BP Control Rates Research Articles

CLINICAL EFFICACY AND SAFETY OF AMLODIPINE/BISOPROLOL/PERINDOPRIL SINGLE-PILL AND FREE COMBINATION THERAPY IN PATIENTS WITH UNCONTROLLED ESSENTIAL HYPERTENSION

Objective: Efficacy and safety of the triple therapy amlodipine 5 mg, bisoprolol 5 mg and perindopril 5 mg in single pill combination (SPC) and in free combination, over a 12-week period. Design and method: Multicenter, randomized, open-label, controlled, phase III study. Patients with uncontrolled hypertension (Systolic Blood Pressure (SBP) > = 140 and < 160mmHg and Diastolic Blood Pressure (DBP) > = 90 and < 100 mmHg) treated either by monotherapy at maximal dose or bitherapy at initial dose were randomized to the SPC (group A), or to the free combination (group B). Previous antihypertensive treatment was discontinued. Efficacy assessments: SBP, DBP, response to treatment (rate of patients with BP normalized and/or decrease of SBP > = 20 mmHg and/or decrease of DBP > = 10 mmHg from baseline) and BP control rate (SBP < 140 mmHg and DBP < 90 mmHg). Patient-reported outcomes were evaluated using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) to assess treatment effectiveness, convenience and global satisfaction at the end of the study. Results: 150 patients were randomized (mean age 55.2 ± 10.1 years). At baseline, mean SBP/DBP in the included population were 149.71 ± 5.09/94.92 ± 2.78 mmHg. After 12 weeks of treatment, important SBP/DBP decrease was observed in both groups (-22.01 ± 10.04/-13.79 ± 7.47 mmHg in group A and -21.81 ± 9.41/-15.06 ± 8.31 mmHg in group B). High response to treatment was observed in both groups (90.91% in group A, 93.06% in group B) but higher proportion of patients were controlled with SPC (91.89% in group A, 87.5% in group B). Treatments were well tolerated. Less treatment-related adverse events were reported in group A (1.3%) versus in group B (6.9%). Most of the patients were satisfied with treatment in both groups, with a better convenience for the group A. Conclusions: In case of uncontrolled BP despite monotherapy at maximal dose or bitherapy at initial dose, switching to triple therapy of amlodipine 5mg+bisoprolol 5mg+perindopril 5 mg leads to a significant decrease of BP (p < 0.001), an improvement of response to treatment and better BP control rate. For similar efficacy, treatment by SPC showed lower rate of treatment-related adverse events and was assessed as more convenient by patients as compared to free combination.

DIAGNOSTIC PERFORMANCE OF PRE-DIALYSIS AND AMBULATORY BLOOD PRESSURE LEVELS IN MEN AND WOMEN HEMODIALYSIS PATIENTS

Objective: Ambulatory-blood-pressure (BP) control is worse in men than in women with chronic kidney disease or kidney transplantation. So far no study assessed in parallel possible effects of sex differences on the prevalence, control, and BP phenotypes according to pre-dialysis and 48-h ABPM in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of pre-dialysis BP in men and women hemodialysis patients. Design and method: 129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Hypertension was defined as follows: (1)pre-dialysis BP greater than or equal to 140/90mmHg or use of antihypertensive agents, (2)48-h BP greater than or equal to 130/80mmHg or use of antihypertensive agents. Results: The prevalence of hypertension was not different between men and women with the use of pre-dialysis BP (92.2% vs 92.3%, p = 0.987, respectively) or 48-h ABPM (92.2% vs 89%, p = 0.411). With the use of pre-dialysis BP men had significantly lower control rates than women (18.5% vs 32.1%, p = 0.025); a similar pattern of worse control in men was apparent with ABPM, but the difference was not statistically significant (22.7% vs 28.4%, p = 0.360). The rate of patients with concordant lack of control by pre-dialysis and ABPM was significantly higher in men than women (65.3% vs 49.4%, p = 0.023); white-coat (14.9% vs 17.6%, p = 0.593) and masked hypertension (10.7% vs 18.8%, p = 0.101) did not differ between-groups. However, the misclassifation rate with the use of pre-dialysis BP was lower in men than women. There was moderate or at best fair agreement between pre-dialysis and ABPM with regards to the prevalence (men: kappa-statistics = 0.39, p < 0.001 and women: 0.27, p = 0.011) and control rates (kappa-statistics = 0.25, p = 0.005 and 0.17, p = 0.124, respectively). Pre-dialysis BP greater than or equal to 140/90mmHg had sensitivity/specificity of 85.9%/51.4% in men and 72.4%/54.5% in women for the diagnosis of elevated 48-h BP. Receiver-operating-curve analyses confirmed this poor diagnostic performance. Conclusions: The prevalence of hypertension is similar between men and women hemodialysis patients but men have worse rates of office BP control. The diagnostic accuracy of pre-dialysis BP was equally poor in men and women hemodialysis patients.

