Current Hypertension Treatment Research Articles

Re-evaluating cardiovascular risk in systolic-dominant, diastolic-dominant and parallelly-elevated hypertension: insights from northeast rural cardiovascular health study

BackgroundHypertension is a major risk factor for cardiovascular disease (CVD), with a high prevalence in rural northeastern China. This study assesses the cardiovascular risk associated with different blood pressure patterns: systolic dominant, diastolic dominant, and parallel elevation.MethodsWe analyzed data from the Northeast Rural Cardiovascular Health Study (NCRCHS), which included 8,189 participants aged 35 and above. Baseline surveys from 2012 to 2013 and follow-ups in 2015 and 2018 provided a median follow-up of 4.66 years. Participants were categorized into ten subgroups based on systolic and diastolic blood pressure elevations. Kaplan-Meier curves and Cox regression models were used to examine CVD incidence and cardiovascular risk across these groups.ResultsThe incidence of CVD varied significantly among hypertension categories. Patients with grade 1 hypertension had no significant increase in cardiovascular risk at nearly 5 years. Notably, parallel elevations in systolic and diastolic pressures posed the highest cardiovascular risk, while a predominant rise in diastolic pressure alone did not significantly increase risk. This highlights the importance of analyzing blood pressure comprehensively for cardiovascular risk stratification and suggests rethinking treatment strategies for diastolic dominant hypertension.ConclusionsOur findings call for a nuanced approach to cardiovascular risk assessment in hypertension, taking into account distinct patterns of systolic and diastolic blood pressure. The study supports personalized treatment interventions and reinforces current hypertension treatment guidelines. We advocate for prioritizing non-pharmacological management in grade 1 hypertension and further clinical evaluation of treatment thresholds for diastolic dominant hypertension.

A systematic review of the impact of pulmonary thromboendarterectomy on health-related quality of life.

Pulmonary thromboendarterectomy (PTE) is the current gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH) and is a viable treatment option for chronic thromboembolic pulmonary disease (CTEPD). The progressive nature of both diseases severely impacts health-related quality of life (HRQoL) across a variety of domains. This systematic review was performed to evaluate the impact of PTE on short- and long-term HRQoL. A literature search was conducted on PubMed for studies matching the eligibility criteria between January 2000 and September 2022. OVID (MEDLINE), Google Scholar, EBSCOhost (EMBASE), and bibliographies of included studies were reviewed. Inclusion of studies was based on predetermined eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Results were synthesized by narrative review. The structure of this systematic review follows the PRISMA guidelines. This systematic review was prospectively registered in the PROSPERO register (CRD42022342144). Thirteen studies (2184 patients) were included. Within 3 months post-PTE, HRQoL improved in both CTEPD and CTEPH as measured by disease-specific and generic questionnaires. HRQoL improvements were sustained up to 5 years postoperatively in patients with CTEPH post-PTE. PTE remains the gold standard for treating CTEPH and improving HRQoL. Residual pulmonary hypertension and comorbidities such as COPD and coronary artery disease decrement HRQoL over time. The impact of mPAP and PVR on HRQoL outcomes postoperatively remain ambiguous. Pulmonary thromboendarterectomy remains the gold standard for treating CTEPH and has shown to improve HRQoL outcomes at 3-month sustaining improvements up to 5-year postoperatively. Residual pulmonary hypertension and comorbidities hinder HRQoL outcomes post-PTE.

DEVELOPMENT AND VALIDATION OF A HPLC/PDA METHOD FOR SIMULTANEOUS QUANTIFICATION OF AMLODIPINE BESYLATE AND VALSARTAN IN DISSOLUTION MEDIA

