Hypertension Blood Pressure Control Research Articles

Advancing cardiovascular neuromodulation: Aortic baroreceptor afferents act as targets for blood pressure control in hypertension.

Aortic baroreceptor afferents act as targets for blood pressure control in hypertension.

Associated Factors to Poor Blood Pressure Control in Hypertensives Followed Up at the Campus University Hospital of Lome (Togo)

Associated Factors to Poor Blood Pressure Control in Hypertensives Followed Up at the Campus University Hospital of Lome (Togo)

Systematic review of motivational interventions to improve adherence to medication in patients with hypertension and meta-analysis

IntroductionAntihypertensive medication non-adherence is an important cause of poor control in hypertension. The role of motivational interventions to increase antihypertensive medication adherence remains unclear. ObjectiveTo systematically review RCTs of motivational interventions for improving medication adherence in hypertension. MethodsEMBASE and Pubmed were searched from inception to February 2019 for RCTs of motivational interventions for improving medication adherence in hypertension vs. usual care. Inclusion criteria: RCTs with motivational intervention to improve medication adherence in adults with hypertension. A blinded review was conducted by 2 reviewers. Disagreements were resolved by consensus/a third reviewer.Data extraction and quality appraisal was performed using the risk of bias tool from cochrane collaboration. The meta-analyses of blood pressure control used random-effects models to report mean difference and 95% CIs. Primary outcome was medication adherence and second outcome was blood pressure control. ResultsThe search methodology yielded 10 studies comprising 1171 participants. Medication adherence improved significantly in 5 studies. We could not perform pool analysis for this outcome due to different measurements of medication adherence. Seven trials reported significant results regarding blood pressure control.On pooled analysis, motivational interventions were not significantly associated with a systolic blood pressure (mean difference, −0.06; 95% CI, −0.05 to 0.18; p=0.63; I2=0.0%) or diastolic blood pressure (mean difference, −0.11; 95% CI, −0.10 to 0.31; p=0.28; I2=23.8%) decrease or blood pressure control. ConclusionsMotivational interventions seem to significantly improve medication adherence but not significantly blood pressure control in hypertension, although evidence is still being based on few studies, with unclear risk of bias.

Aldosterone Synthase Inhibitors and Dietary Interventions: A Combined Novel Approach for Prevention and Treatment of Cardiovascular Disease.

Systemic hypertension (HTN) is the hallmark of cardiovascular disease and the forerunner of heart failure. These associations have been established over decades of research on essential HTN. Advancements in the treatment of patients diagnosed with HTN, consisting of alpha- or beta-adrenergic receptor blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, thiazide, or aldosterone receptor blockers known as anti-mineralocorticoids, in the presence or absence of low sodium salt diets, often fail to control blood pressure adequately to prevent morbidity and mortality. Low sodium diets have had limited success in controlling HTN because low sodium intake is associated with renin-angiotensin-aldosterone system upregulation. Therefore, upregulating aldosterone secretion, sodium, and water retention which, in turn, moves the blood pressure back toward the range of HTN dictated by the baroreceptor reset value, as a compensatory mechanism, especially in resistant HTN. These impediments to blood pressure control in HTN may have been effectively circumvented by the advent of a new class of drugs known as aldosterone synthase inhibitors, represented by baxdrostat.The mechanism of action of baxdrostat as an aldosterone synthase inhibitor demonstrates the inextricable linkage between sodium and blood pressure regulation. Theoretically, combining a low sodium diet with the activity of this aldosterone synthesis inhibitor should alleviate the adverse effect of renin-angiotensin-aldosterone system upregulation. Aldosterone synthesis inhibition should also decrease the oxidative stress and endothelial dysfunction associated with HTN, causing more endothelial nitric oxide synthesis, release, and vasorelaxation. To the best of our knowledge, this is the first systematic review to summarize evidence-based articles relevant to the use of a novel drug (aldosterone synthase inhibitor) in the treatment of HTN and cardiovascular disease. Making the current database of relevant information on baxdrostat and other aldosterone synthase inhibitors readily available will, no doubt, aid physicians and other medical practitioners in their decision-making about employing aldosterone synthase inhibitors in the treatment of patients.

