Blood Pressure In Intervention Group Research Articles

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

Uncontrolled hypertension (ie, a 24-hour ambulatory systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg or clinic systolic blood pressure of ≥140 mm Hg and diastolic blood pressure of ≥90 mm Hg) in young adults is a US public health burden. To evaluate the effect of a telephone coaching and blood pressure self-monitoring intervention compared with usual care on changes in systolic and diastolic blood pressures and behaviors at 6 and 12 months. This randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure testing. This was a geographically diverse, multicentered study within 2 large, Midwestern health care systems. Data were collected from October 2017 to February 2022 and analyzed from February to June 2022. The My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control participants received routine hypertension care. The co-primary clinical outcomes were changes in 24-hour ambulatory and clinic systolic and diastolic blood pressure at 6 and 12 months. The secondary outcomes were hypertension control (defined as ambulatory systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg or clinic systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and changes in hypertension self-management behavior. A total of 316 participants were randomized (159 to the control group and 157 to the intervention group) from October 2017 to December 2020. The median (IQR) age was 35 (31-37) years, 145 of 311 participants (46.6%) were female, and 166 (53.4%) were male; 72 (22.8%) were Black, and 222 (70.3%) were White. There were no differences in baseline characteristics between groups. There was no significant difference between control and intervention groups for mean 24-hour ambulatory systolic or diastolic blood pressure or clinic systolic or diastolic blood pressure at 6 or 12 months. However, there was appreciable clinical reduction in blood pressures in both study groups (eg, mean [SD] change in systolic blood pressure in intervention group at 6 months, -4.19 [9.77] mm Hg; P < .001). Hypertension control did not differ between study groups. Participants in the intervention group demonstrated a significant increase in home blood pressure monitoring at 6 and 12 months (eg, 13 of 152 participants [8.6%] checked blood pressure at home at least once a week at baseline vs 30 of 86 [34.9%] at 12 months; P < .001). There was a significant increase in physical activity, defined as active by the Godin-Shephard Leisure-Time Physical Activity Questionnaire, in the intervention group at 6 months (69 of 100 [69.0%] vs 51 of 104 [49.0%]; P = .004) but not at 12 months (49 of 86 [57.0%] vs 49 of 90 [54.4%]; P = .76). There was a significant reduction in mean (SD) sodium intake among intervention participants at 6 months (3968.20 [1725.17] mg vs 3354.72 [1365.75] mg; P = .003) but not 12 months. There were no significant differences in other dietary measures. The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups; however, both study groups had an appreciable reduction in blood pressure. Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension. ClinicalTrials.gov Identifier: NCT03158051.

The Effects of Chromotherapy on the Stress Level of Patients With Hypertension

Hypertension contributes to 7.5 million deaths or 12.8% of the total mortality rate globally, making it one of the major health problems and is the leading cause of death every year. The high mortality and morbidity rate of hypertension are related to depression and stress. Hence, preventive actions in reducing the stress levels and blood pressure are required. Chromotherapy is a non-pharmacological therapy option to lower blood pressure that has several advantages; inexpensive, easy implementation, and minimal side effects. This research aimed to determine the effectiveness of chromotherapy on the stress level of patients with hypertension. This is a pre-and-post-test quasi-experimental study involving 120 patients with hypertension. The chromotherapy effectively reduce stress level and blood pressure of the treatment group (p0.05). Moreover, the mean score of stress level of treatment group was decreased to 40.10 (± 10.516), while the control group experienced the opposite; an increased mean score to 80.90 (± 12.288). Furthermore, the decreased blood pressure of treatment group was observed by 10-14 mmHg after chromotherapy treatment was given. The chromotherapy is a new innovation in complimentary therapy and can be used as an alternative non-pharmacological treatment that effectively reduces stress level and blood pressure.

Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis.

[Figure: see text].

Orthostatic Hypertension and Intensive Blood Pressure Control; Post-Hoc Analyses of SPRINT.

