Target BP Research Articles

IMPACT OF ANTIHYPERTENSIVE DRUGS ON C REACTIVE PROTEIN (HS-CRP) AND NEUTROPHIL LYMPHOCYTE RATIO (NLR)

Many studies showed the association between inflammation and Hypertension. Inflammatory markers may highlight the state of inflammation in hypertensive patients. This study aimed to investigate impact of antihypertensive drugs on high sensitive C-reactive protein (hsCRP) and neutrophil lymphocyte ratio (NLR). A comparative cross sectional study was conducted on 86 hypertensive patients attending cardiology outpatient clinic in Al-Gamhuoria Modern General Hospital, Aden, in the period from October to December 2023. Participants were divided into three groups: patients treated with mono-therapy from inhibitors of renin angiotensin aldosterone system (RAASI), patients treated with mono-therapy antihypertensive not acting on RAAS (NRAASI) and patients treed with combination of them (drug combination). Data on Age, Sex, BP level, BMI, duration of hypertension (HTN), family history of HTN, and medications used were collected. Blood samples for measuring HsCRP, neutrophils, lymphocytes were drawn. Descriptive statics and chi-square tests were used for data analysis. Almost equivalent distribution for males and females between groups, with a large proportion of the patients within each group laid in the age group 35-55 years. The median values of hypertension duration were 36, 48, and 54 months for RAASIs, NRAASIs and drug combination group, respectively. The target BP was obtained by 46.9% 45.5% and 50% of patients treated with RAASIs, NRAASIs and drug combination respectively. There was a statistically significant difference between SBP and DBP in patients with controlled BP and those with uncontrolled SBP levels and treated by different drug regimens (P=0.000 for each Bp level). There were significant differences between values of hs-CRP of patients with controlled (P=0.000) or uncontrolled (P=0.046) BP and treated with different modalities. The median differences in NLR between the groups were statistically significant; including groups of all patients P=.032, of patients having controlled BP P=0.014 as well as uncontrolled BP P=0.038. Comparing the uncontrolled of BP of the three groups we found the highest prevalence (9.3%)of patients with uncontrolled BP and had the lower level hsCRP (≤3mg /l) was in RAASIs group, while those with higher prevalence (11.6%) of uncontrolled BP and higher level of hs-CRP ( >3mg/l) was in drug combination group. In conclusion, hypertensive patients treated with RAASI, NRAASI and drug combination and reached BP target showed significant reduction in hsCRP and NLR. Patients with uncontrolled BP treated with RAASIs revealed slightly lower hs-CRP than other groups. Careful selection of antihypertensive drugs may affect risks of CVD. This study recommends further prospective studies exploring the anti-inflammatory effect of antihypertensive drugs to ameliorate possible risks of cardiovascular disease.

P149 HYPERTENSION AS A SILENT KILLER: DOES OUR MANAGEMENT REACH THE RECOMMENDED TARGETS: SUDAN MMM 2022?

Introduction: Several explanations might address the failure of antihypertensive medications: poor compliance, excessive salt ingestion, drug interactions, or an unsuspected secondary cause for hypertension. Resistant hypertension, as an additional failure cause, is relatively rare, but all patients should be considered medically treatable until proven otherwise. Therefore, we aim to explore the blood pressure readings and the current control status in hypertensive Sudanese patients. Methods: Utilizing the MMM 2022 Sudan screening data, participants’ BP >18 years was measured using a standard device by trained physicians for three consecutive measures, and a single mean value was calculated excluding the first reading. Participants with a history of hypertension were included in the analysis. Continuous data was presented in mean and standard deviation, and categorical data was presented in frequencies and percentages. According to current guidelines, several antihypertensive medications used were counted for each patient. All participants completed a structured questionnaire after obtaining their approval. Results: The study included 2,292 participants with an established diagnosis of hypertension. The mean age at diagnosis was 46±13 years, around 60% were females, and the median duration of hypertension was 5 (2, 10) years. Of these, 936 (40.9%), 790 (34.5%), and 543 (23.7%) had blood pressure exceeding SBP≥140 mmHg, DBP≥90 mmHg, and BP≥140/90 mmHg, respectively. Table 1 shows the baseline characteristics for each group. Despite the guideline recommendations to control hypertension, 78 (14.4%) were not adherent to medications, and 56 (10.3%) were taking three or more antihypertensive drugs. Conclusions: BP screening enables future decisions to control hypertension-related burden. Adherence to the internationally recommended guidelines will lead to achieving BP targets and prevent undesired outcomes. The subgroup of resistant hypertensive patients needs close monitoring and appropriate medical evaluation.

