Achieve Target Blood Pressure Research Articles

Comparison of Intravenous Anti-hypertensives for Preoperative Blood Pressure Control in Hypertensive Disorders of Pregnancy and Effect of Oral Labetalol.

Intravenous hydralazine and labetalol are recommended as first-line anti-hypertensives for controlling severe hypertension in pregnancy. Our study aimed at identifying the most effective drug with minimum side effects for preoperative management of severe hypertension in parturients scheduled for Caesarean delivery (CD). We also studied the effect of these drugs on patients already on oral labetalol in the antenatal period. A prospective observational study was done on 162 hypertensive parturients scheduled to undergo emergency CD who received hydralazine or labetalol in the preoperative period. Demographic data, booking status, hemodynamic data, time taken to reach adequate control of blood pressure (BP), drug efficacy, the incidence of persistent hypertension, adverse effects associated with the drugs, and maternal and fetal outcomes were noted. The time taken for the control of BP was similar with both drugs (p-value = 0.425). The mean number of doses required to achieve target BP was significantly less with hydralazine compared to labetalol (p-value = 0.009). Patients on tablet labetalol in the antenatal period were poorly controlled when put on the same drug intravenously but had better control with hydralazine (p-value = 0.005). The incidence of persistent hypertension was lower in patients treated with hydralazine compared with labetalol (p-value = 0.008). Both drugs took a similar time for BP control. However, hydralazine was more efficacious, produced adequate control of BP in a higher number of patients, and had a lower incidence of persistent hypertension.

Effect of Fixed-Dose Combination of Efonidipine + S(-) Metoprolol in Indian Hypertensive Patients

Aim: To evaluate the antihypertensive efficacy and safety of the fixed-dose combination (FDC) of Efonidipine and S (-) Metoprolol in adult patients with hypertension.
 Study Design: Multicentric, double-blind, randomized, parallel, comparative Phase III trial.
 Methodology: This clinical trial was conducted at five geographically distributed sites across India and enrolled 240 hypertensive patients. They were randomized (1:1) to receive either FDC of Efonidipine 40 mg + S (-) Metoprolol 25 mg tablet (E+S(-)M group) or FDC of Cilnidipine 10 mg + Metoprolol 50 mg tablet (C+M group) once daily for 90 days. Patients were evaluated for changes in their blood pressure (BP) from baseline to Day 30, 60 and 90. The study site staff, investigator and patients were blinded to the treatment allocation. Blood pressure was recorded as the mean of 3 consecutive measurements taken in a sitting position. Patients achieving target BP (<140/90 mmHg) were evaluated and the safety and tolerability were assessed based on the incidences of adverse events (AEs).
 Results: This study focused on evaluating the mean Systolic BP (SBP) and Diastolic BP (DBP) reduction from baseline to Day 30, 60 and 90. At baseline, patients had a mean (±SD) SBP and DBP of 154.60 (±11.33) mmHg and 98.68 (±8.18) mmHg respectively. After 30 days of the E+S(-)M treatment, the mean SBP/DBP was 136.06±10.55/ 86.68±5.51 mmHg (p<0.0001) and on Day 60 it was 129.48±10.51/ 84.17±5.51mmHg (P <0.0001), corresponding to mean reductions in SBP/DBP of 18.09/11.66 and 24.78/14.17 mmHg, respectively. There was a statistically significant (p <0.0001) reduction to 123.59 ± 15.21 mmHg in SBP and 82.38 ± 5.05 mmHg in DBP observed on Day 90 as compared to baseline. Post-treatment with E+S(-)M group, SBP/DBP reduction of 31.01/16.29 mmHg in hypertensive patients was observed. A total of 95% of the patients achieved a pre-defined target BP <140/90 mmHg on the administration of E+S(-)M. Furthermore, it was observed that 93% of Stage I and 96% of Stage II hypertensive patients achieved the target BP goal. A total of 5.78% of patients experienced adverse events (AEs) in the E+S(-)M group which was similar to that of C+M group. All AEs were mild in severity and resolved without any sequelae at the end of the study. No unexpected adverse events were reported, and the E+S(-)M dosage regimen was well tolerated by the patients. Both the treatment groups were non-inferior to each other.
 Conclusion: The study results demonstrated clinically meaningful reductions in blood pressure after administration of FDC of Efonidipine 40 mg + S(-) Metoprolol 25 mg over a period of 90 days. The treatment was efficacious, safe, and well‑tolerated in the study population.

Evaluation of pharmacist-led telemedicine medication management for hypertension established patients during COVID-19 pandemic: A pilot study.

To evaluate the impact of a telemedicine medication management service in patients with hypertension. Participants were allocated to either a telemedicine service (N = 173) or usual care (UC) (N = 179). The primary outcome was blood pressure (BP) reduction from baseline to the 6-month follow-up visit, the proportion of the target BP achievement, overall adherence to prescribed medication as well as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. At 6 months, BP was controlled in 89.6% (n = 155) of intervention patients and 78.8% (n = 141) of UC patients (OR = 1.14, 95% CI = 1.04-1.25, P = 0.006), giving a mean difference of -6.0 (-13.0 to -2.5 mmHg) and -2.0 mmHg (-4.0 to -0.1 mmHg) in SBP and DBP, respectively. 17.9% (n = 31) of the patients in the intervention group were non-adherent with medications, compared with 29.1% (n = 52) in the UC group (P = 0.014). The composite clinical endpoints were reached by 2.9% in the intervention group and 4.5% in the control group with no significant differences (OR = 1.566, 95% CI = 0.528-4.646). Telemedicine medication management for hypertension management had led to better BP control and medication adherence improvement than UC during COVID-19 epidemic, resulting in a reduction of overall adverse cardiovascular events occurrence.

Uncontrolled hypertension and obstructive sleep apnea: integrated treatment approach

The main goal in the arterial hypertension (AH) management is the target blood pressure (BP) achievement, as it leads to the cardiovascular risk reduction. At the same time, proper BP is achieved less than in 50% of all cases. In addition, there are two types of truly uncontrolled AH in population, such as resistant (RAH) and refractory (RFH) AH. Recent research suggests that RAH may be associated with changes in the renin-angiotensin-aldosterone system, while RFH appears to be more closely associated with sympathetic hyperactivation. These pathophysiological mechanisms are also active in patients with obstructive sleep apnea (OSA). Therefore, the prevalence of OSA in patients with RAH and RFH is very high, and treatment with continuous positive airway pressure (PAP-therapy) can reduce BP levels in such patients. The latter allows us to consider PAP-therapy as an additional method for the target BP achievement in patients with uncontrolled AH and OSA.

EFFECTIVENESS OF ADDITION OF METFORMIN TO STATIN THERAPY FOR PRODIABETOGENIC CHANGES CORRECTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

The aim: to study the effectiveness of adding metformin to statin therapy to correct prodiabetogenic changes in patients with arterial hypertension (AH) and abdominal obesity (AO). Materials and methods. We examined 65 patients with 2-3 degrees of AH in combination with AO of I-II degrees, atherogenic dyslipidemia and insulin resistance (IR) aged 47-59 yrs: group 1 – 35 patients who were treated with statins (atorvastatin) against the background of standard combinations of antihypertensive drugs, metformin was added; group 2 – 30 patients who did not receive metformin. The examination included generally accepted methods. Statistical data analysis was carried out using standard methods using Microsoft Excel 7.0 and SPSS 19.0 application packages. Results. The addition of metformin to atorvastatin against the background of standard antihypertensive therapy and recommendations for the normalization of lifestyle allowed a significant reduction in IR and the incidence of prediabetes in hypertensive patients with AO after 16 weeks of treatment. In patients who did not receive metformin, there was no decrease in these indicators. In the group of patients who used metformin, a significantly higher frequency of achieving target blood pressure levels was revealed than in the group of patients in whom this drug was not used. Conclusions. The effectiveness of the use of the insulin sensitizer metformin for the correction of pro-diabetogenic changes associated with statin therapy in patients with AH, which occurs against the background of AO, atherogenic dyslipidemia, and IR, has been shown.

Factors associated with blood pressure control in patients with hypertension and HIV at a large urban HIV clinic in Uganda.

Globally, people living with HIV on antiretroviral therapy have an increased risk of cardiovascular disease. Hypertension is the most important preventable risk factor for cardiovascular disease and is associated with increased morbidity. We conducted an exploratory survey with hypertensive persons living with HIV who received integrated HIV and hypertension care in a large clinic in Uganda between August 2019 and March 2020 to determine factors associated with blood pressure control at six months. Controlled blood pressure was defined as <140/90 mmHg. Multivariable logistic regression was used to determine baseline factors associated with blood pressure control after 6 months of antihypertensive treatment. Of the 1061 participants, 644 (62.6%) were female. The mean age (SD) was 51.1 (9.4) years. Most participants were overweight (n = 411, 38.7%) or obese (n = 276, 25.9%), and 98 (8.9%) had diabetes mellitus. Blood pressure control improved from 14.4% at baseline to 66.1% at 6 months. Comorbid diabetes mellitus (odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.26-0.64, p < 0.001) and HIV status disclosure (OR = 0.73, 95% CI = 0.55-0.98, p = 0.037) were associated with the absence of controlled blood pressure at 6 months. In conclusion, comorbid diabetes mellitus and the disclosure of an individual's HIV status to a close person were associated with poor blood pressure control among persons living with HIV who had hypertension. Therefore, subpopulations of persons living with HIV with hypertension and comorbid diabetes mellitus may require more thorough assessments and intensive antihypertensive management approaches to achieve blood pressure targets.

Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary

BackgroundThe management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors’ target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40–65 years and the success of achieving risk factors’ target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies.MethodsWe conducted a cross-sectional study involving 37,778 patients aged 40–65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics).ResultsFor 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%.ConclusionsThe success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.

Застосування комплексу на основі магнію та калію (Панцикор) на перебіг артеріальної гіпертензії І-ІІ стадії 1-2-го ступеня з гіпокаліємією

High blood pressure (BP) is noted in 34.8% of the population of Ukraine. Antihypertensive therapy is used by 34.4% of patients, by 14% - a treatment is effective. Resistance to antihypertensive therapy can be caused by a number of reasons, one of which is electrolyte imbalance. Purpose - to analyze the possibilities of using the complex Panzikor in patients with arterial hypertension of the I-II degree and hypokalemia to achieve the target level of blood pressure. Materials and methods. It is examined 34 (57%) patients with hypertension of the 1st degree and 26 (43%) patients with hypertension of the 2nd degree. All subjects were divided into groups: A (n=17) and C (n=13) - patients with AH of 1-2 degree who were prescribed standard antihypertensive therapy and Panzikor (1 sachet once a day for 12 weeks); B (n=17) and D (n=13) - patients with hypertension of 1-2 degree who were prescribed standard antihypertensive therapy. All patients underwent a general clinical examination, determination of potassium and sodium levels in the blood, carbohydrate and lipid parameters. Diaries of medication use and blood pressure measurement were kept. Results. After treatment, a significant decrease in blood pressure was recorded: in the Group A - systolic blood pressure from 156.1±12.2 mm Hg to 131.3±9.1 mm Hg and diastolic blood pressure from 99.7±6.3 mm Hg to 82.1±6.2 mm Hg; in the Group C - systolic blood pressure from 166.3±14.5 mm Hg to 139.4±11.2 mm Hg, diastolic blood pressure from 104.1±7.9 mm Hg to 86.1±6.3 mm Hg. In the Groups B and D, no significant decrease in blood pressure was found. Patients of the Groups A and C showed positive dynamics of blood glucose reduction (in the Group A - from 5.4±0.8 mmol/l to 4.2±0.6 mmol/l; in the Group C - from 4.7±1.3 mmol/l to 4.2±1.1 mmol/l), glycosylated hemoglobin (in the Group A - from 5.2±1.1% to 4.6±1.2%; in the Group C - from 5.1±0.8% to 4.8±0.7%), total cholesterol (in the Group A - from 5.6±1.3 mmol/l to 4.2±1.1 mmol/l; in the Group C - from 5.8±2.7 mmol/l to 4.3±1.1 mmol/l), low density lipoproteins (in the Group A - from 2.9±1.1 mmol/l to 1.5±0.4 mmol/l; in the Group C - from 3.2±1.2 7 mmol/l to 1.8±0.7 mmol/l). Conclusions. Panzikor should be prescribed to patients with hypertension and hypokalemia to effectively achieve target blood pressure levels and stabilize lipid and carbohydrate metabolism indicators. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. No conflict of interests was declared by the authors.

Therapeutic concordance improves blood pressure control in patients with resistant hypertension

IntroductionAn empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients. MethodsWe designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients. ResultsFrom a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012). ConclusionsTaken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.

OR20-5 The Association between Life's Simple 7 Score and Three Biomarkers of Cardiovascular Disease: Aldosterone, CRP, and IL-6

Abstract Background To promote ideal cardiovascular health, the American Heart Association recommends adhering to Life's Simple 7 (LS7)—achieving healthy targets for BMI, physical activity, dietary intake, blood pressure, fasting plasma glucose, and cholesterol, along with smoking abstinence. Retrospective data analyses have shown associations between poorer achievement of LS7 (lower score) and the development of hypertension and cardiovascular disease (CVD). However, less is known about the associations between LS7 and specific biomarkers linked to cardiovascular health. Hypothesis We hypothesized that achievement of LS7 (higher score) would be associated with lower levels of aldosterone and inflammatory markers implicated in CVD in individuals with controlled dietary sodium intake. Methodology The analysis included 379 normotensive and hypertensive individuals (age 18-66 years) from the HyperPATH (International Hypertensive Pathotype) consortium, who were maintained on at least 200 mEq of NaCl daily for one week and had a urinary salt balance of &amp;gt;150 mEq/24 hours at the time of sample collection. We calculated a 14-point summative LS7 score according to participants’ baseline data. Based on the range of LS7 score in this population, we classified participants as 'inadequate' (3-6), 'average' (7-10), and 'optimal' (11-14). We then performed regression analyses (adjusted for age, sex, race, and serum creatinine) between the LS7 score groups (inadequate, average, or optimal) and biochemical measures, including levels of aldosterone, C-reactive protein (CRP), and interleukin 6 (IL-6). Results When comparing across all three LS7 score groups, a higher LS7 score group was associated with lower aldosterone levels both in the serum (p=0.005, -0.97 [-1.63, -0.30]) and urine (p=0.003, -2.34 [-4.07, -0.825]). Additionally, a higher LS7 score group was associated with lower renin (p=0.008, -0.13 [-0.22, -0.03]) and a blunted increase in aldosterone with angiotensin-II infusion (p=0.019, -1.66 [-3.04, -0.27]). Serum potassium and serum cortisol were not associated with the LS7 scores. Being in the 'optimal' LS7 score group was associated with lower serum levels of CRP (p=0.001, -0.1 [-0.15, -0.04]) and IL-6 (p=0.026, -0.84 [-1.59, -0.10]). Notably, among the individual LS7 components, achieving target blood pressure and exercise goals most significantly impacted the associations between LS7 score and aldosterone levels. Conclusions Achieving an optimal American Heart Association's LS7 score was associated with a lower activity of the renin-angiotensin-aldosterone system and lower levels of the inflammatory markers CRP and IL-6, which may help to explain previous reports of better cardiovascular outcomes in individuals with a higher LS7 score. These findings offer a possible link between ideal cardiovascular health targets and biomarkers known to play a central role in the development of CVD. Presentation: Monday, June 13, 2022 12:00 p.m. - 12:15 p.m.