Background: Valsartan, an angiotensin blocker, is often combined with amlodipine (a calcium channel antagonist) in the current treatment of hypertension. There is a generic brand-name drug Exforge® which has been proven to be clinically effective. However, its price is high, making it quite difficult to access, especially in low- and middle-income countries. Therefore, research and development of generic drugs is essential. In addition, research on simultaneous quantification of amlodipine and valsartan in the dissolution medium must be performed to serve as a basis for comparing in vitro equivalence between the two finished products. Objectives: Investigation of the mobile phase for separating amlodipine and valsartan using the isocratic elution method and validation of the simultaneous quantification of amlodipine and valsartan in three different dissolution media with pH of 1.2, 4.5, and 6.8. Materials and methods: Experimental methods on finished tablets containing amlodipine and valsartan. Results: A procedure for simultaneous quantification of amlodipine and valsartan has been developed and validated in three dissolution media using the HPLC method with DAD detector, ZORBAX Eclipse Plus C18 reversed-phase column (4.6 x 250 mm; 5m), isocratic elution method, detection wavelength of 237 nm, flow rate of 1 mL/min, an injection volume of 20 µL, and mobile phase composed of acetonitrile-triethylamine 0.7% (adjusted to pH 3.0 with 0.05% of phosphoric acid) with a ratio of 40:60. The quantitative method achieves linearity with a correlation coefficient R2>0.999 and the linearity for amlodipine and valsartan was determined in the range at pH of 1.2 (0.25-10 µg/mL and 2-160 µg/mL), at pH of 4.5 and 6.8 (0.5-10 µg/mL and 8-160 µg/mL). The values of amlodipine and valsartan content in the test sample on the same day and between two different days were less than 2.0%. The recovery rate ranged from 98% to 102% with the relative standard deviation (RSD) not exceeding 2.0%. Conclusions: The HPLC method with the above chromatographic conditions can be applied for simultaneous quantification of amlodipine and valsartan in three dissolution media with various pH.

Marine Organisms as Potential Sources of Inhibits ACE on Hypertension Patient

Abstract:
 Hypertension is a condition of chronic high blood pressure in the systemic arteries which is a major risk factor for cardiovascular disease, kidney disorders, and death. There are two types of hypertension, the primary hypertension is thought to be caused by hereditary factors, age, gender, race, and an unhealthy lifestyle. Secondary hypertension is caused by an obvious cause. The prevalence of hypertension in Indonesia is quite high with the highest incidence rate in South Kalimantan (44,1%) and the lowest in Papua (22,2%). The pathophysiology of hypertension involves the enzyme Angiotensin Converting Enzyme (ACE) which plays a role in regulating blood pressure. The process of converting Angiotensinogen to Angiotensin I, then Angiotensin II by ACE can cause vasoconstriction and fluid retention, which contribute to hypertension. The changes in circulation and blood vessel structure have played a role in the risk of hypertension complications, including stroke. The marine organisms such as fish, shellfish, cephalopods, seaweed, and algae contain peptides with antihypertensive, anticoagulant, antithrombotic, and hypercholesterolemic activities. For example, hydrolyzate of the jellyfish, Rhopilema esculentum can inhibit ACE with a high level of effectiveness. The current hypertension treatment often uses synthetic drugs such as ACE inhibitors and Angiotensin Receptor Blockers (ARBs), but these have undesirable side effects. Therefore, bioactive peptides from marine organisms can be an efficient and safe natural alternative. The research on protein hydrolysates from various sources has found ACE inhibitory activity and several peptides such as Trp-Pro-Met-Gly-Phe (WPMGF) and APP, KPLL, and VYPFPGPIPNSLPQNIPP were identified to have strong ACE inhibitory activity. These findings indicate the potential use of bioactive peptides from marine organisms as a natural alternative for the treatment and prevention of hypertension.

National Trends in the Us e of Herbal Medicines for the Treatm ent of Hypertens ion Among Adults in Mongolia from Four Cross-Sectional Surveys in 2005, 2009, 2013, and 2019