Pooled analysis of the three trials of the TRIUMF series: efficacy of a triple fixed combination of antihypertensive drugs in the practice of physicians of different specialties in Ukraine

Study objectives – to compare the data obtained in the TRIUMF (antihyperTensive theRapy in UkraIne – BP optiMization in Focus) trials, in particular, TRIUMF-1, TRIUMF-2, TRIUMF-3, to determine possible patterns and significant factors affecting BP control in patients taking 2 or more antihypertensive drugs and switching to the original single pill combination (SPC) of perindopril arginine/indapamide/amlodipine.Materials and Methods. For the pooled analysis, data on 5960 patients obtained from the three trials of the TRIUMF series were selected. All the studies were multicenter prospective trials conducted at different times in Ukraine with the involvement of general practitioners (TR-1), cardiologists (TR-2), and family practitioners (TR-3). According to the inclusion criteria, patients over 18 years of age with hypertension and a history of taking 2 or 3 antihypertensive drugs for at least 1 month whose BP remained above 140/90 mm Hg could be included in the study. The drug of choice for further therapy was Triplixam (Servier, France) – a single pill combination (SPC) of perindopril arginine, amlodipine and indapamide. Each patient was observed for 3 months. Patients visited physicians in 1–2 weeks, 2 months after the start of the study and the corresponding therapy adjustment. The adherence rate was assessed before and after 2 months. The use of beta-blockers (BBs) in the treatment of the cohort of patients with hypertension was analyzed separately. The final analysis included a comparison of the data obtained in the TRIUMF trial series.Results and Discussion. The use of a SPC of perindopril arginine/indapamide/amlodipine allowed to achieve the target BP levels (140/90 or less) after 2 months of therapy in 84 % of patients with a history of taking a combination therapy (2 drugs – 65 %, 3 drugs – 35 %). One of the important criteria for choosing the dose of a triple SPC is the baseline BP values. The higher the degree of hypertension, the higher the dose prescribed by physicians. The minimum dose of the SPC of perindopril arginine, indapamide and amlodipine (5/1.25/5 mg) was prescribed for stage 1 hypertension in 62 %, stage 2 hypertension in 38 %, and stage 3 hypertension in 15 % of patients; the maximum dose (10/2.5/10 mg) was prescribed for stage 1 hypertension in 9 %, stage 2 hypertension in 15 %, and stage 3 hypertension in 43 % of patients included in the study (p<0.05). Therapy with the triple SPC of perindopril arginine, indapamide and amlodipine was well tolerated: adverse events were observed in 0.63 % (TR-1), 1 % (TR-3) and 1.86 % (TR-2) of cases, which was largely due to the previous use of two (65 %) or three (35 %) antihypertensive drugs comprising the SPC by the study patients. Beta-blockers (n=2012) were prescribed due to the presence of a comorbidity (coronary heart disease, angina pectoris – 33.5 %, heart failure – 28.3 %) rather than due to lowered BP. The combination of perindopril arginine/indapamide/amlodipine with BB was well tolerated and 83.9 % of patients achieved BP ≤ 140/90 mm Hg, while 9.36 % achieved ≤ 130/80 mm Hg after 2 months of treatment. There was a significant improvement in the adherence to treatment (TR-2, TR-3) in the majority of patients (75 and 70 %), due to high antihypertensive efficacy, convenience of pill’s administration (one pill instead of three) and good tolerability of the original SPC.Conclusions. Regular medical supervision (cardiologists, family practitioners, general practitioners), high antihypertensive efficacy of the SPC (84 % of patients reached the target BP levels after 2 months of therapy ), convenience of pill’s administration (one pill instead of three), high adherence to treatment confirmed in TR-2 and TR-3 in most patients, and good tolerability of the original SPC of perindopril arginine, indapamide and amlodipine led to a significant improvement in the effectiveness of treatment of patients with hypertension.

The effect of different levels of systolic blood pressure control on new-onset chronic kidney disease in hypertension multimorbidity

To explore the effect of different levels of systolic blood pressure (SBP) control on new-onset chronic kidney disease in hypertension multimorbidity. The hypertensive patients with multimorbidity information were enrolled from the Kailuan Study. The isolated hypertension patients undergoing physical examination during the same period were selected in a 1:1 ratio as control. Finally, 12,897 participants were divided into six groups: Group SBP < 110 mmHg, Group 110 ≤ SBP < 120 mmHg, Group 120 ≤ SBP < 130 mmHg, Group 130 ≤ SBP < 140 mmHg, Group 140 ≤ SBP < 160 mmHg and Group SBP ≥ 160 mmHg. The outcomes were new-onset CKD, new onset proteinuria, decline in eGFR and high or very high risk of CKD. Cox proportional hazards regression was used to examine the hazard ratios (HRs) of the outcomes among SBP levels. When 110 ≤ SBP < 120 mmHg, the incidence density of new-onset CKD, new onset proteinuria and decline in eGFR were 59.54, 20.23 and 29.96 per 1000 person-years, respectively. Compared to this group, the HR (95% CI) values for the risk of new-onset CKD from Group SBP < 110 mmHg to Group SBP ≥ 160 mmHg were 1.03 (0.81–1.32), 1.04 (0.91–1.19), 1.09 (0.95–1.16), 1.16 (1.02–1.21) and 1.18 (1.04–1.24), respectively. For patients over 65 years old, the risks of outcomes were increased when SBP < 120 mmHg. The lowest HR of high or very high risk of CKD for participants with or without multimorbidity occurred when 120 ≤ SBP < 130 mmHg. The HR of new-onset CKD in hypertension multimorbidity was lowest at 110–120 mmHg. The optimal SBP level was between 120 and 130 mmHg for individuals with high or very high risk of CKD. For patients over 65 years old, the low limit of target BP is advised to be not lower than 120 mmHg.

