Blood Pressure Levels In Patients Research Articles

E0281 Relationship between albuminuria and blood pressure level in patients with essential hypertension

ObjectiveTo investigate the relationship between albuminuria detection rate and blood pressure level or body weight index (BMI) in patients with essential hypertension in China's five regions.Method5021 patients with clearly diagnosed...

Self-Management Better than Usual Care in Reducing Blood Pressure Levels in Patients with Uncontrolled Hypertension

Self-Management Better than Usual Care in Reducing Blood Pressure Levels in Patients with Uncontrolled Hypertension

Systolic blood pressure contributes to intracerebral haemorrhage after thrombolysis for ischemic stroke

The frequency and risk factors for intracerebral haemorrhage (ICH) after ischemic stroke are well-known. ICH frequency is increased by the use of antithrombotic or thrombolytic drugs. Several experimental studies have demonstrated a relationship between ICH and hypertension after fibrinolysis, but the optimal blood pressure levels in patients treated with recombinant tissue plasminogen activator (rTPA) are as yet unknown. We evaluated the role of blood pressure in patients with ischemic stroke treated with rTPA within 3 h of symptom onset. We treated 86 consecutive patients admitted to our stroke unit between 2002 and 2008 and prospectively recorded the clinical and instrumental data in our stroke registry. We evaluated haemorrhagic complications by reviewing imaging findings. Blood pressure was recorded before rTPA and at 6, 12, 18, and 32 h. Total cerebral haemorrhage occurred in eleven (12.7%) patients, and symptomatic intracerebral haemorrhage occurred in seven (8.1%). We failed to find a correlation between blood pressure levels and stroke severity at admission. High blood pressure levels correlated with a worse outcome. Systolic blood pressure was significantly higher in ICH patients relative to rTPA-treated patients without haemorrhagic complications (p < 0.03). This study indicates that rTPA-induced haemorrhage is influenced by systolic blood pressure. More aggressive pharmacological reduction of hypertension during fibrinolysis and the subsequent 32 h may reduce this complication.

A study on clinical and sonographic features in obese and nonobese patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an endocrine metabolic dysfunction closely associated with obesity, which predisposes to pregnancy complications. PCOS is a common endocrine disorder affecting 5-10% of the population. It is characterized by chronic anovulation and hyperandrogenism with clinical manifestations of oligomenorrhea, hirsutism and acne. Obese females are at higher risk for metabolic syndrome due to severe hyperandrogenemia, which also leads to high blood pressure. To determine, among patients with PCOS, the correlation of body mass index (BMI) with (1) the clinical manifestations of PCOS and (2) blood pressure. We performed a cross-sectional study of 62 women of reproductive age (29-43 years), who attended the Obstetrics and Gynecology Clinic at King Fahd National Guard Hospital in Riyadh, Kingdom of Saudi Arabia, with the confirmed diagnosis of PCOS. These patients were divided into two BMI groups: nonobese (BMI less than 25 kg/m(2)) and obese (BMI more than 25 kg/m(2)). Patients' waist to hip ratio, acne, hirsutism, and systolic and diastolic blood pressures were also recorded as clinical manifestations in PCOS and compared between the two BMI groups. The mean age of the patients was 35.85 +/- 5.03 years, BMI was 31.91 +/- 6.40 kg/m(2), waist-hip ratio was 0.82 +/- 0.067, Ferriman and Gallway's score for hirsutism was 3.63 +/- 4.35, systolic blood pressure was 113.02 +/- 16.10 mmHg, diastolic blood pressure was 71.79 +/- 10.04 mmHg, and acne was present in 24 cases (38.7%). When the groups were compared according to BMI, a significant increase in systolic and diastolic blood pressures (p = 0.001 and 0.003, respectively) was seen in obese patients, but there was no significant rise in the waist-hip ratio and hirsutism score. We observed a significant and progressive effect of BMI on clinical manifestations and blood pressure levels in patients with PCOS.

