Blood Pressure Control In Patients Research Articles

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 <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.

Effects of acupuncture on obstructive sleep apnea severity, blood pressure control and quality of life in patients with hypertension: A randomized controlled trial.

Obstructive sleep apnea (OSA) is a common condition among patients with hypertension and treatment with continuous positive airway pressure (CPAP) can decrease blood pressure (BP). However, CPAP is not well tolerated by a significant proportion of patients. The authors investigated the effects of acupuncture on OSA severity and BP control in patients with hypertension. Hypertensive patients with mild to moderate OSA (apnea-hypopnea index, 5-30events/hr) were randomly assigned to receive acupuncture or sham-acupuncture treatment. Patients were assessed at baseline and after 10 acupuncture sessions using polysomnography, 24-hr ambulatory BP monitoring and a quality of life questionnaire. Forty-four patients (34% men; mean age, 57.0±5.4years; body mass index, 29.6±3.2kg/m2 ; apnea-hypopnea index, 16.3±6.7events/hr) completed the study. There were no differences in pre-post-intervention apnea-hypopnea index, daytime or nocturnal BP, or quality of life between the acupuncture and sham-acupuncture groups (p>.05). Acupuncture therapy in hypertensive patients with OSA did not reduce OSA severity, daytime or nocturnal BP, or quality of life.

A Web-Based Self-Titration Program to Control Blood Pressure in Patients With Primary Hypertension: Randomized Controlled Trial

BackgroundHypertension is a major cause of mortality in cardiac, vascular, and renal disease. Effective control of elevated blood pressure has been shown to reduce target organ damage. A Web-based self-titration program may empower patients to control their own disease, share decisions about antihypertensive dose titration, and improve self-management, ultimately improving health-related quality of life.ObjectiveOur primary aim was to evaluate the effects of a Web-based self-titration program for improving blood pressure control in patients with primary hypertension. Our secondary aim was to evaluate the effects of that program on improving health-related quality of life.MethodsThis was a parallel-group, double-blind, randomized controlled trial with assessments at baseline, 3 months, and 6 months. We included patients with primary hypertension (blood pressure>130/80 mm Hg) from a cardiology outpatient department in northern Taiwan and divided them randomly into intervention and control groups. The intervention group received the Web-based self-titration program, while the control group received usual care. The random allocation was concealed from participants and outcome evaluators. Health-related quality of life was measured by the EuroQol five-dimension self-report questionnaire. We used generalized estimating equations to evaluate the effects of the intervention.ResultsWe included 222 patients and divided them equally into intervention (n=111) and control (n=111) groups. Patients receiving the Web-based self-titration program showed significantly greater improvement in the systolic and diastolic blood pressure control than those who did not receive this program, at 3 months (–21.4 mm Hg and –5.4 mm Hg, respectively; P<.001) and 6 months (–27.8 mm Hg and –9.7 mm Hg, respectively; P<.001). Compared with the control group, the intervention group showed a significant decrease in the overall defined daily dose at both 3 (–0.202, P=.003) and 6 (–0.236, P=.001) months. Finally, health-related quality of life improved significantly in the intervention group compared with the control group at both 3 and 6 months (both, P<.001).ConclusionsA Web-based self-titration program can provide immediate feedback to patients about how to control their blood pressure and manage their disease at home. This program not only decreases mean blood pressure but also increases health-related quality of life in patients with primary hypertension.Trial RegistrationClinicalTrials.gov NCT03470974; https://clinicaltrials.gov/ct2/show/NCT03470974

Prevalence, Characteristics, and Association of Obstructive Sleep Apnea with Blood Pressure Control in Patients with Resistant Hypertension