We evaluated the association between orthostatic hypertension and cardiovascular outcomes and the effect of intensive blood pressure (BP) control on cardiovascular outcomes in patients with orthostatic hypertension. Post hoc analyses of the SPRINT (Systolic Blood Pressure Intervention Trial) data were conducted; orthostatic hypertension was defined as increase in systolic BP≥20 mm Hg or increase in diastolic BP≥10 mm Hg with standing. Of 9329 participants, 1986 (21.2%) had orthostatic hypertension at baseline. Within the intensive treatment group, participants with orthostatic hypertension were at higher risk of developing the composite cardiovascular outcome (hazard ratio, 1.44 [95% CI, 1.1-1.87], P=0.007) compared with participants without orthostatic hypertension. Within the standard treatment group, there were no significant differences in cardiovascular outcome between participants with and without orthostatic hypertension. In participants with orthostatic hypertension, there was no statistically significant difference in risk of the composite cardiovascular outcome between the intensive and the standard BP treatment group (hazard ratio, 1.07 [95% CI, 0.78-1.47], P=0.68). In participants without orthostatic hypertension at baseline, the intensive treatment group was associated with a lower risk of the composite cardiovascular outcome (hazard ratio, 0.67 [95% CI, 0.56-0.79], P<0.0001). Orthostatic hypertension was associated with a higher risk of cardiovascular outcomes in the intensive and not in the standard treatment group; intensive treatment of BP did not reduce the risk of cardiovascular outcomes compared with standard treatment in patients with orthostatic hypertension. These post hoc analyses are hypothesis generating and will need to be confirmed in future studies.

Home Care Improves Knowledge, Attitude, Practice and Blood Pressure Control in Hypertensive Patients: Exploring the Expanded Role of Community Pharmacists

Hypertension remains a leading cause of morbidity and mortality.This study aimed to evaluate the impact of community pharmacists-provided home care on knowledge, attitude, practice (KAP) and blood pressure (BP) control of hypertensive patients. A quasi-experimental study was conducted in two pharmacies in Banten involving hypertensive patients regularly refilling prescriptions. Patients in Pharmacy A were assigned in the intervention group (IG), whilst those in Pharmacy B in the control group (CG). IG received home care in addition to standard care. Questionnaires to assess KAP were distributed at the initiation and end of the study. BP was measured monthly. A total of 110 patients (60 in IG vs 50 in CG) were enrolled. At baseline there was no significant difference in demographic and clinical characteristics. Post-intervention, proportion of patients with ‘good’ knowledge was considerably higher in IG (100%) vs 2.0% in CG, IG demonstrated ‘very ideal’ attitude compared to ‘less ideal’ in CG, IG performed ‘good’ practice as opposed to ‘fair’ practice in CG. The decrease of systolic BP in IG was significantly greater (14.8 mmHg) vs 1.8 mmHg in CG. In conclusion, expanded role of community pharmacists in providing home care improves KAP and BP control in hypertensive patients.

Home Care Improves Knowledge, Attitude, Practice and Blood Pressure Control in Hypertensive Patients: Exploring the Expanded Role of Community Pharmacists

Hypertension remains a leading cause of morbidity and mortality.This study aimed to evaluate the impact of community pharmacists-provided home care on knowledge, attitude, practice (KAP) and blood pressure (BP) control of hypertensive patients. A quasi-experimental study was conducted in two pharmacies in Banten involving hypertensive patients regularly refilling prescriptions. Patients in Pharmacy A were assigned in the intervention group (IG), whilst those in Pharmacy B in the control group (CG). IG received home care in addition to standard care. Questionnaires to assess KAP were distributed at the initiation and end of the study. BP was measured monthly. A total of 110 patients (60 in IG vs 50 in CG) were enrolled. At baseline there was no significant difference in demographic and clinical characteristics. Post-intervention, proportion of patients with ‘good’ knowledge was considerably higher in IG (100%) vs 2.0% in CG, IG demonstrated ‘very ideal’ attitude compared to ‘less ideal’ in CG, IG performed ‘good’ practice as opposed to ‘fair’ practice in CG. The decrease of systolic BP in IG was significantly greater (14.8 mmHg) vs 1.8 mmHg in CG. In conclusion, expanded role of community pharmacists in providing home care improves KAP and BP control in hypertensive patients.