Single-Pill Combination with Three Antihypertensive Agents to Improve Blood Pressure Control in Hypertension: Focus on Olmesartan-Based Combinations.

Blood pressure control remains an unmet clinical need. Only about half of patients achieve their blood pressure (BP) targets and of these, the majority require combination and double or triple therapies. International guidelines recommend the association of drugs with complementary mechanisms of action and, in particular, the combination of renin-angiotensin system (RAS) inhibitors, calcium channel blockers (CCBs), and diuretics. Among the various angiotensin receptor blockers, olmesartan (OM) is available as a monotherapy and in dual and triple single-pill combinations (SPCs) with amlodipine (AML) and/or hydrochlorothiazide (HCTZ). Several phase III and IV studies, together with real-world studies, have demonstrated the additional benefits of combining OM either with AML or with HCTZ in terms of BP control and target BP achievements both in the general population and in special subgroups of hypertensive patients, such as the elderly, diabetic, chronic kidney disease or obese patients. Ambulatory BP monitoring studies assessing 24h BP have also demonstrated that dual, as well as triple, OM-based SPCs induce a more sustained and smoother BP reduction than placebo and monotherapy. Furthermore, triple OM-based SPC has been shown to improve therapeutic adherence in hypertensive patients compared to free combinations. The availability of OM combined with HCTZ, AML or both at different dosages makes it a valuable option to customize therapy based on the levels of BP and the clinical characteristics of hypertensive patients.

Clinical pharmacy services are reimbursed in Germany: challenges of real world implementation remain

Over the last two decades, community pharmacy has experienced major changes as the role of pharmacists is evolving from a product to a service and a patient focus. As part of this change, new and innovative clinical pharmacy services aimed at improving medicines use and patient outcomes have been designed, both nationally and internationally. Since June 2022, five services are reimbursed by all statutory health insurance funds and private insurance companies in Germany: medication review for patients with polymedication; blood pressure control in hypertension; assuring proper inhalation techniques for patients receiving a new device or a device change; medication review including a follow-up for patients taking oral anticancer drugs or immunosuppressants post-transplantation. Beyond reimbursement, the upscaling and sustainable provision of these professional services are now the main challenges. Implementation research will provide important information for the further development of pharmaceutical care programs.

Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?

Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?

Abstract P188: Electrical Stimulation of Sub-Diaphragmatic Vagal Trunk Alleviates Hypertension in the SHR

Introduction: The vagus facilitates a bidirectional gut-brain communication. Low vagal tone is shown in conditions marked by inflammation and dysbiosis, including hypertension (HTN). However, the role of gut-projecting vagal nerve branches in blood pressure (BP) control is unexplored. Supplementing the potentially impaired gut vagal tone using electrical vagal nerve stimulation (vns) may restore homeostasis of the microbiota-gut-brain axis in HTN. Methods: Male 8 week-old Wistar-Kyoto (WKY, N=6) and spontaneously hypertensive rats (SHR, N=10) were used. Rats were implanted with radiotelemetric BP transducers. WKY rats received either a unilateral surgical vagotomy of the ventral sub-diaphragmatic vagal trunk (vgnx, N=3) or sham surgery (SHAM, N=3). SHR were implanted with either a silicone cuff electrode (500μm, Microprobes for Life Sciences, Gaithersburg, MD) (vns, N=5) or a sham cuff (SHAM, N=5) on same vagal trunk. SHR were connected to an IZ2H current controlled stimulus generator (Tucker-Davis Technologies, Alachua, FL), and subjected to biphasic, 600μA, 0.5s/phase, 25Hz vns for 10 minutes per session, three sessions per day, 5 days per week. 24-hour BP recordings were made once per week for seven weeks in all rats. Relative abundance of gut bacterial phyla ( Firmicutes, Bacteriodetes, Actinobacteria ) was determined in fecal DNA of all rats using qPCR. Results: Compared with SHAM, WKY vgnx showed a significant elevation in systolic BP (SBP) at week 7 post-vgnx (WKY SHAM: 148±4 mm Hg vs. WKY vgnx: 177±4 mm Hg; p <0.05). After 7 weeks of vns, SHR STIM group exhibited a significant dampening in SBP rise from baseline (SHR SHAM: ΔSBP=44±5 mm Hg vs. SHR vns: 22±3 mm Hg; p <0.05) and in mean BP (MBP) rise from baseline (SHR SHAM: ΔMBP=38±4 mm Hg vs. SHR vns: 14±3 mm Hg; p <0.05) compared to SHAM. No difference was observed in relative abundance of major bacterial phyla between the WKY vgnx and SHR vns rats and their respective controls. Conclusions: Bioelectric restoration of gut vagal tone is beneficial in restitution of neural gut-brain axis in control of BP in HTN. Considering no changes were observed in major gut bacterial phyla following WKY vgnx and SHR vns, the observed BP responses may be due to perturbations in gut vagal afferent rather than efferent signaling.