Rationale: Obstructive sleep apnea (OSA) is associated with poor blood pressure (BP) control and resistant hypertension (RH). Nevertheless, studies assessing its prevalence, characteristics, and association with BP control in patients with RH are limited.Objectives: The aim of this multicenter study was to assess the prevalence of OSA in a large cohort of subjects with RH and to evaluate the association of OSA with BP control.Methods: We recruited consecutive subjects with RH from three countries. A formal sleep test and blood pressure measurements, including 24-hour ambulatory blood pressure monitoring, were performed in all participants.Results: In total, 284 subjects with RH were included in the final analysis. Of these, 83.5% (95% confidence interval [CI], 78.7-87.3%) had OSA (apnea-hypopnea index ≥ 5 events/h); 31.7% (95% CI, 26.5-37.3%) had mild OSA, 25.7% (95% CI, 21-31.1%) had moderate OSA, and 26.1% (95% CI, 21.3-31.5%) had severe OSA. Patients with severe OSA had higher BP values than subjects with mild to moderate or no OSA. A greater effect was observed on the average nighttime BP, with an adjusted effect of 5.72 mm Hg (95% CI, 1.08-10.35 mm Hg) in severe OSA compared with participants without OSA. A dose-response association between the severity of OSA and BP values was observed. The prevalence of severe OSA was slightly higher in uncontrolled participants (adjusted odds ratio, 1.69; 95% CI, 0.97-2.99) but was not statistically significant.Conclusions: The present study confirms the high prevalence of OSA in participants with RH. Furthermore, it shows a dose-response association between OSA severity and BP measurements, especially in the nighttime.Clinical trial registered with www.clinicaltrials.gov (NCT03002558).

Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals.

The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130‐139 mm Hg or diastolic blood pressure (DBP) of 80‐89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow‐up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow‐up survey (2007.01‐2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person‐years follow‐up period, 2261 all‐cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904‐1.261) for all‐cause mortality, 1.304 (1.015‐1.675) for CVD mortality, 1.449 (1.107‐1.899) for stroke, and 1.735 (1.051‐2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals.

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) &gt;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 &gt;140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and 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.

Relationship Between a Weighted Multi‐Gene Algorithm and Blood Pressure Control in Hypertension

BackgroundHypertension (HTN) has a strong heritable component and the effectiveness of the treatment for HTN has been shown to be influenced by monogenic guidance. Each of the common HTN pharmacotherapies is ~50% effective in the population and layering blood pressure (BP) medications increases side effects and decreases medication adherence. HTN is a complex disease with primary interactions between the heart, vasculature, and kidney. Known and common genetic variants of each these organs have well‐described mechanisms. Despite the established bell‐curve response to treatment, the complexity of HTN, and functional variants of the major organ systems in HTN: no guidance, to date, utilizes a multi‐gene approach to guide BP therapy.PurposeTo assess the association between a weighted multi‐gene algorithm and BP control in patients with HTN.MethodsNon‐smokers with a family history of HTN were included in the analysis (n=384; age=61.0±0.9, 11% non‐white). 17 genotypes (ADRB1(2 SNPs), ADRB2 (2SNPs), CYP2D6, WNK (3SNPs), SLC12A3, SCNN1A, alpha‐adducin, renin, angiotensin (3 SNPs), ACE, and the angiotensin receptor) were weighted according to previous effect size in the literature (ΔBP when on the target therapy vs. not) as well as the number of peer‐reviewed papers of quality supporting each functional variant. After weighting, each genotype was entered into an algorithm that assessed pairing (e.g. homozygosity of functional ADRB1 is responsive to β‐blockade, heterozygosity is less responsive, and homozygosity of non‐functional is least responsive) within and between organ systems to predict the pharmacotherapy with greatest impact for each individual patient. Each pharmacotherapy was ranked from 1–4 as most to least likely to respond based on the algorithmic assessment of individual patient's genotypes. Three‐years of data was assessed at six‐month intervals for BP and medication history. Current and past pharmacotherapies were also assessed via chart review.ResultsThere was no difference in initial BP at diagnosis between groups matching the top drug recommendation using the multi‐gene weighted algorithm (n=92) vs. those who did not match (n=292). However, from diagnosis to nadir, patients who matched the primary recommendation had a significantly greater drop in BP when compared to patients who did not (ΔSBP= −39.2±2.4 vs. −32.1±1.3mmHg , ΔDBP= −19.4±1.1 vs. −14.0±1.3mmHg , ΔMAP= −24.4±2.1 vs. −19.0±1.2mmHg, respectively, p&lt;0.05 for SBP and DBP). Further, the difference between diagnosis to current 1yr. average BP was lower in the group that matched the top recommendation (ΔSBP= −33.2±2.3 vs. −27.4±1.2mmHg, ΔDBP=−14.8±1.1 vs. −11.5±1.2, ΔMAP= −21.2±2.3 vs. −15.6±1.8, respectively, p&lt;0.05 for SBP and MAP).ConclusionsThese data suggest an association between a weighted multi‐gene algorithm on the BP response to pharmacotherapy. This magnitude of difference has previously been shown to be associated with a significant reduction in heart attack and stroke risk.Support or Funding InformationGeneticure, Inc.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Two-Drug Combinations as First-Step Antihypertensive Treatment.