Disability and Quality of Life Measures in older frail and prefrail people with type 2 diabetes. The MIDFRAIL-Study

AimTo explore the individual response to a multimodal intervention on quality of life (QOL) and disability. Methods843 (77.83 years, 50.65 % men) prefrail and frail individuals ≥ 70 years with type 2 diabetes mellitus. Participants were randomized to the usual care group (UCG) or the multicomponent intervention (IG). Intervention consisted in 16-week progressive resistance training program, 7 educational sessions and the achievement of HbA1c (7–8 %, 53–64 mmol/mol)) and BP (<150 mmHg) targets. QOL (EuroQol EQ-5D-5L), basic (Barthel Index, BI) and instrumental (Lawton and Brody Index) activities of daily living (ADL) were assessed. Multivariate binomial and multinomial logistic regression models were used to explore the effect of the IG, and adherence on the outcomes studied. ResultsThe IG was associated with a significant higher probability of improvement in the QOL [OR(95 %CI): 1.75 (1.20, 2.54), p-value 0.004] and a lower probability of deterioration in QoL [0.61 (0.87, 0.54), 0.006] and Barthel Index [0.59 (0.37, 0.93), 0.023]. A high adherence (≥93 %) was needed to achieve benefits in the QOL while > 84.38 % was needed for achieving the benefits in Barthel Index. ConclusionsIG has proven to be effective in increasing QOL and avoiding the worsening of QOL and basic ADL.

Assessing DNA Degradation through Differential Amplification Efficiency of Total Human and Human Male DNA in a Forensic qPCR Assay.

The assessment of degradation is crucial for the analysis of human DNA samples isolated from forensic specimens. Forensic quantitative PCR (qPCR) assays can include multiple targets of varying amplicon size that display differential amplification efficiency, and thus different concentrations, in the presence of degradation. The possibility of deriving information on DNA degradation was evaluated in a forensic qPCR assay not specifically designed to detect DNA fragmentation, the Plexor HY (Promega), by calculating the ratio between the estimated concentrations of autosomal (99 bp) and Y-chromosomal (133 bp) targets ("[Auto]/[Y]"). The [Auto]/[Y] ratio measured in 57 formalin-fixed, paraffin-embedded samples was compared to a quality score (QS) calculated for corresponding STR profiles using quantitative data (allele peak height). A statistically significant inverse correlation was observed between [Auto]/[Y] and QS (R = -0.65, p < 0.001). The [Auto]/[Y] values were highly correlated (R = 0.75, p < 0.001) with the "[Auto]/[D]" values obtained using the PowerQuant (Promega) assay, expressly designed to detect DNA degradation through simultaneous quantification of a short (Auto) and a long (D) autosomal target. These results indicate that it is possible to estimate DNA degradation in male samples through Plexor HY data and suggest an alternative strategy for laboratories lacking the equipment required for the assessment of DNA integrity through dedicated qPCR assays.

ARE THERE ANY ADVANTAGES TO USING A POLYPILL OR FREE PILL COMBINATION TO PROTECT PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA?

