Blood Pressure Levels In Patients Research Articles

Effect of nebivolol monotherapy or combination therapy on blood pressure levels in patients with hypertension: an updated systematic review and multilevel meta-analysis of 91 randomized controlled trials.

To systematically appraise and summarize the available evidence from published randomized controlled trials considering the effect of nebivolol on blood pressure in patients with hypertension. Literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis. In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = - 6.01 mmHg; 95% CI = [- 7.46, - 4.55] and MD = - 5.01 mmHg; 95% CI = [- 5.91, - 4.11], respectively). Moreover, resulted a similar reduction in systolic BP (MD = - 0.22 mmHg; 95% CI = [- 0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to the active comparator (MD = - 0.71 mmHg; 95% CI = [- 1.27, - 0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparators, there was no significant difference in systolic BP reduction, but a significant reduction in diastolic BP favoring nebivolol. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the dose of nebivolol, age, male sex, trial duration, body mass index (BMI), baseline diabetes, heart failure, and baseline systolic and diastolic BP. Nebivolol, compared to placebo, showed a significant BP reduction and was non-inferior to other active comparators in terms of BP reduction.

Current status of research on nutritional interventions to prevent and improve gestational hypertension and pregnancy outcomes

This study hopes to comprehensively evaluate the current effectiveness and future potential of nutritional interventions in preventing and improving blood pressure levels in patients with gestational hypertension through comparative analyses of clinical data as well as comparing the different dietary structures and treatment standards of pregnant patients in different regions. Comparing the statistical differences in blood pressure, blood lipids and other data indicators among patients with different dietary nutritional structures, comparing whether nutritional interventions are conducted or not as well as the differences in the theoretical knowledge of nutritional structure teaching on the autonomous dietary structure of the pregnant population or the differences in the data of the clinically collected samples, we will continue to explore the possibilities of nutritional interventions in improving and preventing gestational hypertension as well as the outcomes of pregnancies. As well, it is hoped to further explore the contribution of targeted dietary nutritional structure in the direction of modifying pregnancy outcomes, and to provide more possibilities and theoretical foundations for the formalization of dietary nutrition into treatment protocols for the prevention of pregnancy complications in patients with gestational hypertension or in pregnant populations. Summarize the collection and summarize whether existing therapies for improving or treating gestational hypertension in conjunction with nutritional interventions can provide more significant clinical outcomes. On this basis, provide more ideas and possibilities for the incorporation of nutritional therapies into clinical treatment programs.

The effects of blueberry and cranberry supplementation on blood pressure in patients with cardiovascular diseases: A systematic review and meta-analysis of randomized clinical trials.

Blueberries and cranberries are berry fruits with the highest number of randomized clinical trials (RCTs) focusing on blood pressure (BP). This systematic review and meta-analysis of RCTs analyzed the effects of blueberry and cranberry supplementation alone and in concert with systolic BP (SBP) and diastolic BP (DBP) in patients with cardiometabolic diseases. The searches were performed until August 2023 in the following databases: PubMed, Scopus, Web of Science, Cochrane, and Embase. Studies that examined the effects of blueberry or cranberry intake/supplementation were included. The risk of bias was evaluated using the Rob 2 scale. A meta-analysis was performed to estimate the effects of blueberry and cranberry supplementation on BP levels in patients with cardiometabolic diseases. A total of 17 articles were included, from which two found significant results from blueberry and/or cranberry supplementation in reducing BP. Pooled results revealed statistically non-significant reductions of -0.81 mm Hg for SBP (95% confidence interval [CI]: -2.26, 0.63; I2 = 0%) and -0.15 mm Hg for DBP (95% CI: -1.36, 1.05; I2 = 27%). Blueberry and/or cranberry supplementation had neutral effects on SBP and DBP in patients with cardiometabolic diseases, regardless of duration or age. Further high-quality studies are needed to firmly establish clinical efficacy.

Target blood pressure level in patients in the pre- and post-stroke period: features of antihypertensive therapy depending on the stage of hypertension (literature review)

Today, the problem of managing patients in the pre- and post-stroke period is associated with the target level of blood pressure. However, it is difficult to determine, because patients differ in age, duration and stage of hypertension, and comorbidities. Instrumental studies of the brain reveal its various lesions, as well as damage to the heart, impaired autoregulation of cerebral circulation, atherosclerosis of the major vessels of the head and neck. All these factors are certainly crucial for planning the long-term antihypertensive therapy.