Blood pressure (BP) control in patients with hypertension is variable worldwide, and in general, it results largely unsatisfactory. Factors responsible for this phenomenon include insufficient national cardiovascular healthcare policies for prevention, poor patient compliance with prescribed treatment schedules, and the reluctance of physicians to modify treatment strategies when BP is still elevated, that is, the so-called therapeutic inertia. A further important factor favoring poor BP control is the limited use of combination drug treatment, despite evidence of its superior ability to control BP in patients with difficult-to-treat hypertension. In addition, combination treatment allows to achieve BP control more easily (and more quickly) as compared with monotherapy. This article, after briefly examining the main features of BP control, will review the importance in the treatment of hypertension of the drug combination strategy, based on the recommendations of the 2018 European Society of Cardiology/European Society of Hypertension guidelines. Empahsis will be given to the drug combination treatment as first step of the antihypertensive therapeutic intervention. The potential drawbacks and barriers to combination drug treatment as initial therapeutic strategy will also be briefly discussed.

LONG-TERM CLINICAL OUTCOME OF INTENSIVE VERSUS USUAL BLOOD PRESSURE CONTROL IN PATIENTS WITH CORONARY ARTERY DISEASE RECEIVED DRUG-ELUTING STENT

Recent guideline emphasized strict blood pressure (BP) control for the patients at high risk for cardiovascular events. We sought to compare clinical outcome between intensive versus usual BP control in patients with coronary artery disease (CAD) received drug-eluting stent (DES). We reviewed 1,009

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension. Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure. A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow-up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post-hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan-Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log-rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events. RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.

Evaluation of Blood Pressure Control and Associated Factors among Patients with Hypertension in Iraq: A Prospective Cross-sectional Study.

Background:Uncontrolled blood pressure (BP) is a major contributor to cardiovascular disease–related morbidity and mortality. However, evidence regarding the rate and factors associated with uncontrolled BP in Iraq is scarce. The objectives of this study were a) to assess the magnitude of and factors associated with patient BP control and b) to investigate the patient-level prescribing patterns of antihypertensive medications, in a large Iraqi hospital.Materials and Methods:A prospective, cross-sectional study was conducted in the primary care centers of Al-Yarmouk Hospital in Baghdad, Iraq, between April 2018 and August 2018. Eligible patients answered standard survey questions and had their BP measured. Controlled BP was defined as <130/80mm Hg for patients with diabetes and/or chronic kidney disease and <140/90mm Hg for other populations.Results:During the study period, 300 patients were included; of which, 67.3% were female. The average age was 57.6 (9.2) years (range, 25–79 years). Among the 300 patients included, only 38.7% had controlled BP. In univariate analysis, poorly controlled BP was not associated with education, employment, smoking, comorbid conditions excluding diabetes, and therapeutic regimen used. In contrast, the strongest predictors of uncontrolled BP were age <60 years, male sex, and diabetes mellitus. The majority were prescribed monotherapy (53.0%), followed by dual therapy (38.7%), and triple therapy (8.3%). Angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors were the most commonly prescribed medications at 74.7%, followed by beta-blockers at 29.3%, calcium channel blockers at 28.0%, and diuretics at 23.0%.Conclusion:BP control was suboptimal. Effective feasible strategies should be implemented to increase BP control in Iraq to reduce hypertension-related complications.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Controlo intensivo da pressão arterial na diabetes mellitus tipo 2: qual a evidência?