Background: The use of herbal and combined herbal and conventional treatments in people with chronic diseases, such as hypertension, is important. The aim of the present study was to assess national trends in using traditional medicines for the treatment of hypertension among adults in Mongolia from four cross-sectional surveys in 2005, 2009, 2013 and 2019. Methods: Cross-sectional data were analysed from 5,657 persons (15-64 years) of known hypertensives that participated in the 2005, 2009, 2013 or 2019 Mongolia STEPS surveys. Those who knew their hypertension status were asked about the past two weeks of intake of any drug (medication) for increased blood pressure prescribed by a doctor or other health worker, and the current intake of any herbal or traditional remedy for elevated blood pressure. Logistic regression was employed to assess the associations between sociodemographic and comorbid factors and herbal use and concurrent herbal and conventional treatment. Results: The prevalence of known hypertensives slightly increased from 19.0% in 2005 to 23.7% in 2019. The prevalence of current conventional treatment for hypertension among known hypertensives significantly decreased from 74.5% in 2005 to 40.1% in 2019. The proportion of current herbal treatment for hypertension among known hypertensives was overall 6.3% and decreased significantly from 11.7% in 2005 to 9.0% in 2019. The prevalence of current herbal and conventional treatment for hypertension among known hypertensives was overall 4.4%, and significantly decreased from 9.9% in 2005 to 6.0% in 2019. In the 2005 survey, the prevalence of herbal use was significantly higher among those with 12 or more years of education (p<0.01) and urban residence (p<0.001), while in the study years 2009, 2013 and 2019, no significant differences were found in terms of educational level and residence status and prevalence of herbal use. In adjusted logistic regression analysis, inadequate fruit and vegetable consumption decreased the odds and older age increased the odds of herbal use and/or concurrent herbal and conventional treatment for hypertension among hypertensives. Conclusion: The prevalence of herbal and/or conventional treatment of hypertension among hypertensives has decreased among Mongolian adults over a 15-year period. Considering significant levels of herbal treatment in combination with conventional treatment for hypertension, negative drug-herb effects can be expected, and appropriate actions of health systems may be needed.

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings.

HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.

Current diagnostics and treatment of portal hypertension

In industrial nations portal hypertension is mostly aconsequence of liver cirrhosis and is aprerequisite for complications, such as esophageal varices and ascites. The pathophysiology of portal hypertension is complex. It is defined as an increase in the hepatovenous pressure gradient to > 5 mm Hg, with complications to be expected at ≥ 10 mm Hg. Measurement of the pressure of the hepatic vein occlusion is the gold standard for estimating portal pressure but this is not very practical. Liver elastography, in particular, has proven to be an effective noninvasive tool to identify patients with clinically significant portal hypertension (CSPH). Current treatment concepts address the CSPH even before the onset of complications to reduce the likelihood of decompensation. In addition to beta blockers, a transjugular intrahepatic portosystemic shunt is the most important procedure to lower portal vein pressure and enables an improvement in the prognosis of selected patients.

The position of renal denervation in treatment of hypertension: an expert consensus statement.

Hypertension is an important risk factor for cardiovascular disease. In the Netherlands, there are approximately 2.8million people with hypertension. Despite treatment recommendations including lifestyle changes and antihypertensive drugs, most patients do not meet guideline-recommended blood pressure (BP) targets. In order to improve BP control and lower the risk of subsequent cardiovascular events, renal sympathetic denervation (RDN) has been introduced and studied as anon-pharmacological approach. While early data on the efficacy of RDN showed conflicting results, improvements in treatment protocols and study design resulted in robust new evidence supporting the potential of the technology to improve patient care in hypertensive subjects. Recently, 5randomised sham-controlled trials demonstrated the safety and efficacy of the technology. Modelling studies have further shown that RDN is cost-effective in the Dutch healthcare setting. Given the undisputable disease burden along with the shortcomings of current therapeutic options, we postulate anew, clearly framed indication for RDN as an adjunct in the treatment of hypertension. The present consensus statement summarises current guideline-recommended BP targets, proposed workup and treatment for hypertension, and position of RDN for those patients with primary hypertension who do not meet guideline-recommended BP targets (see central illustration).

Abstract MP64: Estimated Impact Of Public Health System Reforms To Increase Hypertension Treatment Coverage In India

Background: Approaches to scale up hypertension (HTN) treatment are needed in India, where only ~10% of individuals with HTN have controlled blood pressure. Objective: Estimate the current HTN treatment capacity of the public health system in India and model the effects of selected health system reform options. Methods: Using constrained optimization models, we estimated the HTN treatment capacity and salary costs of HTN-treating staff within the public health system; and simulated the potential effects of 1) increased workforce, 2) greater task sharing, and/or 3) reduced visit frequency (quarterly) vs the common practice of monthly visits for prescription refills. Results: An estimated 8% of all adults with HTN could be treated in the status quo (current number of health workers, no further task sharing, and monthly visits) (Figure). Treating 70% of adults with HTN with monthly visits without greater task sharing could require an additional 1.6 million staff, with ~200 billion ₹ (≈US$2.7 billion)) in additional annual salaries. Greater task sharing was estimated to allow the current workforce to treat ~25% of individuals with HTN with monthly visits. Quarterly visits (i.e., longer prescription periods) together with greater task sharing could allow the current workforce to treat ~70% of patients with HTN in India. Conclusion: Expanding HTN treatment coverage through workforce expansion alone will require substantial human and financial resources. The combination of greater task sharing and quarterly visits could increase the coverage of HTN treatment to ~70% of adults with HTN in India, without any expansion of the current workforce of the public health system.

