Blood Pressure Control Status Research Articles

Prevalence and control of hypertension among patients on haemodialysis.

Earlier studies provided considerably variable estimates on the prevalence and control rates of hypertension in haemodialysis because of their heterogeneity in definitions and blood pressure (BP) measurement techniques applied to detect hypertension. In this cross-sectional study, 116 clinically stable haemodialysis patients from 3 dialysis centres of Northern Greece underwent home BP monitoring for 1week with the validated automatic device HEM-705 (Omron, Healthcare). Routine BP recordings taken before and after dialysis over 6 consecutive sessions were also prospectively collected and averaged. Hypertension was defined as: (a) 1-week averaged home BP≥135/85mmHg; (b) 2-week averaged predialysis BP≥140/90mmHg; and (c) 2-week averaged postdialysis BP≥130/80mmHg. Participants on treatment with ≥1 antihypertensives were also classified as hypertensives. The prevalence of hypertension was 88.8% by home, 86.2% by predialysis and 91.4% by postdialysis BP recordings. In all, 96 participants (82.7%) were being treated with an average of 2.0±1.1 antihypertensive medications. Among drug-treated participants, 32.6% were controlled by home, 50.5% by predialysis and 45.3% by postdialysis BP recordings. In multivariate logistic regression analysis, greater use of antihypertensive medications and postdialysis overhydration, assessed with bioimpedance spectroscopy, were both independently associated with higher odds of inadequate home BP control. This study shows that the prevalence, but mainly the control rates of hypertension in patients on haemodialysis, differs between peridialytic and interdialytic BP recordings. Therefore, the wider use of home BP monitoring may improve the determination of BP control status in this high-risk population.

MO076LONGITUDINAL CHANGES AND OUTCOME OF HIGH BLOOD PRESSURE IN EUROPEAN CHILDREN ON RENAL REPLACEMENT THERAPY

Abstract Background and Aims Few studies have focused on trends of hypertension (HTN) and status of blood pressure (BP) control over time in children on renal replacement therapy (RRT). In this study, we aimed to evaluate the 5-year trend in BP antihypertensive medications (AHs) use, as well as the association between HTN and mortality among RRT patients enrolled within the ESPN/ERA-EDTA Registry. Method 25.223 BP measurements from 5.032 patients who started RRT before 20 years of age, between 2007-2016, were included. Mixed models were used to analyse trends of BP, the JointPoint regression to assess prevalence of uncontrolled HTN (uHTN) over time, and multivariable Cox proportional hazard models to evaluate association of BP with mortality. Results Mean systolic BP (SBP) at RRT initiation was 1.66(+0.15), 1.05(+0.15) and 1.09(+0.08) SDS in HD, PD and transplanted (Tx) patients, respectively, while it was 1.41(+0.19), 1.12(+0.18), and 0.79(+0.06) SDS in the corresponding RRT categories after 5 years. Patients on HD showed a significant decrease in the prevalence of uHTN over time (57.1% at dialysis start vs 41.4% after 5 years; annual percentage change [APC] -4%; 95% CI: -5.7;-2.2; p<0.05), coupled with a significant reduction in AHs use (APC -3.5%; 95% CI: -6.7;-0.2). PD patients showed a similar reduction in uHTN prevalence (APC -4.9%; 95% CI: -7.2;-2.6; p<0.05), but a significant increase in AHs use (APC +3.6%; 95% CI: 0.6;6.6; p<0.05). After 5 years, Tx patients showed a significant reduction in both prevalence of uHTN (APC -4.8%; 95% CI: -7.8;-1.7; p<0.05) and use of AHs (APC -2.2%; 95% CI: -4.1;-0.3%; p<0.05). Having uHTN was not associated with mortality (HR 0.95; 95% CI: 0.68-1.33). Conclusion A more adequate control of BP over time seemed to be obtained in children on RRT. Findings in PD patients suggest that this requires a progressive increase in the use of AHs.