AS-226: The Level of B-Type Natriuretic Peptide Relates to Left Ventricular Hypertrophy After Acute Myocardial Infarction

Left ventricular hypertrophy (LVH) is a strong risk factor for future cardiovascular events of blood pressure levels in patients with essential hypertension and is a part of progressive morphologic LV change after myocardial infarction (MI). The objective of this study was to assess the factors associated with LVH in the first 6 months after acute myocardial infarction (AMI).

The effect of intravitreal bevacizumab (avastin) administration on systemic hypertension

To determine the short-term effect of intravitreal bevacizumab administration on systemic blood pressure levels of patients and to evaluate the safety of the drug in these patients. Study population was divided into two groups: group A comprised patients who had hypertension and were under medication with antihypertensive drugs; group B comprised patients with normal blood pressure and were not under medication with antihypertensive drugs. All patients were graded according to their blood pressure levels before single dose of bevacizumab (0.05 ml; 1.25 mg) injection, and at day 1 and weeks 1, 3, and 6 thereafter. The blood pressure levels were analysed using repeated measures of analysis of variance (ANOVA). A P-value of <0.05 was considered significant. The study population included 82 patients with a mean age of 67.2+/-5.2 years. In group A, the systolic blood pressure levels showed significant increases at weeks 1, 3, and 6 (P=0.001, P<0.001, and P=0.003, respectively) compared with baseline. Similarly, diastolic blood pressure levels were significantly higher at weeks 3 (P<0.001) and 6 (P=0.016). In group B, the mean systolic and diastolic blood pressure levels showed significant elevations only at week 3 (P=0.004 and P<0.001, respectively). The percentages of both group A and B patients with normal blood pressure decreased at week 3 compared with baseline (P<0.001 and P=0.012 for groups A and B, respectively). The findings of this study show that there is a risk of disregulation of blood pressure levels or persistence of hypertension in hypertensive patients after intravitreal bevacizumab injections.

Poor metabolic and blood pressure control in patients with diabetic retinopathy attending a tertiary ophthalmic hospital in Australia

Aim To determine the adherence to recommended glycemic and blood pressure levels in patients with diabetic retinopathy (DR). Methods A retrospective study in a tertiary eye clinic in Melbourne, Australia. Data pertaining to blood pressure (BP) and glycosylated hemoglobin (HbA1c) level were extracted from charts over a 3-month period. Optimal HbA1c was defined as levels <7%, and optimal BP control was defined as systolic/diastolic <130/80 mmHg. Results Of the 483 patients with DR in this study, only 54% (259/482) had a recorded HbA1c measurement. Of these, only 14% (36/259) had an optimal HbA1c level. Patients with longer diabetes duration were less likely to attain optimal HbA1c levels (age and gender adjusted odds ratio (OR) 0.23; 95% confidence intervals (CIs) 0.08–0.71 for diabetes duration 11–19 years, and OR 0.18%, 95% CI 0.06–0.58 for duration >20 years versus ≤5 years). Optimal BP control was attained in only 18% (86/483) and was associated with younger age (OR 0.98; 95% CI 0.96–0.99, per year increase in age). Conclusion Adherence to clinical guidelines for glycemic and BP control in patients with DR was low, even in a well-developed healthcare system with free ophthalmic care access.

Combination therapy with valsartan/hydrochlorothiazide at doses up to 320/25 mg improves blood pressure levels in patients with hypertension inadequately controlled by valsartan 320 mg monotherapy