The outcomes of the postulated interaction between SARS-CoV-2 and the renin-angiotensin system on the clinician's attitudes toward hypertension treatment.

Concern has arisen about the role played in coronavirus disease 2019 (COVID-19) infection by angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). This study was designed to assess the practice behaviors of physicians toward hypertension treatment with ACE-i or ARBs during the COVID-19 pandemic. A self-administered survey questionnaire consisting of 26 questions about current hypertension treatment with ACE-i/ ARBs was applied to cardiologists, internists, and family physicians in central and western Turkey, between 01 and 19 May 2020. A total of 460 physicians were approached, and 220 (47.8%) participated in the study. Of the total respondents, 78.7% reported that they had not changed their antihypertensive medication prescribing pattern, 8.6% of clinicians had changed ACE-i/ ARBs medicine of patients during the COVID-19 pandemic and 12.7% of them were undecided. The median (±interquartile range) score indicating general reliance level of physicians in ACE-i/ARBs therapy was 8 ± 4 (range, 1–10). In multiple comparison analyses, the general reliance level in ACE-i/ARBs, reliance level when starting a new ACEi/ARBs and changing behavior in heart failure patients were significantly different with regard to the specialties (p:0.02, p:0.009, p:0.005 respectively). Although most of the physicians found the publications about ACE-i/ ARBs during the COVID-19 pandemic untrustworthy, there were variable levels of knowledge and reliance among different physicians and specialty groups. In general, the ACE-i/ ARBs prescribing habits were not affected by safety concerns during the COVID-19 pandemic in Turkey.

Abstract P182: Workforce Reforms And Task Sharing To Improve Hypertension Treatment Coverage In India

Background: Most patients with hypertension in India are not treated, in part due to insufficient healthcare providers. Objective: Estimate the current hypertension treatment capacity of the public healthcare system in India and simulate the effects of workforce system and treatment reforms designed to increase coverage of hypertension treatment. Methods: We estimated the hypertension treatment capacity and salary costs of public healthcare facilities (subcenters, primary and community healthcare centers) under different assumptions on workforce size, task sharing, and treatment frequencies. Results: In 2020, an estimated 9% of all hypertensives in India (~23 million adults) are being treated for hypertension in subcenters and primary/community healthcare centers. Treating 30% of hypertensives without task sharing would require an additional >400,000 staff and >340 billion INR/year in salaries ( Figure ). Task sharing under current legislation was estimated to allow the current workforce to treat 14%, while a feasible extension of task sharing beyond the current legislation (e.g., allowing nurses to prescribe medicines) could treat 57% of hypertensive adults with the same workforce. Applying quarterly visits in addition to the extended task sharing, the current workforce could treat all hypertensives adults in India. Conclusion: Under the current practice, even modest increases of hypertension treatment coverage will require substantial additional human and financial resources. Extended task sharing plus fewer visits with longer prescription period may achieve nationwide hypertension treatment at public systems without additional workforce.