P1216EPIDEMIOLOGY OF HYPERTENSION IN PERITONEAL DIALYSIS USING CLINIC AND AMBULATORY BLOOD PRESSURE MONITORING

Abstract Background and Aims Earlier studies that were based on routine clinic blood pressure (BP) recordings suggested that the prevalence of hypertension is lower in patients on peritoneal dialysis (PD) than in those receiving maintenance hemodialysis. These studies, however, did not incorporate the “gold-standard” method of ambulatory BP monitoring (ABPM). The aim of the present study was to quantify the prevalence and control of hypertension in a cohort of 81 peritoneal dialysis (PD) patients using clinic and ambulatory BP recordings. Method Triplicate BP recordings were obtained after a 5-minute seated rest at clinic with the validated monitor HEM-705 CP (Omron, HealthCare). 24-hour ABPM was subsequently performed with the Mobil-O-Graph device (IEM, Germany). Hypertension was defined as (i) average clinic BP ≥140/90 mmHg or antihypertensive drug use and (ii) 24-hour BP ≥130/80 mmHg or current use of antihypertensive drugs. Results The prevalence of hypertension was 92.6% with clinic BP recordings and 93.8 with ABPM. In all, 75 participants (92.6%) were receiving therapy with an average of 2.4 antihypertensive medications. The rates of adequate control of hypertension were 49.3% with the use of clinic BP recordings and 39.5% with ABPM, respectively. In all, 6.2% of participants were classified as normotensives, 33.3% had concordant control of hypertension with both techniques, 40.7% had concordant lack of control confirmed by both techniques, 5% had “white coat” hypertension and 14.8% had masked uncontrolled hypertension. Conclusion This study suggests that the burden of hypertension among patients on PD is very high and that the wider use of ABPM is important to confirm the BP control status of these patients.

Achievement rate of blood pressure

ABSTRACT Blood pressure (BP) control status was investigated using data of a health checkup held in a Japanese city. In fiscal year 2017, 54,287 persons (age, 40–74 years; males, 49%) underwent the checkup; 28,167 examinees had a systolic BP ≥140 mmHg, a diastolic BP ≥90 mmHg, or took antihypertensive agents. Of these subjects, 20,153 subjects took antihypertensive agents. A BP <140/90 was achieved in 66.6% (13,426) of the treated subjects; however, a BP <130/80 was achieved only in 30.7% (6,188). In conclusion, in 2017, although a relatively large proportion of treated subjects achieved a BP <140/90 mmHg with antihypertensive agents, only approximately half of these subjects reached a BP <130/80 mmHg, which is the latest treatment target for persons aged 75 years or less according to the Japanese hypertension guidelines 2019.

Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia.

BackgroundHypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP remain poorly understood globally. Therefore, this study aimed to assess the magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte referral hospital (NRH).MethodsA hospital-based cross-sectional study was conducted from February to April 2018 at NRH. BP control status was determined by the average consecutive BP recordings across the 3 months. The data was entered and analyzed using SPSS version 20.0 and p-value <0.05 was considered statistically significant.ResultsOut of 297 study participants included, the majority were females, 181 (60.9%), and the mean age of the patients was 59.4 ±10.4 years. About half, 137 (46.12%), of the patients had at least one comorbidity and the most common class of anti-hypertensive medication was angiotensin-converting enzyme inhibitors (88.2%). The mean of systolic blood pressure was 132.41± 15.61mmHg, while the mean of diastolic blood pressure was 84.37± 9.32 mmHg. The proportion of participants with optimally controlled BP was 63.6% and 36% were adherent to their medications. Male sex (Adjusted Odd Ratio [AOR]: 1.89, 95% CI: 1.09–4.84), illiteracy (AOR= 1.56, 95% CI: 1.22–6.78), duration of hypertension diagnosis > 10 years (AOR= 2.01, 95% CI: 1.04–16.11), non-adherence (AOR= 3.14, 95% CI: 1.35–10.76) and lack of physical exercise (AOR= 2.8, 95% CI: 1.16–6.74) were positively associated with uncontrolled BP status. Whereas age older than 55 years (AOR= 0.38, 95% CI: 0.11–0.92) was negatively associated with uncontrolled BP.ConclusionBP control was relatively achieved in about two-third of pharmacologically treated patients. We recommend better health education and care of patients to improve the rate of BP control status.