Cold Pressor Test in Primary Hypertension: A Cross-Sectional Study.

ObjectivesTo investigate the characteristics of patients with primary hypertension who had positive responses to the cold pressor test (CPT).MethodsThis cross-sectional study was conducted between November 2018 to November 2019, and the CPT was performed in patients with primary hypertension in 48 hospitals. The demographic characteristics and complications were collected through a questionnaire and physical examinations. A 12-month follow-up was conducted to identify the occurrence of the following events: a) all-cause mortality; b) myocardial infarction; c) stroke; d) hospitalized for heart failure.ResultsThe CPT was positive in 30.7% of the patients. Compared with the negative CPT group, the positive CPT group was associated with a lower rate of blood pressure control, and was more likely to have a high salt diet, diabetes, hyperuricemia, left ventricular wall thickening, carotid plaques, coronary heart disease and heart failure. A high-salt diet (OR = 1.228, 95%CI: 1.037–1.456) was found to be correlated with the positive result of CPT. Among patients in the positive CPT group, those using diuretics had a significantly higher rate of blood pressure control than those not using diuretics (54.6 vs.42.6%, x2 = 6.756, P = 0.009). After a 12-month follow-up, the incidence of heart failure in the positive CPT group was significantly higher than that in the negative CPT group (7.35 vs.5.01%, x2 = 3.945, P = 0.047).ConclusionsPatients with positive responses to the CPT had lower rates of BP control and a high risk of heart failure, which may be related to their preference for a high-salt diet. The use of diuretics helps to better control blood pressure in those patients.

Real-world evidence on the strategy of olmesartan-based triple single-pill combination in Korean hypertensive patients: a prospective, multicenter, observational study (RESOLVE-PRO)

BackgroundIn this prospective, multicenter, non-comparative observational study, the effectiveness and safety of the triple single-pill combination (SPC) of olmesartan/amlodipine/hydrochlorothiazide (OM/AML/HCTZ) were evaluated in a real clinical practice setting in Korean patients with essential hypertension.MethodsA total of 3752 patients were enrolled and followed for 12 months after administration of OM/AML/HCTZ. Primary endpoint was change from baseline to month 6 in the mean systolic blood pressure (SBP). Secondary endpoints included changes from baseline in the mean SBP at month 3, 9, 12 and the mean diastolic blood pressure (DBP) at month 3, 6, 9, 12; changes in the mean SBP/DBP according to age and underlying risk factors; and blood pressure control rate (%) at different time points. Adherence to and satisfaction with OM/AML/HCTZ treatment among patients and physicians were assessed by medication possession ratio (MPR) and numeric rating scale, respectively, as exploratory endpoints. Safety was evaluated by the incidence and severity of adverse events (AEs) as well as the discontinuation rate due to AEs.ResultsOM/AML/HCTZ administration led to significant reductions in the mean SBP/DBP by 11.5/6.6, 12.3/7.0, 12.3/7.2, and 12.8/7.4 mmHg from baseline to month 3, 6, 9 and 12, respectively (P < 0.0001). The BP reductions were maintained throughout the 1-year observation period in all patients with different age groups and risk factors (diabetes mellitus, cardiovascular disease, and renal disease). The BP control rate (%) of < 140/90 mmHg was 65.9, 67.9, 68.9, and 70.6% at month 3, 6, 9, and 12, respectively. The mean MPR during the observation period was 0.96. The safety results were consistent with the previously reported safety profile of OM/AML/HCTZ.ConclusionsTreatment with the triple SPC of OM/AML/HCTZ demonstrated significant effectiveness in reducing SBP/DBP and achieving target BP control with high adherence over the 1-year observation period in Korean hypertensive patients and was well-tolerated.Trial registrationCRIS, KCT0002196, Registered 3 May 2016.

Efficacy &amp; tolerability of bisoprolol in comparison to metoprolol in Indian patients with stage-1 hypertension: multicentre, parallel group, open labelled, randomised noninferiority clinical study

