Chronic Hypertensives Research Articles

Effectiveness of a Disease Management Program (DMP) in controlling the progression of Chronic Kidney Diseaseamong hypertensives and diabetics.

The occurrence rate of stage 5 chronic kidney disease (CKD) will be 151 per million population in India in the coming years. Comorbidities like diabetes mellitus and hypertension are the usual triggers of CKD. Hence this study aimed to control the progression of CKD and to note the effectiveness of a structured education program that would help in the prevention of complications related to diabetes and hypertension. This quasi-experimental study was conducted among 88 participants who had hypertension, diabetes mellitus, or both for five or more years. The study objective was to find the effect of a Disease Management Program on delaying progression of CKD in patients with hypertension or diabetes mellitus.The baseline data were obtained from demographic proforma, and the clinical data collected were the blood pressure, serum creatinine, and random blood sugar (RBS) of the participants. The management of hypertension and diabetes mellitus was taught to them. In the fourth and the eighth month, blood pressure and blood sugar were reassessed. At one-year blood pressure, blood sugar, and serum creatinine were tested. Baseline and one-year follow-up blood pressure, blood sugar, and estimated Glomerular Filtration Rate were compared. Descriptive statistics and "Wilcoxon signed-rank test" were used to analyze the data. In one year, the mean systolic blood pressure reduced by six mm of Hg and mean blood sugar by 24 mg/dl. The prevalence of CKD stage three and above (< 60 ml/min/m2) was nine (10.22%). The median decline in eGFR was 5 ml/min/m2 (Z= 5.925, P< 0.001). The Disease Management Program led to improvements in blood pressure and diabetes control and median progression of CKD was estimated at five ml/min/m2/year.

Comparing Intraocular Pressure, Ocular Blood Flow, and Retinal Nerve Fiber Layer Thickness in Early and Chronic Hypertensives With Normotensives

Purpose To compare blood pressure (BP), intraocular pressure (IOP), ophthalmic artery flow (OAF) velocity, retinal nerve fiber layer (RNFL) thickness, and visual fields in newly diagnosed hypertension (HT) patients (before treatment), chronic HT (on antihypertensive medications >5 years) and normotensives. Methods A prospective, cross-sectional study at a tertiary care centre in India. Three groups of 45 patients each: group 1 - early HT, group 2 - chronic HT, and Group 3 - normotensives, underwent evaluation of BP, IOP by Goldmann applanation tonometry (GAT), OAF velocity by transcranial doppler (TCD), RNFL analysis by spectral-domain optical coherence tomography (SD-OCT), and visual fields. Results The BP was highest in early HT > chronic HT > normotensives (p < 0.001). The IOP of early HT, chronic HT, and normotensives were 15.87 ± 2.19 mmHg, 13.47 ± 1.92 mmHg, and 15.67 ± SD 1.75 mmHg (p < 0.001). The OAF velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV) in cm/sec] was lowest in chronic HT (30.80 ± 7.05, 8.58 ± 1.58) < early HT (35.47 ± 5.34, 10.02 ± 1.74) < normotensives (36.29 ± 4.43, 10.44 ± 2.29), (p < 0.001). The average RNFL thickness was significantly lower in chronic HT (p = 0.022). The PSV, EDV, and MFV showed significant correlation with IOP (r = 0.247, p = 0.004; r = 0.206, p = 0.016; r = 0.266, p = 0.002) and average RNFL thickness (r = 0.309, p= <0.001; r = 0.277, p = 0.001; r = 0.341, p < 0.001) Conclusions Patients with chronic HT demonstrated the lowest retrobulbar flows, IOP and lower RNFL measurements. Lower ocular perfusion may be associated with lower IOP and may be a risk factor for end-organ damage (RNFL) independent of IOP.