Objectives. To investigate the efficacy and tolerability of valsartan (Val) 320 mg once daily (o.d.), Val/hydrochlorothiazide (HCTZ) 320/12.5 mg o.d. and Val/HCTZ 320/25 mg o.d. in patients with hypertension not adequately controlled by Val monotherapy. Methods. This double‐blind, active‐controlled, parallel‐group, randomized trial recruited patients ⩾18 years with mild‐to‐moderate essential hypertension, defined as mean sitting diastolic blood pressure (MSDBP) of ⩾95 mmHg and <110 mmHg without treatment. After washout, 3805 eligible patients received Val 320 mg o.d. single‐blind for 4 weeks. Subsequently, patients with MSDBP ⩾90 and <110 mmHg (n = 2702) were randomized to double‐blind treatment with Val 320 mg, Val/HCTZ 320/12.5 mg or Val/HCTZ 320/25 mg for 8 weeks. Mean changes in MSDBP and mean sitting systolic BP (MSSBP) from the start of the single‐blind period were analysed, as well as the proportion of responders (MSDBP <90 mmHg or ⩾10 mmHg decrease from the start of the double‐blind period). Tolerability and safety were also assessed. Results. Reductions in MSDBP and MSSBP were observed in all groups. Both combinations were associated with significantly greater reductions than monotherapy for MSDBP and MSSBP at Weeks 8 and 12 (all p<0.0001). Both combinations also resulted in significantly greater proportion of responders at study end (74.9% and 68.8% for Val/HCTZ 320/25 mg and Val/HCTZ 320/12.5 mg, respectively) than monotherapy (52.7%; both p<0.0001). In addition, a dose–response was observed with increasing dose of HCTZ with respect to MSSBP. All treatments were well tolerated. Conclusions. The combination of Val and HCTZ at doses of 320/12.5 mg and 320/25 mg increases antihypertensive efficacy in patients with mild‐to‐moderate hypertension inadequately controlled with Val 320 mg monotherapy, without compromising tolerability.

Impact of body mass index on blood pressure levels in patients with polycystic ovary syndrome

As there is controversy about the prevalence of hypertension in patients with polycystic ovary syndrome (PCOS) and, up to the present moment, no studies have evaluated the impact of body mass index (BMI) on blood pressure levels (BP) in these patients, we studied retrospectively sixty-nine patients with PCOS, with BMI of 29.0 +/- 6.7 kg/m(2) and aged 25.6 +/-5.6 yr, subdivided into three groups according to BMI (normal, overweight and obese) and evaluated regarding BP (mercury sphygmomanometer), basal hormonal profile, fasting glucose, and insulin sensitivity (HOMA-IR). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were normal (118.1 +/- 17.0 and 74.7+/- 11.5 mmHg, respectively), with a hypertension prevalence of 20.3%. Of these patients, 78.6% were obese and 21.4% were overweight. When the groups were compared according to BMI, a significant increase in SBP and DBP was observed (higher in overweight and obese patients for SBP and higher in obese for DBP), as well as a significant progressive increase in glucose, insulin, homeostatic model assessment, and a significant progressive decline in LH levels. When the patients were subdivided as normotensive or hypertensive, a significant difference was observed only for BMI (28.2 +/- 6.1 and 34.7 +/- 8.6 kg/m(2), respectively; p = 0.007). In conclusion, we observed a significant and progressive impact of BMI on blood pressure levels in our patients with polycystic ovary syndrome.

Home blood pressure monitoring in general practice: expectations and concerns

Home blood pressure monitoring in general practice: expectations and concerns

24-Hour ambulatory blood pressure monitoring

In industrialized countries, the management of hypertension is the principal reason for patients’ visits to physicians, and it is also the principal use for prescription drugs. However, the inherent variability of blood pressure (BP) from moment to moment and day to day makes it difficult for physicians to classify a patient as either normotensive or hypertensive. In addition, BP levels tend to be elevated in the clinical setting. These factors can lead to inaccuracies in classifying patient BP levels. The use of noninvasive ambulatory blood pressure monitoring (ABPM), which became a practical reality in the 1960s, has grown dramatically in recent years. The increased use of this diagnostic tool is underscored by the large number of ABPM devices commercially available: N40 at last count. In the United States, the Centers for Medicare and Medicaid Services recently approved government payment to physicians for beneficiaries who receive ABPM when bwhite coat Q hypertension is suspected. Despite the limited approval, ABPM may rapidly evolve from a procedure used occasionally in select clinical settings to a widely applied technique that is used across a broad range of medical specialties. Against this background, the Duke Clinical Research Institute and the American Heart Journal convened a panel of experts in ABPM. The main goal of the meeting was to identify the utility and role of ABPM in contemporary clinical practice. This article summarizes the proceedings of the conference; it is not, however, a comprehensive overview of all the issues in ABPM. Instead, it focuses on 3 important clinical areas: the utility of ABPM for risk prediction, the application of ABPM in clinical practice, and the role of ABPM in the evaluation of antihypertensive agents. For each of these areas, this article highlights areas where consensus exists among experts and identifies key issues that require further discussion and research.