Objective: Arterial hypertension (AH) has been acknowledged as a leading cause of death. Treating AH alone may provide only limited benefits while it is recommendable to manage the total cardiovascular risk. The aim was to assess the treatment of AH and dyslipidemia (DLP) in patients in specialists’ offices. Design and method: This project was conducted from April to June 2023 in 51 specialists’ offices (SPO) (33% cardiology, and 67% internal medicine) in Slovakia. We have enrolled all 18-year-old pts who are willing to complete a short questionnaire and take office BP. Results: We enrolled 514 pts with AH (42% women), mean age 61,5 ± 17,2 years from SPOs. The mean OBP was 134,9 ± 10,9/ 80,3 ± 7,2 mmHg. The average total cholesterol (TC) was 5,7 mmol/l, LDL-C 3,0 mmol/l. TC (6,12 vs 5,15 mmol/l, p&lt;0,01) was higher in male patients, and LDL-C was higher in female patients (3,05 vs 2,91 mmol/l). 76% pts experienced both AH and DLP simultaneously. In comparison to those without HLP, AH patients with HLP were given 0.5 active substances and 0.8 pills more. In total 79% pts with AH and HLP were treated with a free pill combination with a statin, while only 16% were treated with polypill. The use of polypill was more frequent in female pts (18%) vs male pts (14%). Target BP lower than 140/90 mmHg was reached in 68% pts with polypill, and in 53% pts without polypill. Non-HDL- C was lower in pts with polypill (3,6 vs 4,03 mmol/l). The current BP and non-HDL targets were reached more frequently in pts with polypill 56% vs 44% pts. Conclusions: Adherence to medications is important to achieve the full effect of antihypertensive and lipid-lowering drugs. We demonstrated that the use of polypill compared to a free pill combination of statin and AH therapy is more effective. 27% of patients reached BP and LDL targets when were treated by polypill. Using polypill in our pts we aim to reach a higher rate of BP and cholesterol control in Slovakia to meet the objectives of the Charter 70/2023 initiative.

PREDICTIVE FACTORS FOR ACHIEVEMENT OF TARGET SYSTOLIC BLOOD PRESSURE AND HEART RATE: SUB-ANALYSIS OF PRIDE STUDY

Objective: To define predictors for achievement of target systolic blood pressure (SBP) and heart rate (HR) in the PRIDE study (NCT03730116). Design and method: It was a 12-week ambispective observational study to assess antihypertensive and antianginal effectiveness of Bisoprolol/ Perindopril (Biso/Per) single-pill combination (SPC) in outpatients with coronary artery disease (CAD), history of myocardial infarction (MI) and arterial hypertension (HTN). This analysis aimed to evaluate predictive values of baseline (BL) demographic and clinical characteristics to achieve target SBP and HR in study population. Results: Of 481 included patients, 154 (32.0%) were female, mean age 61.4 (8.9) years. Prevalence of type 2 diabetes mellitus (T2D) at BL was 24.1%. Proportions of patients with Grade I, II, III or isolated HTN (ISH) and those with controlled HTN (BP&lt; 140/90 mm Hg) at BL were 55.3% (n=266), 10.8% (n=52), 5.0% (n=24), 5.0% (n=24), 23.9% (n=115), correspondingly. Mean duration of HTN and CAD were 12.8 (8.4) and 6.1 (6.3) years. Proportions of patients treated with 2,5/2,5, 5/5, 5/10 and 10/10 mg of Biso/Per SPC at BL were 12.1%, 33.5%, 34.3%, 20.2% correspondingly. Doses were changed in 1.6% of cases by week 12 of observation. At week 12, mean SBP, DBP and HR significantly decreased by 24.9 (16.4), 12.2 (11.0) mm Hg and 14.4 (11.7) bpm, respectively (p&lt; 0.001 for all). Multivariable analyses revealed grade III HTN at BL was the only significant negative predictor for achieving SBP&lt; 140 mm Hg, whereas grade III HTN, CAD with angina of functional class II and older age (more 65 y.o.) were negative predictors for achieving SBP &lt; or equal 130 mm Hg at week 12 of observation. Grade III HTN at or presence of T2D at BL decreased the likelihood of achieving target HR (55-60 bpm), according to the data given in Table 2. Conclusions: Grade III HTN, concomitant T2D and symptomatic angina were negative predictors for achievement of the target SBP and HR in patients with HTN and a history of MI. There were no positive predictors for achievement of the target BP and HR explored.

EFFECTIVENESS &amp; TOLERABILITY OF METOPROLOL ER, TELMISARTAN &amp; CHLORTHALIDONE IN PATIENTS OF ESSENTIAL HYPERTENSION WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY BMI