Relationship Between a Weighted Multi‐Gene Algorithm and Blood Pressure Control in Hypertension

BackgroundHypertension (HTN) has a strong heritable component and the effectiveness of the treatment for HTN has been shown to be influenced by monogenic guidance. Each of the common HTN pharmacotherapies is ~50% effective in the population and layering blood pressure (BP) medications increases side effects and decreases medication adherence. HTN is a complex disease with primary interactions between the heart, vasculature, and kidney. Known and common genetic variants of each these organs have well‐described mechanisms. Despite the established bell‐curve response to treatment, the complexity of HTN, and functional variants of the major organ systems in HTN: no guidance, to date, utilizes a multi‐gene approach to guide BP therapy.PurposeTo assess the association between a weighted multi‐gene algorithm and BP control in patients with HTN.MethodsNon‐smokers with a family history of HTN were included in the analysis (n=384; age=61.0±0.9, 11% non‐white). 17 genotypes (ADRB1(2 SNPs), ADRB2 (2SNPs), CYP2D6, WNK (3SNPs), SLC12A3, SCNN1A, alpha‐adducin, renin, angiotensin (3 SNPs), ACE, and the angiotensin receptor) were weighted according to previous effect size in the literature (ΔBP when on the target therapy vs. not) as well as the number of peer‐reviewed papers of quality supporting each functional variant. After weighting, each genotype was entered into an algorithm that assessed pairing (e.g. homozygosity of functional ADRB1 is responsive to β‐blockade, heterozygosity is less responsive, and homozygosity of non‐functional is least responsive) within and between organ systems to predict the pharmacotherapy with greatest impact for each individual patient. Each pharmacotherapy was ranked from 1–4 as most to least likely to respond based on the algorithmic assessment of individual patient's genotypes. Three‐years of data was assessed at six‐month intervals for BP and medication history. Current and past pharmacotherapies were also assessed via chart review.ResultsThere was no difference in initial BP at diagnosis between groups matching the top drug recommendation using the multi‐gene weighted algorithm (n=92) vs. those who did not match (n=292). However, from diagnosis to nadir, patients who matched the primary recommendation had a significantly greater drop in BP when compared to patients who did not (ΔSBP= −39.2±2.4 vs. −32.1±1.3mmHg , ΔDBP= −19.4±1.1 vs. −14.0±1.3mmHg , ΔMAP= −24.4±2.1 vs. −19.0±1.2mmHg, respectively, p<0.05 for SBP and DBP). Further, the difference between diagnosis to current 1yr. average BP was lower in the group that matched the top recommendation (ΔSBP= −33.2±2.3 vs. −27.4±1.2mmHg, ΔDBP=−14.8±1.1 vs. −11.5±1.2, ΔMAP= −21.2±2.3 vs. −15.6±1.8, respectively, p<0.05 for SBP and MAP).ConclusionsThese data suggest an association between a weighted multi‐gene algorithm on the BP response to pharmacotherapy. This magnitude of difference has previously been shown to be associated with a significant reduction in heart attack and stroke risk.Support or Funding InformationGeneticure, Inc.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Relationship between a Weighted Multi-Gene Algorithm and Blood Pressure Control in Hypertension.