Short-term blood pressure and heart rate variability in congenital central hypoventilation syndrome (Ondine's curse)

The effect of CCHS (congenital central hypoventilation syndrome, or Ondine's curse) on short-term BP (blood pressure) and HR (heart rate) variability was evaluated in 16-year-old subjects presenting a form of CCHS requiring night ventilatory assistance. The 12 patients were compared with 12 age- and gender-matched healthy volunteers. Recordings were obtained during daytime while the subjects were breathing spontaneously. Continuous BP was measured with a Finapres device in the supine, head-up tilt and standing positions. The manoeuvre of actively standing was also analysed. HR levels were elevated in CCHS subjects at supine rest (+23%) with a reduced HR overall variability (-88%). The low- and high-frequency components of HR variability were affected. BP levels were preserved at rest, but the manoeuvres demonstrated a limited capacity to elevate BP. There was no overshoot in BP during the manoeuvre of actively standing, and steady standing BP levels in patients were not higher than supine BP levels as usually observed in healthy controls. The spontaneous baroreflex sensitivity estimated using the sequence technique or the cross-spectral analysis fell in the patients to approx. one-third of the sensitivity estimated in the healthy controls whatever the position. This cardiovascular profile suggests a predominant vagal dysfunction with signs of vagal withdrawal and baroreflex failure, and relative preservation of the cardiac and vascular sympathetic function. It is likely that the impaired ontogeny of the visceral reflexes, considered now to cause CCHS syndrome, includes the baroreceptive pathway and mainly its vagal component.

A novel approach to treatment of hypertension in diabetic patients - a multicenter, double-blind, randomized study comparing the efficacy of combination therapy of Eprosartan versus Ramipril with low-dose Hydrochlorothiazide and Moxonidine on blood pressure levels in patients with hypertension and associated diabetes mellitus type 2 - rationale and design [ISRCTN55725285

Hypertension and diabetes mellitus are closely interrelated and coexist in as many as two-thirds of patients with type 2 diabetes. The consequent risk of such an association is an accelerated development of atherosclerotic cardiovascular disease and nephropathy complications.In choosing an antihypertensive agent, effectiveness needs to be accompanied by favourable metabolic, cardioprotective, and nephroprotective properties. Given the multifactorial nature of hypertension, the approach that has gained widespread agreement is treatment with more than one agent. Agents with different mechanisms of action increase antihypertensive efficacy because of synergistic impacts on the cardiovascular system. Combination therapy allows the use of lower doses of each antihypertensive agent which accounts for the excellent tolerability of combination products.The aim of the present study is to quantify the efficacy of combination therapy of Eprosartan 600 mg respectively Ramipril 5 mg with low-dose Hydrochlorothiazide and Moxonidine on blood pressure levels in patients with essential hypertension and associated diabetes mellitus type 2.The use of monotherapy (Eprosartan or Ramipril) followed by addition of low-dose Hydrochlorothiazide as second agent and of Moxonidine as a third agent will be individualized to the severity of hypertension in the particular patient and to his/her degree of response to current treatment.

Pharmacist intervention program for control of hypertension.

Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment. To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP. Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE-PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, population was stratified by family income in the analyses. Compared with the control group, the pharmacy program resulted in significant systolic BP reduction (-7.8 vs. 0.5 mm Hg; p = 0.01) and an increase in the proportion of controlled patients only for those with high incomes. In the high-income group, the program also had a positive impact on physical activity, self-reported adherence, health concerns, and information transmitted. The low-income group did not appear to benefit from the program. Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents. Impact of pharmacist intervention on BP differed according to patient income status.

Blood pressure in patients with primary aldosteronism is influenced by bradykinin B(2) receptor and alpha-adducin gene polymorphisms.