Abstract Introduction Bisoprolol &amp; Metoprolol are selective β1 adrenergic blockers used in treatment of several diseases, including hypertension (HTN). Unlike Metoprolol, the β1-receptor selectivity of Bisoprolol does not change with increasing dose and Bisoprolol also has a longer half-life. The objective was to compare the efficacy &amp; tolerability of Bisoprolol with Metoprolol in Indian patients with Stage-1 HTN. Method Multicentre, parallel group, open labelled, randomised noninferiority trial was conducted at 6 cardiology centres in India (2010 – 2011). The study was approved by the institutional ethics committee at each centre and was performed in accordance with the good clinical practice guidelines and ICH-GCP. Out 218 adult patients screened, 200 patients between the age group of 18 to 65 years, with systolic blood pressure (SBP) 140–159 mm Hg or diastolic blood pressure (DBP) 90–99 mm Hg were randomly assigned to receive either Bisoprolol 5 mg once daily or Metoprolol-SR 50 mg once daily. Primary outcome measure was the responder rate (% of patients achieving BP &amp;lt;140/90 mm Hg throughout 24 hours) at 12 weeks. The secondary outcome measures were the percentage of patients requiring dose titration at 6 weeks, change in the SBP &amp; DBP from baseline at 6 and 12 weeks, change in the mean night-time blood pressure from baseline at 12 weeks &amp; global efficacy and tolerability assessment on a four-point scale. Results 200 patients (100 each in the 2 arms, 74.5% Males, mean age of 49.55 and 53.39 in the bisoprolol and metoprolol arms respectively) were enrolled in the study. Efficacy analysis was done on 165 patients who completed the study. There was a trend towards a better 24 hr BP control rate with Bisoprolol, responder rates were 68.33% for Bisoprolol and 62.9% for Metoprolol as measured by continuous ambulatory blood pressure measurement. Also Bisoprolol was non-inferior to Metoprolol with respect to percentage of patients requiring dose titration (12.3% vs 11.6%), change in SBP (7.7% vs 7.2%) &amp; DBP (9.6% vs 9.1%), change in mean night-time blood pressure (29.1% vs 25.3%) and reduction in heart rate (9.2% vs 6.7%). The two treatments were also similar with respect to efficacy &amp; tolerability on Global Assessment by doctors &amp; patients respectively. Conclusion Bisoprolol is non-inferior to Metoprolol-SR with respect to efficacy &amp; safety in patients of stage-1 HTN, with a trend towards better control of 24 hr BP in this non-inferiority trial. This study was conducted at a time when β-blockers were considered as first-line therapies for the management of hypertension. Our study supports the use of bisoprolol in Indian patients, based on the non-inferiority (as compared to metoprolol) and with the advantageous profile of the molecule. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The study was supported by a research grant from Merck.

An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension.

Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM’s inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339–0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209–0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107–1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.

Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018.

[Figure: see text].

COMBINATION OF NON-DIPPING PROFILE WITH HIGH NIGHTTIME SYSTOLIC BLOOD PRESSURE IN RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER CARDIOVASCULAR RISK

Objective: Non-dipping profile is an important predictor of adverse cardiovascular (CV) outcomes. Its associations with subclinical vascular damage in rheumatoid arthritis (RA) are not known yet. We aimed to assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with CV risk in patients with RA. Design and method: The study group included 85 patients with RA (females 77.6%, aged 59.7 ± 14.3 years, HTN 65%, mean DAS-28 3.7 ± 1.1) and control group (40 patients matched by gender, age and risk factors). Office BP was measured with a validated oscillometric device, 24-hour ABPM by BPLab Vasotens. CV risk was calculated as mSCORE. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn &lt; 120 mmHg (G2), non-dippers with SBPn &gt; 120 (G3). p &lt; 0.05 was considered significant. Results: Rate of BP control was 58% in RA and 67% in the controls (p = 0.48). Patients with RA vs controls were characterized by higher mean SBPn (123 ± 17 vs 112 ± 10 mmHg, p = 0.002), lower diurnal index (DI) (median 4 vs 7.5%, p = 0.006), higher rate of night hypertension (49.4 vs 12.5% (χ2 = 17, p &lt; 0.001)). RA patients more often had non-dipping profile (DI &lt; 10%): 83.5 vs 62.5%, (χ2 = 7.4, p = 0.02). In RA group patients with SBPn &gt; 120mmHg had higher age (64.8 ± 12.6 vs 54.8 ± 14.3 years), office BP (142 ± 19/82 ± 11 vs 121 ± 14/76 ± 9mmHg), HTN duration (med 5.5 vs 0 years), mSCORE (med 6.1 vs 2.5%), p &lt; 0.001 for trend. Patients with DI &lt; 10% had higher age (60.8 ± 14.8 vs54.1 ± 10 years, p = 0.04). SBPn significantly correlated with age (r = 0.5), office SBP (r = 0.6) and DBP (r = 0.3), mSCORE (r = 0.5);non-dipping pattern–with age (r = 0.2). After adjustment by SBPn, no differences were observed between G1 and G2. Patients in G3 vs G1 had higher CRP (med 16.6 vs 6.7 mg/l, p = 0.03), mSCORE (med 7.1 vs2.3%, p &lt; 0.001 for both); in G3 vs G2–higher mSCORE (med 7.1 vs 2.1%), p &lt; 0.001 for trend and ESR (med 46 vs 23 mm/h, p = 0.03). Conclusions: Patients with RA were characterized by higher incidence of non-dipping pattern, SBPn elevation. Combination of high SBPn and non-dipping pattern was associated with higher CV risk. These associations may be mediated by inflammation. The publication was prepared with the support of the RUDN University Program 5-100.