Hypertension (HTN) is a complex disease with interactions among multiple organ systems, including the heart, vasculature, and kidney with a strong heritable component. Despite the multifactorial nature of HTN, no clinical guidelines utilize a multi-gene approach to guide blood pressure (BP) therapy. Non-smokers with a family history of HTN were included in the analysis (n = 384; age = 61.0 ± 0.9, 11% non-white). A total of 17 functional genotypes were weighted according to the previous effect size in the literature and entered into an algorithm. Pharmacotherapy was ranked from 1–4 as most to least likely to respond based on the algorithmic assessment of individual patient’s genotypes. Three-years of data were assessed at six-month intervals for BP and medication history. There was no difference in BP at diagnosis between groups matching the top drug recommendation using the multi-gene weighted algorithm (n = 92) vs. those who did not match (n = 292). However, from diagnosis to nadir, patients who matched the primary recommendation had a significantly greater drop in BP when compared to patients who did not. Further, the difference between diagnosis to current 1-year average BP was lower in the group that matched the top recommendation. These data suggest an association between a weighted multi-gene algorithm on the BP response to pharmacotherapy.

Untreated Obstructive Sleep Apnea Is Associated With Myocardial Injury Independent of Blood Pressure Control in Hypertension.

Obstructive sleep apnea (OSA) and hypertension are independent risk factors of cardiovascular morbidities. This study aims to investigate the relationship between OSA, blood pressure (BP) control, and myocardial injury in patients with difficult-to-control hypertension. Patients with hypertension who required three or more medications were prospectively recruited at a tertiary referral center. In-laboratory polysomnography, followed by blood tests for fasting glucose, glycated hemoglobin, lipids, high-sensitivity troponin I (hsTnI), B-type natriuretic peptide (BNP), C-reactive protein, and advanced oxidation protein products were performed. After polysomnography, 24-hour ambulatory BP monitoring was arranged. A total of 98 participants were analyzed, with mean age 51 ± 9 years and body mass index 30 ± 5 kg/m2. Previously undiagnosed severe OSA (apneahypopnea index [AHI] ≥ 30 events/h) was present in 51 patients (52%). hsTnI was negatively correlated with nocturnal dip in systolic BP (r = -.205, P = .048). After controlling for confounders, including BP control, AHI and oxygen desaturation index (ODI) were positively correlated with hsTnI (r = .282, P = .009 and r = .279, P = .010, respectively) and C-reactive protein (r = .302, P = .005 and r = .285, P = .008, respectively), but not with BNP or advanced oxidation protein products. Age, ODI, and loss of nocturnal systolic BP dip were significant determinants of hsTnI level (β = .225, P = .022; β = .293, P = .003; and β = -.215, P = .029; R2 = .151). Age, female sex, 24-hour mean diastolic BP, and metabolic syndrome, but not indices of apnea severity, were predictors of BNP level. Unrecognized severe OSA was common in patients with difficult-to-control hypertension, and OSA severity was associated with myocardial injury, independent of BP control with medications. Registry: ClinicalTrials.gov, Title: A Cross-sectional Study of the Occurrence and Effect of Obstructive Sleep Apnea in Subjects With Resistant Hypertension, Identifier: NCT00843583, URL: https://clinicaltrials.gov/ct2/show/NCT00843583.

Human carotid bodies as a therapeutic target: new insights from a clinician's perspective.

From the physiological point of view, carotid bodies are mainly responsible for the ventilatory response to hypoxia; however, they also take part in the regulation of sympathetic tone. According to preclinical data, these structures likely contribute to the development and progression of sympathetically mediated diseases. Moreover, carotid body deactivation in animal models improved blood pressure control in hypertension and reduced mortality in heart failure, along with reducing sympathetic activity. On this basis, two first-in-man studies have been recently performed to investigate the safety and feasibility of such an approach in humans. In this review we summarise the current knowledge regarding the function of carotid bodies, the prevalence of their abnormalities, and the consequences of their excision in human hypertension and heart failure.

Renal Denervation Therapy: Can it Contribute to Better Blood Pressure Control in Hypertension?