Primary aldosteronism (PA) is the most common cause of endocrine hypertension. PA is most frequently presented as moderate to severe hypertension, but the clinical and biochemical features vary widely. The aim of our study was to identify genetic variants that influence the phenotype of patients with PA. We hypothesized that genetic variants potentially affecting aldosterone production (aldosterone synthase, CYP11B2), renal proximal tubule reabsorption (alpha-adducin), or the mechanisms of counterbalance leading to vasodilatation and sodium excretion (bradykinin B(2)-receptor, B(2)R) could influence the clinical and biochemical characteristics of patients with PA. We studied three polymorphisms of these genes (C-344T of CYP11B2, G460W of alpha-adducin, and C-58T of B(2)R) in 167 primary aldosteronism patients (56 with aldosterone-producing adenoma and 111 with idiopathic hyperaldosteronism). B(2)R and alpha-adducin genotypes were strong independent predictors of both systolic and diastolic blood pressure levels; plasma renin activity and aldosterone also play a marginal role on BP levels. Body mass index, age, sex, and CYP11B2 genotype displayed no significant effect on the clinical parameters of our population. In particular, alpha-adducin and B(2)R polymorphisms accounted for 13.2% and 11.0% of the systolic and diastolic blood pressure variance, respectively. These data suggest that genetic variants of alpha-adducin and the bradykinin B(2)-R influence the blood pressure levels in patients with primary aldosteronism.

Salt intake, hypertension and diabetes mellitus.

Diabetes mellitus affects approximately 135 million people in the world. Diabetes and hypertension are both relatively common diseases in westernised countries. Both entities increase with age. Essential hypertension accounts for the majority of hypertension in people with type 2 diabetes, who constitute more than 90% of those with a dual diagnosis of diabetes and hypertension. The benefit conferred per mm Hg blood pressure reduction appears to be greater in persons with type 2 diabetes than in those with hypertension and non-coexistent diabetes mellitus. Similar to a subset of patients with essential hypertension, type 2 diabetic patients manifest dietary NaCl-induced exacerbation of hypertension. Recent guidelines have emphasised that the target blood pressure levels for patients with diabetes should be lower than in other hypertensive groups. An increased total body sodium and enhanced vascular reactivity are found in people with diabetes and most type 2 diabetic patients are salt sensitive. Type 2 diabetes with hypertension is associated with reduced renal plasma flow when dietary salt intake is high. Experimental, observational and interventional evidence support the benefits of sodium restriction in hypertensives. However, the full effects of sodium restriction are usually not obvious for at least 5 weeks. Other favourable effects of moderate reduction in sodium intake are a regress left ventricular hypertrophy, decrease in diuretic-induced potassium wastage, reduction in proteinuria, protection against stroke and from osteoporosis and renal stones, and enhancement of the antihypertensive effect of the antihypertensive agents.

Treatment of hypertension in type 2 diabetes.

Hypertension is one of the most common medical conditions in the United States, affecting 50 million American adults and accounting for one of four physician office visits. It is often undetected and undertreated, creating significant public health consequences. In diabetes, hypertension is an even greater problem, as diabetes has become the most common single cause of end-stage renal disease (ESRD) in the world, and diabetes is increasing in prevalence. The most important factor in slowing the decline of renal function in diabetes is aggressive treatment of hypertension. Recent guidelines have emphasized that the target blood pressure levels for patients with diabetes should be lower than in other hypertensive groups. The best specific approach for the treatment of hypertension in diabetic patients is the subject of much debate. It may be in the end that the specific drug choice has less overall importance than the actual attainment of adequate blood pressure control. In addition, more credence must be placed on the value of treating systolic hypertension than has traditionally been given. Coexisting diabetes and hypertension are a common clinical scenario that can set off a vicious cycle of increasing renal damage, rising blood pressure, and increased cardiovascular morbidity and mortality. Treatment often requires multiple drugs to effectively preserve renal function and prevent complications.

Relationship between lipoprotein(a) levels, oxidative stress, and blood pressure levels in patients with essential hypertension.