BP VALUES AND CONTROL RATES IN A GENERAL POPULATION: IMPACT OF THE ESC-ESH AND ACC-AHA GUIDELINES

Abstract Objective: The recent guidelines on the hypertension (HTN) management, ESC-ESH and ACC-AHA, establish different recommendations for BP goals. The impact in the rates of BP control differs among the countries based on the prevalence of HTN. The objective was to assess the rates of BP control in a Mediterranean population. Design and method: The sample was recruited from beneficiaries of the Valencian Health Agency's health care system, with a population of 3799884 people older than 25 years in 2012. The observational study was undertaken as part of routine clinical practice in data from the last 6 months of 2016. Hypertension was defined by a recorded physician diagnosis, or antihypertensive medication use. Results: Among the total population, 2552417 normotensives and 1247467 hypertensives were included. Among normotensives 123332 (4.8%) were diabetics and 45142 (1.7%) CKD. Among HTN, 387590 (31%) were diabetics and 272800 (21.8%) CKD. BP values was recorded in 46% of subject no diagnosed of HTN and 80% of HTN. According the ESH-ESC (&lt;140/90 mmHg) and the ACC-AHA (&lt;130/80 mmHg) criteria, distribution of subjects with BP higher that the recommended among the non-diagnosed of HTN (left figure) and the rate of control by the in the HTN (right figure), by decades of age and sex are below. Conclusions: Control rates of hypertension among subjects diagnosed varies across age and sex. Furthermore, large per cent of subjects with BP recorded were not diagnosed of hypertension neither are receiving antihypertensive treatment. The magnitude of this “diagnosed inertia” is clearly magnified, around twice, if the ACC criteria for diagnosis and goals are adopted.

Fixed-Dose Combination Medications for Treating Hypertension: A Review of Effectiveness, Safety, and Challenges.

To summarize the recent evidence on the effectiveness and safety of antihypertensive fixed-dose combination (FDC) medications, and to describe the facilitators and barriers to implementing FDCs in US clinical practice. Recent clinical practice guidelines include FDC use for treating high BP. Clinical trials in recent years support the use of antihypertensive FDCs including low-dose triple- and quadruple-therapy FDCs. Initiating a low-to-standard dose dual-therapy FDCs showed better BP control than initiating treatment with a standard-dose monotherapy, and triple-therapy FDCs produced better BP control rates than dual-therapy FDCs. Retrospective cohort studies showed that FDCs are associated with increased medication adherence, reduced clinical inertia, decreased time to BP control, and improved cardiovascular outcomes. We further discussed barriers and facilitators of wider implementation of antihypertensive FDCs in clinical practice. FDC treatment for hypertension is not commonly used despite historical and recent data which support the effectiveness, safety, and benefits of FDCs. Simplified and protocolized treatment algorithms, team-based care, shared decision-making principles are crucial to successful utilization and implementation of FDC in clinical practice.

THU0126 COMBINATION OF NON-DIPPING PROFILE WITH ELEVATION OF NIGHTTIME SYSTOLIC BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK

Background:Nocturnal hypertension (HTN) and non-dipping profile are important predictors of adverse cardiovascular (CV) outcomes. Their associations with subclinical vascular damage in rheumatoid arthritis (RA) are still a matter of investigation. It was shown that 10-year atherosclerotic CV disease risk (rASCVD) may be more accurate in CV risk prediction in RA than SCORE. Associations of impaired 24-h BP phenotypes with CV risk in RA are not well-studied yet.Objectives:To assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with arterial stiffness and CV risk assessed by rASCVD in patients with RA.Methods:Study group included 90 patients with RA (females 78.7%, age 59.5±14.2 years, HTN 64%, median (med) HTN duration 6.4 years, RA duration – 7.2 years, seropositive RA 66%, mean DAS-28(CRP) 3.8±1.0) and control group (45 patients matched by gender, age and risk factors). All patients with HTN received antihypertensive therapy. Office BP was measured with a validated oscillometric device, 24-hour ABPM was performed with BPLab Vasotens, carotid-femoral PWV was assessed by applanation tonometry. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn&lt;120 mmHg (G2), non-dippers with SBPn≥120 (G3). CV risk in RA group was calculated as 10-year rASCVD. Risk≥7.5% was considered as high. p&lt;0.05 was considered significant.Results:Median rASCVD was 6.3%. Rate of BP control was 60% in RA and 66% in the controls (p=0.5). Patients with RA vs controls had higher mean SBPn (124±16 vs 110±8 mmHg, p=0.003), lower diurnal index (DI) (med 3.8 vs 8.1%, p=0.02), higher rate of night HTN (49.6 vs 12.2% (p=0.0002). The RA and control groups didn`t differ by dipping patterns, although RA patients more often had non-dipping profile (DI &lt;10%): 83.9 vs 61.3%, (p=0.02). RA patients with SBPn ≥120 mmHg had higher age (63.7±12.5 vs 52.9±14.5 years), office SBP (143±17 vs 122±13 mmHg), HTN duration (med 5.4 vs 0.5 years), PWV (10.3±3.0 vs 7.9±2.5 m/s) and rASCVD (12 vs 3.4%), p&lt;0.001 for trend. Analysis in hypertensive RA group confirmed significant differences in PWV (11.3±3.1 vs 9.1±3.2 m/s, p=0.02) and rASCVD (med 13.5 vs 10.5%, p=0.045). Patients with DI&lt;10% had higher age (60.9±13.8 vs 54.3±11 years, p=0.04) and rASCVD (med 8.5 vs 3.1%, p=0.02). Patients with rASCVD ≥7.5% compared to &lt;7.5% had higher SBPn (133±11 vs 112±8 mmHg), lower median DI (0 vs 6%), more often had masked HTN (43 vs 16%) and night HTN (48 vs 16%), p&lt;0.01 for trend. SBPn significantly correlated with age (r=0.6), office SBP (r=0.5) and DBP (r=0.4), PWV (r=0.6), rASCVD (r=0.6); non-dipping pattern – with age (r=0.2), and rASCVD (r=0.3). After adjustment by SBPn, no differences were observed between G2 and G3. Patients in G3 vs G1 had higher PWV (10.4±3.1 vs 7.6±1.7 m/s, p=0.004), CRP (med 15.7 vs 7.8 mg/l, p=0.03), rASCVD (med 12.8 vs 3.1%) (p&lt;0.001); in G3 vs G2 – higher PWV (10.8±3.1 vs 8.2±2.3 m/s), rASCVD (med 12.8 vs 2.7%) and ESR (med 45 vs 21 mm/h, p&lt;0.01 for trend).Conclusion:Patients with RA had higher incidence of non-dipping pattern and SBPn elevation. Combination of high SBPn and non-dipping was associated with higher arterial stiffness and CV risk – this may be mediated by inflammation. Higher CV risk was associated with masked and night HTN. This may help in defining indications for ABPM in this population.

Clinical efficacy, safety and tolerability of Aliskiren Monotherapy (AM): an umbrella review of systematic reviews

BackgroundAliskiren is a newly developed drug. Its role in lowering BP has been recognized. However, the role of aliskiren in treating heart and renal diseases are still controversial.ObjectiveTo evaluate the existing evidence about clinical efficacy, safety and tolerability of aliskiren monotherapy (AM).MethodsAn umbrella review of systematic reviews of interventional studies. We searched Pubmed, Embase and Cochrane Library up to June 2019. Two reviewers applied inclusion criteria to the select potential articles independently. The extract and analyze of accessible data were did by two reviewers independently too. Discrepancies were resolved with discussion or the arbitration of the third author.ResultsEventually, our review identified 14 eligible studies. Results showed that for essential hypertension patients, aliskiren showed a great superiority over placebo in BP reduction, BP response rate and BP control rate. Aliskiren and placebo, ARBs or ACEIs showed no difference in the number or extent of adverse events. For heart failure patients, AM did not reduce BNP levels (SMD -0.08, − 0.31 to 0.15) or mortality rate (RR 0.76, 0.32 to 1.80), but it decreased NT-proBNP (SMD -0.12, − 0.21 to − 0.03) and PRA levels (SMD 0.52, 0.30 to 0.75), increased PRC levels (SMD -0.66, − 0.8 to − 0.44). For patients who are suffered from hypertension and diabetes and/or nephropathy or albuminuria at the same time, aliskiren produced no significant effects (RR 0.97, 0.81 to 1.16).ConclusionWe found solid evidence to support the benefits of aliskiren in the treatment of essential hypertension, aliskiren can produce significant effects in lowering BP and reliable safety. However, the effects of aliskiren in cardiovascular and renal outcomes were insignificant.Trial registrationStudy has been registered in PROSPERO (CRD42019142141).

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Philippines (a country report).