The role of depression and antidepressant treatment in antihypertensive medication adherence and persistence: Utilising electronic health record data

Higher blood pressure levels in patients with depression may be associated with lower adherence to antihypertensive medications (AHMs). Here, we use electronic health record (EHR) data from the Estonian Biobank (EstBB) to investigate the role of lifetime depression in AHM adherence and persistence. We also explore the relationship between antidepressant initiation and intraindividual change in AHM adherence among hypertension (HTN) patients with newly diagnosed depression. Diagnosis and pharmacy refill data were obtained from the National Health Insurance database. Adherence and persistence to AHMs were determined for hypertension (HTN) patients initiating treatment between 2009 and 2017 with a three-year follow-up period. Multivariable regression was used to explore the associations between depression and AHM adherence or persistence, adjusting for sociodemographic, genetic, and health-related factors. A linear mixed-effects model was used to estimate the effect of antidepressant treatment initiation on antihypertensive medication adherence, adjusting for age and sex. We identified 20,724 individuals with newly diagnosed HTN (6294 depression cases and 14,430 controls). Depression was associated with 6% lower probability of AHM adherence (OR = 0.943, 95%CI = 0.909–0.979) and 12% lower odds of AHM persistence (OR = 0.876, 95%CI = 0.821–0.936). Adjusting for sociodemographic, genetic, and health-related factors did not significantly influence these associations. AHM adherence increased 8% six months after initiating antidepressant therapy (N = 132; β = 0.078; 95%CI = 0.025–0.131). Based on the EHR data on EstBB participants, depression is associated with lower AHM adherence and persistence. Additionally, antidepressant therapy may help improve AHM adherence in patients with depression.

Real-world trends in pre-dialysis blood pressure levels of patients undergoing dialysis in Japan using a web-based national database.

The prevalence of hypertension is high among patients undergoing dialysis. We extracted data of patients undergoing dialysis between 2012 and 2020 with recorded pre-dialysis systolic blood pressure (SBP) using a web-based national database in Japan. Following the 2019 Japanese Society of Hypertension guidelines, we classified SBP and assessed its trends over time based on sex, age, diabetes status, and the anti-hypertensive medication use. Using the 2020 database, we examined 336,759 Japanese patients undergoing dialysis (114,249 female; 222,510 male). The mean age was 69.4±12.5years, and the mean SBP was 152.3±24.7mm Hg. The prevalence rate of pre-dialysis hypertension was 70.2%, with 32.5%, 24.5%, and 13.2% of patients having grade I, grade II, and grade III hypertension, respectively. From 2014 to 2020, prevalence rate of pre-dialysis hypertension and absolute values of pre-dialysis SBP were higher in dialysis patients with diabetes than in those without diabetes across all age groups and sexes. Younger patients with diabetes or those on anti-hypertensive medication exhibited an SBP of approximately 160mm Hg. Cerebrovascular death in patients with diabetes was associated with a higher rate of pre-dialysis hypertension than that in those without diabetes, and there was a significant difference in the prevalence of grade III hypertension between the two groups. In conclusion, the mean pre-dialysis SBP among patients undergoing dialysis remained high, and younger patients with diabetes or those receiving anti-hypertensive medications had poor blood pressure control. Optimal blood pressure management may be necessary to reduce the risk of cardiovascular mortality.

Impact of Nonsurgical Periodontal Treatment on Blood Pressure: A Prospective Cohort Study.

Arterial hypertension and periodontitis are two of the most common diseases worldwide and recent evidence supports a causal relationship between them. Despite all antihypertensive strategies, an important number of patients are undiagnosed and a large number of the diagnosed fail to achieve optimal blood pressure (BP) measurements. Some studies point out that periodontal treatment could have positive effects on BP levels. The aim of this study is to determine if nonsurgical periodontal treatment can help BP level control in prehypertensive patients with periodontitis. Thirty-five patients were included in the study and received nonsurgical periodontal treatment according to necessity. Clinical data, periodontal data, and BP measurements were taken at baseline, periodontal re-evaluation visit (4-6 weeks after treatment), and 6-month follow-up. Periodontal treatment caused a statistically significant reduction (p < 0.05) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at re-evaluation visit of 4.7 (p = 0.016) and 3.4 mm Hg (p = 0.015), respectively. The effect was maintained at 6-month follow-up visit with a reduction in SBP and DBP of 5.2 (p = 0.007) and 3.7 (p = 0.003) mm Hg, respectively. Despite the limitations of this study, it suggests that nonsurgical periodontal treatment can be effective in lowering BP levels in patients with prehypertension and periodontitis. Moreover, it highlights the importance of dentists in prevention, detection, and control of this important cardiovascular risk factor.