High plasma levels of lipoprotein(a) [Lp(a)] are considered a risk factor for the development of coronary artery disease. In vitro experiments have shown that oxidized Lp(a) is able to impair the arterial endothelium-dependent dilation, thus suggesting a possible role of Lp(a) in the genesis of essential hypertension. The aim of our work was to investigate the correlation of blood pressure levels with plasma Lp(a) concentration, apo(a) isoform size, and peroxidative stress in patients with essential hypertension. The study was performed in 54 untreated hypertensive patients whose blood pressure was monitored for 24 h by ambulatory blood pressure monitoring. Lp(a) concentration was measured by a double monoclonal antibody-based enzyme immunoassay demonstrated to be insensitive to apo(a) size heterogeneity. Apo(a) isoforms were determined by a high-resolution SDS-agarose gel electrophoresis followed by immunoblotting. A significant correlation was found between Lp(a) levels and the night-time systolic and diastolic pressures (r=0.32, P<0.05 and r=0.30, P<0.05, respectively), as well as with the mean night-time fall in systolic and diastolic blood pressures (r=-0.28, P<0.05 and r=-0.29, P<0.05, respectively). These relationships were further potentiated when peroxidative stress data were taken into consideration (r=0.37 and r=0.40, P<0.01 for the night-time systolic and diastolic pressures, respectively and r=-0.34 and r=-0.38, P<0.01 for the night-time fall in systolic and diastolic blood pressures, respectively). Apo(a) isoform size did not affect these relationships. Our data suggest that Lp(a) and peroxidative stress may be involved as cofactors in essential hypertension, with a mechanism that remains to be elucidated.

Comparación de la eficacia antihipertensiva de monoterapia en dosis crecientes versus terapia asociada en bajas dosis

When hypertension treatment does not achieve the expected reduction in blood pressure levels, experts recommended increasing the dose of the initially used drug or the addition of a new medication.To compare the efficacy of increasing doses of losartan or the addition of hydrochlorothiazide to achieve adequate blood pressure levels in patients with hypertension.Seventy- three patients aged 64.4 +/- 5.3 years, with stage 1 or 2 essential hypertension were studied. If after four weeks of treatment with losartan 50 mg od, blood pressure levels were still high, the dose was increased to 100 mg od. After four weeks with this new schedule, the treatment was switched to losartan 50 mg and hydrochlorothiazide 12.5 mg for another four weeks.Thirty- seven patients normalized blood pressure with losartan 50 mg od. Of the 36 patients that did not respond, 69% achieved a normal blood pressure with losartan 100 mg od and 81% did so with the combination of losartan and hydrochlorothiazide. Combination therapy resulted in a better blood pressure lowering than monotherapy (33.2 +/- 3.2 and 29.5 +/- 3.4 mm Hg for systolic blood pressure respectively, 16.4 +/- 3.2 and 13.2 +/- 3.4 mm Hg for diastolic blood pressure, p < 0.05). No changes in blood glucose, total and HDL cholesterol, triglycerides, urea nitrogen and uric acid were observed with the combination therapy.In this group of patients, combination therapy achieved better blood pressure levels than monotherapy in high doses.

Two highly monounsaturated oils, olive oil and high-oleic sunflower oil, induce different triacylglycerol molecular species distribution in rat liver

Olive oil, but not high-oleic sunflower oil, is known to decrease blood pressure levels in patients with essential hypertension. Differences have been found in the minor component and triacylglycerol (TAG) contents. In order to determine whether differences are found in the content of liver lipids after administration of two monunsaturated oils from distinct sources, Wistar rats were fed with olive oil or high-oleic sunflower oil. Both oleic acid-rich oils caused similar effects on liver total lipids, phospholipids and cholesterol. When olive oil was administered to rats, the liver fatty acid content was also very similar to that of rats receiving high-oleic sunflower oil. However, olive oil intake resulted in a greater amount of dioleoylacylglycerol molecular species in rat liver, suggesting an increase in these species synthesis. This effect was not observed in rats consuming high-oleic sunflower oil, although the liver triacylglycerol pool was as high as that of rats receiving olive oil.