Incidence of cardiovascular diseases (CVD) in the Philippines based on the Philippine Heart Association survey among hospital-based population showed hypertension as the highest (38.6%), followed by stroke (30%), coronary artery disease(CAD) (17.5%), and heart failure (10.4%). Based on Philippine FNRI data, the prevalence of coronary, cerebrovascular, and peripheral arterial diseases were 1.1%, 0.9%, and 1.0%, respectively. Cardiovascular risk factor prevalence were the following: diabetes at 3.9%, dyslipidemia at 72%, smoking at 31%, obesity at 4.9% (BMI), and 10.2% and 65.6% by waist-hip ratio in men and women, respectively. In a more recent study on risk factors, urban dwellers were more hypertensive, overweight, obese, and with impaired fasting glucose. More smokers and dyslipidemia by high TC, high non-HDL-C, and low HDL-C were seen in those living in the rural areas. Subjects with higher level of education were more overweight, obese and have dyslipidemia by a high TC, TG, and LDL-C while there were more smokers, low HDL-C, and hypertensive participants who have reached a lower level of education. Latest data on prevalence of hypertension were 28% equal for males and females. Unaware was 9%. Treatment rate was 56%, compliance was 57%, and BP control rate was 20%. Antihypertensive medications used were beta-blockers (36%), calcium channel blockers (CCB) (33%), angiotensin receptor blockers (ARB) (28%), ACE inhibitors (5%), and centrally acting agents (4%). Mortality from CVD was stroke, mostly infarct (22.6%), myocardial infarction (6.5%), and Heart Failure (6.5%).

Effects of a comprehensive intervention on hypertension control in Chinese employees working in universities based on mixed models

We conducted a comprehensive intensive intervention for hypertension patients working in universities or colleges. From July 2015 to March in 2016, 220 hypertension subjects were recruited, with 165 cases in intensive intervention group and 55 in standard intervention group. After 24 months of intervention, 208 ones including of 157 in intensive intervention group and 51 in standard intervention group were included in the final analysis. The patients in standard intervention group were given routine intervention, which mainly including of drug treatment and health education. The patients in intervention group were given comprehensive intensive intervention in addition to routine intervention, including follow-up management of hypertension, emotional, lifestyle intervention and else. The study and experimental protocols were approved by institutional review board of Zhejiang Hospital and Fu Wai Hospital and registered (ChiCTR-ECS-14004641, date of registration: May 8, 2014). After 2 years, compared with the standard intervention group, SBP/DBP in the intensive intervention group decreased by 3.7/4 mmHg and BP control rate increased by 8.9%, and the unhealthy behaviors and life quality including tension and pressure were also improved in the intensive intervention group. We used mixed effect model to analyze the intervention effect which could solve the problems of missing values and correlation. The intensive intervention of hypertension control including follow-up management, emotional and lifestyle intervention in occupational places could promote the development of the prevention, treatment and control of hypertension among staff in colleges and universities.

Blood Pressure Control Behaviors and Control Rate and Socioeconomic Status in Chinese Adult Hypertensives in 2013

Background: Hypertension has reached an epidemic proportion in China but is often sub-optimally controlled. Sufficient engagement in BP-lowering strategies can result in effective BP control. However, studies about the pattern of self-management practices and the contribution of antihypertensive strategies to BP control quality by further considering the role of socioeconomic factors in Chinese hypertensive population using nationwide representative data were incompletely investigated. Methods: We used data from a national representative survey which sampled 177,099 adults aged ≥18 in mainland China in 2013-2014. A total of 31,714 diagnosed hypertensives were included in the analyses. Information regarding general characteristic, history of chronic diseases, and profiles of self-care behaviors was collected by questionnaire-based interview. Laboratory tests and physical measurements were undertaken on each participant. The prevalence of BP control behaviors and BP control rate were examined overall and by several SES factors. Rao-Scott chi-square tests were used for comparisons between subgroups. A Venn diagram was used to present the distribution and overlap of behaviors. Findings: 72·9% reported consistent adherence to medication, 12·9% exhibited non-adherence to medication, 21·6% reported adopting lifestyle modifications, 16·0% reported BP monitoring, 8·1% did not use any strategies, and 2·1% reported seeking other agents. People who took medications consistently were more likely to adopt non-pharmaceutical strategies than those who did not adhere to prescription. Those who were older, being higher income and education levels, had urban residency and being widowed/separated status were more likely to use combined medication and non-medication strategies. Consistent medication generated a control rate of 29·3%, higher than occasional medication (24·4%) and lifestyle modification (26·4%). Lifestyle changes worked a little better than taking no measures (26·4% vs· 26·1%). Poor medication adherence worked even worse than taking no measures (24·4% vs. 26·1%), and consistent medication paired with non-pharmacological agents worked better than any single treatment. Socioeconomic status such as age, gender, marital status and geographical region remained confounding factors in terms of causality between strategies and BP control quality. Interpretation: Population-based health education programs and SES-considered interventions were needed to encourage better engagement in prescribed treatment and combined strategies to help address unfavorable BP control profiles. Funding Statement: National Key Research and Development Project (2018YFC1313904). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study protocol was approved by the ethical committee of the Chinese Center for Disease Control and Prevention. All study participants were informed and signed a written consent.

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Malaysia.