Objective: We conducted real world study to assess effectiveness (on blood pressure [BP; mmHg]) and tolerability of fixed dose combination (FDC) of 25/50 mg Metoprolol + 40 mg Telmisartan + 12.5 mg Chlorthalidone in treating hypertension and stable coronary artery disease (CAD). Body mass index (BMI) is one of the factors that affects hypertension and CAD. Hence, we performed this subgroup analysis to assess effectiveness of the FDC based on patients’ BMI. Design and method: A retrospective, multicenter study retrieved data over 15 months from electronic medical records of 1,810 adult patients with systolic BP greater or equal to 140 and/or diastolic BP greater or equal to 90 and stable CAD; 1,784 were treated with FDC for 24 ± 2 weeks. Mean change in BP from baseline, proportion of patients achieving target BP (systolic BP &lt; 140 and diastolic BP &lt; 90) and incidence of adverse events were analyzed in patients with BMI &lt; 18.5 kg/m2 (underweight n= 9); 18.5-22.9 kg/m2 (normal n= 249), 23.0-24.9 kg/m2 (overweight n= 464) and greater or equal to 25 kg/m2 (obese n=1,062). Results: Mean changes in systolic (underweight, -33.6; normal, -29.9; overweight, -27.7; obese, -31) and diastolic BP (underweight, -12.2; normal, -11.5; overweight, -12; obese, -12.2) from baseline to 24 ± 2 weeks were significant (p&lt;0.001), Fig 1. Proportion of patients achieving target BP at 24 ± 2 weeks in all except underweight category was &gt;84%. Fourteen patients had adverse events; hypotension being most common. Conclusions: In a real-world setting, the FDC of Metoprolol + Telmisartan + Chlorthalidone was effective in reducing blood pressure and was well-tolerated in treating hypertension with CAD across all BMI categories. The study demonstrated significant reductions in both systolic and diastolic BP for patients with different BMI levels, highlights the potential benefits of FDC in managing hypertension in various body weight groups.

EFFECTIVENESS &amp; TOLERABILITY OF METOPROLOL ER, TELMISARTAN &amp; CHLORTHALIDONE IN ESSENTIAL HYPERTENSION PATIENTS WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY COMORBIDITIES

Objective: We conducted a real-world study to assess effectiveness (on blood pressure [BP; mmHg]) and tolerability of fixed dose combination (FDC) of 25/50 mg Metoprolol + 40 mg Telmisartan + 12.5 mg Chlorthalidone in treating hypertension and stable coronary artery disease (CAD). Considering comorbidities as risk factors for hypertension and CAD, this subgroup analysis was conducted in patients with common comorbidities. Design and method: A retrospective, multicenter study retrieved data over 15 months from electronic medical records of 1,810 adult patients with essential hypertension [systolic BP (SBP) greater than or equal to 140 and/or diastolic BP (DBP) greater than or equal to 90] and stable CAD. Of 1,784 patients who received this FDC for 24 ± 2 weeks; 1,224 had comorbidities (obesity: 1,062; diabetes mellitus: 494; dyslipidaemia: 270; hypothyroidism: 121). Results: Mean change in SBP / DBP (obese: -31.1 / -12.2; diabetes mellitus: -29.8 / -11.4; dyslipidaemia: -28.6 / -10.7; hypothyroidism: -26.4 / -8.5) from baseline to 24 ± 2 weeks was significant (p&lt;0.001, Fig 1). Proportions of patients achieving target BP (SBP &lt; 140 and DBP &lt; 90) was &gt;90% in diabetes mellitus and hypothyroidism and &gt;82% in obese and dyslipidaemia patients. Of 14 patients with adverse events (hypotension being most common), 10 had comorbidities. Conclusions: This real-world study demonstrated that the FDC of Metoprolol + Telmisartan + Chlorthalidone was effective in reducing blood pressure and well tolerated in treating patients with hypertension and CAD who had common comorbidities.

FOLLOW-UP OF RENAL DENERVATION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Aim. Determining the long-term efficacy and safety of RDN the results of a 10-year follow-up Design and method: We selected 1146 patients with resistant arterial hypertension (RAH) who received 3 or more antihypertensive drugs. 16 patients were selected for renal artery denervation. RDN was performed in 8 patients (0.70%). 8 patients refused the procedure. The age was 52.13 ± 3.88 years (40–66), the duration of hypertension was 16.75 ± 2.17 (12–25) years. The number of antihypertensive drugs was 5.5 ± 0.18 (patients was in refractory hypertension). Office SBP/DBP on optimization of therapy was 156.88/95.00 ± 2.98 mm Hg and heart rate - 68.88 ± 3.28 beats/min. 24SBP/DBP was 149.16 ± 5.40/86.98 ± 5.08 mm Hg. 24HR was 70.12 ± 2.94 beats/min. All patients tolerated the procedure well. Results: The decrease in office SBP/DBP in the dynamics of 1 month, 12 months, 2 years, 5 years and 10 years were -12,59/-10,0, -11,17/-2,57, -20,31/-11,71, -27,71/-13,33 and -30,21/-16,67 mm Hg, respectively. The office heart rate (HR) decreased, its dynamics were -3.74 bpm, -4.68 bpm, -1.45 bpm, - 2.13 bpm. -4.21 bpm, - 3.88 bpm., respectively. The decrease in 24SBP/DBP was -14,45/-6,95, -8,70/-10,01, -19,45/-12,37, -19,91/-11,24, -29,93/-13,61 and -26,13/-23,35 mm Hg. (p&lt;0.05 for all values). 24HR dynamics: -3.16 bpm, - 4.19 bpm, + 1.43 bpm. -1.51 bpm, -4.46 bpm, and -5.49 bpm, respectively. After 2, 5, and 10 years, all patients reached the target blood pressure level both in the office and with ABPM. Patients reduced the number of antihypertensive drugs from 5.50±0.18 to 3.50±0.30 - after 5 years and 3.67±0.18 - after 10 years after RDN. GFR change over 10 years from 76.10±5.62 to 64.60±1.93 ml/min/1.73m2, p&gt;0.05. One patient died of thyroid cancer 2 years later. All other patients are alive and have not had any cardiovascular event or death during 10 years. Conclusions: Long-term results of renal artery denervation showed no cardiovascular events or cardiovascular death over 10 years. RDN contributed to a reduction in the number of antihypertensive drugs from 5.5 to 3.67 after 10 years of therapy. All patients achievement of the target BP level.