Prevalence of vitamin D deficiency in the hypertensive south Indian population

Aim. The leading cause of early cardiovascular death worldwide is systemic hypertension (HTN). It is accountable for 57% of stroke and 24% of coronary heart disease deaths in India. Vitamin D indirectly regulates blood pressure through regulating the RAAS across clinical, pathophysiological, and molecular domains. This study examines Vitamin D deficiency in South Indian hypertensives. Materials and Methods. In this cross-sectional observational study, 500 routine health checkup patients at our clinic were assessed and enrolled. Demographics, symptoms, and lifestyle were collected using a standard questionnaire. Patients with chronic and newly diagnosed hypertension were included in the study. Blood was drawn to test Vitamin D (25-OH) levels. The data was evaluated to compare hypertensives who were already on medication and those who were newly diagnosed. Results. The population showed hypovitaminosis D, with an average Vitamin D level of 20.2 ± 10.3 ng/mL. A considerable number of newly diagnosed hypertensives had Vitamin D deficiency, with an average value of 17.7 ± 8.7 ng/mL. The observed value was significantly lower than the chronic hypertensive group (17.7 ± 8.7 ng/mL vs. 21.4 ±10.9, p &lt;0.001). LDL, HDL, cholesterol, creatinine, and HbA1C levels were not signi­ficantly different across groups. Vitamin D levels were similar for outdoor and indoor workers (p = 0.727). Conclusion. Our study demonstrates there is a high prevalence of vitamin D insufficiency in the hypertensive South Indian population. There were substantially lower levels of Vitamin D identified in those who were newly diagnosed hypertensives compared to chronic hypertensives on treatment.

Choix thérapeutiques des hypertendus et diabétiques en milieu rural : Une étude mixte dans deux zones de santé de l'Est de la République Démocratique du Congo

Therapeutic choices of hypertensive and diabetics in rural areas: A mixed study in two health zones in the East of the Democratic Republic of Congo.BackgroundOne third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare.AimIn this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions.SettingThe study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC.MethodsA mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis.ResultsOut of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics.ConclusionTo ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

955 Is body composition different in neonates of mothers with hypertensive disorders of pregnancy?

Neonates of mothers with hypertensive disorders of pregnancy (HDP) are at increased risk of cardiovascular complications later in life, although the etiology for this risk is unclear. Neonatal adiposity, as measured by body composition (BC), is also associated with future health. Thus, we compared BC in infants born to women with HDP to BC in infants of normotensive mothers. We hypothesized that neonates in the HDP group will have increased adiposity at birth. This was a retrospective cohort study of term infants at our tertiary institution from March 2018 to June 2019. BC and % body fat (%BF) are measured routinely on all term neonates with a validated anthropometric model using birth weight, length and suprailiac skin fold thickness (SFT). Eligible subjects included women with HDP identified from our perinatal database and matched to normotensive mothers by gestational age, sex, and delivery date. Median SFT and %BF were obtained and a Mann Whitney U and Chi-squared tests were performed with alpha set at 0.05 for significance. 142 neonates were identified and compared to 150 controls. 19(13%) had chronic hypertension, 77(55%) gestational hypertension, 31(22%) preeclampsia without severe features and 15(10%) preeclampsia with severe features. Demographic characteristics were similar between both groups. The rate of NICU admissions (8.5% vs.5.3%) and Induction (70% vs 35%) was higher but not statistically significant in the HDP group. The rate of low birth weight babies was not significantly different (6 vs 4 p=0.25). SFT was not significantly different (median 4.6mm vs 4.40mm, p = 0.09) but the %BF was higher in the study group (median 13.15 vs 11.72 p=0.01). When chronic hypertensives were excluded from the study group, the findings remained the same. Percent body fat is higher in neonates of mothers with hypertensive disorders of pregnancy. Alterations in adiposity may contribute to an increased risk of cardiovascular disease later in life.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Perinatal outcomes in women with elevated blood pressure and stage 1 hypertension