Cardiovascular disease (CVD) accounts for a third of all deaths in Malaysia. The background CV risk of Malaysia is much higher than that of developed countries in the west and in Asia. This high CV mortality is contributed by the high prevalence of CV risk factors especially hypertension which is very prevalent, coupled with low awareness and low control rates. This highlights the importance of home blood pressure measurements (HBPM). HBPM is an important adjunct in the management of hypertension, particularly to identify those unaware as well as white-coat hypertension which is high in treated hypertensive patients in Malaysia. Ownership of HBPM devices in Malaysia is high, and this is an opportunity as well as timely to encourage more use of HBPM. The Malaysian national guidelines do not require HBPM for the diagnosis of hypertension but do recommend HBPM for specific situations. The most commonly prescribed anti-hypertensives are calcium channel blockers, followed by renin-angiotensin system blockers. Despite the wide availability of anti-hypertensive agents, BP control rates remain low. It is important that strategies are in place to ensure that individuals are aware of the need to have their BP monitored regularly and this can be facilitated by the use of HBPM. Hence, there is a plan to develop a local HBPM consensus document. Strategies to reduce salt intake would also be beneficial. In summary, identification of those unaware and better control of BP with the help of HBPM would help reduce the burden of CV mortality and morbidity in Malaysia.

Blood pressure control and cardiovascular risk profile in hypertensive patients under specialist care in Argentina: Results from the CHARTER study.

Worldwide, hypertension control rate is far from ideal. Some studies suggest that patients treated by specialists have a greater chance to achieve control. The authors aimed to determine the BP control rate among treated hypertensive patients under specialist care in Argentina, to characterize patients regarding their cardiovascular risk profile and antihypertensive drug use, and to assess the variables independently associated with adequate BP control. The authors included adult hypertensive patients under stable treatment, managed in 10 specialist centers across Argentina. Office BP was measured thrice with a validated oscillometric device. Adequate BP control was defined as an average of the three readings <140/90mmHg (and <150/90 in patients older than 80years). The authors estimated the proportion of adequate BP control and the variables independently associated with it through a multiple conditional logistic regression model. Among the 1146 included patients, 48.2% were men with a mean age of 63.5 (±13.1) years old. Mean office BP was 135.3 (±14.8)/80.8 (±10) mmHg, with a 64.8% (95% CI: 62%-67.6%) of adequate control. The mean number of antihypertensive drugs was 2.1 per participant, the commonest being angiotensin receptor blockers and calcium channel blockers. In multivariable analysis, only female sex was a predictor of adequate BP control (OR 1.33 [95% CI 1.02-1.72], P=.04). In conclusion, almost 65% of hypertensive patients treated in specialist centers in Argentina have adequate BP control. The challenge for future research is to define strategies in order to translate this control rate to the primary care level, where most patients are managed.

Hypertension artérielle sévère nouvellement diagnostiquée dans un pays en Afrique sub-saharienne : aspects épidemio-cliniques, thérapeutique et évolutifs

ObjectivesHigh Blood Pressure (HBP) is a worldwide public health problem. It can be particularly severe in the Black race. Recent studies in Cameroon, showed an alarming prevalence, leading us to want to study the epidemiological, clinical, therapeutic and evaluative aspects of severe, (BP op to 180/110mmHg), recently diagnosed HBP in Yaounde. Our objective was to determine its clinical presentation and evolution. MethodsWe conducted nine months prospective cohort study, from January to September 2016. We recruited from the active population participants who voluntarily accepted blood pressure screening offered in various localities in Yaounde, and were aged from 18 years and above. ResultsOf a total of 6519 people who participated in the screening, 1875 (28.8%.), presented a HBP and 363 (5.6%) had severe HBP. Our cohort comprised 153 (42.1%) of these individuals with sustained severe hypertension, not on medication, who accepted the invitation to participate in the study. The range of 45–54 years and 55–64 years were the most represented; the sex ratio was 0.9. The cardiovascular risk factors number range from 5 to 8 with a median of 6. Systolic BP ranged from 184 to 225mmHg with a median of 200mmHg; while the diastolic BP ranged between 111–132.5mmHg with a median of 119mmHg. Kidney injury (77.8%) was the main complications. We identified 3 clinical forms: hypertensive emergencies 121 (79.1%) cases and hypertensive crises 32 (20.9%) cases. In these two groups, 33 (21.6%) patients presented with “super HBP” (a blood pressure>250/150mmHg). The average rate of BP control over 6 month was 39%. The main cause of poor BP control was lack of therapeutic compliance. We registered one death at the 3rd month of follow up due to acute kidney injury. ConclusionSevere HBP prevalence in Yaounde is high in the active fraction of the population insidiously affected. Particularly, unsuspected renal impairment appears to be the major complication. The bad blood pressure control is linked to poor therapeutic observance and persistence.