Aim: To verify if intensive antihypertensive treatment (systolic blood pressure <130mmHg) has beneficial effects on cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus and hypertension, compared with standard antihypertensive treatment (systolic blood pressure <140mmHg). Data sources: National Guideline Clearinghouse, NHS Evidence, CMA InfoBase, Cochrane, DARE, MEDLINE/PubMed. Review methods: Meta-analyses (MA), systematic reviews, randomized controlled trials (RCT) and guidelines in English and Portuguese, published between 2006 and 2016 were searched, using the MeSH terms ‘antihypertensive agents’, ‘diabetes mellitus’, and ‘blood pressure’. The Strength of Recommendation Taxonomy (SORT) scale from the American Family Physician was used to evaluate the levels of evidence (LE) and the strength of recommendation (SR). Results: A total of 662 articles were obtained, amongst which 12 fulfilled the inclusion criteria: three MA, one RCT and eight guidelines. MA showed that intensive blood pressure (BP) control reduces the risk of stroke, microalbuminuria and nephropa-thy in diabetic patients (LE 2). However, intensive BP control was associated with an increased risk of adverse effects in these patients, and seems to increase cardiovascular mortality (LE 2). The RCT has only shown a reduction on the risk of development of microalbuminuria (LE 2). Finally, most guidelines do not recommend intensive BP control in diabetic patients and advise that the BP control should be more intensive only in young diabetic patients, in those with target organ damage, or those with more than one risk factor for atherosclerotic cardiovascular disease. Conclusions: According to the evidence available, intensive BP control in patients with type 2 diabetes should not be recommended, except in young diabetic patients and in certain risk groups (SR B). Nevertheless, this study reinforces the importance of BP control in these patients, and highlights the key role of the family physician in the individualized assessment of the risks and benefits of intensive BP treatment.

CHANGES OF PULSE WAVE VELOCITY AND THE EFFECTIVENESS OF BLOOD PRESSURE CONTROL IN PATIENTS WITH HYPERTENSION AND MORBID OBESITY AFTER BARIATRIC SURGERY

Objective: Research objective was studying of pulse wave velocity (PWV) changes and the effectiveness of blood pressure (BP) control in obese patients after bariatric treatment. Design and method: It were surveyed 22 untreated patients (11 males) with morbid obesity. The body mass index before the surgery was 47.6 ± 2.14 kg/m2. Hypertension was detected in 20 (90.9%) patients: grade 1 was established in 9 (40.9%), grade 2 - in 8 (36.4%) and grade 3 - in 3 (13.6%) patients. According to target organ damage stage I hypertension was established in 4 (18.2%), stage II in 16 (72.7%) patients. Low cardiovascular (CV) risk was established in 1 (4.55%) patient, moderate CV risk in 1 (4.55%) patient, high CV risk in 16 (72.7%) patients, very high CV risk in 4 (18.2%) patients. The combined antihypertensive therapy was prescribed to all patients with hypertension and obese before surgery to reach normal BP values. As a result 2-component therapy was prescribed to 6 (27,3%) patients, 3-component therapy - to 8 (36,4%), 4-component therapy - to 5 (22,7%), 5-component therapy - to 1 (4,55%) patient. The effectiveness of the prescribed antihypertensive therapy was evaluated using office BP measurement. BP control in all patients was repeated after bariatric treatment. Results: Systolic BP level significantly decreased from 152,60 ± 5,71 mm Hg to 121,70 ± 3,02 mmHg (p < 0,001) after bariatric surgery. Diastolic BP also declined during estimated period from 86,20 ± 3,13 to 69,0 ± 2,92 mm Hg (p < 0,001). PWV levels decreased from 8,66 ± 0,27 to 7,14 ± 0,46 (p < 0,005). Significant positive results achieved after bariatric treatment allowed 5 (22.7%) patients first to reduce dosages, and subsequently to stop taking antihypertensive therapy in order to achieve normotension, and 15 (68.2%) patients - significantly to reduce dosages and quantity of taken drugs. Conclusions: Weight loss as a result of surgical treatment of obesity significantly improves BP control and PWV level in patients with morbid obesity, allows to reduce doses and the number of taken medications, to achieve not only long-term weight loss, but also to reduce the risk of serious CV events. This category of patients requires careful further dynamic monitoring by a multidisciplinary team of specialists.

