Control Of Blood Pressure Levels Research Articles

Incorporating the patient-centered approach into clinical practice helps improve quality of care in cases of hypertension: a retrospective cohort study

BackgroundTreating hypertensive patients by integrating the patient-centered approach would influence the practice and outcome of treatment. Our purpose was to determine whether the implementation of a patient-centered approach in health care delivery can improve adhering to guidelines and the quality-of-care.MethodsA retrospective study was conducted using secondary data from the electronic medical records of the patients treated in the two primary care outpatient settings at the Family Medicine (FM) and Social Security (SS) clinics. A key feature of the FM clinic is the incorporation of a patient-centered approach in its service delivery. Individual information regarding initial assessment and treatment at the follow-up visits was reviewed for 1 year. Comparison of adherence to treatment guidelines between the two primary care clinics was performed by using chi-square, Fisher’s exact test or a t-test. To explore the difference in blood pressure and BP control between the two clinics, linear and logistic regression analysis respectively were performed with an adjustment for CV risk score in 2016 as a key confounder.ResultsThe evidence included 100 records from each clinic, showed variation between the two primary care sites. The FM clinic had more complete records regarding family history of hypertension, assessment for secondary causes, prescription for lifestyle modification and appropriate adjustment of medication. Higher levels of blood pressure control were recorded in the FM clinic, specifically systolic pressure 2.92 mmHg (p = 0.073) and diastolic pressure 5.38 mmHg (p < 0.001) lower than those recorded in the SS clinic. There was a 2.96 times higher chance for BP goals to be achieved in patients in receipt of hypertensive care at the FM clinic (p = 0.004).ConclusionsAdopting a patient-centered approach in service delivery could improve the quality of care for hypertension patients in primary care in Thailand.

Retinal Microvascular Changes in Hypertensive Patients with Different Levels of Blood Pressure Control and without Hypertensive Retinopathy

ABSTRACT Purpose To determine possible correlations between different levels of blood pressure (BP) control and retinal microvascular changes in the macula and optic nerve head, using coherence tomography angiography (OCTA) in hypertensive patients without hypertensive retinopathy. Methods This was an observational, cross-sectional study. Seventy-three patients and 40 healthy volunteers were included in this study. The patients and volunteers were divided into four groups and from each participant one eye was selected randomly: Group A comprised 32 hypertensive patients with intensive BP control; Group B comprised 26 hypertensive patients with standard BP control; Group C comprised 15 hypertensive patients with poor BP control; Group D comprised 40 control subjects. 6 × 6 mm macula scan and 4.5 × 4.5 mm optic nerve head scan were obtained using OCTA. Results In macula scans, most measured regions of retinal VD showed significant reduction in group C, compared to groups A, B, and D (all P < .05). Partial measured regions of retinal VD were significantly lower in group B than groups A and D (all P < .05). In ONH scans, RNFL thickness and inside disc capillary density were significantly thinner and lower in groups B and C than in group D (all P < .05). SBP was significantly correlated with RNFL thickness (R = 0.430, 95% CI −0.583 to −0.201, P ≤ 0.001). Conclusions We demonstrated that the frequency of OCTA follow-up may improve detection of reduced retinal VD, thus avoiding further retinal damage in hypertensive patients; however, the clinical implications of this finding deserve further study. Moreover, further exploration is needed regarding the implication that reduced SBP may be beneficial for lowering the risk of glaucoma.

Visit-to-visit blood pressure variability and risk of chronic kidney disease: A systematic review and meta-analyses.