Clinical Implications

HomeHypertensionVol. 75, No. 4Clinical Implications Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBClinical Implications Originally published11 Mar 2020https://doi.org/10.1161/HYPERTENSIONAHA.120.14732Hypertension. 2020;75:893is related toRisk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive TherapyPrevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension UnitBlood Pressure Variability and the Risk of DementiaBlood Pressure Variability and Dementia (page 982)Download figureDownload PowerPointDementia is a major health concern and the prevalence rises with the aging of the population. Recently, raised blood pressure variability (BPV) has emerged as a novel risk factor for development and progression of cognitive decline. However, evidence for the association of BPV and incidence of dementia is limited. In this nationwide retrospective cohort study, we therefore aimed to investigate the association between visit-to-visit BPV and the incidence of dementia in 7 844 814 participants without a history of any dementia who underwent ≥3 health examinations from 2005 to 2012 in the Korean National Health Insurance System cohort. Dementia was directly associated with higher BPV, both systolic and diastolic. In particular, having both higher systolic and diastolic BPV had additive effects on the risk of all-cause dementia, Alzheimer dementia, and vascular dementia. These associations were consistent across variability indices and independent of various factors, including use of antihypertensive drugs, blood pressure control status, or absolute blood pressure change during follow-up. These observations suggest the possibility of a causal relationship between BPV and development of dementia. They highlight that antihypertensive treatment which attenuates long-term BPV may offer benefits in reducing dementia risk in high-risk groups such as older people. Further research is warranted to examine whether reducing variability of blood pressure parameters decreases adverse outcomes.Hypokalemia: Combination Antihypertensive Therapy (page 966)Download figureDownload PowerPointManagement of arterial hypertension implies both lifestyle changes and medical treatment. In most cases, nonpharmacological strategies are not sufficient to achieve optimal blood pressure control and ≈70% of patients with high blood pressure achieve the therapeutic goal of <140/90 mm Hg with combination therapy only. Hypokalemia and hyperkalemia are common side effects of the drugs used to treat hypertension. Awareness of the risk factors associated with potassium disturbances is important to identify patients at risk. We found that the combination of thiazides with calcium channel blockers, renin-angiotensin system inhibitors, or β-blockers was strongly associated with increased hypokalemia risk within 90 days of treatment initiation, despite potassium supplementation in many patients. We recommend close monitoring of potassium status in patients prescribed thiazide diuretics. Maybe use of thiazide-like diuretics instead of thiazides can reduce the risk of low potassium concentrations, as they have a lower natriuretic effect.Hypokalemia and Primary Aldosteronism in Patients with Hypertension (page 1025)Download figureDownload PowerPointPrimary aldosteronism (PA) used to be considered a rare disorder associated with severe hypertension and spontaneous hypokalemia. The widespread screening of patients with hypertension using the aldosterone-to-renin-ratio increased the detection of milder forms and, as a consequence, normokalemic hypertension was uncovered as the most common phenotype of PA, with hypokalemia detected in around a third of cases. The Endocrine Society guideline recommends screening for PA in patients with moderate and severe hypertension, drug-resistant hypertension, and in cases of adrenal incidentaloma. The prevalence of PA is well defined in these patient cohorts. The guideline also highly recommends screening hypertensive patients with spontaneous or diuretic-induced hypokalemia. Surprisingly, the prevalence of PA in patients with hypokalemic hypertension is unknown; the guideline recommendation is based on expert opinion and pathophysiological considerations. In our retrospective observational study, we present the first report of the prevalence of PA in patients with hypokalemia referred to a tertiary hypertension unit. The prevalence of PA gradually increased with decreasing serum potassium concentrations reaching 9 of every 10 patients with spontaneous hypokalemia and serum potassium <2.5 mmol/L. Patients with hypertension and hypokalemia displayed a worse cardiovascular risk profile than patients with normokalemia, independent of PA diagnosis. With our findings, we confirm that hypokalemia strongly suggests PA and support the guideline recommendation to screen hypokalemic patients with hypertension, although normokalemia does not exclude the diagnosis. Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2020) Worldwide Increase in Diagnosis of Hypertension in Children, AAP Grand Rounds, 10.1542/gr.43-5-59, 43:5, (59-59), Online publication date: 1-May-2020. Related articlesRisk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive TherapyMaria Lukács Krogager, et al. Hypertension. 2020;75:966-972Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension UnitJacopo Burrello, et al. Hypertension. 2020;75:1025-1033Blood Pressure Variability and the Risk of DementiaJung Eun Yoo, et al. Hypertension. 2020;75:982-990 April 2020Vol 75, Issue 4 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.120.14732PMID: 32160097 Originally publishedMarch 11, 2020 PDF download Advertisement