Antihypertensive regimen and blood pressure control in patients with hypertension in a tertiary hospital in Zaria-Nigeria

Hypertension is a major public health problem worldwide. In Nigeria, records have shown an increasing prevalence with suboptimal evaluation of blood pressure (BP) control. Generally, antihypertensives have recorded significant successes in BP control over the years. This study was aimed at investigating antihypertensive regimens and BP control in patients with hypertension. The study was a retrospective study on randomly selected hypertensive patients receiving treatments in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Patients’ demographics, co-morbidities, BP readings and antihypertensives were collected from the patients’ case files using a semi-structured Performa between July, 2013 and June, 2015. Data obtained were presented in charts and figures as percentages. A total of 94 patients were captured in the study. The patients were mostly females (71.3%) and between the ages of 41-60 years (64.0%). Combination therapy with mostly diuretics (bendroflumethiazide and hydrochlorothiazide) were recorded (91.0%). Overall BP control was low (35.1%). In conclusion, the study revealed maximal utilization of antihypertensive combination therapy with a poor overall BP control. A non-pharmacological approach alongside rational use of the antihypertensive regimen is encouraged.Keywords: Antihypertensive, Blood Pressure control, Diuretics, Regimen, Retrospective

Physician perceptions of blood pressure control in patients with chronic kidney disease and target blood pressure achievement rate.

BackgroundBlood pressure (BP) control is the most-established method for the prevention of chronic kidney disease (CKD) progression. However, the ideal BP target for CKD patients is still under debate.MethodsWe performed a survey of regular registered members of the Korean Society of Nephrology to determine physician perceptions of BP control in patients with CKD. In addition, we evaluated the target BP achievement rate using data from the APrODiTe-2 study.ResultsTwo-thirds of physicians considered the target BP for CKD to be < 130/85 mmHg. The systolic BP (SBP) thresholds for diabetic CKD, proteinuria ≥ 300 mg/day, 30 ≤ glomerular filtration rate (GFR) < 60 mL/min/1.73 m2, age < 60 years, and the presence of atherosclerotic (ASO) complications were significantly lower than the SBP thresholds of the opposite parameters. The three major hurdles to controlling BP were non-compliance with lifestyle modification and medications, and self-report of well-controlled home BP. Most physicians prescribed home and ambulatory BP monitoring to less than 50% of their patients. The target BP achievement rates using the SBP thresholds in this survey were as follows: non-diabetic (69.3%); diabetic (29.5%); proteinuria < 300 mg/day (72.3%); proteinuria > 300 mg/day (33.7%); GFR ≥ 60 (76.4%); GFR < 30 (47.8%); no evidence of ASO (67.8%); and the presence of ASO (42.9%).ConclusionThe target BP was lower in patients with higher cerebro-cardiovascular risks. These patient groups also showed lower target BP achievement rates. We also found a relatively lower application and clinical reflection rate of home or ambulatory BP monitoring.

Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis.

The prevalence of hypertension is high and is increasing worldwide, whereas the proportion of controlled hypertension is low. To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches. Randomized controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension. Two investigators independently extracted data and assessed study quality. A total of 121 comparisons from 100 articles with 55920 hypertensive patients were included. Multilevel, multicomponent strategies were most effective for systolic BP reduction, including team-based care with medication titration by a nonphysician (-7.1 mm Hg [95% CI, -8.9 to -5.2 mm Hg]), team-based care with medication titration by a physician (-6.2 mm Hg [CI, -8.1 to -4.2 mm Hg]), and multilevel strategies without team-based care (-5.0 mm Hg [CI, -8.0 to -2.0 mm Hg]). Patient-level strategies resulted in systolic BP changes of -3.9 mm Hg (CI, -5.4 to -2.3 mm Hg) for health coaching and -2.7 mm Hg (CI, -3.6 to -1.7 mm Hg) for home BP monitoring. Similar trends were seen for diastolic BP reduction. Sparse data from low- and middle-income countries; few trials of some implementation strategies, such as provider training; and possible publication bias. Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control. National Institutes of Health.