Although the first results from studies suggested important benefits regarding blood pressure (BP) control in resistant hypertension by the use of diverse systems of renal denervation (RDN) in the setting of resistant hypertension, the Symplicity HTN-3, randomized sham-controlled trial reduced the enthusiasm and led to a more critical approach towards this neuromodulation innovative therapy. Nowadays there is an ongoing research attempt to justify the pathophysiological background of RDN since overdrive of the sympathetic nervous system is one of the key mechanisms leading to the development and progression of the hypertensive and cardiovascular diseases. Future RDN trials based on the clinical findings and gaps from previous works will try to identify those parameters to help identify better BP response, target the most suitable population and conclude whether this interventional approach can contribute to the clinical problem of uncontrolled hypertension.

Antihypertensive control and new-onset atrial fibrillation: Results from the Swedish Primary Care Cardiovascular Database (SPCCD).

Background Atrial fibrillation is associated with increased cardiovascular morbidity and mortality. Hypertension is an important risk factor for the development of atrial fibrillation. Aim This study assessed the relationship between blood pressure control and new-onset atrial fibrillation in hypertensive patients. Methods and results We followed 45,530 hypertensive patients with no previously documented atrial fibrillation, attending primary healthcare in Sweden during 2001-2008. After a mean follow-up of 3.5 years 2057 patients (4.5%) developed atrial fibrillation. Compared to patients with no atrial fibrillation, the new-onset atrial fibrillation group (after adjustment for age, sex, diabetes mellitus, heart failure, ischaemic heart disease, cerebrovascular disease and number of visits) had higher mean in-treatment systolic blood pressure (SBP) and diastolic blood pressure of 3.8 mmHg (95% confidence interval (CI) 3.0-4.6; P < 0.0001) and 1.6 mmHg (95% CI 1.2-2.0; P < 0.0001), respectively. Similarly, mean in-treatment pulse pressure in the new-onset atrial fibrillation group was 2.2 mmHg (95% CI 1.6-2.9; P < 0.001) higher. In a logistic regression analysis, achieved SBP ≥ 140 mmHg was associated with a higher risk of new-onset atrial fibrillation, compared to SBP 130-139 mmHg (odds ratio (OR) 1.5; 95% CI 1.3-1.7) and to SBP < 130 mmHg (OR 1.3; 95% CI 1.1-1.5). There was no difference in risk for new-onset AF between SBP 130-139 and <130 mmHg (OR 0.9; 95% CI 0.7-1.1). Conclusion The present findings indicate that blood pressure control in hypertension is associated with a lower risk of new-onset atrial fibrillation.

Effectiveness and content analysis of interventions to enhance medication adherence and blood pressure control in hypertension: A systematic review and meta-analysis

Objective: The objective of this systematic review is to evaluate the effectiveness of medication adherence interventions on blood pressure control in hypertensive patients. In addition, we aim to explore what barriers and facilitators in the interventions may have been targeted and how these might be related to the effect size on blood pressure (BP).Design: This review is a hypertension-specific update to the previous Cochrane Review by Nieuwlaat et al. (2014) on interventions to enhance medication adherence. A systematic literature search was carried out and two authors independently screened titles and abstracts for their eligibility for inclusion and independently extracted data from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. A meta-analysis was conducted and additionally, theoretical factors in interventions were identified using the Theoretical Domains Framework.Results: The meta-analysis found a modest main effect of adherence interventions on SBP (MD −2.71 mm Hg, 95% CI −4.17 to −1.26) and DBP (MD −1.25 mm Hg, 95% CI −1.72 to −.79). However, there was substantial significant heterogeneity across both outcomes. A narrative review on adherence outcomes was conducted. In terms of the theoretical analysis, the relationship between the total number of times the domains were coded within an intervention and change of SBP (r = −.234, p = .335) and DBP was not significant (r = −.080, p = .732). Similarly, the relationship between the total number of times different domains were coded within an intervention and change of SBP (r = .080, p = .746) and DBP was not significant (r = −.188, p = .415).Discussion: This review and meta-analysis of interventions documented significant but modest post-intervention improvements in BP outcomes among hypertensive patients. However, this is a tentative finding as substantial heterogeneity and potential biases were present. One of the greatest challenges of this review was assessing risk of bias, extracting sufficient data to calculate effect size and coding interventions with the amount of information provided in papers. It is imperative that future adherence research comprehensively reports methodology.