Effect of Alcohol-Mediated Renal Denervation on Blood Pressure in the Presence of Antihypertensive Medications: Primary Results from the TARGET BP I Randomized Clinical Trial.

Renal denervation (RDN) has demonstrated clinically relevant reductions in blood pressure among individuals with uncontrolled hypertension despite lifestyle intervention and medications. The safety and effectiveness of alcohol-mediated RDN has not been formally studied in this indication. TARGET BP I is a prospective, international, sham-controlled, randomized, patient- and assessor-blinded trial investigating the safety and efficacy of alcohol-mediated RDN. Patients with office systolic blood pressure (SBP) ≥150 and ≤180 mmHg, office diastolic BP ≥90 mmHg and mean 24-hour ambulatory SBP ≥135 and ≤170 mmHg, despite prescription of 2-5 antihypertensive medications were enrolled. The primary endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 3 months post procedure. Secondary endpoints include mean between-group differences in office and ambulatory BP at additional time points. Among 301 patients randomized 1:1 to RDN or sham control, RDN was associated with a significant reduction in 24-hour ambulatory SBP at 3 months (mean ± standard deviation -10.0 ± 14.2 mmHg versus -6.8 ± 12.1 mmHg, treatment difference -3.2 mmHg, 95% confidence interval [CI] -6.3, 0.0 mmHg; P=0.0487). Subgroup analysis of the primary endpoint revealed no significant interaction across predefined subgroups. At 3 months, the mean change in office SBP was -12.7 ± 18.3 mmHg and -9.7 ± 17.3 mmHg (difference, -3.0, 95% CI -7.0, 1.0; P=0.173), for RDN and sham, respectively. No significant differences in ambulatory or office diastolic BP were observed. Adverse safety events through 6 months were uncommon with 1 instance of accessory renal artery dissection in the RDN group (0.7%). No significant between-group differences in medication changes or patient adherence were identified. Alcohol-mediated RDN was associated with a modest but statistically significant reduction in 24-hour ambulatory systolic BP compared with sham control. No significant differences between groups in office BP or 6-month major adverse events were observed.

Cardiovascular risk management among individuals with type 2 diabetes and severe mental illness: a cohort study

Aims/hypothesisThe aim of this study was to compare cardiovascular risk management among people with type 2 diabetes according to severe mental illness (SMI) status.MethodsWe used linked electronic data to perform a retrospective cohort study of adults diagnosed with type 2 diabetes in Scotland between 2004 and 2020, ascertaining their history of SMI from hospital admission records. We compared total cholesterol, systolic BP and HbA1c target level achievement 1 year after diabetes diagnosis, and receipt of a statin prescription at diagnosis and 1 year thereafter, by SMI status using logistic regression, adjusting for sociodemographic factors and clinical history.ResultsWe included 291,644 individuals with type 2 diabetes, of whom 1.0% had schizophrenia, 0.5% had bipolar disorder and 3.3% had major depression. People with SMI were less likely to achieve cholesterol targets, although this difference did not reach statistical significance for all disorders. However, people with SMI were more likely to achieve systolic BP targets compared to those without SMI, with effect estimates being largest for schizophrenia (men: adjusted OR 1.72; 95% CI 1.49, 1.98; women: OR 1.64; 95% CI 1.38, 1.96). HbA1c target achievement differed by SMI disorder and sex. Among people without previous CVD, statin prescribing was similar or better in those with vs those without SMI at diabetes diagnosis and 1 year later. In people with prior CVD, SMI was associated with lower odds of statin prescribing at diabetes diagnosis (schizophrenia: OR 0.54; 95% CI 0.43, 0.68, bipolar disorder: OR 0.75; 95% CI 0.56, 1.01, major depression: OR 0.92; 95% CI 0.83, 1.01), with this difference generally persisting 1 year later.Conclusions/interpretationWe found disparities in cholesterol target achievement and statin prescribing by SMI status. This reinforces the importance of clinical review of statin prescribing for secondary prevention of CVD, particularly among people with SMI.Graphical