Hypertension was redefined in 2017 with lower diagnostic thresholds; elevated blood pressure is defined as systolic blood pressure of 120 to 129 mm Hg with diastolic blood pressure of <80 mm Hg and stage 1 hypertension as systolic blood pressure of 130 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg. These guidelines did not include pregnant women. There is limited information on stage 1 hypertension and pregnancy outcomes. This study aimed to determine whether elevated blood pressure and stage 1 hypertension as newly defined by the 2017 American College of Cardiology and the American Heart Association guidelines are associated with an increased risk of hypertensive disorders of pregnancy and other adverse maternal and neonatal outcomes. In this retrospective cohort study, 18,801 women with singletons from 2013 to 2019 were categorized as normotensive, prehypertensive (elevated blood pressure), stage 1 hypertensive, or chronic hypertensive. Women with ≥2 systolic blood pressures of 120 to 129 mm Hg before 20 weeks' gestation were classified into the elevated blood pressure group. Women with ≥2 systolic blood pressures of 130 to 139 mm Hg or ≥2 diastolic blood pressures of 80 to 89 mm Hg before 20 weeks' gestation were assigned to the stage 1 hypertension group. Women were classified as chronic hypertensives if they had any of the following: ≥2 systolic blood pressure of ≥140 mm Hg or ≥2 diastolic blood pressure of ≥90 mm Hg before 20 weeks' gestation, a history of chronic hypertension, or antihypertensive medication use before 20 weeks' gestation. Women with pregestational diabetes, lupus, or <2 blood pressures before 20 weeks' gestation were excluded. The association of stage 1 hypertension with the risk of developing hypertensive disorders of pregnancy was estimated using multivariate logistic regression controlling for maternal sociodemographic characteristics, gestational weight gain by prepregnancy body mass index, parity, and aspirin use. Secondary outcomes included subgroups of hypertensive disorders (gestational hypertension, preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome), gestational diabetes, placental abruption, intrauterine growth restriction, preterm birth, neonatal intensive care unit admission, stillbirth and neonatal death, and maternal intensive care unit admission. All outcomes were adjusted for potential confounders. Of the 18,801 women, 13,478 (71.7%) were normotensive, 2659 (14.1%) had elevated blood pressure, 1384 (7.4%) were stage 1 hypertensive, and 1280 (6.8%) were chronic hypertensive. A dose-response relationship was observed: the risk of hypertensive disorders of pregnancy increased from 4.2% in normotensive women to 6.7% (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.79) in women with elevated blood pressure, to 10.9% (adjusted odds ratio, 2.54; 95% confidence interval, 2.09-3.08) in women with stage 1 hypertension, and 28.4% (adjusted odds ratio, 7.14; 95% confidence interval, 6.06-8.40) in women with chronic hypertension. Compared with normotensive women, women with stage 1 hypertension had an increased risk of neonatal intensive care unit admissions (15.8% vs 13.0%; adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.42), preterm birth at <37 weeks' gestation (7.2% vs 5.2%; adjusted odds ratio, 1.45; 95% confidence interval, 1.16-1.81), and gestational diabetes (14.8% vs 6.8%; adjusted odds ratio, 2.68; 95% confidence interval, 2.27-3.17). Our study demonstrates that elevated blood pressure and stage 1 hypertension, using the 2017 American College of Cardiology and the American Heart Association guideline definition, are associated with increased maternal and neonatal risk. This group of women warrants further investigation to determine whether pregnancy management can be altered to reduce maternal and neonatal morbidity.

Phenomapping of subgroups in hypertensive patients using unsupervised data-driven cluster analysis: An exploratory study of the SPRINT trial.

Hypertensive patients are highly heterogeneous in cardiovascular prognosis and treatment responses. A better classification system with phenomapping of clinical features would be of greater value to identify patients at higher risk of developing cardiovascular outcomes and direct individual decision-making for antihypertensive treatment. An unsupervised, data-driven cluster analysis was performed for all baseline variables related to cardiovascular outcomes and treatment responses in subjects from the Systolic Blood Pressure Intervention Trial (SPRINT), in order to identify distinct subgroups with maximal within-group similarities and between-group differences. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular outcomes and compare the effect of intensive antihypertensive treatment in different clusters. Four replicable clusters of patients were identified: cluster 1 (index hypertensives); cluster 2 (chronic kidney disease hypertensives); cluster 3 (obese hypertensives) and cluster 4 (extra risky hypertensives). In terms of prognosis, individuals in cluster 4 had the highest risk of developing primary outcomes. In terms of treatment responses, intensive antihypertensive treatment was shown to be beneficial only in cluster 4 (HR 0.73, 95% CI 0.55-0.98) and cluster 1 (HR 0.54, 95% CI 0.37-0.79) and was associated with an increased risk of severe adverse effects in cluster 2 (HR 1.18, 95% CI 1.05-1.32). Using a data-driven approach, SPRINT subjects can be stratified into four phenotypically distinct subgroups with different profiles on cardiovascular prognoses and responses to intensive antihypertensive treatment. Of note, these results should be taken as hypothesis generating that warrant further validation in future prospective studies.

C‐Reactive Protein Levels and Blood Pressure Loads with Training

Blood pressure (BP) load is the percentage of BP readings above a particular threshold within a given period. Elevated BP loads translate to organ exposures to high pressures for greater amounts of time. Because of this, BP load was heralded as a strong predictor of target organ damage (TOD). However, recent evidence has not confirmed its prognostic value above 24 hr ambulatory blood pressure monitoring (ABPM). Although questioned, it is incorporated in AHA ABPM guidelines for children and adolescents. Newer evidence in chronic kidney disease and untreated hypertensives has shown an independent association of BP load with various measures of TOD. Additionally, a marker of systemic inflammation (neutrophil‐to‐lymphocyte ratio) has been shown to correlate with BP load.ObjectiveThis analysis investigated the relationship between classic inflammatory biomarker C‐Reactive Protein (CRP) and debated measure BP Load in a high‐risk population for cardiovascular diseases (CVD).MethodsSedentary, middle‐to‐older age African Americans free of disease underwent aerobic exercise training (AEXT) 3x/week for 24 weeks. Intensity targets progressed to sustain 60% VO2 max. Because of the strong relationship between BMI and BP, participants were required to maintain a constant weight. ABPM was conducted before and after training, and BP loads determined. Fasted blood draws were utilized at these times to measure circulating CRP and categorize future CVD risks based on baseline CRP levels. Slightly less conservative thresholds for BP readings were used because of this known high‐risk population.ResultsWith training, daytime SBP and DBP loads decreased for those only in the low risk CRP group (p=.047 and p=.036, respectively). Nighttime values, however, did not change for either CRP group with training. For daytime values at baseline and final, there was no difference in SBP load (&gt;124 mmHg) for those classified as at low (&lt;1mg/L), average (1–3mg/L) or high (&gt;3mg/L) risk for CVD based on CRP levels. When a more conservative threshold was utilized (SBP &gt;139 mmHg) there was a difference between CRP groups after training (p&lt;.05). There was a similar trend for DBP load (DBP&gt;74 mmHg), with a difference appearing after training (p&lt;.05). Nighttime DBP load did not differ between groups either before or after training. SBP load, however, differed between CRP groups at baseline when a more (&gt;119 mmHg, p&lt;.05), but not less (&gt;104 mmHg) conservative threshold was used. Groups after training showed no SBP load difference.ConclusionsCRP levels may contribute to BP loads and resultant TOD. These may be a specific indicator of the response to AEXT, especially in those considered low‐risk. Because nighttime BP load did not change with training in either category, but daytime values did decrease, the reasons for this need to be further examined. It is possible that a different stimulus may be necessary to cause changes in nighttime values. This is especially important since recent evidence has shown nighttime values to be a greater indicator of clinical events and cardiovascular outcomes than daytime BP values. Additionally, BP load thresholds may need to be adjusted for various populations. Future studies are needed to confirm the independent effect of BP load in this high‐risk population, and its relationship to inflammation.Support or Funding InformationNIH Grant #R01 HL085497‐01A1 Systolic (&gt;139 mmHg) and Diastolic (&gt;74 mmHg) Blood Pressure load decreased after training in low‐risk subjects. SBP Load showed between group differences only after, but not before training.* p&lt;.05 within groups. # p&lt;.05 between groupsimageSystolic (&gt;139 mmHg) and Diastolic (&gt;74 mmHg) Blood Pressure load decreased after training in low‐risk subjects. SBP Load showed between group differences only after, but not before training.* p&lt;.05 within groups. # p&lt;.05 between groups Neither Systolic (&gt;104 mmHg) nor Diastolic (&gt;64 mmHg) Blood Pressure load decreased after training for subjects. SBP (&gt;119) Load showed between group differences before, but not after training. # p&lt;.05 between groupsimageNeither Systolic (&gt;104 mmHg) nor Diastolic (&gt;64 mmHg) Blood Pressure load decreased after training for subjects. SBP (&gt;119) Load showed between group differences before, but not after training. # p&lt;.05 between groupsThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Analysis and identification of symptoms and risk factors in a cohort of chronic hypertensive patients in a tertiary care hospital in Sri Lanka

ABSTRACTBackground: Hypertension (HT) is identified as a highly prevalent cardiovascular risk factor and also as a separate disease entity, leading to significant mortality and morbidity. The rate of HT is increasing worldwide with a faster rate identified in developing countries. Thus, it is important to evaluate epidemiological patterns of chronic HT in a developing country like Sri Lanka.Methodology: This is a cross-sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka, to assess symptoms and risk factors among patients with chronic HT.Results: In a cohort of 266 chronic hypertensives, the mean values for age of population, age of onset, and duration of HT, respectively, are 63, 45, and 8 years. At presentation, 24.8% were asymptomatic. The commonest presentation at diagnosis was dizziness accounting for 33.8% cases, followed by chest pain, headache, loss of consciousness, and shortness of breath accounting for 7.5%, 13.5%, 2.6%, and 4.5%, respectively. Approximately 36.5% of patients had a positive family history. Fathers of 7.1% patients, mothers of 19.2%, and both parents of 10.2% patients had HT. 38.7% of patients had one or more siblings with HT. 34.6% had diabetes mellitus.Conclusion: Symptoms of those with HT are mostly nonspecific and should be considered as possible warning signs prior to the development of sinister complications of the disease. Family history of HT with affected siblings, or one of the parents, was, observed in more than one-third of patients. Early screening and prevention of modifiable risk factors are important in these patients to prevent debilitating complications.

Study on ECG Changes in Chronic hypertensive Patients in a Medical College Hospital of Odisha

Aims: Aim of this study was to analyze and compare the variations and abnormalities in ECG wave forms among people with chronic hypertension and controls. Methods: The study was conducted in Hi-Tech Medical College & Hospital, Bhubaneswar during the period from Sept 2013 – Aug 2015. The study included 50 people with chronic hypertension and 50 controls, each between ages 40-70 years from general population, and also from Medicine outpatient department, HMC&H, Bhubaneswar. Following an explanation about the nature and purpose of study, those subjects who are willing to participate where included after obtaining their consent. Subjects with exclusion criteria were dropped. Detailed history from subjects, blood pressure (sitting position) and electrocardiogram was recorded during resting state in supine position. The ECG results were evaluated for parameters like heart rate, P wave, PR interval, QRS complex, QRS axis, QT interval, QTc interval, ST segment and T wave. Results: There was statistically significant increase in QT interval & QTc interval in chronic hypertensives than controls. There was increased occurrence of LVH, ST depression and T wave inversion in chronic hypertensives than controls. Conclusion: This study shows that chronic hypertension is associated with QT prolongation. Most frequently occurring ECG abnormalities in chronic Hypertension are LVH, ST depression and T wave inversion.

Hypertension Editors’ Picks

<i>Hypertension</i> Editors’ Picks

Treating Acute Hypertension in the Hospital

Physicians treat chronic hypertension almost exclusively in ambulatory care settings according to evidence-based guidelines1 based on blood pressure (BP) measurements obtained under prescribed conditions.2 Other recommendations cover how to deal with hypertension in dialysis units2 and emergency departments,3 but none address a very commonly encountered problem: what to do about acutely elevated BP (which I refer to below in the common parlance of “acute hypertension”) in patients hospitalized for reasons other than hypertension. Indeed, excluding articles on patients with hypertensive emergencies and urgencies, there is little published about treatment of acutely elevated BP in hospitalized patients, although the practice seems to be common and based on firmly held, but poorly justified, beliefs.4 In this commentary, I argue for developing a rational approach to treating acute hypertension that de-emphasizes “treating the numbers” and focuses on patient safety. ### How Common Is Acute Hypertension in Hospitalized Patients? Most patients hospitalized for reasons other than hypertensive emergency or urgency who subsequently sporadically manifest acute hypertension deemed worthy of clinical concern probably also have chronic hypertension. In recent national data of hospitalizations, hypertension was listed as a primary diagnosis (International Classification of Diseases [ICD]–9 CM code 401) for 301 000 admissions but as a secondary diagnosis for 9 003 000 hospitalizations.5 These figures are probably an underestimate of the actual prevalence of hypertension in inpatients because 29% of the US adult population is now affected.6 One estimate of the rate of hypertension in patients in our center (the University of Michigan Health System[UMHS]) can be derived from patients attending our anesthesiology preoperative evaluation clinic, who have an incidence of 26.7% of stage 1 and 10.9% of stage 2 hypertension (unpublished data, 2010). Using these prevalence figures, during a 1-year period (October 1, 2007, to September 30, 2008) in which there were 29 545 adult admissions to …