ObjectivePrevious studies have shown that visit-to-visit blood pressure variability (BPV) is associated with chronic kidney disease (CKD). However, the results have not been consistent among studies. This systematic review and meta-analysis was conducted to comprehensively assess the association between visit-to-visit BPV and the risk of CKD.MethodsMedline, Embase, and the Cochrane Library were searched from the date of inception through 1 August 2019 using the terms “blood pressure variability,” “chronic kidney disease,” “nephropathy,” and other comparable terms. The primary outcome was the development of CKD. Two reviewers extracted the data independently. Meta-analysis was performed using a random effects model.ResultsFourteen studies were included in the systematic review and meta-analysis. The risk of CKD was significantly greater in patients with high baseline systolic blood pressure variability (SBPV) than in patients with low baseline SBPV: the standard deviation (SD) showed relative risk (RR) of 1.69 and 95% CI of 1.38–2.08, the coefficient of variation (CV) showed RR of 1.23 and 95% CI of 1.12–1.36, and variance independent of mean (VIM) showed RR of 1.40 and 95% CI of 1.15–1.71. RRs for each unit increase in visit-to-visit SBPV and risk of CKD were 1.05 (95% CI: 1.03–1.07) for SD, 1.06 (95% CI: 1.03–1.09) for CV, and 1.1 (95% CI: 0.96–1.25) for VIM. Diastolic BPV was similarly predictive of CKD based on SD and CV.ConclusionsIncreased visit-to-visit BPV might be an independent risk factor for CKD. However, significant heterogeneity was present; thus, future prospective studies are needed to confirm our findings. Our results indicate that treatment of hypertension should control blood pressure levels and prevent abnormal fluctuations in blood pressure to reduce the risk of CKD.

Clinical care & blood pressure control among hypertensive people living with human immune deficiency virus: Prospective cohort study

BackgroundHypertension has emerged as a new threat to the health and well-being of people living with human immune deficiency virus (PLHIV). However, no data exist on care delivery and blood pressure control over time in Ethiopia. We assessed clinical care & level of blood pressure control among hypertensive people living with Human Immune Deficiency Virus (HIV). MethodsWe conducted a prospective cohort study among adult hypertensive PLHIV and HIV-negative patientsat chronic care clinics of Jimma University Medical Center in Ethiopia. We explored self-management practices and blood pressure control of study participants. Multivariable Cox-regression was used to identify the predictors of the outcome. ResultsA total of 303 eligible participants with mean age of 43.30 ± 12.55years were followed and males comprised of 52.1%. After 12 months of follow-up, 60.2% of HIV-positive and 53% of HIV-negative patients showed uncontrolled blood pressure. The overall perception of self-management behaviors was 2.10 ± 0.77 (p = 0.122), which was at moderate level. An increased waist circumference [AHR: 2.16; 95% CI: (1.58–5.18);p = 0.021],chronic disease co-morbidity[AHR:3.94;95%CI:(2.24–8.74);p = 0.046],alcohol use history[AHR:1.26; 95%CI:(1.08–2.23);p = 0.031], HIV infection[AHR:3.06;95%CI:(1.93–11.34);p=0.042], infrequent use of fruits & vegetables [AHR:3.77;95%CI: (1.34–10.57);p=0.012], infrequent engagement on physical exercise[AHR:3.48;95%CI:(1.48–8.17);p = 0.004],frequent use of high fats food [AHR:2.56;95%CI: (1.25–5.25);p = 0.011] were an independent predictors of uncontrolled blood pressure. ConclusionThe rate of uncontrolled blood pressure is significantly higher in the HIV- infected population. There was a gap in the clinical care of hypertension in terms of hypertension self-management among hypertensive HIV-positive patients. Our study highlights the need for better integration of hypertension care to HIV clinical setting.

Effects of blood pressure level management on maternal and perinatal outcomes in pregnant women with mild to moderate gestational hypertension.

This study aims to investigate the effects of blood pressure control level on maternal and perinatal outcomes in pregnant women with mild to moderate gestational hypertension (GHp). A total of 344 pregnant women who initially diagnosed as mild to moderate gestational hypertension were recruited in this study. They were divided into 4 groups according to the stabilized blood pressure level (BPL) during pregnancy. The clinical parameters and the incidence of adverse pregnancy outcomes were compared among the four groups. The association between blood pressure levels and relative factors were analyzed using the χ2 test. Multivariate logistic regression analysis was adopted for risk factors associated with adverse pregnancy outcomes. The results showed the prevalence of obesity was significantly associated with blood pressure levels of mild-moderate GHp pregnant women (p = 0.029). The incidence of severe GHp, SPE in group A, group B, and group C were statistically significant (p < 0.001, p = 0.041, respectively). In the patients who used drugs to control BPL, the incidence of severe GHp has a significant association with the initial blood pressure levels (p = 0.004). However, no significant difference was found in the incidence of sPE, PE + Upro, and SGA (all p > 0.05). Multivariate logistic regression analyses results showed that the gestational factor BPL was an independent risk factor for the incidence of sGHp. The AMA, primigravida, gestational BPL, and edema were risk factors for the incidence of preeclampsia with proteinuria. To the incidence of sPE, gestational BPL is the independent risk factor. Finally, preeclampsia anamnesis and FGR trend are the high-risk parameters to the incidence of SGA. Timely management and control of blood pressure in pregnant women with mild to moderate GHp were beneficial to reduce the occurrence of severe GHp and sPE, but the incidence of SGA does not affected.

Kidney dysfunction is associated with risk of cardiovascular events in middle-aged and elderly population with hypertension: A5-yearcommunity-based cohort study in China .

To evaluate the association between kidney dysfunction and cardiovascular disease (CVD) events in a middle-aged and elderly population in China. In July 2009, a baseline survey of health status was performed in adults aged 55 years and older from Beijing, China. Occurrence of CVD events and mortality in subjects free of CVD at baseline was recorded in a 5-year follow-up period until December 2014. The association of mild (eGFRCKD-EPI 45 - 59 mL/min/1.73m2) and moderate to severe (eGFRCKD-EPI < 45 mL/min/1.73m2) kidney dysfunction with adverse outcomes were analyzed with Cox regression analysis. A total of 1,257 subjects were included in the final analysis. The risk of CVD events in those with mild kidney dysfunction increased by 65% (HR: 1.65, 95% CI: 1.04-2.62) as compared to those with normal kidney function. Subjects with both hypertension and CKD experienced more significantly increased risk of CVD events (adjusted HR = 1.87, 95% CI 1.17-2.97) and stroke (adjusted HR = 2.24, 95% CI 1.24-4.04). Pulse pressure (PP) ≥60 mmHg was the strongest risk factor for stroke in patients with CKD, with the adjusted HR value of 1.98 (95% CI 1.08-3.64). Moderate to severe kidney dysfunction was an independent risk predictor of CVD events. Among subjects with hypertension or poorly controlled blood pressure level, the presence of CKD significantly increased the risks of CVD events and stroke.

Effect of intensive health management on blood pressure and quality of life in patients with hypertension

Objective To investigate the effect of intensive health management on blood pressure and quality of life in patients with hypertension. Methods Totally 107 patients with hypertension were selected and conducted with intensive health management for one year. The blood pressure level and quality of life were compared before and after the implementation of intensive health management. Results After implementation of intensive health management, the levels of systolic blood pressure(SBP)and diastolic blood pressure(DBP)were significantly lower than those before implementation of intensive health management(P<0.05), while the scores of psychology, society, environment, body and comprehensive score were significantly higher than those before implementation of intensive health management(P<0.05). Conclusion Intensive health management can control blood pressure level and improve quality of life in patients with hypertension.

The impact of body mass index and number of antihypertensive medications on clinical management of hypertension in primary health care

Introduction: Hypertension (HTN) is an extremely common disease and its prevalence is increasing globally. The association between obesity and HTN is not yet fully understood, insulin resistance and renal dysfunction are said to be the main causes of obesity-related HTN. This study explored the effect of obesity and different number of medications on blood pressure (BP) control in patients with HTN. Methods: This was a retrospective study conducted in the outpatient primary care clinic at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results: A total of 286 patients were included in the study with an average weight of 80.6 kg and an average body mass index (BMI) of 32.2. Only 63% of the participants had controlled BP. There was a trend toward better controlled BP levels among male participants (67.1%) compared with females (57.7%) and among those with higher BMI levels, P = 0.099 and 0.094, respectively. Patients receiving two antihypertensive medications were more likely to have their BP controlled compared to those receiving four medications (odds ratio [95% confidence interval] =2.62 [1.32, 5.20]; P = 0.006). Conclusion: Uncontrolled BP was not associated with BMI. Taking two antihypertensive medications was associated with more BP control than monotherapy or combination of therapy with three drugs or more.

Prescription of pharmacotherapy and blood pressure control among hypertensive outpatients in two semi-urban hospitals in Cameroon: a cross-sectional study.

Introductionseveral international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians.Methodswe consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (southwest region of Cameroon). Controlled BP was defined as BP < 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP < 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8).Resultsof the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI, 19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). Seventy percent (70%) of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent combination. The rate of BP control was 52% overall, and 60% in participants on monotherapy.ConclusionCCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control.

Controle da pressão arterial em idosas de uma universidade da terceira idade: efeitos de ações educativas e da prática do Pilates

OBJETIVO: Verificar os níveis da pressão arterial sistólica e diastólica de mulheres idosas praticantes regulares do método Pilates, associado com palestras sobre educação em saúde.MÉTODOS: Estudo quase-experimental com 81 mulheres idosas (68,21±7,05 anos). As participantes foram divididas em Tercis, de acordo com o número de presenças nas atividades: T1: 1 a 12 visitas; T2: 13 a 24 visitas; e, T3: 25 a 36 visitas. Os valores da pressão arterial (PA) foram classificados em: pressão controlada – pressão arterial sistólica (PAS) inferior a 140 mmHg e pressão diastólica (PAD) até o limite 90 mmHg –; pressão arterial não controlada (PANC) (valores da PAS&gt;140 mmHg e PAD&gt;90 mmHg). Por meio de um questionário foram coletados dados sociodemográficos, comorbidades, hábitos de vida e número de medicamentos. Adicionalmente, foram mensurados o índice de massa corporal (IMC) e a circunferência abdominal (CA). O teste qui-quadrado foi utilizado para comparar as variáveis nominais. Diferenças estatísticas entre os grupos foram estabelecidas pela ANOVA. A análise de regressão logística verificou o efeito da assiduidade sobre os valores da PAS e da PAD controlada e não-controlada. O nível de significância adotado foi de α=0,05.RESULTADOS: Alcoolismo, tabaco e morar só apresentaram níveis estatísticos de significância (p≤0,5). Verificou-se que a assiduidade nas atividades mostrou razão de chance (OR) de 17% para obtenção de níveis de PAD controlada e que o não comparecimento nas atividades determinou 58% de chance para níveis de PAS não-controlada.CONCLUSÕES: O controle dos níveis pressóricos se apresentou diretamente proporcional à assiduidade das idosas na prática do Pilates e nas palestras sobre educação em saúde

Gender Difference in the Level of Blood Pressure Control among Hypertensive Patients on Treatment

Gender Difference in the Level of Blood Pressure Control among Hypertensive Patients on Treatment

P6368Blood pressure control in a registry of clinical practice, PINNACLE-BRAZIL REGISTRY

Abstract Introduction The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top-ranking cause of all deaths globally. Purpose We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guideline-derived recommendations, after one year of the clinical practice registry Methods Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in “real world” clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement &lt;140/90 mmHg was 47.9% (baseline) and 57.3% (follow-up). Percentage of patients who had a blood pressure &lt;140/90 mm Hg, or who had a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. Conclusion The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. Acknowledgement/Funding ACC Foundation

6072Risk of stroke in hypertensive patients with atrial fibrillation treated with oral anticoagulants

Abstract Background Hypertension is common in patients with atrial fibrillation (AF) and carries an additional risk for complications, most notably stroke and bleeding. We assessed the history of hypertension, level of blood pressure control, and an interaction with the choice of oral anticoagulants on clinical outcomes. Purpose To gain insights into the risks of hypertension in the setting of AF and explore possible interactions with the safety and efficacy of non-vitamin K oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs). Methods We performed a systematic review and meta-analysis of studies that randomised patients to NOACs or VKAs and reported outcomes stratified by presence of hypertension. Collected outcomes included: ischaemic stroke or systemic embolism (SE), death from any cause, hemorrhagic stroke, major bleeding, and intracranial hemorrhage. Log adjusted hazard ratios (HR) and corresponding standard error were calculated, and HRs were compared using Mantel-Haenszel random effects. Quality of the evidence was assessed with Cochrane risk of bias tool. Results Five high-quality studies were eligible, including 71,602 participants who received NOACs (apixaban, dabigatran, edoxaban, rivaroxaban) or VKAs, with median follow-up of 1.8–2.8 years. 89.2% of participants had a history of hypertension. Compared with patients without hypertension, those with controlled and uncontrolled hypertension had higher risk for stroke/SE (HR: 1.21 [1.04–1.41] and HR: 1.50 [1.12–2.01], respectively) and haemorrhagic stroke (HR: 1.78 [1.06, 3.00] and HR: 1.66 [0.99–4.01], respectively). On a continuous scale, the risk of stroke increased 7% per 10mmHg increase in systolic blood pressure. As shown in the Table, no interactions were found between hypertension status and the efficacy or safety of NOACs versus VKAs. Table 1. Interaction of presence of hypertension on the comparative efficacy and safety of NOAC versus VKA Hypertension (n=63,869) No hypertension (n=7,733) P-value (int) Adjusted HR, 95% CI Adjusted HR, 95% CI Stroke or systemic embolism 080, 0.72–0.89 0.79, 0.53–1.19 0.98 Haemorrhagic stroke 0.55, 0.41–0.74 0.24, 0.04–1.37 0.36 Death from any cause 0.91, 0.84–0.98 0.89, 0.76–1.04 0.82 Major bleeding 0.90, 0.76–1.07 0.84, 0.69–1.01 0.57 Intracranial haemorrhage 0.41, 0.24-.068 0.48, 0.14–1.69 0.81 Major or clinically relevant non-major bleed 0.90, 0.68–1.18 0.91, 0.55–1.53 0.96 Conclusions Adequate blood pressure management is vital to optimally reduce the risk of stroke in patients with atrial fibrillation. The benefits of NOACs over VKAs, also apply to patients with elevated blood pressure.

Practical and personal education of dietary therapy in hypertensive patients.

The guidelines for the management of hypertension by the Japanese Society of Hypertension (JSH2019) defined blood pressure (BP) levels of 130-139/80-89 mmHg as "elevated blood pressure". The JSH2019 also revised the target level of BP control to a lower level. Thus, lifestyle modifications are quite important regardless of the use of antihypertensive drugs. Among the lifestyle modifications, salt reduction is most important, especially among East Asian people, who still consume a significant amount of salt. Since the awareness of salt reduction may not necessarily lead to actual salt reduction, the assessment of individual salt intake is essential when members of the medical staff provide practical guidance regarding salt reduction. The evaluation methods of salt intake are classified as the assessment of dietary contents and the measurement of urinary sodium (Na) excretion. Since highly reliable methods, such as the measurement of 24-h urinary Na excretion, are not convenient in practical clinical settings, the combination of the assessment of dietary contents using questionnaires and the estimation of salt intake using spot urine is recommended as a practical evaluation procedure. Repeated assessment of salt intake and practical guidance from dieticians are useful for long-term adherence to salt reduction. The Japanese Society of Hypertension Salt Reduction Committee began to certify flavorful foods as being low in salt content in 2013. More than 200 products have been certified as of April 2019. The utilization of these products is expected to aid in the salt reduction of hypertensive individuals as well as the Japanese general population.

A Cross Sectional Clinical Analysis of Hemiplegia (Pakkavatham) Related to Diabetes Mellitus (Mathumeham) and Hypertension (Erathakothippu)

Background: Stroke (Pakkavatham) is the second leading mortality cause in global and death occurrence rates, rising in middle to older aged people. This condition is increased due to the dietary pattern and lifestyle modifications.&#x0D; Aim: To determine about the interrelationship of Type II Diabetes Mellitus DM) and Systemic Hypertension (SHT) associated with hemiplegia.&#x0D; Study Design: Cross Sectional Descriptive Observational Study.&#x0D; Place and Duration of Study: This study work was carried out in 50 patients in Government Siddha Medical College and Hospital, Palayamkottai, Tirunelveli, Tamil Nadu from April 2019 to September 2019.&#x0D; Materials and Methods: This study was carried in 50 subjects (30 subjects in Out Patient Department (OPD) and 20 subjects in In Patient Department (IPD) were randomly selected and the data were collected by interviewing with a structured questionnaire. The ethical clearance was attained from the Institutional Ethical Committee.&#x0D; Results: The highest incidence was male patients (38%) than female patients, the affected age group was 51-60 years. The prevalence was seen in male alcoholic consumers (46%), chronic smokers (44%) respectively. The incidence was mostly seen in hypertensive (70%) and non-diabetic (46%) male patients. Among the 50 patients, 14 patients (28%) had both SHT and DM. The most prevalence was seen in hypertensive patients than DM or SHT combined with DM patients. The moderate improvement was seen in the patients (32%) of control blood pressure and serum glucose level.&#x0D; Conclusion: The SHT may influence in the prevalence of Pakkavatham and control blood pressure and serum glucose level may be improved the good prognosis in Pakkavatham patients.

Home Blood Pressure Monitoring by a Mobile-Based Model in Chongqing, China: A Feasibility Study.