Time in target range of systolic blood pressure and clinical outcomes in atrial fibrillation patients: results of the COOL-AF registry

We aimed to investigate the relationship between time in target range of systolic blood pressure (SBP-TTr) and clinical outcomes in patients with atrial fibrillation (AF). We analyzed the results from multicenter AF registry in Thailand. Blood pressure was recorded at baseline and at every 6 monthly follow-up visit. SBP-TTr were calculated using the Rosendaal method, based on a target SBP 120–140 mmHg. The outcomes were death, ischemic stroke/systemic embolism (SSE), major bleeding, and heart failure. A total of 3355 patients were studied (mean age 67.8 years; 41.9% female). Average follow-up time was 32.1 ± 8.3 months. SBP-TTr was classified into 3 groups according to the tertiles. The incidence rates of all-cause death, SSE, major bleeding, and heart failure were 3.90 (3.51–4.34), 1.52 (1.27–1.80), 2.2 (1.90–2.53), and 2.83 (2.49–3.21) per 100 person-years, respectively. Patients in the 3rd tertile of SBP-TTr had lower rates of death, major bleeding and heart failure with adjusted hazard ratios 0.62 (0.48–0.80), p < 0.001, 0.64 (0.44–0.92), p = 0.016, and 0.61 (0.44–0.84), p = 0.003, respectively, compared to 1st SBP-TTr tertile. In conclusion, high SBP-TTr was associated with better clinical outcomes compared to other groups with lower SBP-TTr. This underscores the importance of good blood pressure control in AF patients.

Role of Home Blood Pressure Monitoring in Treatment Follow-up by Hypertensive Patients Cohort

Background: The main benefit of home-based blood pressure monitoring (HBPM) is the potential approach to reduce the risk of white-coat hypertension (HTN) and to encourage patients to take ownership of their condition. This study was conducted to assess the role of HBPM in treatment follow-up in a cohort of hypertensive patients. Materials and methods: This was a prospective observational study conducted from December 2017 to May 2018. A total of 100 patients fulfilling the inclusion and exclusion criteria were selected by purposive sampling from Medicine Outdoor of Dhaka Medical College Hospital (DMCH). In total, 100 hypertensive patients were enrolled, and informed consent was obtained. Subsequently, the study subjects received information and training on BP self-management and performed 2 resting measurements per day for 4 days per week for 3 months. All measurements were performed using validated BP monitors.The study endpoints included patient awareness, attainment of BP goals, adherence to antihypertensive treatment, lifestyle modification, assessment of discrepancy between office and HBPM, and white coat HTN or masked HTN at 3 months. SPSS version 22.0 was used for data analysis and reporting. Results: Overall, the mean age was 57.76 ±12.60 years with a range of 34 – 80 years. Males were more prevalent than females, and the ratio was 1.17:1. The majority of cases (76.0%) had established HTN with a history of taking medication, whereas others were non-compliant with medications. Among them 47% had obesity, and 24% had diabetes mellitus. Of the patients, 91% adherence to HBP monitoring, 84.0% adherence to medication, and 75.0% achieved their target BP. The achievement of target blood pressure was significantly higher among the study subjects who adhered to HBP monitoring, and the p-value was &lt; 0.04 (Fisher’s Exact test). Conclusion: In a cohort of patients with arterial hypertension, information, and training on BP self-measurement and direct involvement of patients using HBPM led to improvement in BP control and could be an effective method by incorporating it into the usual care of hypertensive patients in the hypertension management center of the community. J MEDICINE 2024; 25: 17-23

Antihypertensive efficacy and safety of azilsartan medoxomil in patients with diabetes mellitus in real clinical practice. According to the CONSTANT study

Background. Obesity and associated diseases are the most common comorbidities in patients with arterial hypertension (AH). The combination of AH and type 2 diabetes mellitus (DM2) significantly exacerbates the cardiovascular risk in this patients. BP control is one of the key components of the multivariate approach to reducing the risk of DM 2 complications. The use of drugs with pronounced antihypertensive properties and at the same time the ability to improve metabolic parameters should be a priority in this category of patients. Assessing the efficacy and safety of azilsartan medoxomil, the last molecule from the ARB class in patients with AH and DM 2 is an urgent task.Purpose. Evaluation of antihypertensive efficacy and safety of azilsartan medoxomil in patients with AH and DM 2 and overweight or obesity.Materials and methods. 235 overweight or obese patients with AH and DM2 enrolled in the international multicenter observational non-interventional prospective study CONSTANT with azilsartan medoxomil according to the approved label. The observation period is 6 months.Results. The dynamics of SBP by visit 4 (6 months) was 29,7±14,5 mmHg, DBP - 13,36±10,9 mmHg (r≤0,001). Overall, the group achieved BP targets in 211 (89.41%) DM patients enrolled in the study. Response to therapy (reduction in SBP by at least 20 mmHg, DBP of 10 mm Hg) was obtained in 177 (75.0%) patients. Glycated hemoglobin (p&lt;0.001) and fasting glucose (p&lt;0.001) significantly decreased in patients with AH and DM. A decrease in total cholesterol, triglycerides, and LDL was observed, including in DM patients not taking statins (p&lt;0.001). Overall, a decrease in waist circumference was observed across the group (p&lt;0.005).Conclusion. Azilsartan medoxomil in real clinical practice proved to be a highly effective antihypertensive drug in patients with AH and DM. The ability of the drug, including in combination with other drugs, to improve the metabolic profile, reduce the volume of adipose tissue makes it a priority drug of choice in patients with AH, obesity and type 2 DM.