W15.1 Pregnancy induced hypertension and subsequent health and mortality of women: a record linkage study

The decreased volume of maternal extracellular fluid in preeclamptics may result in a different rate of atrial natriuretic peptide secretion and thus affect its plasma levels. Our objectives were to determine whether there was a difference in plasma levels of atrial natriuretic peptide in the various hypertensive disorders of pregnancy. Forty-nine pregnant women in the third trimester of pregnancy were evaluated: 21 with preeclampsia, 17 with chronic hypertension during pregnancy and 11 normotensives. The atrial natriuretic peptide concentration was 13.9 ± 5.9 pg/ml, 17.8 ± 13.5 pg/ml and 16.7 ± 7.4 pg/ml in the preeclamptics, chronic hypertensives and normotensives, respectively. The differences between the three groups were not statistically significant. Atrial natriuretic peptide plasma levels remained stable in the various hypertensive disorders of pregnancy.

W15.4 Preeclampsia is probably an independent risk factor for cardiovascular disease

The decreased volume of maternal extracellular fluid in preeclamptics may result in a different rate of atrial natriuretic peptide secretion and thus affect its plasma levels. Our objectives were to determine whether there was a difference in plasma levels of atrial natriuretic peptide in the various hypertensive disorders of pregnancy. Forty-nine pregnant women in the third trimester of pregnancy were evaluated: 21 with preeclampsia, 17 with chronic hypertension during pregnancy and 11 normotensives. The atrial natriuretic peptide concentration was 13.9 ± 5.9 pg/ml, 17.8 ± 13.5 pg/ml and 16.7 ± 7.4 pg/ml in the preeclamptics, chronic hypertensives and normotensives, respectively. The differences between the three groups were not statistically significant. Atrial natriuretic peptide plasma levels remained stable in the various hypertensive disorders of pregnancy.

W15.3 Hypertension in pregnancy is associated with elevated C-reactive protein levels later in life

The decreased volume of maternal extracellular fluid in preeclamptics may result in a different rate of atrial natriuretic peptide secretion and thus affect its plasma levels. Our objectives were to determine whether there was a difference in plasma levels of atrial natriuretic peptide in the various hypertensive disorders of pregnancy. Forty-nine pregnant women in the third trimester of pregnancy were evaluated: 21 with preeclampsia, 17 with chronic hypertension during pregnancy and 11 normotensives. The atrial natriuretic peptide concentration was 13.9 ± 5.9 pg/ml, 17.8 ± 13.5 pg/ml and 16.7 ± 7.4 pg/ml in the preeclamptics, chronic hypertensives and normotensives, respectively. The differences between the three groups were not statistically significant. Atrial natriuretic peptide plasma levels remained stable in the various hypertensive disorders of pregnancy.

Antihypertensive Medication Adherence, Ambulatory Visits, and Risk of Stroke and Death

This study seeks to determine whether antihypertensive medication refill adherence, ambulatory visits, and type of antihypertensive medication exposures are associated with decreased stroke and death for community-dwelling hypertensive patients. This retrospective cohort study included all chronic medication-treated hypertensives enrolled in Tennessee's Medicaid program (TennCare) for 3-7 years during the period 1994-2000 (n = 49,479). Health care utilization patterns were evaluated using administrative data linked to vital records during a 2-year run-in period and 1- to 5-year follow-up period. Antihypertensive medication refill adherence was calculated using pharmacy records. Associations with stroke and death were assessed using Cox proportional hazards modeling. Stroke occurred in 619 patients (1.25%) and death in 2,051 (4.15%). Baseline antihypertensive medication refill adherence was associated with decreased multivariate hazards of stroke [hazard ratio (HR) 0.91; 95% confidence interval (CI), 0.86-0.97 for 15% increase in adherence]. Adherence in the follow-up period was associated with decreased hazards of stroke (HR 0.92; CI 0.87-0.96) and death (HR 0.93; CI 0.90-0.96). Baseline ambulatory visits were associated with decreased death (HR 0.99; CI 0.98-1.00). Four major classes of antihypertensive agents were associated with mortality reduction. Only thiazide-type diuretic use was associated with decreased stroke (HR 0.89; CI 0.85-0.93). Ambulatory visits and antihypertensive medication exposures are associated with reduced mortality. Increasing adherence by one pill per week for a once-a-day regimen reduces the hazard of stroke by 8-9% and death by 7%.

Management of Blood Pressure for Acute and Recurrent Stroke

Marc Fisher MD Kennedy Lees MD Section Editors: Hypertension is the most important modifiable risk factor for stroke.1,2 It is estimated that 25% or more of strokes may be attributable to hypertension. Because many patients with stroke have mild hypertension or prehypertension, we have shifted our focus and now think of stroke on a continuum of risk based on blood pressure (BP) level rather than on a threshold effect.3 Because high BP may not exist in isolation, a wider definition of hypertension has been proposed that also takes into account the absolute risk of cardiovascular events and associated metabolic factors or early disease markers.3 Lowering BP reduces the risk of stroke. Epidemiological studies have shown that for each 10 mm Hg lower systolic blood pressure (SBP), there is a decrease in risk of stroke of approximately one third in persons aged 60 to 79 years. This association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, stroke subtypes, and for fatal and nonfatal events.4 Lowering diastolic blood pressure (DBP) was once the main target to achieve stroke and other cardiovascular event reduction, but SBP has now become the target.3 As recently shown, even the elderly with sustained SBP elevation may gain from BP reduction in relation to less fatal or nonfatal stroke, death, and heart failure.5 Although the role of longer-term BP control to improve outcomes in patients with stroke is undisputed, BP management immediately after a stroke remains controversial. In an effort to resolve this controversy, several pilot clinical trials have been initiated. In this review, we discuss the results of some of these trials and available evidence-based guidelines for BP control in the settings of acute ischemic and hemorrhagic stroke (excluding subarachnoid hemorrhage) and …

447: Urinary placental growth factor in chronic hypertensives and pregestational diabetics

To investigate if urinary placental growth factor (PlGF) in those who are typically at increased risk for developing preeclampsia [chronic hypertensives (CHTN) and pregestational diabetics (PGD)] may be used as a screening tool to identify those who will develop preeclampsia (PRE).

The arterial system in pre‐eclampsia and chronic hypertension with superimposed pre‐eclampsia

To determine if the normal gestational changes in mechanical properties of the arterial system are altered in pre-eclampsia. Prospective controlled observational study. University urban tertiary medical centre. Eleven pre-eclamptics and 10 chronic hypertensives with superimposed pre-eclampsia were compared with 14 normotensive gravidas experiencing preterm labour, all receiving MgSO(4). Two additional control groups were studied as well: (A) nine normal pregnant women receiving neither magnesium nor epidural, for baseline comparisons; and (B) eight normotensive gravidas receiving epidural anaesthesia. Two-dimensional targeted M-mode echocardiograms and continuous wave Doppler velocity were used to obtain instantaneous pressure and flow data. Total vascular resistance (TVR) quantified the steady component of systemic arterial load; pulsatile arterial load was characterised by global arterial compliance (AC), aortic input impedance spectrum (Z(1)) and characteristic impedance (Z(0)). TVR, AC, Z(1), Z(0). Controls, pre-eclamptics and chronic hypertensives with superimposed pre-eclampsia, respectively: TVR index 1328 [299], 1973 [609]*, 2428 [562]*(,#) dyn second cm(-5) m(2); AC area index 1.69 [0.46], 1.19 [0.46]*, 0.93 [0.38]* mL mmHg(-1) m(-2); Z(0) index 253.2 [61.3], 327.0 [135.1], 307.5 [130.9] dyn second cm(-5) m(2); and Z(1) index 184.2 [56.5], 283.6 [81.6]*, 357.1 [119.5]* dyn second cm(-5) m(2) (*P < 0.05 vs control;(#)P < 0.05 vs pre-eclampsia). Normal gravidas (in secondary controls group A) had decreased mean systolic and diastolic blood pressures, and increased AC and cardiac indices, compared with women receiving magnesium tocolysis, verifying the need for these primary controls. No differences were noted between normotensive gravidas receiving epidural anaesthesia (secondary controls group B) and the non-anesthetised controls (group A), eliminating epidural as a confounder. The normal gestational changes in systemic arterial mechanical properties are significantly altered in pre-eclampsia and these alterations are more marked with superimposed hypertensive disease.