Abstract 16890: Coronary Artery Calcium for Personalizing Antihypertensive Therapy: A Pooled Cohort Analysis

Background: The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease (CVD) to inform hypertension (HTN) treatment in adults with elevated BP or low-risk stage 1 HTN. Use of coronary artery calcium (CAC) score, an excellent imaging risk-prediction tool, to guide HTN therapy has not been well studied. Methods: Participants free of CVD were pooled from three population cohort studies; 1) Multiethnic Study of Atherosclerosis, 2) Coronary Artery Risk Development in Young Adults and 3) Jackson Heart Study. Risk for incident CVD events (heart failure, stroke or cardiovascular mortality) by the CAC status and the BP treatment group was assessed. Multivariable Cox proportional hazards models were used to estimate the hazard ratios. The 10-year number needed to treat to prevent a single CVD event was also estimated. Results: This study included 11,499 participants (mean age 56 years; 55.2% women; 42.1% blacks). CAC score was non-zero in 38.2% of the participants. Over a median follow-up of 8.5 years, 910 incident CVD events occurred. Compared to those with zero CAC, participants with non-zero CAC score had a higher CVD incidence rate (per 1000 person-years) at all BP levels (elevated BP/low-risk stage 1 HTN: 14.5 vs 2.7; high-risk stage 1 or stage 2 HTN: 27.1 vs 8.8). Multivariable adjusted hazards of adverse CVD events displayed similar patterns ( Figure ). Among those with zero CAC, the 10-year number needed to treat to prevent 1 CVD event was 154 for those with elevated BP/low-risk stage 1 HTN and 47 for those with high-risk stage 1 or stage 2 HTN. Among those with non-zero CAC score, the number needed to treat was lower, 33 and 18 respectively. Conclusions: Utilization of CAC score may be an effective precision medicine approach to personalize HTN therapy in elevated BP or low-risk stage 1 HTN when treatment is not recommended by the current guidelines.

Nursing case management for people with hypertension in primary health care: A randomized controlled trial.

Hypertension is a chronic disease that requires continuous and long-term care to prevent or delay the development of associated complications. Although various interventions for hypertension exist, case management in Brazil's primary healthcare is understudied. We examined nursing case management effectiveness for controlling blood pressure among Brazilian adults with hypertension in the public healthcare system. A randomized controlled trial with a 12-month follow-up was conducted at a primary healthcare clinic in southern Brazil. Adult patients with hypertension were randomly allocated to intervention (n = 47) and usual care groups (n = 47). The nursing case management model includes nursing consultations, telephone contact, home visits, health education, and appropriate referrals. Patient outcomes (blood pressure, body mass index, waist circumference, quality of life, treatment adherence) were assessed at baseline and 6- and 12-month follow-up for the intervention group and at baseline and 12-month follow-up for the usual care group. Data were collected from only the intervention group at T6 to avoid contact between the researcher and the usual care group, and to check the care plan and modify it if necessary. After the intervention, the intervention group's blood pressure decreased significantly compared to the usual care group. The differences in systolic and diastolic blood pressure between the groups was -8.3 (intervention)/1.1 (usual care) mmHg (p = .004) and -7.4/-0.6 mmHg (p = .007), respectively. The intervention group had significantly greater improvement in waist circumference (-2.0/1.2 cm), body mass index (- 0.4/0.3), and treatment adherence (4.8/-1.1) than the usual care group (all p < .05). Nursing case management in primary healthcare may be effective for improving outcomes among patients with hypertension.

Incorporation of Biomarkers Into Risk Assessment for Allocation of Antihypertensive Medication According to the 2017 ACC/AHA High Blood Pressure Guideline: A Pooled Cohort Analysis.

Risk for atherosclerotic cardiovascular disease was a novel consideration for antihypertensive medication initiation in the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) guideline. Whether biomarkers of chronic myocardial injury (high-sensitivity cardiac troponin T ≥6 ng/L] and stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥100 pg/mL) can inform cardiovascular (CV) risk stratification and treatment decisions among adults with elevated BP and hypertension is unclear. Participant-level data from 3 cohort studies (Atherosclerosis Risk in Communities Study, Dallas Heart Study, and Multiethnic Study of Atherosclerosis) were pooled, excluding individuals with prevalent CV disease and those taking antihypertensive medication at baseline. Participants were analyzed according to BP treatment group from the 2017 American College of Cardiology/American Heart Association BP guideline and those with high BP (120 to 159/<100 mm Hg) were further stratified by biomarker status. Cumulative incidence rates for CV event (atherosclerotic cardiovascular disease or heart failure), and the corresponding 10-year number needed to treat to prevent 1 event with intensive BP lowering (to target systolic BP <120 mm Hg), were estimated for BP and biomarker-based subgroups. The study included 12 987 participants (mean age, 55 years; 55% women; 21.5% with elevated high-sensitivity cardiac troponin T; 17.7% with elevated NT-proBNP) with 825 incident CV events over 10-year follow-up. Participants with elevated BP or hypertension not recommended for antihypertensive medication with versus without either elevated high-sensitivity cardiac troponin T or NT-proBNP had a 10-year CV incidence rate of 11.0% and 4.6%, with a 10-year number needed to treat to prevent 1 event for intensive BP lowering of 36 and 85, respectively. Among participants with stage 1 or stage 2 hypertension recommended for antihypertensive medication with BP <160/100 mm Hg, those with versus without an elevated biomarker had a 10-year CV incidence rate of 15.1% and 7.9%, with a 10-year number needed to treat to prevent 1 event of 26 and 49, respectively. Elevations in high-sensitivity cardiac troponin T or NT-proBNP identify individuals with elevated BP or hypertension not currently recommended for antihypertensive medication who are at high risk for CV events. The presence of nonelevated biomarkers, even in the setting of stage 1 or stage 2 hypertension, was associated with lower risk. Incorporation of biomarkers into risk assessment algorithms may lead to more appropriate matching of intensive BP control with patient risk.

PENGARUH PENATALAKSANAAN RELAKSASI NAPAS DALAM TERHADAP PENURUNAN TEKANAN DARAH PADA PENDERITA HIPERTENSI DI WILAYAH KERJA PUSKESMAS PURWOHARJO COMAL

&lt;p&gt;Hypertension is a non-communicable disease and one of the risk factors for degenerative diseases such as heart disease, stroke and other blood vessel disease, which is one of the important health problems worldwide because of its high and increasing prevalence, hypertension leads to death by 9 , 4 million annually, hypertension accounts for about 45% of deaths from ischemic heart disease and 51% from stroke. Various risk factors for hypertension include smoking and exposure to cigarette smoke, drinking alcohol, diet / diet, unhealthy lifestyle, obesity, medication, and family history (heredity).&lt;/p&gt;&lt;p&gt;Hypertension is a non-communicable disease and one of the risk factors for degenerative diseases such as heart disease, stroke and other blood vessel disease, which is one of the important health problems worldwide because of its high and increasing prevalence, hypertension leads to death by 9 , 4 million annually, hypertension accounts for about 45% of deaths from ischemic heart disease and 51% from stroke. Various risk factors for hypertension include smoking and exposure to cigarette smoke, drinking alcohol, diet / diet, unhealthy lifestyle, obesity, medication, and family history (heredity).&lt;/p&gt;&lt;p&gt;The systolic blood pressure of pre test in the treatment group and the p-value control group was 0.651 greater than 0.05 and the post test systolic blood pressure in the treatment group and the p-value control group was 0.000 less than 0.05 , While pre-tested diastolic blood pressure in treatment group and p-value control group was 0.218 greater than 0.05 and postharvest diastolic blood pressure in treatment group and p-value control group of 0.000 was smaller than 0.05.&lt;/p&gt;&lt;p&gt;Pre-test systolic blood pressure in the treatment group and the control group did not influence the combination of deep breathing relaxation and progressive muscle relaxation to decreased blood pressure and post-test systolic blood pressure. There was an effect of a combination of deep breathing relaxation and progressive muscle relaxation to blood pressure drop, diastolic blood pressure Pre-test in the treatment group and the control group there was no effect of a combination of deep breathing relaxation and progressive muscle relaxation to the drop in blood pressure and post-test diastolic blood pressure there was an effect of a combination of deep breathing relaxation and progressive muscle relaxation on blood pressure reduction.&lt;/p&gt;Combination of deep breathing relaxation and progressive muscle relaxation, Decrease in blood pressure in patients with primary hypertension.

Pengaruh Senam Jantung Sehat terhadap Tekanan Darah Penderita Hipertensi di Wilayah Kerja Puskesmas Lepo-Lepo

ABSTRACTHypertension is the increase in systolic and diastolic blood pressure that occurs persistently. Healthy heart gymnastic is one of the non pharmacologic therapies for hypertensive patients. Healthy heart gymnastic can increase activity of parasympathetic nerve and decrease activity of sympathetic nerve, so that could lead decrease of blood pressure. The aim of this research was to find out the effect of healthy heart gymnastic towards blood pressure before and after exercise in hypertensive patients. Research design was quasi experimental with pre test and post test control group design. The Samples were 20 hypertensive patients aged 18 to 65 years, determined by using purposive sampling techniques. Samples were divided into two groups, i.e control group (n=10) consisted of 3 males and 7 females and intervention group (n=10) consisted of 10 females. Healthy heart gymnastic Intervention implemented during four weeks with modrate intensity (60% MHR) and fifth times in a week. The research was held in Health Centers Lepo-Lepo, Kendari, Southeast Sulawesi. Measurement of blood pressure by indirect method and measurements of pulse pressureby pulse meter. Data were analyzing by paired t test for systolic blood pressure in intervention group and Wilcoxon test for diastolic blood pressure in intervention group. Data have considered if p value &lt; 0,05. The results have shown there were significant differences in systolic blood pressure (p = 0,000) and diastolic blood pressure (p = 0,004) before and after healthy heart gymnastic in intervention group. Conclusion of this research is healthy heart gymnastic can decrease blood pressure in hypertensive patients, so that usable as one of alternative treatment in hypertensive patients.Key Words: healthy heart gymnastic, hypertension, decrease of blood pressure, health centers lepo-lepo

Intensive Blood Pressure Treatment for Resistant Hypertension.

Evidence about the target blood pressure (BP) in patients with resistant hypertension is limited. The present study aimed to assess the efficacy of intensive BP treatment (systolic BP target, <120 mm Hg) versus standard BP treatment (systolic BP target, <140 mm Hg) in patients with resistant hypertension. This is a secondary analysis using data from SPRINT (Systolic Blood Pressure Intervention Trial). This study included 1397 patients with resistant hypertension and 7698 without resistant hypertension. Using the Cox proportional hazards model, we compared time to first occurrence of a major adverse cardiovascular event (cardiovascular death, myocardial infarction, and stroke) between the intensive and standard BP treatment groups. Mean follow-up was 3.1 years; major adverse cardiovascular events was confirmed in 381 patients. Risk of major adverse cardiovascular events was significantly lower in the intensive treatment group than in the standard treatment group (hazard ratio, 0.62; 95% CI, 0.40-0.96; P=0.03). Risks of all-cause and cardiovascular death in patients with resistant hypertension were also significantly lower in the intensive treatment group than in the standard treatment group (hazard ratio for all-cause death: 0.60; 95% CI, 0.38-0.97; P=0.03; hazard ratio for cardiovascular death: 0.34; 95% CI, 0.15-0.81; P=0.01). Similar associations were observed in various subgroups. Intensive BP treatment was significantly associated with a decreased risk of major adverse cardiovascular events in patients with resistant hypertension.

Effect of Intensive Blood Pressure Lowering on Kidney Tubule Injury: Findings From the ACCORD Trial Study Participants

Random assignment to intensive blood pressure (BP) lowering (systolic BP<120mmHg) compared to a less intensive BP target (systolic BP<140mmHg) in the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD-BP) trial resulted in a more rapid decline in estimated glomerular filtration rate (eGFR). Whether this reflects hemodynamic effects or intrinsic kidney damage is unknown. Longitudinal analysis of a subgroup of clinical trial participants. A subgroup of 529 participants in ACCORD-BP. Urine biomarkers of tubular injury (kidney injury molecule 1, interleukin 18 [IL-18]),repair (human cartilage glycoprotein 39 [YKL-40]), and inflammation (monocyte chemoattractant protein 1) at baseline and year2. Changes in eGFR from baseline to 2 years. We compared changes in biomarker levels and eGFRs across participants treated to an intensive versus less intensive BP goal using analysis of covariance. Of 529 participants, 260 had been randomly assigned to the intensive and 269 to the standard BP arm. Mean age was 62±6.5 years and eGFR was 90mL/min/1.73m2. Baseline clinical characteristics, eGFRs, urinary albumin-creatinine ratios (ACRs), and urinary biomarker levels were similar across BP treatment groups. Compared to less intensive BP treatment, eGFR was 9.2mL/min/1.73m2 lower in the intensive BP treatment group at year 2. Despite the eGFR reduction, within this treatment group, ACR was 30% lower and 4 urinary biomarker levels were unchanged or lower at year 2. Also within this group, participants with the largest declines in eGFRs had greater reductions in urinary IL-18 and YKL-40 levels. In a subgroup analysis of participants developing incident chronic kidney disease (sustained 30% decline and eGFR<60mL/min/1.73m2; n=77), neither ACR nor 4 biomarker levels increased in the intensive treatment group, whereas the level of 1 biomarker, IL-18, increased in the less intensive treatment group. Few participants with advanced baseline chronic kidney disease. Comparisons across treatment groups do not represent comparisons of treatment arms created solely through randomization. Among a subset of ACCORD-BP trial participants, intensive BP control was associated with reductions in eGFRs, but not with an increase in injury marker levels. These findings support that eGFR decline observed with intensive BP goals in ACCORD participants may predominantly reflect hemodynamic alterations.

Benefits of Intensive Blood Pressure Treatment in Patients With Type 2 Diabetes Mellitus Receiving Standard but Not Intensive Glycemic Control

This study aimed to assess whether intensive blood pressure (BP) treatment has benefits in preventing cardiovascular events, including heart failure in patients with type 2 diabetes mellitus. Using the ACCORD BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) data, hazard ratios for cardiovascular events with 95% confidence intervals were calculated using the Cox proportional hazard models to compare the time to the first cardiovascular event in patients receiving standard (n=2362) or intensive glycemic control (n=2371). The overall mean follow-up period was 4.5 years, and cardiovascular events were confirmed in 528 patients. The cardiovascular event risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group than in the standard BP treatment group (hazard ratio, 0.71; 95% confidence interval, 0.56-0.90; P=0.005), whereas that in patients receiving intensive glycemic control did not differ significantly between the groups (hazard ratio, 1.06; 95% confidence interval, 0.83-1.36; P=0.61). There was a significant interaction between the BP treatment strategy and glycemic control (P=0.02). The stroke risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group, but not in patients receiving intensive glycemic control. Although not significant, all-cause mortality in patients receiving intensive glycemic control was higher in patients receiving intensive BP treatment than in those receiving standard BP treatment (hazard ratio, 1.38; 95% confidence interval, 0.99-1.92; P=0.05). Benefits of intensive BP treatment were observed only in ACCORD BP participants receiving standard glycemic control without additional risk factors.

Blood pressure management and progression of chronic kidney disease in a canine remnant kidney model.

The canine remnant kidney model is fundamental to understanding the relationship between hypertension and chronic kidney disease (CKD). This study aimed to create a 1/16 remnant kidney model and to determine whether blood pressure (BP) control affects the progression of CKD. A group of dogs received BP treatment (group A) and another received BP treatment except for the first 2 weeks (group B). The remnant kidney model was induced using a two-step subtotal nephrectomy method; dogs received antihypertensive therapy. Systolic BP, blood urea nitrogen, serum creatinine, urinary protein, and creatinine levels were measured weekly. Kidney tissues were obtained at the conclusion of the study. Systolic BP was controlled to <160 mmHg in both groups for 18 weeks, except for the first 2 weeks in group B. Proteinuria was elevated after renal ligation in both groups, but gradually increased in group B and decreased in group A (p = 0.009). Blood urea nitrogen (p = 0.014) and creatinine (p = 0.020) levels were higher in group B than in group A. More histological damage was observed in group B than in group A. Induction of 1/16 nephrectomy successfully established CKD. Control of BP may be important to prevent or control the progression of CKD in dogs.

PEMBERIAN MILKSHAKE PISANG SEBELUM LATIHAN TERHADAP KELELAHAN DAN TEKANAN DARAH ATLET SEPAK BOLA

Background : Fatigue is affected by decreased muscle glycogen and decreased blood flow to muscle. In addition, dilation and constriction of blood vessels during exercise also affects blood pressure. Bananas are a source of carbohydrates and potassium. Carbohydrates are used to energy and potassium are used to regulate heart rate and maintain fluid and electrolyte balance. Calcium in milk can help muscle contraction during exercise.Objective : to determine the effect of banana milkshake on fatigue and blood pressure in football athletes.Methods : true experiment study with pre and post only control group design. Subjects of this study is 14 football athletes were randomly divided into 2 groups: the control group given banana and the treatment group given the banana milkshake. Fatigue at soccer athletes in PS Undip was measured with a harvard step test by calculating the Body efficiency index and blood pressure measured before and after the test. Data were analyzed by independent t-test and paired t-test.Results : Mean Body Efficiency Index (VO2max) before treatment in treatment group 89.85 ± 8.46 and after treatment 92.41 ± 9.813 and in control group before treatment 94.45 ± 11.596 and after treatment 99.01 ± 8.325. The difference of systolic and diastolic blood pressure in treatment group before treatment was 19.43 ± 22.44 and 0.00 ± 7.68 while in control group 19.28 ± 14.96 and 2.71 ± 10.68. After treatment in treatment group 30.57 ± 18.88 and 2.143 ± 10,023 while control group 13.43 ± 18.15 and 6.28 ± 18.98.Conclusion : There is no effect of banana milkshake on fatigue and blood pressure. Bananas are more effective than banana milkshakes.

Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department.

IntroductionWhile moderate to severely elevated blood pressure (BP) is present in nearly half of all emergency department (ED) patients, the incidence of true hypertensive emergencies in ED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency.MethodsWe performed a retrospective cohort study from a single, urban, teaching hospital. Using pharmacy records, we identified patients age 18–89 who received IV antihypertensive treatment in the ED. We defined treatment as inappropriate if documented suspicion for an indicated cardiovascular condition or acute end-organ injury was lacking. Data abstraction included adverse events and 30-day readmission rates, and analysis was primarily descriptive.ResultsWe included a total of 357 patients over an 18-month period. The mean age was 55; 51% were male and 93% black, and 127 (36.4%) were considered inappropriately treated. Overall, labetalol (61%) was the most commonly used medication, followed by enalaprilat (18%), hydralazine (18%), and metoprolol (3%). There were no significant differences between appropriate and inappropriate BP treatment groups in terms of clinical characteristics or adverse events. Hypotension or bradycardia occurred in three (2%) patients in the inappropriate treatment cohort and in two (1%) patients in the appropriately treated cohort. Survival to discharge and 30-day ED revisit rates were equivalent.ConclusionMore than one in three patients who were given IV bolus antihypertensive treatment in the ED received such therapy inappropriately by our definition, suggesting that significant resources could perhaps be saved through education of providers and development of clearly defined BP treatment protocols.