Blood pressure control in hypertension. Pros and cons of available treatment strategies.

The low rate of blood pressure (BP) control that characterizes the hypertensive population in real life is traditionally associated to factors such as low adherence of patients to the prescribed treatment regimen, physicians' therapeutic inertia, and deficiencies of the healthcare systems. This study will focus on a fourth factor that may also be importantly involved, i.e. reluctance to adopt drug treatment strategies that more effectively reduce an elevated BP. The point will be made that, vis-à-vis strategies based on patients' persistence in monotherapy, drug combinations are accompanied by a much more frequent BP control. In particular, it will be argued that compared with the administration of additional drugs after initial monotherapy, use of combination treatment from the beginning may carry important advantages, such as a faster BP control, and thus an earlier protection in patients at a high cardiovascular risk and a better adherence to the prescribed drugs and thus a more frequent long-term achievement of target BP values, possibly also with a more effective cardiovascular protection. This may justify a more clear support of this treatment strategy by future guidelines, in the attempt to lessen the contribution of hypertension to cardiovascular disease and death.

Effects of health-prone behavior concerning breast cancer on blood pressure control in hypertensives

Effects of health-prone behavior concerning breast cancer on blood pressure control in hypertensives

Can Erythrocyte Catalase Regulate Blood Pressure?

This study investigated the effect of antihypertensive therapy with lisinopril on plasma cholesterol concentration and erythrocyte catalase activity in hypertensive patients. We observed, for the first time, significant inverse correlations between systolic blood pressure (BP) and erythrocyte catalase activity and between diastolic BP and erythrocyte catalase activity. Plasma total and low density lipoprotein (LDL) cholesterol as well as triglyceride levels were similar between baseline and 1-, 3-, and 6-month treatment values in the same patients; however, systolic and diastolic BP levels were expectedly reduced after the therapy. Thus, there was no association between BP and lipid-cholesterol metabolism. These findings confirm antihypertensive effect of lisinopril and suggest that erythrocyte catalase is involved in BP control in hypertension and antihypertensive therapy.

Loss of Hydrogen Sulfide‐Stimulated Ca 2+ Spark Activity in Arteries from Rats with Intermittent Hypoxia‐Induced Hypertension

Obstructive sleep apnea (OSA) is a risk factor for hypertension. Previous studies from our laboratory demonstrate increased blood pressure and increased myogenic vascular tone in mesenteric arteries from rats exposed to intermittent hypoxia (IH), a model of OSA. We have also observed that hydrogen sulfide (H2S) activates Ca2+ sparks in mesenteric arteries, and that IH exposure in rats decreases H2S-dependent dilation in mesenteric arteries. Therefore, we hypothesized that IH exposure would decrease H2S-activated Ca2+spark activity in mesenteric arteries to augment vasoconstriction. Mesenteric arteries collected from male Sprague-Dawley rats exposed to IH (20 exposures/hr of 5% O2/5% CO2 7 hr/day for 14 days) were loaded with the Ca2+indicators fluo-4 AM and Oregon Green BAPTA-1 and then cannulated and pressurized to 75 mmHg. Basal Ca2+spark activity was decreased in arteries from IH rats (0.31±0.04 vs. 0.43±0.02 sparks/cell/sec in Sham). The inhibitor of H2S synthesis (beta cyanoalanine, BCA) decreased spark activity activity in Sham arteries te abolish this diffference. Vascular smooth muscle cell (VSMC) depolarization induced by elevating extracellular [K+] or by increasing luminal pressure) increased Ca2+ spark activity in arteries from Sham but not IH rats and this increase in Ca2+ spark activity was prevented by removing the endothelium or by incubating with BCA. Ryanodine (10 µM) eliminated basal Ca2+ spark activity and prevented both H2S-induced dilation and H2S-induced spark activation. Our results provide evidence of impaired H2S-induced Ca2+ spark regulation of vascular reactivity in a rodent model of OSA and point to this pathway as a target for blood pressure control in hypertensives.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries