Control Of Essential Hypertension Research Articles

The effectiveness of person-centred quality improvement strategies on the management and control of hypertension in primary care: A systematic review and meta-analysis.

To evaluate the effectiveness of person-centred quality improvement strategies on the management and control of adults with hypertension in primary care. A systematic review and meta-analysis was conducted using the Medline, Cochrane Central Register for Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, and APA PsycINFO databases (January 1980 to March 2020). Randomized controlled trials that evaluated person-centred quality improvement strategies for the management and control of essential hypertension among adults ( 18 years) in primary care were included. Random effects models were used to estimate weighted mean differences (WMD) for the change in systolic and diastolic blood pressures (SBP, DBP) from baseline; risk ratios (RR) were calculated for the proportion of participants achieving target blood pressures, for each quality improvement strategy assessed. A qualitative review of the implementation details of the interventions was conducted to identify common components of interventions that were effective in improving blood pressure outcomes. Eight studies were included (total of 5654 patients). Findings favour use of person-centred quality improvement interventions over usual care (RR=1.23 [95% CI: 1.01; 1.48]) for improving blood pressure outcomes. Self-management (RR=1.43 [95% CI: 1.23; 1.65]) had the greatest effects on blood pressure targets. Clinician education resulted in the greatest SBP reduction (WMD:6.09 mmHg [95% CI: 2.32; 9.85]), while patient education and patient reminder systems (both WMD:4.86 mmHg [95% CI: 0.88; 8.83]) saw the most improvements in DBP. While interventions varied in their strategy implementation, common features of effective interventions included tailored communication with patients, use of health information technology, and multidisciplinary collaboration. Person-centred quality improvement strategies were effective in improving blood pressure outcomes. Further research is needed regarding the context of implementing interventions to provide greater insight into the components of a person-centred quality improvement intervention most effective in improving hypertension outcomes.

Recent Advances in the Endogenous Brain Renin-Angiotensin System and Drugs Acting on It.

The RAS (renin-angiotensin system) is the part of the endocrine system that plays a prime role in the control of essential hypertension. Since the discovery of brain RAS in the seventies, continuous efforts have been put by the scientific committee to explore it more. The brain has shown the presence of various components of brain RAS such as angiotensinogen (AGT), converting enzymes, angiotensin (Ang), and specific receptors (ATR). AGT acts as the precursor molecule for Ang peptides—I, II, III, and IV—while the enzymes such as prorenin, ACE, and aminopeptidases A and N synthesize it. AT1, AT2, AT4, and mitochondrial assembly receptor (MasR) are found to be plentiful in the brain. The brain RAS system exhibits pleiotropic properties such as neuroprotection and cognition along with regulation of blood pressure, CVS homeostasis, thirst and salt appetite, stress, depression, alcohol addiction, and pain modulation. The molecules acting through RAS predominantly ARBs and ACEI are found to be effective in various ongoing and completed clinical trials related to cognition, memory, Alzheimer's disease (AD), and pain. The review summarizes the recent advances in the brain RAS system highlighting its significance in pathophysiology and treatment of the central nervous system-related disorders.

Screening and validation of differentially expressed microRNAs and target genes in hypertensive mice induced by cytomegalovirus infection.

Introduction: Multiple studies have suggested an association between cytomegalovirus (CMV) infection and essential hypertension (EH). MicroRNAs (miRNAs) play a critical role in the development of EH by regulating the expression of specific target genes. However, little is known about the role of miRNAs in CMV-induced EH. In the present study, we compared the miRNA expression profiles of samples from normal and murine cytomegalovirus (MCMV)-infected C57BL/6 mice using high-throughput sequencing analysis. Methods: We collected the thoracic aorta, heart tissues, and peripheral blood from 20 normal mice and 20 MCMV-infected mice. We identified differentially expressed miRNAs in the peripheral blood samples and predicted their target genes using bioinformatics tools. We then experimentally validated them using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and the target genes with double luciferase reporter gene assay. Results: We found 118 differentially expressed miRNAs, among which 9 miRNAs were identified as potential MCMV infection-induced hypertension regulators. We then validated the expression of two candidate miRNAs, mmu-miR-1929-3p and mcmv-miR-m01-4-5p, using qRT-PCR. Furthermore, the dual-luciferase reporter gene assay revealed that the 3′-untranslated region (UTR) of endothelin A receptor (Ednra) messenger RNA (mRNA) contained a binding site for mmu-miR-1929-3p. Collectively, our data suggest that MCMV infection can raise the blood pressure and reduce mmu-miR-1929-3p expression in C57BL/6 mice. Moreover, we found that mmu-miR-1929-3p targets the 3′-UTR of the Ednra mRNA. Conclusion: This novel regulatory axis could aid the development of new approaches for the clinical prevention and control of EH.

A Role of Inflammation and Immunity in Essential Hypertension-Modeled and Analyzed Using Petri Nets.

Recent studies have shown that the innate and adaptive immune system, together with low-grade inflammation, may play an important role in essential hypertension. In this work, to verify the importance of selected factors for the development of essential hypertension, we created a Petri net-based model and analyzed it. The analysis was based mainly on t-invariants, knockouts of selected fragments of the net and its simulations. The blockade of the renin-angiotensin (RAA) system revealed that the most significant effect on the emergence of essential hypertension has RAA activation. This blockade affects: (1) the formation of angiotensin II, (2) inflammatory process (by influencing C-reactive protein (CRP)), (3) the initiation of blood coagulation, (4) bradykinin generation via the kallikrein-kinin system, (5) activation of lymphocytes in hypertension, (6) the participation of TNF alpha in the activation of the acute phase response, and (7) activation of NADPH oxidase—a key enzyme of oxidative stress. On the other hand, we found that the blockade of the activation of the RAA system may not eliminate hypertension that can occur due to disturbances associated with the osmotically independent binding of Na in the interstitium. Moreover, we revealed that inflammation alone is not enough to trigger primary hypertension, but it can coexist with it. We believe that our research may contribute to a better understanding of the pathology of hypertension. It can help identify potential subprocesses, which blocking will allow better control of essential hypertension.

Erectile dysfunction in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life

ObjectivesEstimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. Material and methodsType of study: Observational study of prevalence in men with essential hypertension. Measurements: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). ResultsThe study included 262 hypertensive men with an average age of 65.84 years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. ConclusionsErectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome.

Disfunción eréctil en pacientes con hipertensión arterial. Riesgo cardiovascular e impacto en su calidad de vida

ObjectivesEstimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. Material and methodsType of study: Observational study of prevalence in men with essential hypertension. Measurements: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). ResultsThe study included 262 hypertensive men with an average age of 65.84years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. ConclusionsErectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome.

Within the Brain: The Renin Angiotensin System.

For many years, modulators of the renin angiotensin system (RAS) have been trusted by clinicians for the control of essential hypertension. It was recently demonstrated that these modulators have other pleiotropic properties independent of their hypotensive effects, such as enhancement of cognition. Within the brain, different components of the RAS have been extensively studied in the context of neuroprotection and cognition. Interestingly, a crosstalk between the RAS and other systems such as cholinergic, dopaminergic and adrenergic systems have been demonstrated. In this review, the preclinical and clinical evidence for the impact of RAS modulators on cognitive impairment of multiple etiologies will be discussed. In addition, the expression and function of different receptor subtypes within the RAS such as: Angiotensin II type I receptor (AT1R), Angiotensin II type II receptor (AT2R), Angiotensin IV receptor (AT4R), Mas receptor (MasR), and Mas-related-G protein-coupled receptor (MrgD), on different cell types within the brain will be presented. We aim to direct the attention of the scientific community to the plethora of evidence on the importance of the RAS on cognition and to the different disease conditions in which these agents can be beneficial.

What is the test-retest reliability of the Malay version of the Hypertension Self-Care Profile self efficacy assessment tool? A validation study in primary care

ObjectivesSelf-efficacy and self-care measures are key attributes to optimal control of essential hypertension. Self-efficacy can be measured by the Hypertension Self-Care Profile (HTN-SCP) tool but its utility is dependent on...

Comparative study of efficacy and adverse effects profile of azilsartan, olmesartan and candesartan in the control of essential hypertension

Background: Hypertension has been identified as the leading risk factor for mortality worldwide. It may lead to damage of heart, kidney, brain, vasculature and the other organs results in premature morbidity and death. The angiotensin receptor blockers are effective antihypertensive agent with excellent tolerability profiles. Azilsartan medoximil is a new ARB recently approved for treatment of hypertension. The objective of the study was to compare efficacy and tolerability of once daily treatment of the new angiotensin type1 receptor blocker (ARB) Azilsartan with Olmesartan and Candesartan.Methods: The study was a prospective, randomized open label comparison. Total 411 patients were recruited for the study. Patients were divided into four groups. Group A comprising of 105 patients received azilsartan (40mg), Group B comprising of 106 patients received azilsartan (80mg), Group C comprising of 102 patients received olmesartan (40mg) and Group D comprising of 98 patients received candesartan (12mg). Blood pressure was monitored at base line, after 2 weeks, 4 weeks and 8 weeks of treatment.Results: All groups were well matched in terms of age, weight, clinical findings and laboratory values. All drugs reduced both systolic blood pressure (SBP) and Diastolic blood pressure (DSP) significantly, but the reduction in SBP and DSP with azilsartan (80mg) was significantly greater than other drugs. The difference in BP reduction between azilsartan (40mg) and olmesartan (40mg) were not significant but both azilsartan (40mg) and olmesartan (40mg) were significantly more effective than candesartan(12mg).Conclusions: The study indicates that azilsartan (80mg) is more effective in the control of hypertension than olmesartan and candesartan with similar safety profile.

Pharmacological Monotherapy versus Renal Artery Denervation in Controlled Hypertensive Patients

<p><strong>Aim: </strong>The aim of this prospective observational non-inferiority study was to compare the capacity for control of essential hypertension between renal sympathetic denervation (RSD) and either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).</p><p><strong>Methods and results</strong>: Seventy-four previously controlled essential hypertensive patients on ACEI/ARB monotherapy were evaluated; eleven patients agreed to proceed with RSD and had their antihypertensive agent withdrawn on the day of the procedure. During the six months of follow-up, there was no significant change in mean 24-hour ambulatory blood pressure measurements (ABPM) from baseline to three and sixmonths in the ACEI/ARB group (118±8/80±3 <em>vs.</em> 116±8/79±3 and 115±8/79±4 mmHg, respectively). No change was also observed in the RSD group (117±8/81±2 <em>vs.</em> 115±6/80±2 and 114±7/79±3 mmHg, respectively). There were no differences between groups at interval time points. There were also no changes in renal function or echocardiographic parameters, during follow-up.</p><p><strong>Conclusions:</strong> For the first time, this study reports possible non-inferiority of RSD when compared to ACEI or ARB monotherapy in the control of essential hypertension. A randomized trial with appropriate concealment of treatment, more patients and an extended follow-up period is needed to evaluate the potential benefits of RSD in comparison to ACEI/ARB use in patients with controlled hypertension.</p>

The Effect of Acetyl Salicylic Acid Induced Nitric Oxide Synthesis in the Normalization of Hypertension through the Stimulation of Renal Cortexin Synthesis and by the Inhibition of Dermcidin Isoform 2, A Hypertensive Protein Production

Currently, there is no specific medication for essential hypertension (EH), a major form of the condition, in man. As acetyl salicylic acid (aspirin) is reported to stimulate the synthesis of renal (r)-cortexin, an anti-essential hypertensive protein, and, as aspirin is reported to inhibit dermcidin isoform 2 (dermcidin), a causative protein for EH, the role of aspirin in the control of EH in man was studied. Oral administration of 150 mg aspirin/70 kg body weight in subjects with EH was found to reduce both the elevated systolic and diastolic blood pressures to normal levels within 3 h due to the normalization of dermcidin level in these subjects. The plasma cortexin level at day 0, 1, 30 and 90 were 0.5 pmol/ml, 155.5 pmol/ml, 160.2 pmol/ml, 190.5 pmol/ml respectively with increased NO synthesis (r=+0.994). In vitro studies demonstrated that the incubation of the goat kidney cortex cells with aspirin stimulated (r)-cortexin synthesis due to NO synthesis. It could be suggested that the use of aspirin might control EH in man.

Assessment of primary healthcare professionals’ management of hypertensive patients with riser pattern

Ambulatory blood pressure monitoring (ABPM) was implemented in our primary care setting four years ago. Since then, 450 ABPMs have been performed and 69 riser subjects identified. The riser pattern is an independent risk factor for both incidence of cardiovascular events and their associated mortality. The purpose of this study was to assess the amount of control of essential hypertension (EH) among riser patients and to evaluate how our health professionals manage therapeutic changes in riser individuals. This retrospective study involved 34,289 inhabitants served in a centre in the Barcelona metropolitan area. EH individuals (450) were recruited and ABPM was performed following guidelines of the MAPAPRES (www.cardiorisc.com/MP/index_MP.asp). Good control of blood pressure was observed in 46% of dipper and non-dipper subjects but only 35% of riser subjects had blood pressures within good control ranges. The measured cardiovascular risk was either high or very high in 35% of riser individuals. Changes in medication were introduced in riser patients with both good and poor blood pressure control. A second follow-up ABPM was done in only 27% of the riser individuals. In these subjects, therapeutic changes successfully modified ABPM patterns in 87% of cases. Therapeutic changes in riser patients were introduced when these subjects were poorly controlled and these changes were highly effective. Additional ABPM to confirm the effectiveness of therapeutic changes was only performed in some individuals. Thus, for management of riser patients, more specific training of health professionals is needed.

The vascular endothelium: still amazing us 30 years on

As pharmacology undergraduates, we both recall our lecturers' confident assertion that the vascular endothelium was nothing more than a slippery, inert monolayer, functioning to aid the non-turbulent flow of blood to the tissues. All this changed in the 1970s, largely with the discovery that angiotensin-converting enzyme (ACE) was located in vascular endothelial cells (Caldwell et al., 1976). The importance of angiotensin II in blood pressure maintenance and the subsequent development of ACE inhibitors remain key factors in the control of essential hypertension in man. Nothing, however, could have prepared the scientific community for the impact of the simple organ-bath experiments of Robert Furchgott at the end of that decade (Furchgott and Zawadzki, 1980). The ensuing ‘EDRF story’ has been reviewed many times, and in this Themed Issue of the British Journal of Pharmacology (BJP), the importance of this discovery is also highlighted but placed in context with more recent endothelial discoveries (Garland et al., 2011a). The purpose of this issue of the BJP is not to provide a forum for comprehensive reviews on all aspects of the pharmacology of the vascular endothelium. Instead, it presents a snapshot of some of the overviews originally presented in a symposium we organized for WorldPharma2010 in Copenhagen, together with original research papers with an endothelial theme. For both of us, there have been many exciting general developments in the endothelial story over the past decade, but of these, two stand out. One is the increasing recognition of the relevance of spreading or conducted vasodilatation, the phenomenon whereby electrical signals generated at one locus in a blood vessel are able to spread significant distances along that vessel (irrespective of the direction of fluid flow) to influence contractility remote from the region of signal initiation. The discovery that catecholamines can activate this fundamental process via β-adrenoceptors can be found in this issue (Garland et al., 2011b). The second key development in our understanding has been the recognition of the fundamental role of microdomain signalling, particularly in the functional responses initiated by the endothelium. With technical developments in imaging, microelectrodes and other means to study the mechanisms that underlie function in very small blood vessels, the amazing intra- and extra-cellular complexities of endothelial-myocyte interactions have begun to unravel. Of particular note has been the focus on microdomains within the endothelial cell projections that traverse holes in the internal elastic lamina. Such microdomains are of critical importance not only for the vascular extracellular calcium-sensing receptor (Smajilovic et al., 2011), but also for the actions of endothelial cell NADPH oxidases (Wingler et al., 2011) and gasotransmitters, such as H2S (Szabo and Papapetropoulos, 2011). Their relevance has been further highlighted since WorldPharma2010. Thus, in conditions such as hypertension, deficiencies in individual microdomain components may play a central role in the altered vascular responsiveness associated with the disease (Garland, 2010; Weston et al., 2010). Although the inhibitory effects of the endothelium on vascular tone continue to receive much attention, the production of endothelium-derived contractile factors (EDCFs) is also of vital importance. In this issue, Feletou et al. (2011) review this aspect of endothelium-mediated vasomotor control and particularly the roles played by the diverse products of cyclooxygenase enzymes in ageing and cardiovascular disorders. The last article in this issue provides an additional dimension to the vascular endothelial cell story, with new findings concerning the phenomenon of neurovascular coupling (Longden et al., 2011). In cerebral blood vessels, astrocytic end-feet encircle cerebral arterioles, and, together with intravascular endothelial cells, form a diameter-controlling system of enormous complexity and subtlety. The similarities and differences between the types of Ca2± sensitive K+ channel within the ‘end-feet’ and the vascular endothelial cells is fascinating when read in conjunction with the movies included in the paper's Appendix. So, from small beginnings come great things. The use of the pharmacologists' tool of bioassay enabled Robert Furchgott's discovery of endothelial NO, and as a result, focused subsequent generations on the importance of this cellular monolayer. Technological developments have already allowed and continue to enable us to unravel the complex interactions between the endothelium and the rest of the cardiovascular system. While it is now clear that these interactions are a fundamental aspect of cardiovascular physiology and pathophysiology, there is surely much that remains to surprise and inform us!

Simultaneous determination of related substances of telmisartan and hydrochlorothiazide in tablet dosage form by using reversed phase high performance liquid chromatographic method

Objective:Telmisartan is a potent, long-lasting, nonpeptide antagonist of the angiotensin II type-1 (AT1) receptor that is indicated for the treatment of essential hypertension. Hydrochlorothiazide is a widely prescribed diuretic and it is indicated for the treatment of edema, control of essential hypertension and management of diabetes insipidus. In the current article a new, accurate, sensitive, precise, rapid, reversed phase high performance liquid chromatography (RP-HPLC) method was developed for determination of related substances of Telmisartan and Hydrochlorthiazide in tablet dosage form.Materials and Methods:Simultaneous determination of related substances was performed on Kromasil C18 analytical column (250 × 4.6 mm; 5μm pertical size) column at 40°C employing a gradient elution. Mobile phase consisting of solvent A (solution containing 2.0 g of potassium dihydrogen phosphate anhydrous and 1.04 g of Sodium 1- Hexane sulphonic acid monohydrate per liter of water, adjusted to pH 3.0 with orthophosphoric acid) and solvent B (mixture of Acetonitrile: Methanol in the ratio 80:20 v/v) was used at a flow rate of 1.0 ml min–1. UV detection was performed at 270 nm.Results:During method validation parameter such as precision, linearity, accuracy, specificity, limit of detection and quantification were evaluated, which remained within acceptable limits.Conclusions:HPLC analytical method is linear, accurate, precise, robust and specific, being able to separate the main drug from its degradation products. It may find application for the routine analysis of the related substances of both Telmisartan and Hydrochlorthiazide in this combination tablets.

Biofeedback for hypertension: a systematic review

To assess the evidence for the long-term effectiveness of biofeedback for the treatment of essential hypertension in adults. A systematic review following accepted international guidelines was conducted. Randomized controlled trials that compared biofeedback procedures with antihypertensive medication, placebo (sham biofeedback treatment), no intervention or other behavioural treatments were included. The outcome measure was change in blood pressure. The inclusion criteria were fulfilled by 36 trials. Twenty-one trials employed biofeedback treatment with no adjunctive therapy, whereas 15 others used biofeedback treatment alongside another treatment. The majority of trials were small with no posttreatment follow-up or follow-up of less than 6 months. Qualitative heterogeneity of the included studies (e.g. poor quality of the trials, differences in interventions and inconsistencies in the measurement of outcomes) meant that it was inappropriate to pool data in the form of a meta-analysis. A narrative summary of the data based on trial authors' conclusions is presented. No studies reported long-term (>12 months) follow-up of patients. Data were grouped first by treatment type and then by comparator. Trial results were variable and conflicting, demonstrating no clear benefits of biofeedback in relation to moderation of hypertension. Although there may be other reported life benefits to its use, we found no convincing evidence that consistently demonstrates the effectiveness of the use of any particular biofeedback treatment in the control of essential hypertension when compared with pharmacotherapy, placebo, no intervention or other behavioural therapies. Any future research needs to be conducted using accepted quality standards and given current guidelines for the treatment of hypertension is likely to be considered only as an adjunct to pharmacological treatment.

The effects of biofeedback for the treatment of essential hypertension: a systematic review

To assess the evidence for the long-term effectiveness of biofeedback for the treatment of essential hypertension in adults and to model any clinical benefits. Bibliographic databases including the Cochrane Library, EMBASE, MEDLINE, ISI Web of Knowledge/Web of Science, ISI Web of Knowledge/ISI Proceedings, the Cochrane Library 2007, CINAHL, AMED and PsycINFO were searched up to May 2007. A systematic review following accepted guidelines was conducted. Randomised controlled trials (RCTs) that compared biofeedback procedures with antihypertensive medication, placebo (sham biofeedback treatment), no intervention or other behavioural treatments were included. The outcome measure was change in blood pressure. A total of 927 non-duplicate references were identified by the search strategy and subsequently screened for inclusion in the review. From these, 41 publications (including three abstracts) reporting 36 RCTs with a total population of 1660 treated patients met the inclusion criteria of the review. Twenty-one trials employed biofeedback treatment with no adjunctive therapy and 15 trials used biofeedback treatment alongside another treatment. The majority of trials were small with no post-treatment follow-up or follow-up of less than 6 months. The poor quality of the trials, differences in interventions and inconsistencies in the measurement of outcomes meant that it was inappropriate to pool data across studies. A narrative summary of the data based on trial author conclusions is presented. No studies reported long-term (> 12 months) follow-up of patients. Data were grouped first by treatment type and then by comparator. Trial results were variable and conflicting, demonstrating no consistent benefits of biofeedback in relation to moderation of hypertension. The lack of evidence of clinical effectiveness negated the need to conduct an economic analysis. No evidence was found that consistently demonstrated the effectiveness of any particular biofeedback treatment in the control of essential hypertension when compared with pharmacotherapy, placebo (sham biofeedback treatment), no intervention or other behavioural treatments. Given the current standards for the treatment of hypertension, further research is likely to be considered only as an adjunct to pharmacological interventions.

A randomized trial of tight vs. less tight control of mild essential and gestational hypertension in pregnancy

To assess the effects of applying a tight vs. a less tight control of mild chronic essential or gestational non-proteinuric hypertension in pregnancy. A randomized trial was conducted in 2006-2007 in the University of Ain Shams, Egypt. Eligible participants (n=125) were randomly assigned to either tight or less tight control of mild chronic (essential) or gestational (non-proteinuric) hypertension. The primary outcome measure was the development of severe hypertension during follow-up. Analysis was by intention-to-treat. In the tight target group, adjustment of the dose with an increment of 191 mg yielded a mean dose of methyldopa of 1267+/-406 mg. Both systolic and diastolic BP levels were significantly less than in the tight target group. More women in the less tight group had severe hypertension during follow up (RR 3.167 and 95% CI 1.36-7.37). The rate of antenatal hospitalization was significantly higher in the less tight target group with a relative risk of 2.57 and 95% CI 1.16-5.70. The gestational age at delivery was significantly better in the tight target group. Preterm delivery and birth weight were not significantly different between the study groups. Tight control of blood pressure reduces the rate of antenatal hospitalization and does not adversely affect perinatal outcomes in women with mild essential or gestational hypertension.

Stop Hypertension with the Acupuncture Research Program (SHARP): clinical trial design and screening results

Hypertension is a major public health problem with serious medical and financial consequences. Barriers to successful conventional pharmacological treatment include side effects, out-of-pocket expenses, patient noncompliance and insufficient dosages. Acupuncture has been studied as an alternative therapy for controlling blood pressure (BP) but previous studies have serious methodological limitations. This paper describes the design of the Stop Hypertension with the Acupuncture Research Program (SHARP) trial, a pilot randomized clinical trial designed to gather preliminary data regarding the efficacy of traditional Chinese medicine (TCM)-based acupuncture for control of essential hypertension. The design of the SHARP trial balanced rigorous clinical trial methodology with principles of TCM. Eligible participants had systolic BP (SBP) 140–179 mm Hg and diastolic BP (DBP) 90–109 mm Hg in the absence of antihypertensive therapy. Following screening, participants were randomized to one of three groups: individualized, standardized or control acupuncture. Treatments were designed according to principles of TCM; nonspecific effects associated with the interventions were standardized across the randomized groups. For individualized acupuncture, points were tailored to each participant. Standardized acupuncture used a prespecified set of points. The invasive sham control acupuncture regimen was designed to be non-active. Each participant received a “prescription” for individualized acupuncture from an acupuncturist who was masked to treatment assignment, and was subsequently treated by an independent acupuncturist. Patients and those assessing BP were masked to treatment group. Acupuncture was delivered twice a week for 6 weeks. Follow-up visits were every 2 weeks to week 10 and then at months 4, 6, 9 and 12. The primary endpoint will be change in SBP from baseline to 10 weeks. DBP, BP trajectories over the 12-month follow-up and antihypertensive medication requirements will also be examined. Initial contact was documented for 1442 prospective participants from March 2001 to April 2002; 424 provided informed consent and 192 were ultimately randomized.

Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension

Congenic rat strains are important tools for the genetic dissection of essential hypertension.

The identification of mutated genes and the characterization of disease pathways in monogenetic forms of human arterial hypertension has been very successful during the past decade, although only little progress has been made with regard to the genetic analysis of essential hypertension. Inbred rat strains that display hypertension as an inherited trait represent an attractive substitute for the dissection of the polygenetic basis of human essential hypertension. The power of studying these inbred models with natural allelic variation is that each strain can be thought of as a different subtype of essential hypertension. Thus, to study the genetics of hypertension using a potpourri of inbred hypertensive rat strains may help to identify a set of genes that can give rise to hypertension in the heterogeneous clinical situation of essential hypertension. Indeed, multiple blood pressure quantitative trait loci (QTL) have been identified in the rat genome and a few of those have been implicated in the human disease by homology mapping already. Here, we discuss the role of congenic breeding strategies to further dissect the genetics of hypertension in the rat. Based on recent accomplishments it can be anticipated that by using congenic strains, the genetic sifting of the collection of blood pressure QTLs identified so far will lead to the identification of additional and new candidate genes. This will open the possibility for the development of new diagnostic and therapeutic means contributing to a better control of human essential hypertension.