Effect of Aggressive Blood Pressure Control on the Recurrence of Atrial Fibrillation After Catheter Ablation: A Randomized, Open-Label Clinical Trial (SMAC-AF [Substrate Modification With Aggressive Blood Pressure Control]).

Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113.

Study on the Intervention Effects of Pinggan Prescription () on Spontaneously Hypertensive Rats Based on Metabonomic and Pharmacodynamic Methods.

To investigate the effects of Pinggan Prescription (, PGP) on hypertension by the associated methods of metabonomic and pharmacodynamic. A total of 32 male spontaneously hypertensive rats (SHRs) were randomly divided into two groups by using the random number table method: a treatment group (n=18) and a model group (n=14). The Wistar rats (n=14) were used as the normal group. Different prescription were used to intervene three groups: the treatment group in which PGP extract was administered orally at a dose of 18.336 g/kg (PGP/body weight), and the model group in which physiological saline was administered at the equivalent dose. The same treatment was applied to the normal group as the model group. The blood pressure was measured by tail-cuff method, and pharmacodynamic indexes including cyclic adenosine monophosphate (cAMP) and angiotensin II (Ang II) were tested by enzyme-linked immunosorbent assay. The plasma samples from three groups were detected by gas chromatography-mass spectrometry (GC-MS). Compared with the model group, blood pressure of treatment group was obviously reduced after continuous curing with PGP (P<0.01). The pharmacodynamic results illustrated that the content of Ang II increased with the raised blood pressure and the cAMP expressed the converse trend. After curing with PGP, the content of Ang II decreased, the difference between model group and treatment group was significant (P<0.01), and the cAMP expressed the converse trend. Five potential biomarkers were identified, including arachidonic acid, hexadecanoic acid, elaidic acid, octadecanedioic acid and 9,12-octadecadienoic acid. These metabolites had shown significantly changes as followed: arachidonic acid, hexadecanoic acid and elaidic acid were significantly higher and octadecanedioic acid and 9,12-octadecadienoic acid were lowered in the model group than those in the normal group. After the treatment of PGP, the metabolites had the trends of returning to normal along with the reduced blood pressure. PGP intervention for hypertension played a major role in the metabolism of arachidonic acid and linoleic acid. Metabonomic with pharmacodynamic methods could be potentially powerful tools to investigate the mechanism of Chinese medicine.

DLBS1033 REDUCES BLOOD PRESSURE OF HYPERTENSIVE WISTAR-STRAIN RATS

The purpose of this study was to determine the effects of DLBS1033 on blood pressure reduction in hypertension--induced wistar strain rats. Design used in this study was true experimental design. The study was conducted at Biomedical Laboratory, Physiology, Faculty of Dentistry, Jember University, and Clinical and Community Pharmacy Laboratory, Pharmacy Faculty, Jember University. Subjects were taken from male Wistar rats aged 2-3 months, weighing 150-200 grams, as many as 22 rats. Intervention samples were induced into hypertension by giving prednisone in a dose of 1.5 mg/kg/day orally and 2% NaCl followed DLBS1033 of 0.5 grams/kgbw/day orally in the treatment group. T test results on systolic blood pressure (p = 0.00), which was &lt;0.05, showing significant differences in systolic blood pressure in treatment groups. It can be concluded that DLBS1033 can lower systolic blood pressure in wistar rats with induced hypertension using prednisone 1.5 mg/kgbw/day and NaCl 2%.