Achievement of target blood pressure among community residents with hypertension and factors associated with therapeutic failure in the northern territory of Japan.

This study aimed to determine the rate of achieving the target blood pressure (BP) defined by Japanese hypertension management guidelines and to examine factors associated with achieving the target BP. This cross-sectional study, which was conducted between January 2012 and December 2015, examined the BP control status and associated factors among 9,016 Japanese community residents with hypertension. Residents were divided into the following six groups: G1, young, middle-aged, and early-phase elderly patients; G2, patients with cerebrovascular disease; G3, patients with coronary artery disease; G4, patients with chronic kidney disease with proteinuria; G5, patients with diabetes; and G6, patients with chronic kidney disease without proteinuria. BP target achievement rates were calculated for each group. A multivariate analysis identified factors associated with "therapeutic failure" of target BP. The target BP was achieved by 52.6% participants in G1, 84.3% in G2, 50.6% in G3, 45.6% in G4, 48.7% in G5, and 75.0% in G6. The body mass index and receiving antilipidemic medication were associated with therapeutic failure. This study shows that achievement rates for treatment goals among Japanese patients with hypertension are still low. Body mass index and treatment of dyslipidemia may be associated with the control of BP.

Comparison of the blood pressure management between sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists

The cardiovascular and renal protective effects of sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1Ras) are enhanced by low/controlled blood pressure (BP). However, the BP-lowering efficacy of SGLT-2is and GLP-1Ras have not been compared directly. We compared the rates of achieving target BP with SGLT-2i and GLP-1Ra treatments in Japanese patients with type 2 diabetes mellitus (T2DM). This retrospective study included 384 SGLT-2i- and 160 GLP-1Ra-treated patients with BP > 130/80 mmHg before treatment. Inverse probability weighting methods using propensity scores were used in this study. The integrated odds ratios (OR) for BP control rates were calculated and clinical changes were analyzed using a generalized linear model. SGLT-2i treatment resulted in significantly higher BP control rates than that in the GLP-1Ra treatment (integrated OR = 2.09 [1.80, 2.43]). Compared with GLP-1Ra, SGLT-2i treatment demonstrated significantly larger decreases in diastolic BP, mean arterial pressure, and body weight (− 3.8 mmHg, P = 0.006; − 4.1 mmHg, P = 0.01; and − 1.5 kg, P = 0.008, respectively) and increased annual estimated glomerular filtration rate (eGFR; 1.5 mL/min/1.73 m2/year, P = 0.04). In T2DM patients with poorly controlled BP, compared with GLP-1Ra, SGLT-2i treatment significantly improved BP management and increased eGFR.

Blood pressure target achievement in older adults with hypertension and chronic heart failure with preserved ejection fraction: the impact of adipose tissue function

Objective. To assess the impact of adipose tissue dysfunction for target blood pressure levels achieving in arterial hypertension (AH) and chronic heart failure with preserved left ventricular ejection fraction (HFpEF) in real clinical practice.Materials and methods. We examined 91 elderly patients (&gt; 75 y.o.) with AH and HFpEF during hospital admission. The mass and mass fraction of adipose tissue, serum levels of adipokines (adiponectin, leptin) and proinflammatory cytokines (TNFa and IL6) were assessed. Steady normotension at discharge was used as a marker of the target blood pressure level achievement possibility.Results. By the time of the planned discharge, stable normotension was recorded in 24.2% of patients. In senile patients with failure to achieve normotension, isolated systolic AH was most common - 55.1%. Patients with persistent hypertension at the time of the planned discharge were characterized by a low ability of adipose tissue to secrete adiponectin: 0.05 (0.03; 0.12) vs 0.37 (0.12; 0.5) μg/mL/kg (p = 0.037 ). The minimum values of adiponectin (corrected for adipose tissue mass) were in patients with systolic-diastolic AH (0.04 (0.03; 0.06) μg/ml/kg, Jonkhier-Terpstra test, p = 0.033). A regression model for achieving normotension in senile patients with HFpEF was built with a total percentage of correct classifications of 93.8% before bootstrap and 95.8% after: the maximum values of the Wald statistics were achieved with respect to the predictors "adiponectin", "TNF-a" and "heart rate".Conclusion. The development of adipose tissue dysfunction, accompanied by a decrease in the “rescue hormone” adiponectin synthesis, is associated with the failure to achieve normotension during medication of the inpatient treatment in senile patients with AH and HFpEF.

Efficacy and Safety of Esaxerenone in Hypertensive Patients with Diabetic Kidney Disease: A Multicenter, Open-Label, Prospective Study.

IntroductionClinical data of esaxerenone in hypertensive patients with diabetic kidney disease (DKD) are lacking. We evaluated the efficacy and safety of esaxerenone in patients with DKD and an inadequate response to blood pressure (BP)-lowering treatment.MethodsIn this multicenter, open-label, prospective study, patients were divided into urinary albumin-to-creatinine ratio subcohorts (UACR < 30, 30 to < 300, and 300 to < 1000 mg/gCr). Esaxerenone was initiated at 1.25 mg/day and followed by incremental dose escalation based on BP and serum potassium level monitoring. The treatment period was 12 weeks. The primary endpoint was change in morning home systolic BP/diastolic BP (SBP/DBP) from baseline to end of treatment (EOT). Secondary endpoints included achievement rate of target BP, change in UACR from baseline, and safety.ResultsIn total, 113 patients were enrolled. Morning home SBP/DBP significantly decreased from baseline to EOT in the total population (− 11.6/− 5.2 mmHg, both p < 0.001) and in all UACR subcohorts (all p < 0.001). The target BP achievement rate was 38.5%. Significant reductions in bedtime home and office BPs were also shown in the total population and all UACR subcohorts. UACR significantly improved from baseline to EOT in the total (− 50.9%, p < 0.001) and all UACR subcohorts (all p < 0.001). Incidence of serum potassium elevation as drug-related treatment emergent adverse events was 2.7%. The change from baseline in estimated glomerular filtration rate (eGFR) was − 4.8 mL/min/1.73 m2.ConclusionEsaxerenone demonstrated a BP-lowering effect and improved albuminuria. The effects were consistent regardless of the severity of albuminuria without clinically relevant serum potassium elevation and eGFR reduction.Clinical Trial RegistrationjRCTs06119002.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02294-z.

Abstract P118: Metabolic And Hemodynamic Disorders In Obese Patients With True And Pseudo-resistant Hypertension

Objective: to conduct a comparative assessment between pseudo-resistant and true resistant hypertension (RH) in obesity. Methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: In the absence of a difference in BP levels, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had circadian rhythm (CR) violations with a predominance of the non-dipper CR. Despite the target BP achievement after 6 months, in the majority (91.42%) of non-RH patients, the CR normalized, while in RH a normal CR was only in 60.87%. At the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-RH, then after 6 months of therapy, patients with true RH had significantly higher office SBP levels (p&amp;lt;0.01) and 24 h average SBP according to ABPM data (p&lt;0.05) compared with pseudo-RH. Already at the stage of inclusion in the study, the normal CR in true RH was significantly less common than in pseudo-RH, and during the prescribed therapy, a similar trend persisted: after 6 months of therapy, 71.05% of pseudo-RH had a normal CR, while with true RH - only about half of the patients. Obese patients with true RH had also significantly lower BMI and LDL-cholesterol (p&lt;0.05) as well as higher levels of aldosterone and SBP (p&amp;lt;0.05) compared with pseudo-RH. Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese patients with RH are characterized by more pronounced CR disturbances and higher levels of office and out-of-office BP, compared with non-RH. Compared with pseudo-RH, the presence of true RH in obesity is associated with higher SBP and aldosteron levels, as well as lower BMI and LDL-cholesterol.

Abstract P223: Hypertension Telemonitoring And Protocolized Case Management For Community-Dwelling Older Adults: A Randomized Controlled Trial

Background: Home blood pressure (BP) telemonitoring combined with case management leads can reduce BP in adults with hypertension. However, the benefits of telemonitoring and case management for hypertension are not well established in older (age &gt;= 65 years) adults. Interventions that can safely improve BP control in this distinct group will be critically important, particularly given recent trials showing cardiovascular benefits of intensive BP lowering in this group, and their increased vulnerability to over-treatment-related side effects. Methods: Twelve-month, open-label, randomized controlled trial of community-dwelling older adults comparing home BP telemonitoring (HBPM) with pharmacist-led case management versus enhanced usual care with HBPM alone. The primary outcome was the proportion achieving age-specific systolic BP targets on 24-hour ambulatory BP monitoring (ABPM). Changes in HBPM were also examined. Logistic and linear regression were used for analyses, with adjustment for baseline BP. Results: Subjects randomized to intervention (n = 61) and control (n = 59) groups were mostly female (77%), with mean age of 79.5 years. The adjusted odds ratio (aOR) for ABPM BP target achievement was 1.48 (95% CI 0.87-2.52, p = 0.15). At 12 months, the mean difference in BP changes between intervention and control groups was -1.6/-1.1 for ABPM (p-value 0.26 for systolic and 0.10 for diastolic BP), and -4.9/-3.1 for HBPM (p-value 0.04 for systolic BP and 0.01 for diastolic BP), favoring the intervention. Intervention group subjects had a higher rate of systolic BP &lt; 110 (21% vs 5%, p = 0.009), but no differences in orthostatic symptoms, syncope, non-mechanical falls, or ED visits. Adherence to HBPM declined by 12 months, with 65% of trial-completers providing all 4 of the study-driven 3-monthly HBPM series. Conclusions: Home BP telemonitoring and pharmacist case management did not improve achievement of target range ambulatory BP, but did reduce home BP. It was not associated with major adverse consequences. Further trials will be necessary to refine HBPM interventions, improve adherence, and determine effectiveness in older individuals more conclusively.

Why take organ damage in hypertension seriously?

The focus of recent European guidelines has been early initiation of antihypertensive therapy in risk groups, rapid achievement of target blood pressure with fixed combinations of antihypertensive drugs, and the best possible management of an individuals cardiovascular risk. Early intervention in the development of hypertension-mediated organ damage (HMOD) has been shown to have an effect on the subsequent reduction in the risk of cardiovascular events. The point of HMOD origination correlates with the magnitude and duration of blood pressure elevation, and there is no clearly defined boundary from which vascular damage begins to develop. A reduction in blood pressure with pharmacotherapy demonstrably decreases the risk of ischaemic heart disease, stroke, as well as the mortality rate (1). Large clinical trials have consistently shown a significant reduction in the risk of these complications with antihypertensive medications across the entire spectrum from mild to severe hypertension, including hypertension in the elderly as well as isolated systolic hypertension (2). Based on the latest knowledge, a reduction in blood pressure by a mere 5 mm Hg has a cardioprotective effect even in normotensive individuals, which fundamentally changes the view on the diagnosis and definition of hypertension as a disease (3).

Effect of milrinone versus placebo on hemodynamic in patients with septic shock: A randomize control trial

Background: Sepsis is one of the most serious healthcare problems worldwide, which is associated with high mortality and financial burdens. The common causes of death are refractory shock and multi-organ failure. Myocardial dysfunction, a relatively common complication of septic shock, causes a significantly decrease in stroke volume and cardiac output. This results in insufficient blood supply to the organs, creates multi-organ failure and finally, leading to death. The Surviving Sepsis Campaign Guidelines 2016 also recommended using dobutamine in septic shock patients who had been resuscitated until achieving normal blood pressure target of mean arterial pressure 65 mmHg or more, but still had evidence of inadequate tissue perfusion. Milrinone action via an alternative pathway from the sympathetic inotropic agents, makes the milrinone to be used as an option for improve cardiac function among sepsis patients. However, there are few studies of milrinone in patients with septic shock. Methods: We plan to conduct a double blind randomized controlled trial, enrolling patients at Siriraj hospital and Hat-Yai hospital. The adults with the diagnosis of septic shock according to definition of SEPSIS III will be screened. Patients who receive fluid resuscitation at least 30 mL/kg, mean arterial pressure (MAP) ≥ 65 mmHg, with a clinical sign of poor tissue perfusion, or evidence of impaired left ventricular systolic function (left ventricular ejection fraction (LVEF) &lt; 40%) will be enrolled. The patients were randomly assigned in a 1:1 ratio by their sequential number to receive either milrinone (intervention group) or placebo (control group). The physician performs an echocardiogram for assessing cardiac function, before the starting of the study drug and after the 6 and 24 hours. The monitoring of vital signs, urine output, and lactate at 6 and 24 hours after milrinone or placebo commencement is recorded. Conclusion: This study will evaluate the efficacy of milrinone in improving cardiac output among adult patients with septic shock who is resuscitated to achieve target blood pressure but still have signs of poor tissue perfusion.

Comparative efficacy and safety of oral nifedipine with other antihypertensive medications in the management of hypertensive disorders of pregnancy: a systematic review and meta-analysis of randomized controlled trials.

Hypertensive disorders of pregnancy are the most frequently occurring medical condition during pregnancy, resulting in fetal and/or maternal morbidity and mortality. This meta-analysis compared the efficacy and safety of nifedipine with other antihypertensive medications used in hypertensive disorders of pregnancy. A comprehensive search was performed using PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The meta-analysis was carried out using Review Manager Software, and the pooled effect estimate was generated as standardized mean difference and odds ratio with 95% confidence interval and two-sided P -value. The meta-analysis was comprised of 22 randomized control trials with 2595 participants. It was found that meantime and number of doses required to achieve target blood pressure were lower in the nifedipine group ( P < 0.05). Even though it is statistically insignificant, fetal APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores less than seven favors nifedipine intervention. Furthermore, none of the fetal or maternal secondary outcomes were found significant. Nifedipine was found to be more effective than other antihypertensive medications to reduce blood pressure, particularly in patients with severe hypertension. However, future clinical studies, including real-world data are necessary to establish the safety profile of nifedipine concerning the fetal outcomes in hypertensive pregnant women.

Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial.

Home blood pressure (BP) telemonitoring combined with case management leads to BP reductions in individuals with hypertension. However, its benefits are less clear in older (age ≥ 65 years) adults. Twelve-month, open-label, randomized trial of community-dwelling older adults comparing the combination of home BP telemonitoring (HBPM) and pharmacist-led case management, vs. enhanced usual care with HBPM alone. The primary outcome was the proportion achieving systolic BP targets on 24-h ambulatory BP monitoring (ABPM). Changes in HBPM were also examined. Logistic and linear regressions were used for analyses, adjusted for baseline BP. Enrollment was stopped early due to coronavirus disease 2019. Participants randomized to intervention (n = 61) and control (n = 59) groups were mostly female (77%), with mean age 79.5 years. The adjusted odds ratio for ABPM BP target achievement was 1.48 (95% confidence interval 0.87-2.52, P = 0.15). At 12 months, the mean difference in BP changes between intervention and control groups was -1.6/-1.1 for ABPM (P-value 0.26 for systolic BP and 0.10 for diastolic BP), and -4.9/-3.1 for HBPM (P-value 0.04 for systolic BP and 0.01 for diastolic BP), favoring the intervention. Intervention group participants had hypotension (systolic BP < 110) more frequently (21% vs. 5%, P = 0.009), but no differences in orthostatic symptoms, syncope, non-mechanical falls, or emergency department visits. Home BP telemonitoring and pharmacist case management did not improve achievement of target range ambulatory BP, but did reduce home BP. It did not result in major adverse consequences.