Purpose: Increasing attention is being paid to the role of the intelligent self-management of hypertension under the context of increasing prevalence but limited medical resources. However, heterogeneity in interventions and outcome measures has hindered the interpretation of research evaluating mobile health technologies for hypertension control, and little study of such technology has been performed in China. Objective: This was a feasibility study aimed to understand patient and medical practitioners’ acceptance and experience of a mobile-phone based platform for the management of hypertensive patients. Methods: The model used behavioral incentives for daily blood pressure measurement and physician-facing prioritization of patients based on level of blood-pressure control. Patients were enrolled by purposive sampling. The platform was used for two-week blood pressure monitoring through WeChat, which simulated our future app. Qualitative interviews with patients and providers were conducted in time. Results: Twenty hypertensive patients and two providers were enrolled and used the platform throughout the two weeks. Patients reported daily home blood pressure monitoring to be simple, feasible and increased their health awareness. Specifically, patients self-reported that reminders, the daily frequency and time of monitoring, and positive reinforcement were important for maintaining adherence. Providers reported that they could manage patients more quickly and accurately, but reasonable feedback information was needed to avoid excessive increases in workload. Conclusion: The adoption of mobile-based technology to monitor patient’s blood pressure may provide a practical solution for managing patients in Chongqing, China. Patient health education and enhanced app functionality could improve patient compliance and satisfaction while reducing provider workload.

THE PARACLINICAL EVOLUTION OF OBESE HYPERTENSIVE PATIENTS

Objective: to assess paraclinical evolution in obese patients with essential systemic hypertension Design and method: 150 patients older than 40 years, with SH (more than 7 years, diagnosed between 35 and 42 years age) and obesity (BMI>30 kg/m2) were included. It was a retrospective study. All the patients with systolic heart failure NYHA II-IV and coronary major events were excluded. In all patients were recorded retrospective data regarding clinical findings, blood tests (lipid profile, glycemia, uric acid, TSH, microalbuminuria), ECG, blood pressure monitoring (at least one in the last 2 years) and echocardiography (performed in the last year). The patients were divided into two groups: the study group (n = 72) with hyperuricemia – and the control group (n = 78): patients without hyperuricemia. In all patients were assessed LV function and rest heart rate. In both groups were included only patients with heart rate <90b/min, in sinus rhythm and with EF>55%. Results: The mean age was 48.9 years and 52.9% were men. The patients from the two groups had the same profile of risk factors and associated comorbidities (except hyperuricemia). The treatment and the level of blood pressure control were the same (average BP was 141.5/84.8 in study group and 141.6/84.9 in control group). The median duration of systemic hypertension was 8.4 years (between 7 and 12 yrs). The heart rate was slowly increased in the study group (76.4 vs 70.2). The echocardiography showed an increased end diastolic left ventricle diameter in study group (57.2 vs 56.7 mm) and left atrium diameter (41.5 vs 40.5 mm). In the study group were registered during SH evolution 9 new cases of diabetes mellitus type 2 and 11 patients with microalbuminuria. In the control group were registered during SH evolution 4 new cases of diabetes mellitus type 2 and 7 patients with microalbuminuria. Conclusions: Hyperuricemia could be considered an independent risk factor for patients with systemic hypertension. Its presence accelerates the deterioration of clinical parameters of these patients in spite of the control of hypertension and similar clinical profile. Further studies are needed to confirm.

Antihypertensive therapy and adequacy of blood pressure control among adult hypertensive diabetic patients with chronic kidney disease in a tertiary referral hospital

ABSTRACTBackground: Tight blood pressure control retards the development of end-stage renal disease in hypertensive diabetic patients with chronic kidney disease. There is limited literature on blood pressure control among this patient population in a resource-limited setting.Research design and methods: A tertiary hospital-based cross-sectional study with 237 hypertensive diabetic patients with chronic kidney disease was conducted. A pre-tested questionnaire was used to assess patients’ awareness of their ideal blood pressure. Data on blood pressure readings and antihypertensive therapies were abstracted into predesigned data collection forms and analyzed using STATA software version 13.0.Results: The participants’ mean age was 61.8 ± 12.7 years and 106 (44.7%) patients were aware of the blood pressure targets. Adequate blood pressure control was found in 30.8%. Most (58.7%) were using ≥ 3 antihypertensive drug classes. Calcium channel blockers (51.1%), with principally amlodipine (26.2%) and nifedipine (24.1%), were the most preferred agents. Bivariate analysis showed enalapril (p = 0.009) and nifedipine (p = 0.022) being associated with adequate blood pressure control. However, nifedipine (AOR 2.79; 95% CI: 1.12–6.9, p = 0.028) and awareness of ideal blood pressure targets (AOR 4.57; 95% CI: 1.25–16.7, p = 0.022) were independent predictors of good control.Conclusion: Adequacy of blood pressure among hypertensive diabetic patients with chronic kidney disease is low and may be attributable to unawareness of its target level and using inappropriate therapy. Future studies should correlate level of blood pressure control with patient-, clinician-, and hospital-related factors.

Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men

IntroductionTighter blood pressure control is widely thought to be associated with better erectile function, although the preponderance of data is limited to dichotomous representations of hypertension without an attempt to look at degree of blood pressure control. AimTo determine the association between optimal blood pressure control over time and the development of erectile dysfunction (ED) in a cohort of potent men. MethodsWe performed a retrospective cohort study of newly diagnosed hypertensive men without major medical comorbidities in an integrated healthcare system. Patients were stratified by exposure to hypertension, with varying levels of blood pressure control, as measured by ordinal categories of systolic blood pressure and deviation from the mean systolic pressure. Main Outcome MeasuresIncidence of ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health records within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnosis of ED and 2 filled prescriptions for ED medications. ResultsWe identified 39,320 newly diagnosed hypertensive men. The overall incidence for ED was 13.9%, with a mean follow-up of 55.1 ± 28.7 months. Higher average systolic blood pressure was associated with a higher risk of ED in a dose-dependent manner (trend test, P < .001). Wide variation in blood pressure control was associated with a higher incidence of ED (OR [95% CI]; 1.359 [1.258–1.469]) and a shorter time to the development of ED (log rank, P < .0001). Clinical ImplicationsWe believe these data may serve as a motivator for hypertensive men to better adhere to their hypertension treatment regimen. Strength & LimitationsThe retrospective nature of our study precludes us from drawing more than an association between tighter blood pressure control and ED. Strengths of our study include the large sample size, community cohort, and completeness of follow-up. ConclusionAmong adults diagnosed with hypertension, tighter blood pressure control, as measured by average systolic blood pressure and deviation from the average, is associated with a lower incidence and a longer time to the development of ED.Hsiao W, Bertsch RA, Hung Y-Y, et al. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019;16:410–417.

Baixa adesão terapêutica em hipertensão arterial sistêmica: prevalência e fatores associados na atenção básica à saúde

INTRODUÇÃO: O abandono do tratamento pode ocorrer sem que os profissionais da Atenção Básica identifiquem os motivos para tais condutas concorrendo para o agravamento dos casos. OBJETIVO: Estimar a associação entre fatores sociodemográficos, culturais e de estilo de vida com a adesão terapêutica de hipertensos. MÉTODOS: Realizou-se um estudo transversal com usuários hipertensos que usavam medicação para controle dos níveis pressóricos e buscavam atendimento em unidades de atenção básica em um distrito sanitário da cidade do Salvador, Bahia. Foram incluídos os que tinham idade maior que 18 anos e excluídos os que tinham alteração cognitiva e também mulheres com hipertensão gestacional. A magnitude da associação entre as variáveis estudadas e a adesão terapêutica foi estimada pelo cálculo da razão de chances (Odds Ratio, OR), adotando-se o intervalo de confiança a 95% (IC95%). RESULTADOS: A amostra foi composta com 185 hipertensos e a prevalência de não adesão ao tratamento foi de 68,1%. Os fatores associados com a não adesão terapêutica foram situação conjugal solteiro, separado, viúvo (OR= 2,23; IC95% 1,04 – 4,47), não alteração dos hábitos alimentares (OR= 2,51; IC95% 1,12 – 5,59), assim como faltar às consultas (OR=4,20; IC95% 1,16 – 15,18) e entender bem tudo que é dito em uma consulta (OR=0,60; IC95% 0,38 – 0,95). CONCLUSÕES: Grande parte dos hipertensos não apresentou adesão terapêutica, e os fatores associados são passíveis de modificação por meio de tecnologias leves e investimentos na qualidade da atenção primária à saúde. Devem ser encorajados novos estudos com desenhos longitudinais que possam identificar as causas da não adesão.