Prevalence and control of hypertension in hemodialysis patients using ambulatory blood pressure in the area of Blida (Algeria)

We aimed to evaluate the prevalence and control of hypertension using ABPM in a large hemodialysis population according to the latest definitions. A total of 178 hemodialysis patients underwent 24 hour ABPM during a regular hemodialysis session and pre-hemodialysis interval (PHD). HT was defined as pre-hemodialysis BP > = 140/90 mmHg or use of antihypertensive (ATH) drugs and ambulatory BP > = 130/80 mmHg or use of ATH drugs. The control phenotypes of hypertension were defined as follows: – concordant control (PHD BP < 140/90 mmHg and ABPM < 130/80 mmHg); – concomitant lack of control (PHD BP > = 140/90 mmHg and ABPM > = 130/80 mmHg); – “white coat” phenomenon (PHD BP > = 140/90 mmHg and ABPM < 130/80 mmHg); – masked hypertension (PHD BP < 140/90 mmHg and ABPM > = 130/80 mmHg). Mean BP values were: 141.7 ± 19 and 79.8 ± 11 mmHg. There was higher prevalence of uncontrolled systolic pressure and diastolic pressure rate in men ( P < 0.001). In PHD, the prevalence of HT was 93.1%. According to the ABPM and during the haemodialysis period, the prevalence was 84.6%. The proportion of hypertensive patients receiving treatment was 80.4%. With the use of BP in PHD and ABPM, 11.1% of hypertensive patients had concomitant control of BP, 63.2% of patients had no control of BP, 15.5% had a white coat phenomenon and 10.2% had masked HT. In multivariate analysis, only the use of antihypertensive drugs was independently associated with an increased likelihood of no control. A significant relationship between uncontrolled BP and diabetic nephropathy was found ( P = 0.01). Patients with uncontrolled BP most often used a calcium antagonist alone (87% vs. 48%). There was a significant difference in the presence of diabetes and cardiovascular disease between studied groups ( P < 0.01). The prevalence of hypertension in hemodialysis patients is extremely high. BP control rates differ between ABPM and office BP. Poor BP control in men may result from lower compliance. Combined antihypertensive therapy may increase adherence to reduce cardiovascular risk.

HYPERTENSIVE PATIENTS WITH RHEUMATOID ARTHRITIS ARE CHARACTERIZED BY HIGHER LEVELS OF THE OFFICE BLOOD PRESSURE AND WORSE CONTROL OF CENTRAL BLOOD PRESSURE COMPARED TO THE CONTROLS

Objective: Rheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk. Arterial hypertension (HTN) is an important modifiable CVD risk factor. Its prevalence and significance in RA is still a matter of investigation. The aim of the study was to evaluate the office peripheral and central BP levels in patients with RA compared to the control group. Design and method: The study group included 85 patients without known CVD (77.6% females, age 59.7 ± 14.3 (M ± SD) years, 65% with HTN, median duration of HTN 6.6 years. Median duration of RA was 7 years, seropositive RA was diagnosed in 65%. Median hsCRP was 10 mg/dl, median rheumatoid factor – 51.3 IU/ml, mean DAS-28(CRP)-3.7 ± 1.1. All received disease-modifying anti-rheumatic drugs. The control group included 40 patients matched by basic parameters (77.5% females, age 58.9 ± 15.5 years, 60% with HTN, median duration of HTN 5 years). All patients with HTN received antihypertensive therapy. Office peripheral BP was measured with a validated oscillometric device, office central BP (CBP)–with applanation tonometry. CBP elevation was assessed according to individual reference values by gender and age. p < 0.05 was considered significant. Results: The rate of BP control in hypertensive patients was 58% in RA and 67% in the control group (χ2 = 0.5, p = 0.48). In patients without HTN mean office peripheral and central BP levels were similar in the RA and the control groups: 117 ± 13/73 ± 9 vs 117 ± 7/68 ± 8 mmHg and 108 ± 13/74 ± 10 mmHg vs 106 ± 10/71 ± 8 mmHg respectively (p > 0.05 for the trend). In patients with HTN corresponding BP levels were the following: 138 ± 17/82 ± 10 vs 130 ± 16/74 ± 11 mmHg (p = 0.04 for SBP; p = 0.0003 for DBP) and 132 ± 20/82 ± 10 vs 120 ± 17/74 ± 12 mmHg (p = 0.01 for SBP; p = 0.001 for DBP). The elevation of CBP was observed in 42.4% of RA patients and 17.5% of the controls (χ2 = 14.9, p = 0.0001): 16.7% vs 0% in the group without HTN (χ2 = 6.0, p = 0.01) and 56.4% vs 29.2% in the HTN group (χ2 = 9.9, p = 0.002), respectively. Conclusions: Despite similar BP control patients with RA are characterized by higher levels of office peripheral and central BP compared to the control group. RA is associated with worse control of central BP.