NURSE’S ROLE IN THE CONTROL OF ARTERIAL HYPERTENSION AND MORBIMORTALITY FACTORS IN THE ELDERLY

Arterial hypertension is a non-communicable, asymptomatic chronic disease that is entirely linked to the high rates of morbidity and mortality that affect the quality of life of the elderly. We seek to understand how arterial hypertension can be treated to reduce the number of deaths in elderly people and describe the role of the nursing team in controlling arterial hypertension. This is an integrative review established by Cooper, the searches took place in the Virtual Health Library and Pubmed, using the descriptors “hypertension”, “nurse”, “prevention”, “mortality associated with each other by the Boolean operator “and”, in the period from 2016 to 2021, resulting in the initial search of 972 articles that after applying the selection criteria and reading in full, 38 remained that made up the research corpus. The socio-environmental and genetic conditions, which when related to senescence and unhealthy life habits, imply the triggering of hypertension, a health problem with loss of quality of life and increased morbidity and mortality. Nursing professionals who work in primary care are the crucial link in the early detection and development of actions aimed at health care, aiming to control the blood pressure levels of patients affected by AH, disseminating information aimed at health education.

Unique Gene Expression Signature in Periadrenal Adipose Tissue Identifies a High Blood Pressure Group in Patients With Cushing Syndrome.

Cushing syndrome (CS) is a rare disease caused by excess cortisol levels with high cardiovascular morbidity and mortality. Hypertension in CS promotes hypercortisolism-associated cardiovascular events. Adipose tissue is a highly plastic tissue with most cell types strongly affected by the excess cortisol exposure. We hypothesized that the molecular and cellular changes of periadrenal adipose tissue in response to cortisol excess impact systemic blood pressure levels in patients with CS. We investigated gene expression signatures in periadrenal adipose tissue from patients with adrenal CS collected during adrenal surgery. During active CS we observed a downregulation of gene programs associated with inflammation in periadrenal adipose tissue. In addition, we observed a clustering of the patients based on tissue gene expression profiles into 2 groups that differed in blood pressure levels (CS low blood pressure and CS high blood pressure). The 2 clusters showed significant differences in gene expression pattens of the renin-angiotensin-aldosterone-system. Renin was the strongest regulated gene compared with control patients and its expression correlated with increased blood pressure observed in our patients with CS. In the CS high blood pressure group, systemic renin plasma levels were suppressed indicative of an abnormal blood pressure associated with periadrenal adipose tissue renin-angiotensin-aldosterone-system activation. Here, we show for the first time a relevant association of the local renin-angiotensin-aldosterone-system and systemic blood pressure levels in patients with CS. Patients from the CS high blood pressure group still had increased blood pressure levels after 6 months in remission, highlighting the importance of local tissue effects on long-term systemic effects observed in CS.

