important and increasing socioeconomic burden. Despite the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), recommended BP target <140/90mmHg for patients with stable CAD, in 2017 the American College of Cardiology and the American Heart Association (ACC/AHA) updated BP target to <130/80mmHg. We aimed to analyze the prevalence of BP control in patients with premature CAD using both criteria. In addition, antihypertensive therapy, lifestyle, clinical, and sociodemographic characteristics of the patients were evaluated in order to identify factors associated with the achievement of BP targets. The present study included 1206 patients with CAD diagnosed before 55 and 65years old in men and women, respectively. Sociodemographic, clinical, and biochemical data were collected. The results indicate that 85.6% and 77.5% of subjects with premature CAD achieved JNC-7 non-strict and ACC/AHA strict BP target, respectively. Consistently, number of antihypertensive drugs and hypertension duration >10years were inversely associated with BP targets, whereas total physical activity and smoking were directly associated with BP targets, regardless of BP criteria. Considering that age, gender, and hypertension duration are non-modifiable cardiovascular-risk factors, our results highlight the need for more effective strategies focused on increase physical activity and smoking cessation in young patients with CAD. These healthier lifestyles changes should favor the BP target achievement and reduce the socioeconomic and clinical burden of premature CAD.

Blood Pressure Control among Hypertensive Diabetic Patients on Follow-Up at Chronic Clinic of Nekemte Referral Hospital in West Ethiopia.

Background Hypertension is a prevalent comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age. Adults with diabetes historically have two or three times higher rate of cardiovascular disease (CVD) than adults without diabetes. Objective The aim of this study was to assess blood pressure (BP) control and its predictors among hypertensive diabetic patients on follow-up at the chronic clinic of Nekemte Referral Hospital (NRH) in West Ethiopia. Methods A cross-sectional study was conducted among hypertensive adult patients comorbid with diabetes taking antihypertensive drugs for at least one year in NRH. Both bivariable and multivariable analyses were done. The odds ratio, along with 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multivariable logistic regression analysis. The level of statistical significance was declared at p value <0.05 levels. The patient's written informed consent was obtained after explaining the purpose and procedures of the study. Results A total of 186 study participants were included in this study. The mean age of the participants was 51.2 ± 12.2 years. Blood pressure and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. In the multivariable analysis, age ≥60 years (AOR = 4.537, 95% CI = 1.142–18.024, p=0.032), duration with hypertension ≥5 years (AOR = 3.534, 95% CI = 1.062–11.760, p=0.040), cigarette smoking (AOR = 7.697, 95% CI = 2.356–25.146, p=0.001), nonadherence (AOR = 6.584, 95% CI = 2.337–18.553, p < 0.001), and uncontrolled glycaemia (AOR = 21.630, 95% CI = 8.057–58.070, p < 0.001) were independent predictors of uncontrolled blood pressure. Conclusion Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions on modifiable factors should be done to improve BP control of patients' comorbid with diabetes.

How Behavior Change Strategies are Used to Design Digital Interventions to Improve Medication Adherence and Blood Pressure Among Patients With Hypertension: Systematic Review.

BackgroundInformation on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited.ObjectiveHypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control.MethodsWe included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors.ResultsThe analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration.ConclusionsThis review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement.

May Measurement Month 2019: adherence to treatment and hypertension control in Russia

The International Society of Hypertension and the World Hypertension League initiated a blood pressure screening study called May Measurement Month 2019 (MMM19) to improve the detection of elevated blood pressure (BP) and to assess BP control in patients with hypertension (HTN).Aim. To assess adherence to treatment of the hypertensive population according to MMM19 campaign in Russia.Material and methods. During May 2019, 5394 people from 21 regions of Russia took part in the screening. Participation was voluntary and did not imply gender restrictions; all subjects were over 18 years of age. During the screening, BP was measured three times using electronic and mechanical sphygmomanometers, as well as a questionnaire on the diabetes, history of cardiovascular events, smoking, and alcohol consumption was filled. Information was also collected on the date of last BP check and the administration of statins, acetylsalicylic acid and antihypertensive drugs. Data on height and body weight was obtained from respondents.Results. The analysis included data from 5274 participants aged 18 to 96 years (men — 1834 (34,8%)). Median age was 25 years, quartiles — 20 and 49 years. According to MMM19 data, the proportion of HTN patients in the Russian population was 31,9%, and with the exception of participants under 25 years old — 51,5%. Patients with HTN over 25 years old take antihypertensive therapy in 73,6%; 38,6% are characterized by irregular drug intake. Only 11,8% of men and 17,2% of women reach the target blood pressure &lt;130/80 mm Hg. Only 20-30% of patients who used 4-5 antihypertensives reached the target BP level.Conclusion. According to MMM19 in Russia, only a third of high-risk patients measured BP over the past 12 months. There is also low adherence to antihypertensive therapy and inadequate control of HTN. Patients with HTN and a history of cardiovascular events are more likely to take antihypertensives regularly.

Improved Sleep Quality Improves Blood Pressure Control among Patients with Chronic Kidney Disease: A Pilot Study

Background: Despite the abundance of data documenting the consequences of poor sleep quality on blood pressure (BP), no previous study to our knowledge has addressed the impact of sleep improvement on resistant hypertension among patients with chronic kidney disease (CKD). Methods: The aim of this pilot study was to determine whether improved sleep quality and duration will improve BP control in patients with resistant hypertension and CKD. It was a prospective single-center cohort study that involved 30 hypertensive subjects with CKD presenting with primary resistant hypertension and poor sleep quality or duration <6 h/night. Sleep quality and duration were modified using either sleep hygiene education alone or adding sleep medication. The cohort’s BP was followed every 3 months for 6-month duration. The average home and clinic BPs were collected at each follow-up visit. The primary outcome baseline change in systolic BP (SBP) and diastolic BP (DBP; home and clinic) at 3 and 6 months after documented sleep improvement. Secondary outcomes included change from baseline in mean arterial pressure, and delta SBP after sleep improvement. Results: African American patients represented 50% of the cohort. All patients had evidence of CKD with GFR ≤60 mL/min and were obese with 40% having type 2 diabetes mellitus. The primary endpoint of change in clinic SBP and DBP was significantly reduced at 3 months, baseline 156 ± 15/88 ± 8 vs. 3 months 125 ± 14/73 ± 7 (p < 0.0001). This difference persisted at 6 months. However, there was no further reduction in-home or clinic BPs between the 3- and 6-month periods. Home and clinic average delta SBP change at 3 months from baseline was –34.4 ± 15 and –30.8 ± 19 mm Hg respectively. Delta SBP change was associated with sleep improvement of >6 h/night, that is, gaining an extra 3–4 h’ sleep duration, home; R² = 0.66, p < 0.0001 and clinic; R² = 0.49, p < 0.0001. Conclusion: Optimizing sleep quality and duration to >6 h/night improved BP control and was associated with a significant delta change in SBP within 3 months of follow-up. Physicians should obtain a sleep history in patients with CKD who present with resistant hypertension.

Safety and Efficacy of Ginkgo-Damole and Nitroglycerin or Sodium Nitroprusside on Hypertensive Cerebropathies: A Meta-Analysis.

Objective To systematically evaluate the safety and efficacy of ginko-damole combined with nitroglycerin or unitary sodium nitroprusside on hypertensive cerebropathy. Methods Four Chinese databases (VIP, CBM, Wanfang database, and CNKI database) and three English databases (Cochrane, PubMed, and EMBASE) were used to screen randomised controlled trials (RCTs) on treatments of hypertensive cerebropathy using both ginko-damole and nitroglycerin or unitary sodium nitroprusside. Outcomes included clinical effect, blood pressure after treatment, and adverse effects. These indicators were then analysed statistically using the RevMan 5.3 and Stata 12.0 software. Results Altogether, 16 RCTs including 1507 patients with hypertensive cerebropathy were included in the present meta-analysis, of which, 755 patients treated with combined ginko-damole and nitroglycerin were included in the observation group and 752 patients treated with sodium nitroprusside were included in the control group. The curative effect of the observation group was significantly better than that of the control group (RR: 1.115 [1.077, 1.155], p < 0.05). DBPs of the observation and control groups were both lower after treatment, and no significant difference was observed between the observation and control groups (MD: −1.072 [−2.578, 0.434], p > 0.05). SBPs in the observation group were significantly lower than those in the control group (MD: −2.842 [−5.222, −0.462], p < 0.05). The probability of adverse response in both groups did not differ significantly (RR: 0.752 [0.412, 1.374], p > 0.05). Conclusion Compared with sodium nitroprusside, the combined ginkgo-damole and nitroglycerin could better control blood pressure in patients with hypertensive cerebropathy and showed enhanced clinical effects and improved safety. However, due to poor quality of the included studies, results of the present meta-analysis should be confirmed by more stringent RCTs.

The Obstinate Refractory and Resistance Hypertension

Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic <i>and</i> a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.