Antihypertensive drug adherence and its association with blood pressure control status

BackgroundThe relation between antihypertensive drug adherence and blood pressure (BP) control status has been less frequently investigated. ObjectivesIn this article, we aimed to evaluate the relation between medication adherence and hypertension (HTN) status among Iranian hypertensive adults. Materials and methodsThis cross-sectional study was conducted from August 2015 to March 2016 in one city in Iran, Isfahan. Participants aged 18–84 years were eligible for enrollment in the project. After 5 min of rest in a quiet room, BP was measured three times from each participant's right arm with calibrated tools and standard methods. Drug adherence scores were collected through a specific questionnaire. Finally, 252 individuals diagnosed with HTN and being aware of their disorder formerly were selected for further analysis. ResultsThe mean age of male and female participants was 60.5 ± 11.5 and 60.6 ± 11.3 years, respectively (P = 0.94). Controlled and uncontrolled HTN were observed among 59.9% and 40.1% of the study population, respectively. Employed subjects had poor adherence status (P = 0.04), and the older age was associated with better drug adherence scores (P = 0.03). Our considerable finding revealed that increasing drug frequency was associated with higher medication usage compliance (P < 0.001). ConclusionOur data suggested that despite decreasing drug adherence with being employees, younger age, new HTN occurrence, or higher educational duration, increasing the number of drugs was associated with better medication adherence grades. Several comprehensive population-based studies are necessary proving these relations.

The HOPE Asia Network activity for "zero" cardiovascular events in Asia: Overview 2020.

The impact of hypertension-related cardiovascular disease and target organ damage, and therefore the benefits of blood pressure (BP) control, is greater in Asian than in Western countries. Asia-specific features of hypertension and its effective management are important and active areas of research. The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016 and is now a member of the World Hypertension League. The main goal of the HOPE Asia Network is to improve the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia. Considerable work has already been done on the journey to achieving this goal. We have shown that BP control status in Asia differs between countries, and even between regions within the same country. Several expert panel consensus recommendations and clinical guidance papers are available to support the use of home and ambulatory BP monitoring in the region. In addition, the AsiaBP@Home study prospectively investigated home BP control status across 15 specialist centers using the same validated device and measurement schedule. We have also proposed the concept of systemic hemodynamic atherothrombotic syndrome (SHATS), a vicious cycle of BP variability and vascular disease on cardiovascular events and organ damage, and suggested a SHATS score for risk stratification for clinical practice. This special issue of the journal collates Asia-specific resources and data, contributing to advances in hypertension management and cardiovascular disease prevention in the region.

Comparative Effects of Perindopril and Zofenopril on Blood Pressure Control and Oxidative Status Blacks Hypertensive Patients.

Comparative Effects of Perindopril and Zofenopril on Blood Pressure Control and Oxidative Status Blacks Hypertensive Patients.

Impact of pre-existing hypertension and control status before atrial fibrillation onset on cardiovascular prognosis in patients with non-valvular atrial fibrillation: A real-world database analysis in Japan.

Hypertension is an important risk factor for non-valvular atrial fibrillation (NVAF) and its prognosis. However, there is no study to clarify the impact of pre-existing hypertension and BP control status before the onset of AF on the prognosis after the onset of AF. This retrospective real-world cohort analysis used data from the Japan Medical Data Center Co., Ltd database. The presence of NVAF and hypertension, plus the occurrence of adverse events, was based on ICD-10 codes in the database. The primary composite AF-related cardiovascular event end point included ischemic stroke, hemorrhagic stroke, and acute myocardial infarction. Of the 21523 patients identified as having new-onset NVAF between January 2005 and June 2016, 7885 had blood pressure (BP) data before the onset of NVAF available and were included in the analysis (4001 with pre-existing hypertension and 3884 without pre-existing hypertension). The rate of primary composite end point events was 10.3 and 4.4 per 1000 patient-years in patients with and without hypertension, respectively (P<.001). In addition, lower systolic BP (<120mmHg) before the onset of NVAF was associated with a lower incidence of cardiovascular events after the development of NVAF (P<.001). This highlights the importance of earlier and tighter 24-hour BP control before the onset of NVAF in patients with hypertension, not only for reducing the occurrence of new-onset of NVAF, but also for reducing both hemorrhagic and ischemic cardiovascular events after the onset of NVAF.

A nationwide assessment of blood pressure control and the associated factors in Chinese type 2 diabetes mellitus patients.

A subgroup analysis of the nationwide, cross-sectional 3B STUDY was performed to understand the current blood pressure (BP) control status and treatment patterns in Chinese diabetes patients as well as to identify factors associated with BP control. The demographic data, anthropometric parameters, and laboratory results were collected from 24512 type 2 diabetes patients. The BP goal was a systolic BP <130mmHg and a diastolic BP <80mmHg regardless of a history of hypertension or current antihypertensive treatment. The overall prevalence of hypertension was 59.9% with geographical differences. Among the diabetes patients with hypertension, 76.9% received antihypertensive medicines. Calcium channel blockers (39.3%), angiotensin II receptor antagonists (26.6%), and then β-blockers (14.0%) or angiotensin-converting enzyme inhibitors (13.6%) were frequently used for BP control. Only 17.5% (n=2658) of diabetes patients with hypertension reached the recommended target BP. Body mass index <24kg/m2 , urban resident, frequent physical activity, good adherence to medication, comorbidity with cardiovascular disease, achieving glycemic goal (HbA1c <7.0%), achieving lipid goal (low-density lipoprotein cholesterol <2.59mmol/L) were independent factors that predicted achievement of target BP goal. On the contrary, comorbidity with chronic kidney disease predicted failure to achieve target BP goal. Patients who were treated in a cardiology department or lived in the North were more likely to achieve BP goals. A considerable proportion of diabetic patients failed to achieve guideline-recommended BP targets. More aggressive efforts should be made to overcome the diverse barriers and facilitate the optimization of diabetes management.

A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial

Hypertension is the leading cause of cardiovascular disease globally. Despite proven benefits, hypertension control is poor. We hypothesised that a comprehensive approach to lowering blood pressure and other risk factors, informed by detailed analysis of local barriers, would be superior to usual care in individuals with poorly controlled or newly diagnosed hypertension. We tested whether a model of care involving non-physician health workers (NPHWs), primary care physicians, family, and the provision of effective medications, could substantially reduce cardiovascular disease risk. HOPE 4 was an open, community-based, cluster-randomised controlled trial involving 1371 individuals with new or poorly controlled hypertension from 30 communities (defined as townships) in Colombia and Malaysia. 16 communities were randomly assigned to control (usual care, n=727), and 14 (n=644) to the intervention. After community screening, the intervention included treatment of cardiovascular disease risk factors by NPHWs using tablet computer-based simplified management algorithms and counselling programmes; free antihypertensive and statin medications recommended by NPHWs but supervised by physicians; and support from a family member or friend (treatment supporter) to improve adherence to medications and healthy behaviours. The primary outcome was the change in Framingham Risk Score 10-year cardiovascular disease risk estimate at 12 months between intervention and control participants. The HOPE 4 trial is registered at ClinicalTrials.gov, NCT01826019. All communities completed 12-month follow-up (data on 97% of living participants, n=1299). The reduction in Framingham Risk Score for 10-year cardiovascular disease risk was -6·40% (95% CI 8·00 to -4·80) in the control group and -11·17% (-12·88 to -9·47) in the intervention group, with a difference of change of -4·78% (95% CI -7·11 to -2·44, p<0·0001). There was an absolute 11·45 mm Hg (95% CI -14·94 to -7·97) greater reduction in systolic blood pressure, and a 0·41 mmol/L (95% CI -0·60 to -0·23) reduction in LDL with the intervention group (both p<0·0001). Change in blood pressure control status (<140 mm Hg) was 69% in the intervention group versus 30% in the control group (p<0·0001). There were no safety concerns with the intervention. A comprehensive model of care led by NPHWs, involving primary care physicians and family that was informed by local context, substantially improved blood pressure control and cardiovascular disease risk. This strategy is effective, pragmatic, and has the potential to substantially reduce cardiovascular disease compared with current strategies that are typically physician based. Canadian Institutes of Health Research; Grand Challenges Canada; Ontario SPOR Support Unit and the Ontario Ministry of Health and Long-Term Care; Boehringer Ingelheim; Department of Management of Non-Communicable Diseases, WHO; and Population Health Research Institute. VIDEO ABSTRACT.

Abstract P177: The Dissociation of Heart Rate and Blood Pressure Masks the Regulatory Role of Heart Rate in Systemic Hemodynamics

Blood pressure (BP) and heart rate (HR) are independent cardiovascular risk factors but there is little information about interactions among HR, BP, and systemic hemodynamics throughout the day. We performed 24-hour ambulatory pulse wave analysis (Mobil-O-Graph, IEM, Stolberg, DE) with measurements at 20 minute intervals. Variables measured were: systolic and diastolic BP (SBP and DBP), HR, oscillometric pulse wave velocity (oPWV), stroke volume index (SVI), and total vascular resistance index (TVRI). We also performed regression analyses within-subjects to determine the slopes of the SVI-HR and TVRI-HR relationships within individuals and for the group. We studied 89 individuals (mean age 61 years, weight 84 kg, BP 138/82 mm Hg (38 normal or controlled BP, 51 uncontrolled BP), resting HR 69 beats/min (bpm), 36% non-white, 64% female); 24-hour mean HR was not correlated with corresponding SBP or DBP values (r= -0.013 and r= 0.154, pNS, respectively) and this dissociation persisted in corresponding day-time vs. night-time comparisons and subgroup stratification by BP control status, age, and gender. In contrast, 24-hour mean HR was strongly correlated with 24-hour mean cardiac index (r=0.629, p&lt;0.000) but strongly inversely related to mean 24-hour SVI and TVRI (r= -0.508 and r= -0.505, p&lt;0.000 each); each 10 beat/min change in mean HR was associated with a 2.3 mL/m 2 (6%) change in SVI and a corresponding 6% change in TVRI. Analysis of individual 24-hour studies also revealed no correlations between HR and BP but the within-individual slopes and correlation coefficients between HR and SVI or TVRI were more variable; higher oPWV (which correlated with the SD of SBP, p=.01) was associated with a lesser sensitivity of SVI to HR change and a greater sensitivity of TVRI to HR change (p&lt;0.001 each) independent of age, gender, or BP. We conclude that BP is normally independent of HR, which plays a hidden but important regulatory role in the underlying systemic hemodynamics between and within individuals. The clinical impact of differential sensitivity of systemic hemodynamics to HR change is not established but people with stiffer arteries display diminished SVI sensitivity and greater TVRI sensitivity to HR change, which may contribute to their greater SBP variability.

BLOOD PRESSURE CONTROL STATUS IN DIALYSIS PATIENTS

Objective: Blood pressure (BP) management is important for dialysis patients, because hypertension is a powerful risk factor of cardiovascular disease. However, the BP of the dialysis patients is strongly influenced by body fluid volume reduction during dialysis session and by weight gain until the next dialysis. It is reported that the larger the variation of BP during dialysis is, the worse the prognosis is. In this study, we examined BP control status during dialysis in patients on maintenance hemodialysis. Design and method: Subjects comprised 298 patients on hemodialysis (197 males, 101 females, mean age 68 ± 13 years old) who had been regularly followed at Kokura Daiichi Hospital. We assessed BP during dialysis, antihypertensive medication and comorbidity. Results: Average BP before and after dialysis were 142 ± 18/76 ± 12 and 132 ± 17/72 ± 11 mmHg, respectively. The achievement rate of target BP before dialysis (<140/90 mmHg) was 44%. Forty-one % of all patients were classified as intradialytic hypotension (systolic BP falls by 20 mmHg or more during dialysis). Thirty-one % of the patients with intradialytic hypotension had taken some vasopressors. The patients with uncontrolled BP before dialysis took greater number of antihypertensive drugs compared to good controlled patients. They were younger and showed shorter dialysis history, and higher prevalence of diabetes mellitus and intradialytic hypotension. In a multivariate analysis, predialytic systolic BP correlated positively with body mass index, intradialytic hypotension and diabetic nephropathy and negatively with dialysis history. Conclusions: The achievement rate of target BP before dialysis was low in our dialysis patients, and many patients showed intradialytic hypotension. Predialytic systolic BP was associated with higher body mass index and prevalence of intradialytic hypotension.

Knowledge, attitudes and practices related to hypertension among residents of a disadvantaged rural community in southern Zimbabwe.

BackgroundHypertension contributes significantly to cardiovascular and renal diseases. It can be controlled by lifestyle modifications, however in poor communities there is lack of awareness, and treatment and control of hypertension is often poor. The aim of this study was to determine hypertension knowledge, attitudes and practices in a disadvantaged rural community in Matebeleland South province of Zimbabwe.MethodsWe conducted a descriptive cross-sectional survey on hypertensive patients in the community. A pre-tested and validated interviewer-administered questionnaire was used to collect demographic, awareness, treatment and control data among consenting hypertensive patients.Results304 respondents were enrolled into the study (mean age, 59 years), and a majority were women (65.4%). The treatment default rate was 30.9%, and 25% of respondents on medication did not know their blood pressure control status. Knowledge on hypertension was poor, with 64.8% of respondents stating that stress was its main cause, 85.9% stated that palpitations were a symptom of hypertension and 59.8% of respondents added salt on the table. The more education respondents had received, the more likely they were knowledgeable about hypertension (odds ratio for secondary education, 3.68 [95% CI: 1.61–8.41], and for tertiary education, 7.52 [95% CI: 2.76–20.46], compared to those without formal education). Those who believed in herbal medicines (50.7%) and those who used traditional medicines (14.5%) were 53% (95% CI: 0.29–0.76) and 68% (95% CI: 0.29–0.76) less likely to be knowledgeable about hypertension compared to those who did not believe in or use traditional medicines, respectively.ConclusionMembers of the community had poor knowledge on hypertension. This was associated with a lack of education and with strong beliefs in herbal and traditional medicines in the community, which influenced attitudes and practices on hypertension. Dietary risk factors were linked to poor knowledge. Hypertensive medicine shortages at the clinic resulted in worsened hypertension care and poor hypertension outcomes in the community.

Blood pressure and cognitive performances in middle-aged adults: the Aging, Health and Work longitudinal study.

Our objective was to investigate the impact of both prevalent and incident hypertension on cognition in middle-aged individuals followed up for 10 years and to explore the extent to which blood pressure control by antihypertensive drugs could modify this relationship. Three thousand, two hundred and one participants from the Vieillissement Santé Travail (Aging, Health and Work) (VISAT) cohort study, aged 32, 42, 52 and 62 years at baseline were followed up 5 and 10 years later. Blood pressure, antihypertensive medication use as well as memory and speed cognitive performances were assessed at baseline and follow-up. Linear mixed models were used for analyses. At 10-year follow-up, compared with nonhypertensive participants, prevalent hypertensive individuals showed poorer global cognitive performances (β = -2.99 ± 0.96, P = 0.002 for participants aged 32 or 42 years at baseline and β = -5.94 ± 1.00, P < 0.001 for those aged 52 or 62). Patients with incident hypertension had poorer global cognitive performances over time compared with patients without hypertension. When considering prevalent hypertension and blood pressure control status by antihypertensive therapy, untreated and uncontrolled hypertension were associated with poorer cognitive performances than controlled and no hypertension (untreated hypertension compared with no hypertension: β = -5.51 ± 0.75, P < 0.001; uncontrolled hypertension compared with no hypertension: β = -6.13 ± 1.40, P < 0.001). Our findings showed that both prevalent and incident hypertension are associated with poorer global cognitive function in middle-aged individuals and suggested a potential preventive effect of antihypertensive therapy on cognition. Thus, for brain functioning, heightened efforts to detect hypertension and adequately treat it are of critical importance.