EFFECT OF LOW BLOOD PRESSURE ON ACUTE HEART FAILURE PROGNOSIS ACCORDING TO HEART FAILURE CLASSIFICATION

Objective: Blood pressure (BP) management is complex in patients with heart failure (HF), but is important with respect to HF progression and clinical prognosis. We evaluated the actual prescribing patterns of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) and beta-blockers (BB) in patients with HF at discharge and clinical prognosis according to initial BP level in patients with acute HF. Design and method: Study data were obtained from a multicenter cohort that included patients hospitalized for acute HF. Patients who had available data regarding initial BP and left ventricular ejection fraction were included in this analysis. The patients were classified into two groups: heart failure reduced ejection fraction (HFrEF) group versus. HF mildly reduced ejection fraction (HFmrEF) and HF preserved ejection fraction (HFpEF) group. Initial systolic blood pressure (SBP) was classified into &lt;100, 100-119, 120-139, 140-159, and &gt; = 160mmHg, and diastolic blood pressure (DBP) into &lt;50, 50-69, 70-89, 90-109, &gt; = 110mmHg. Results: Among 2,778 patients, HFrEF patients used ACEi, ARB, or BB at discharge even if their SBP was as low as less than 100mmHg, and there was no significant difference in frequency of medication use by BP level. However, HFmrEF and HFpEF patients showed a tendency to significantly decrease the frequency of medication use as BP decreased. In HFrEF, the lower the initial BP, the higher the incidence of all-cause death and composite clinical events including HF readmission or all-cause death (Table). However, in HFpEF and HFmrEF, there was no significant difference in clinical outcome according to BP. In addition, initial SBP (&lt;120mmHg) was independently associated with 1.81-fold increased risk of long-term mortality [Odds ratio (OR) 1.81, 95% confidence interval (CI) 1.349-2.417, p &lt; 0.001], and initial DBP (&lt;80mmHg) was also 2.24-fold increased risk [OR 2.24, 95% CI 1.645-3.053, p &lt; 0.001]. Conclusions: Poor clinical prognosis is expected if the initial BP low in patients with HFrEF, and low BP (&lt;120/80mmHg) affects increased mortality independently of HF medication use. Clinicians should be aware of the effect of low BP in patients with acute HF and provide delicate BP control.

Effect of Sleep Duration on Blood Pressure in Patients with SARS-CoV-2 Infection and Hypertensive Urgencies in Shanghai Fangcang Shelter Hospital.

To evaluate the effect of sleep duration on blood pressure in patients with hypertension urgencies combined with SARS-CoV-2 infection in a Fangcang shelter hospital. From April 10, 2020 to May 20, 2022, we statistically analyzed the blood pressure and sleep conditions of 52 patients with combined hypertension urgencies and SARS-CoV-2 infection admitted in Shanghai National Convention and Exhibition Center Fangcang shelter hospital. They were divided into the short-term (daily sleep duration: <7 h) and normal sleep group (7-9 h). We performed a comparison of the control effects of basic antihypertensive drugs. Additionally, patients in the short-term sleep group underwent drug therapy for sleep regulation and continuous monitoring of blood pressure. Among these patients, the blood pressure was higher in the short-term sleep group than that of the normal sleep group, and also more difficult to control (p <0.05). Furthermore, the blood pressure of the patients in the short-term sleep group was more easily controlled after treatment with drugs for sleep regulation and basic antihypertensive drugs (p <0.05). The blood pressure level in patients with combined SARS-CoV-2 infection and hypertension urgencies was higher in those with a shorter duration of daily sleep, and also more difficult to control in Fangcang shelter hospital. Drug therapy for sleep regulation should be administered early to obtain sufficient blood pressure control effects.

Effect of cortisol on achieving target blood pressure levels in patients with resistant hypertension and chronic kidney disease

Background. Resistant hypertension is defined as failure to achieve the target blood pressure (BP), despite treatment with at least three antihypertensive drugs that include a diuretic, and is associated with a poor prognosis. This is caused by organ damage from long-term exposure to high blood pressure, and is also linked to diabetes mellitus, chronic kidney disease and obesity. The purpose of the work is to evaluate biological markers associated with failure to achieve the target level of blood pressure in patients taking 3 or more antihypertensive drugs, depending on the presence of chronic kidney disease. Materials and methods. The study included 1146 patients with resistant hypertension who took 3 or more antihypertensive drugs. They were examined using both instrumental and laboratory methods with the measurement of office blood pressure upon admission to the hospital and upon discharge, evaluation of biochemical blood parameters, levels of creatinine, blood lipids, renin, blood aldosterone, cortisol. Results. The average age of the patients was 57.90±0.37 years. There were more women than men— 62.7 versus 36.7%. The body mass index was 31.00±0.19kg/m2. The average office systolic/diastolic BP upon admission to the hospital was 174.60±0.64/100.50±0.38 mmHg. 22.4% of patients had glomerular filtration rate (GFR) &lt;60ml/min/1.73m2. In the subgroup with GFR ≥60ml/min/1.73m2, the achievement of the target BP was 44.76%, which is significantly higher than in patients with GFR &lt;60ml/min/1.73m2 (12.56%, p&lt;0.05). Blood cortisol level in the subgroups with failure to reach the target level of office blood pressure was 127.72±4.20 μg/dl (with GFR&lt;60 ml/min/1.73m2) and 163.71±15.20 μg/dl (GFR ≥60ml/min/1.73m2), which was significantly higher compared to the patients with the target BP level: 6.02±0.90 μg/dl (with GFR &lt;60ml/min/1.73m2; p&lt;0.05) and 47.84±4.40 μg/dl (in the subgroup with GFR ≥60ml/min/1.73m2; p&lt;0.05). Conclusions. In patients with resistant hypertension, elevated blood cortisol content, regardless of GFR, was associated with failure to achieve the target level of office blood pressure.

Arterial hypertension and chronic kidney disease: consensus statement on patient management

Arterial hypertension is both the cause and the result of the progression of chronic kidney disease, which affects about 10-15% of the population worldwide and the prevalence of which is steadily increasing. As the glomerular filtration rate decreases, the blood pressure level rises respectively. Arterial hypertension (AH) and chronic kidney disease (CKD) are independent and well-known risk factors for the development of cardiovascular diseases, and their combination significantly increases the incidence and mortality from cardiovascular disease. Blood pressure control is the most important factor in slowing the progression of CKD and reducing cardiovascular risk. Currently, there is a place for discussions in the scientific community regarding the target blood pressure levels in patients suffering from CKD. Non-pharmacological methods of treatment can reduce the level of blood pressure in some cases, but do not help to achieve the target values in most of the cases. Patients with hypertension and CKD need combined drug therapy. Certain modern drugs have additional cardio- and nephroprotective properties and should be considered as the first line of therapy. A personalized approach based on evidence-based principles makes it possible to achieve blood pressure control, reducing cardiovascular risk and slowing the progression of CKD. This consensus summarizes the current literature data, as well as highlights the main approaches to the management of patients with hypertension and CKD.

Physical activity and arterial hypertension

Arterial hypertension is the most important modifiable cardiovascular risk factor for all-cause morbidity and mortality worldwide. It is associated with an increased risk of cardiovascular diseases (CVD) and cognitive impairment. In this regard, accumulating evidence points to beneficial effects of intensified blood pressure lowering by implementation of protective lifestyle patterns (e.g. physical activity, diet) or pharmacotherapy. The aim of this clinical review is to summarize the role of physical activity and/or exercise in prevention and treatment of arterial hypertension. Epidemiology, prospective observational studies, and randomized controlled trials have shown positive effects of physical activity on blood pressure levels in patients with hypertension and in patients with high-normal and normal blood pressure. Thus, physical activity can prevent or slow down micro- and macrovascular end-organ damage. Physical activity should be recommended for prevention and treatment of all hypertension grades, but most patients with hypertension will concomitantly require drug treatment (depending on hypertension grade and individual cardiovascular risk profile). Currently, increasing attention is directed to the role of personalized exercise prescriptions for prevention and treatment of arterial hypertension and for addressing cardiometabolic risk.

Obstructive sleep apnea syndrome and cardiovascular risk factors in the antihypertensive therapy "escape" phenomenon

To assess the role of obstructive sleep apnea and other cardiovascular (CV) risk factors in the development of the antihypertensive therapy (AHT) efficacy "escape" phenomenon in patients with arterial hypertension (AH). The data of 75 patients with AH stage I-II, grades 1-3 were proceeded. All patients included in the study underwent night respiratory monitoring. After AHT prescription, blood pressure (BP) was monitored by three measurement methods (office, daily monitoring and self-control of blood pressure) - initially, in 1, 3 and 6 months after the inclusion - in order to confirm the initial therapy efficacy and to identify or exclude the "escape" phenomenon. In 36.0% of patients, the "escape" phenomenon was diagnosed in 1 or 3 months of observation. When comparing the group with the "escape" phenomenon, an initially higher level of systolic BP was revealed according to office measurements, 24-hour monitoring and self-control BP monitoring (134.0±4.7 mmHg vs 126.0±8.5 mmHg; 129.0±2.3 mmHg vs 121.0±7.7 mmHg; 131.0±8.2 mmHg vs 121.5±6.2 mmHg resp.; р<0,05). There were no differences in sleep apnea and CV risk factors between the groups. However in patients with a minimal SpO2≤85% during sleep, there were a higher levels of office systolic BP both before the AHT prescription, and during its use (157.6±10.4 mmHg vs 152.4±8.1 mmHg resp., р<0,05; 132.0±6.8 vs 127.1±8.9 mmHg resp.; р<0,05), and mean 24-hour systolic BP (125.7±5.9 vs 121.6±8.2 mmHg resp.; р<0,05) - compared with patients with a minimum SpO2>85%. The higher BP level in patients with lover nocturnal hypoxemia does not allow us to exclude the delayed negative impact of obstructive sleep apnea, especially severe, on the BP profile in case of initially successful AH control.

Effects of brisk walking on fasting blood glucose and blood pressure in diabetic patients

Background: Aerobic exercises have been administered as an adjunct treatment for health conditions; however, the effects of brisk walking on Type 2 diabetes mellitus (T2DM) patients living with hypertension in Ghana are yet to be explored.Aim: To determine the effects of brisk walking on fasting blood glucose and blood pressure of patients with T2DM living with hypertension in Ghana.Setting: The National Diabetes Management and Research centre at Korle-Bu Teaching Hospital.Methods: Males and females above 18 years with T2DM and hypertension were included. Fasting blood glucose, anthropometric measurements and distance walked were measured at baseline and after 8 weeks of intervention. The intervention consisted of brisk walking three times a week for 8 weeks.Results: Sixty participants completed the intervention. There was a statistically significant reduction of fasting blood glucose (baseline: 8.79 mmol/L (3.55), after intervention: 7.62 mmol/L (2.73) with p = 0.02) and blood pressure levels: (systolic blood pressure baseline: 141.12 mmHg (2.91) after intervention 120.75 mmHg (1.21) with p = 0.00); diastolic blood pressure (baseline: 80.78 mmHg (1.66), after intervention mmHg 69.38 (1.05) with p = 0.00) between baseline and post-intervention.Conclusion: Eight weeks of brisk walking reduced the levels of fasting blood glucose and blood pressure in patients with T2DM and hypertension.Contribution: This study will enlighten healthcare workers about the integration of brisk walking as a possible adjunct to control blood glucose and blood pressure levels in patients with T2DM and hypertension.

Device and non-device-guided slow breathing to reduce blood pressure in hypertensive patients: a systematic review and meta-analysis

Abstract Backgroud Hypertension (HTN) is a multifactorial chronic disease. Considering the high prevalence rates of this disease, treatment of HTN is necessary, not only to reduce BP levels, but also to prevent the development of cardiovascular, cerebrovascular and kidney diseases. This treatment can be medication and/or non-farmacological, like device-guided slow breathing (DGSB) or non-device-guided slow breathing (NDGSB). Purpose The aim of this systematic review and meta-analysis is to summarize the effects of DGSB and NDGSB on blood pressure levels of patients with hypertension. Methods This study is systematic review and meta-analysis of randomized clinical trials, about hypertensive patients, with or without comorbidity, over 18 years old, of both sexes, with or without hypertensive medication. The selected studies showed comparisons between groups that performed DGSB and/or NDGSB with control conditions. The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. Results Twenty-two studies involving 17,214 participants were included in the quantitative analysis. Considerable heterogeneity was revealed between studies. Using random effect model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms BP values and in relation to their variations (SBP, MD −2.13 mmHg, [95% CI −12.71 to 8.44], 288 individuals; I2=93%, high heterogenity: DBP, MD −0.90, 95% CI −3.97 to 2.11, 288 individuals; I2=63%, substantial heterogenity. SBP variations MD −2.42, 95% CI −7.24 to 2.40, 443 individuals; I2=85% high heterogenity/DBP variations MD −1.67, 95% CI −4.57 to 1.24, 443 individuals; I2=80%, high heterogenity). Conclusion Based on these results it appears that DGSB did not reduce blood pressure in hypertensive patients and NDGSB is a new path for future. Funding Acknowledgement Type of funding sources: None.

PECULIARITIES OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING INDICES IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