The Impact of a Medication Therapy Management Service on the Outcomes of Hypertension Treatment Follow-Up Care in an Ethiopian Tertiary Hospital: A Pre-Post Interventional Study.

According to a report from the WHO, an estimated 1.13 billion people worldwide have hypertension. Medication therapy management (MTM) service is a clinical service based on the theoretical and methodological framework of pharmaceutical care practice, which aims to ensure the best therapeutic outcomes for the patient by identifying, preventing, and resolving drug therapy problems (DTPs). The goal of this study was to determine the impact of MTM on hypertension management in Ethiopia. A pre-post interventional study design was used. Descriptive statistics, linear regression, and logistic regressions were employed to present and analyze data. The final analysis included 279 patients out of 304, with a 7.8% attrition rate. The prevalence of drug therapy problems (DTPs) reduced from 63.4% at baseline to 31.5% during the post-intervention phase. Polypharmacy (AOR = 2.46; 95% CI: 1.27-4.77) and complications (AOR = 0.52; 95% CI: 0.27-0.99) were substantially associated with DTPs at the start of the study. The MTM resulted in a significant reduction in mean systolic blood pressure (SBP) (AOR = 5.31, 95% CI (3.50-7.11), P < .001), as well as a significant increase (P < .001) in the number of study patients who reached a target BP. At the end of the MTM intervention, non-adherence was linked with DTP (AOR = 2.40; 95% CI: 1.33-4.334) and living outside Addis Ababa (AOR = 1.73; 95% CI: 1.38-1.88). On average, treatment satisfaction was 86.55% (+SD) 10.34. To resolve DTPs and improve clinical outcomes, the MTM service was critical. The majority of patients were found to be compliant with a high treatment satisfaction score.

Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations.

Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.

Efficacy and safety of olmesartan medoxomil‑amlodipine besylate tablets (Sevikar®) in older patients with essential hypertension: Subgroup analysis from the Sevikar study.

Essential hypertension is a notable threat for the older (age, ≥65 years) population. However, to the best of our knowledge, a real-world study assessing olmesartan medoxomil-amlodipine besylate (OM-AML) tablets in older Chinese patients with essential hypertension has not been performed. Therefore, the present study aimed to evaluate the efficacy and safety of OM-AML tablets in these patients. A total of 463 older Chinese patients with essential hypertension treated with OM-AML (20/5 mg) tablets (Sevikar®) were analyzed in a prospective, single-arm, multi-center, real-world study. Seated systolic blood pressure (SeSBP) and seated diastolic blood pressure (SeDBP) at baseline, and at week (W)4 and W8 after OM-AML tablet administration were measured. The mean ± standard error change of SeSBP/SeDBP was -10.3±0.8/-4.6±0.5 and -12.5±0.8/-5.6±0.5 mmHg at W4 and W8, respectively. At W4, 74.1 and 26.8% of patients achieved BP target according to the China and American Heart Association (AHA) criteria, while at W8, 78.0 and 38.7% of patients reached these BP targets accordingly. Finally, 76.5 and 80.5% of patients achieved BP response at W4 and W8, respectively. Furthermore, home-measured SeSBP and SeDBP were significantly decreased from W1 to W8 (both P<0.001). Additionally, the satisfaction of both patients and physicians was elevated at W8 compared with at W0 (both P<0.001). The medication possession rate from baseline to W4 and W8 was 95.5 and 92.5%. The most common drug-associated adverse events by system organ classes were nervous system disorder (4.5%), vascular disorder (2.8%), and general disorder and administration site conditions (2.6%), which were generally mild. In conclusion, OM-AML tablets may be considered effective and safe in lowering BP, enabling the achievement of guideline-recommended BP targets in older Chinese patients with essential hypertension.

Intensive medical therapy - lipid targets and newer treatment options, dual antiplatelets, BP targets after ischemic stroke and ICH

Intensive medical therapy - lipid targets and newer treatment options, dual antiplatelets, BP targets after ischemic stroke and ICH