Heart failure with preserved ejection fraction in the elderly: pathophysiology, diagnostic and therapeutic approach.

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise. It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age. HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus, obesity, atrial fibrillation and renal dysfunction. The diagnosis relies in the integration of clinical information, laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise. Conditions that have a specific treatment such as coronary artery disease, valvular disease, cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate. Aggressive management of comorbidities, optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations. There are no specific therapies that have shown to decrease mortality in HFpEF. In symptomatic patients with history of hospital admission for decompensated heart failure, the implantation of a wireless pulmonary artery pressure monitor should be considered. Finally, given the high mortality of this condition, goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.

Blood pressure level, hypertension prevalence and control status in oldest old in China

Objective: To investigate blood pressure level, hypertension prevalence and control status in the oldest old in China. Methods: A cross-sectional data set of Chinese Longitudinal and Health Longevity Study (CLHLS) in 2014 was used to investigate the blood pressure level and hypertension prevalence and control status in the oldest old. Results: A total of 4 587 elderly people aged ≥80 years were surveyed with mean age (91.3±7.8) years old, including 1 896 males (41.3%). The mean SBP was (139.5±22.0) mmHg, DBP was (79.6±11.8) mmHg, and the pulse pressure difference was (60.0±18.7) mmHg. The prevalence rate of hypertension was 56.5% (95%CI: 55.1%- 58.0%), the awareness rate of hypertension was 52.2% (95%CI: 50.3%-54.1%), the control rate was 11.5% (95%CI: 10.3%-12.5%), and the control rate of those with awareness of hypertension was 22.2% (95%CI: 19.9%-24.4%). Age, gender, BMI, residence place and living area were related to blood pressure level and control status of the oldest old. Conclusions: The blood pressure level and the prevalence of hypertension in the oldest old in China were different from those in developing countries and adults in China, while similar to that in the younger elderly in China. The prevalence rate of hypertension was high and the control rate was low. Age, gender, BMI, residence place and living area were related with blood pressure level, hypertension prevalence and control status.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

Blood pressure and low-density lipoprotein cholesterol control status in Chinese hypertensive dyslipidemia patients during lipid-lowering therapy

ᅟThe present study comprised 17,096 Chinese hypertensive dyslipidemia patients who received lipid-lowering treatment for > 3 months in order to investigate blood pressure (BP) as well as low-density lipoprotein cholesterol (LDL-C) goal attainment rates in Chinese hypertensive dyslipidemia patients on antidyslipidemia drugs. The factors that interfered with BP, or BP and LDL-C goal attainment rates and antihypertensive treatment patterns, were analyzed. In total, 89.9% of the 17,096 hypertensive dyslipidemia patients received antihypertensive medications mainly consisting of a calcium channel blocker (CCB) (48.7%), an angiotensin receptor antagonist (ARB) (25.4%) and an angiotensin-converting enzyme inhibitor (ACEI) (15.1%). In cardiology departments, usage rates of β-blockers (19.2%) were unusually high compared to other departments (4.0–8.3%), whereas thiazide diuretics were prescribed at the lowest rate (0.3% vs 1.2–3.6%). The overall goal attainment rates for combined BP and LDL-C as well as BP or LDL-C targets were 22.9, 31.9 and 60.1%, respectively. The lowest BP, LDL-C and BP combined with LDL-C goal attainment rates were achieved in endocrine departments (19.9, 48.9 and 12.4%, respectively). Combination therapies showed no benefit particularly for BP goal achievement. A multivariate logistic regression analysis showed that age < 65 years, alcohol consumption, diabetes, coronary heart disease (CHD), cerebrovascular disease (CVD), chronic kidney disease (CKD), body mass index (BMI) ≥ 28 kg/m2 and not achieving total cholesterol goals were independent predictors for achieving BP, LDL-C or combined BP and LDL-C goals. In summary, the BP and LDL-C goal achievement rates in Chinese dyslipidemia outpatients with hypertension were low, especially in endocrine departments. Combination therapies were not associated with improvement of the goal achievement rates.Trial registrationClinical trial registration number NCT01732952