Relevance. Until now, there is an ongoing debate about the value of different indicators of blood pressure (BP) − systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse blood pressure (PBP) as predictors of essential hypertension (EH). In this regard the issue of target BP levels in patients of different ages remains studied incompletely. Objective is to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups. Materials and methods. ABPM indicators were determined in 130 patients who were divided into 4 groups. 1st group (n=57) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old); 3rd group (n=15) – middle-aged patients without EH – control for the 1st group; 4th group (n=15) − elderly patients without EH − control for the 2nd group. Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily SBP (mm Hg), the average daly DBP (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP. Results. In group 1 the average and maximal DBP were lower than in group 2 by 7,4% (p&lt;0,001) and 13,1% (p&lt;0,05), respectively. In group 1, the average daily and maximal SBP decreased by 3,8% and 4,1%, respectively; average heart rate by 3,8%; DI of SBP by 7,8% and DI of average BP by 5,8% but the data were unreliably smaller compared to the data of middle-aged patients. In group 1, the maximal DBP, DI SBP and DBP were not significantly different from the corresponding indicators in the control group. The maximal DBP was higher by 29,3% and amounted to 115,6±21,0 mm Hg and DI SBP and DI DBP are lower by 11,1% and 17,9%, respectively; and were equal to 9,6±7,4 and 13,8±8,1, respectively. In the 2nd group the following parameters decreased unreliably (p&gt;0,05): heart rate by 8,6% and was 63,0±9,1/min., DI SBP by 17,6% and was 8,9±5,5%; DI DBP by 16,1% and was 14,1±7,1%; DI of average BP– by 20,4% and was equal to 11,3±6,1%. Conclusions. It is found that with the age DBP decreases with steadily increased SBP in hypertensive patients. The average daily and the maximal daily DBP are significantly less by 7,4% (p&lt;0,001) and 13,1% (p&lt;0,05) accordingly in elderly patients compared with the middle-aged.

Feasibility and efficacy of a nurse practitioner-and pharmacist-led hypertension clinic.

Hypertension (HTN) affects over one third of adults in the United States. Blood pressure (BP) management and patient education are provided by physicians, advanced practice clinicians, pharmacists, and nurses. In the traditional medical/clinic model, physicians have provided and directed HTN care. However, advanced practice nurses and pharmacists are also well trained and positioned to manage HTN. The purpose of this study was to explore the feasibility of an HTN clinic, led by a nurse practitioner (NP) and PharmD, specifically analyzing if targeted HTN can be achieved in this setting. Registry data were used to analyze the initial and the most recent visit BP levels in patients who were seen in an NP/PharmD-led HTN clinic. Measures of central tendency and differences between initial and most recent visit were also compared. A total of 46 patients were included in this analysis. Data showed that there was no statistically significant difference in the first visit (144/86) and the most recent visit (138/84) BP ( p = .26), but that there was a clinical trend in decreasing BP as well as narrowing of BP ranges and interquartile ranges between visit. The NP/PharmD-led clinic is feasible and can help lower BP and narrow ranges toward targeted BP.

Network Meta-Analysis of the Antihypertensive Effect of Traditional Chinese Exercises on Patients with Essential Hypertension.

Background In recent years, traditional Chinese exercises (TCEs) have been gradually used to reduce the blood pressure levels of patients with essential hypertension. However, there are several types of TCEs, and there is no comparative study on the antihypertensive effects of various TCEs in patients with essential hypertension. Objective The objective is to compare the therapeutic effects of Taijiquan (TJQ), Baduanjin (BDJ), Wuqinxi (WQX), and Yijinjing (YJJ) on essential hypertension and provide a reference for clinical treatment and scheme optimization. Methods The China National Knowledge Infrastructure (CNKI), Wanfang, China Scientific Journal Database, China Biology Medicine database (CBM), PubMed, Embase, Cochrane Library, and Web of Science databases were searched to collect all randomized controlled trials (RCTs) of TCEs in the treatment of essential hypertension. The search time was from the establishment of each database to November 2021. After data extraction and quality evaluation, the network meta-analysis was performed with Stata 16.0 and ADDIS 1.16.8. Results Finally, 45 RCTs involving 3864 patients were included. Network meta-analysis showed that YJJ had the best effect in reducing systolic blood pressure, and the difference was statistically significant [MD = −14.27, 95% CI = (−20.53∼−8.08), P < 0.05]. The best probability ranking was YJJ (P=0.736) > TJQ (P=0.203) > WQX (P=0.059) > BDJ (P=0.002). In terms of reducing diastolic blood pressure, the treatment effect of YJJ was the best, and the difference was statistically significant [MD = −7.77, 95% CI (−12.19∼−3.33), P < 0.05]. The best probability ranking was YJJ (P=0.702) > TJQ (P=0.178) > WQX (P=0.095) > BDJ (P=0.025). Conclusion The results showed that TCEs significantly reduced systolic and diastolic blood pressure compared with the control group, and YJJ might be the best choice. However, a larger sample, multicenter, double-blinded, high-quality RCTs are needed to make clear conclusions.