SO084SILDENAFIL DRUG IN HEMODIALYSIS PATIENTS WITH PULMONARY HYPERTENSION

Abstract Background and Aims Pulmonary hypertension (PH) is not an uncommon progressive condition in prevalent hemodialysis (HD) patients, associated with high morbidity and mortality. Sildenafil drug has limited studies about the efficacy of the drug and optimal dose among prevalent HD patients with PH. Aim of the study to assess the effects of sildenafil drug on estimated Pulmonary Artery pressure value (ePAP) mmHg via transthoracic Doppler Echocardiography and 6-minute walk test ( 6MWT) among hemodialysis patients with pulmonary hypertension. Method Randomized, double-blind, placebo-controlled clinical trial, from December 2018 to May 2019, involving 60 eligible patients on regular adequate HD with PH, estimated Pulmonary Artery Pressure (ePAP) ≥35 mmHg via Doppler echocardiography. HD patients with mean age 52.6±10.8 year divided randomly into 3 groups: Group 1 (20 patients) received 25 mg sildenafil, group 2 (20 patients) received 50 mg sildenafil and group 3 (20 patients) who received placebo as daily dose treatment for 3 months duration. Every patient in the study was subjected to full history taking and clinical examination. Exclusion Criteria: Current treatment of pulmonary hypertension, patient with evident history of cardiac diseases or chronic pulmonary diseases or systemic autoimmune diseases, portal hypertension, HIV, patients with uncontrolled hypertension or severe anaemia or hypersensitivity to sildenafil, treatment with any drugs that may interact with sildenafil all were excluded from the study. Transthoracic echocardiography was done at the begging of the study and after three months in mid-week non-dialysis day for assessment of the change in ePAP, pulmonary artery pressure calculated using the modified Bernoulli equation, and assessment of right ventricular functions . Exercise capacity assessment by 6MWT to assess the clinical response to the drug, was done for every patient at the start of the study and after 3 months of treatment. Clinically meaningful change estimate for the 6MWT considered as increase more than 30 meters. Results Significant increase in mean of 6 MWT in both group 1,2 received 25 mg,50 mg sildenafil respectively after 3 m duration of treatment versus non-significant change in placebo group as basal 6 MWT was (171 ±45, 214 ±58, 175 ±39) meters in group 1,2 and placebo group respectively (p>0.05). Means 6 MWT post-treatment were (205 ±57, 258 ±59, 182 ±49) meters (P<0.001) in group 1, 2&3 respectively, as post Hoc test results, showed significant increase in 6MWT2 in group 2 in comparison to group 1 and placebo group (P<0.01), as shown in figure (1).There was a significant decrease in e PAP in each group of studied groups after treatment (P<0.01). As mean basal ePAP1 measures were (48 ±9, 43.5 ±16, 48.5 ±12) mmHg in group 1,2,3 respectively (P>0.05).There were no significant differences between the studied groups regarding means of ePAP2 post-treatment were ( 42 ±9, 39 ±15, 44.5±8) mmHg in group 1,2,3 respectively (P>0.05). However, the degree of severity of PH was more improved after treatment duration with sildenafil as in group 1 there were 5 patients downgraded from moderate to mild and 2 patients downgraded from severe to moderate after treatment. In group 2 there were 4 patients downgraded from moderate to mild PH and 2 patients downgraded from severe to moderate PH. In 3rd group (placebo group) only one patient downgraded from moderate to mild PH. There were 4 patients dropouts from the study two of them from group 2 (receiving 50mg) due to sildenafil related side effects appeared through the study. Conclusion This a clinical trial confirmed the efficiency of both 50mg and 25mg sildenafil daily dose in reducing e PAP and improving functional exercise capacity in chronic haemodialysis patients with pulmonary hypertension disease.

Prevalence, awareness, treatment, and control of hypertension in southwestern China

This study investigated the prevalence, awareness, treatment, and control of hypertension and associated factors among urban adults in southwestern China. The study was conducted from 2013–2014 and used a multistage cluster sampling method to select a representative sample of 11,517 people in southwestern China, aged 35–79 years. Hypertension was defined as either systolic blood pressure of 140 mmHg or greater, diastolic blood pressure of 90 mm Hg or greater, or self-reported current treatment for hypertension with antihypertensive medications. In the study population, hypertension prevalence was found to be 38.4%, with rates of 40.0% and 37.5% for men and women, respectively (p = 0.03). Hypertension prevalence increased with age in both men and women (trend p both <0.01). Among hypertensive patients, 47.9% were aware of their hypertension, 40.1% were undergoing antihypertensive treatment, and 10.3% achieved BP control. A multiple-factor analysis revealed that age, male gender, low educational achievement, family history of hypertension, overweight or obesity, abdominal obesity, and hypertriglyceridemia were positively related to hypertension, while physical exercise was negatively related to hypertension. The prevalence of hypertension among urban adults aged 35 to 79 years in southwestern China was high, while levels of awareness, treatment, and control of hypertension were low. Multifaceted interventional measures are needed to solve the unmet needs.

Management of hypertension in pregnancy: a descriptive report of two clinic practices

ABSTRACTObjective: To describe the current clinical practice in the treatment of hypertension in pregnancy.Methods: Retrospective chart review described hypertension treatment of pregnant women in two urban clinics in Minnesota USA, over 27 months. Data elements collected: blood pressure (BP) readings with gestational age, goal BP documented, and pharmacological treatments utilized.Results: Sixty patients had multiple elevated BP readings in prenatal care encounters. Of 60 included patients, 18 were treated with antihypertensives and 11 had documented BP goals. Documented goal BPs varied in numeric goal and some only listed systolic or diastolic goal.Conclusion: Inconsistencies exist in current treatment and documentation of hypertension in pregnancy.

Vasodepressor Effects of Adenosine in the Cat are Independent of Cyclooxygenase, Potassium Channels, and Nitric Oxide Pathways.

BackgroundPulmonary arterial hypertension is a hemodynamic disorder. Signs and symptoms are generally difficult to recognize because they are non-specific. The current treatment for pulmonary arterial hypertension offers no cure or prevention; therefore, it is important to explore treatment avenues for novel pulmonary arterial hypertension treatments. In this study, we tested the hypothesis: pulmonary vasodilator responses of adenosine are dependent on the activation of l-type calcium channels, independent of the synthesis of nitric oxide from l-arginine, activation of adenosine triphosphate-sensitive potassium channels, and the release of cyclooxygenase products.MethodsWe performed an isolated lobar lung preparation in mongrel cats. The thromboxane A2 analog U-46619 was used to increase lobar arterial pressure to a high steady level. We recorded responses to adenosine and other vasodepressor agents in the pulmonary vascular bed of a cat under conditions of controlled pulmonary blood flow and constant left atrial pressure.ResultsThese data show that adenosine has significant vasodepressor activity in the pulmonary vascular bed of the cat. The data suggest that pulmonary vasodilator responses to adenosine are partially dependent on the activation of adenosine 1 and 2 receptor pathways, and independent of the activation of cyclooxygenase activation, adenosine triphosphate-sensitive K + channels, or synthesis of nitric oxide in the pulmonary vascular bed of the cat.ConclusionsVasodepressor effects of adenosine are species specific, and this species specificity will impact the development of future testing and treatments for pulmonary arterial hypertension. Clinical studies are warranted to see if adenosine moieties could play a therapeutic role in patients with pulmonary arterial hypertension and/or other pulmonary pathogeneses.

The association between obesity and cardiovascular disease mortality in different strata of socioeconomic position: evidence from pooled Norwegian health surveys.

Socioeconomic position (SEP) is related to both obesity and cardiovascular disease (CVD). There is little evidence on whether SEP modifies the relation between obesity and CVD. The aim of the study was to investigate whether the association between obesity and CVD mortality is stronger among people with disadvantaged than among people with advantaged life course SEP. Data from Norwegian population-based cardiovascular health surveys (1985-2003), including body mass index and CVD risk factors (cholesterol, blood pressure, smoking, current treatment for hypertension) were linked to socioeconomic indicators from register and census data (1960-90), and to the Cause of Death Registry (up until 2014). The total number of participants was 398 297. In comparison with normal weight, the age-adjusted hazard ratios and 95% confidence intervals of CVD mortality among obese participants were 2.39 (2.07-2.75) and 2.08 (1.70-2.53) among men and women with high SEP, respectively and 1.88 (1.60-2.21) and 1.75 (1.43-2.14) among men and women with low SEP. Adjustment for CVD risk factors attenuated the results in a similar manner in all SEP groups, and among both women and men. Obesity was consistently associated with a higher risk of CVD mortality, with only minor variation according to SEP. This means that preventing or treating obesity is, for the purpose of reducing CVD risk, equally important for an individual with high or low SEP.

Hypertension prevalence and risk factors among residents of four slum communities: population-representative findings from Port-au-Prince, Haiti.

The aim of this study was to estimate the prevalence of hypertension and its risk factors among adults in four slum communities in Port-au-Prince. Cluster area random sampling was used to select adults for a health and demographic survey, including anthropometric measurements. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg, or current hypertension treatment, and was age-standardized to WHO world population. Correlates of hypertension were tested using sex-stratified logistic regression. Overall, 20.3% of adults had hypertension (28.5% age-standardized), including 22.3% of men and 18.9% of women. Three percent of participants reported current hypertension treatment, and 49.5% of them had their hypertension controlled. Overweight/obesity (BMI ≥25) was the most common risk factor (20.6% among men, 48.5% among women), while smoking was less common (11.8 and 3.9%, respectively). Increasing age and hypertension prevalence in immediate surroundings were associated with greater odds of hypertension. Among men, having in-migrated in the 3 years prior (versus ≥3 years) was also associated with hypertension [adjusted odds ratio (aOR)=3.32, 95% confidence interval (95% CI): 1.79-6.17], as was overweight and obesity (aOR = 1.90, 95% CI: 1.09-3.33, and aOR = 5.73, 95% CI: 2.49-13.19, respectively) and nonreceipt of needed medical care in the preceding 6 months (aOR = 2.82, 95% CI: 1.35-5.88) among women. Hypertension prevalence was high across the age spectrum, in addition to substantial levels of overweight/obesity and unmet healthcare needs. It is important to better understand the possible effects of intraurban migration and environmental risk factors on hypertension and ensure that the benefits of increasingly cost-effective prevention and treatment programmes extend to slum residents.

May Measurement Month 2017: an analysis of blood pressure screening results in China-East Asia.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. In China, several hypertension screening programmes are undertaken in the elderly in the community and in youths at university entrance and graduation. However, most people, especially the middle-aged working population, do not often have their BP measured. The current awareness (46.9%), treatment (40.7%), and control rates (15.3%) of hypertension remain low, while the proportion of screenees with hypertension is high in adult Chinese (23.2%). An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. About 125 236 individuals were screened. After multiple imputation, with 124 623 as denominator, 32 089 (25.7%) had hypertension. Of the 103 981 individuals not on antihypertensive medication, 11 447 (11.0%) were hypertensive. Of the 20 547 individuals on antihypertensive medication, 7392 (36.0%) had uncontrolled BP (≥140/90 mmHg). An opportunistic screening may effectively identify those with high BP regardless of the use of antihypertensive medication and shows similar information on BP as a survey in a randomly selected population sample.

A16403 Analysis on epidemiological characteristics of hypertension among adults in 8 counties of Xinjiang

Objectives: To study the epidemic characteristics and risk factors of hypertension among adult residents in 8 counties of Xinjiang. Methods: A total of 4140 Han and Uygur residents aged over 18 years old were investigated by stratified cluster random sampling method in 8 counties of Xinjiang in 2013. Personal characteristics, blood pressure, blood glucose and lipid were collected by face to face investigation, physical measurements and laboratory testing. Hypertension was defined in accordance to the 2010 guidelines for hypertension prevention and control as SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg, or self-reported current treatment for hypertension with antihypertensive Medication. The study was approved by Entical Review Committee of Chinese Center for Disease Control and Prevention (ID: 201307). Factors were analyzed by unconditioned logistic regression analysis. Results: The overall prevalence of hypertension was 34.3% (1421/4140). The prevalence of hypertension was higher in Han residents (43.1%) than Uygur residents (25.5%) (χ2 = 142.706, P < 0.001). It was showed that hypertension was related to gender (OR = 0.65, 95%CI: 0.48–0.87), urban/rural areas (OR = 1.55, 95%CI: 1.10–2.20), age groups (OR = 2.38, 95%CI: 2.04–2.77), BMI (OR = 1.62, 95%CI: 1.35–1.93), central obesity (OR = 1.33, 95%CI: 1.02–1.73), education background (OR = 0.75, 95%CI: 0.63–0.89), dyslipidemia (OR = 1.64, 95%CI: 1.33–2.03) and diabetes mellitus (OR = 1.98, 95%CI: 1.54–2.56) in Han residents, and was related to urban/rural areas (OR = 1.74, 95%CI: 1.22–2.48), age groups (OR = 2.47, 95%CI: 2.12–2.88), BMI (OR = 1.71, 95%CI: 1.44–2.02) and central obesity (OR = 1.55, 95%CI: 1.14–2.13) in Uygur residents. Conclusion: The prevalence of hypertension was high in Xinjiang, especially in Han residents. There was different risk factors of hypertension in Han and Uygur residents.

Hypertension in Mozambique: trends between 2005 and 2015.

To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25-64 years old population. A cross-sectional study of a representative sample of the population aged 15-64 years (n = 2965) was conducted in 2014-2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25-64 years. The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014-2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014-2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15-24 years, in 2014-2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8-16.4). Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.