DBP In Patients Research Articles

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

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

FEATURES OF DAILY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE

Objective: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Design and method: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to glomerular filtration rate (eGFR), according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicom-combi device (Russia). Results: Among the examined patients, preserved renal function of CKD C1 was observed in 20.8% (n = 25); CKD C2 – in 50.8% (n = 61); CKD C3A – in 19.2% (n = 23); CKD C3B – in 9.2% (n = 11) p<0.001. CKD C4 and terminal stages were not detected. It was revealed that according to increasing of degree of CKD, values of the average daily SBP (p = 0.013) average daytime SBP (p = 0.04), mean night SBP (p = 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values, p = 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP ⇙2 = 40.62 p<0.01; DBP ⇙2 = 47.21, p<0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKD C3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group ⇙2 = 9.35, p = 0.02. In the group of patients with CKD C3b, individuals with a daily profile of SBP/DBP night-pickers significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP ⇙2 = 32.47 p<0.001, in DBP ⇙2 = 64.25 p<0.001. There was a significant increase in patients with a daily profile of over-dipper according to DBP in patients with CKD C3b:0% vs 4.91% vs 13.04% vs 27.27% ⇙2 = 41.47, p<0.001. Conclusions: AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.

Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation with Two Different Doses of Labetalol in Controlled Hypertensive Patients

BACKGROUND
 In this study, we wanted to compare the efficacy of two different doses of Labetalol for controlling the hemodynamic responses to laryngoscopy and tracheal intubation under the same anaesthetic techniques in controlled hypertensive patients.
 
 METHODS
 This was a hospital-based prospective, randomized, and double-blinded study conducted among 96 patients who presented for a pre-anaesthetic check-up to the Department of Anaesthesiology and Critical Care, at Gauhati Medical College and Hospital, over a period of 1 year from 1st September 2021 to 31st August 2022 after obtaining clearance from the institutional ethics committee, and written informed consent from the study participants.
 
 RESULTS
 Intragroup comparison of mean SBP in patients receiving IV Labetalol 0. 15 mg/Kg and IV Labetalol 0. 3mg/Kg was statistically significant. In an intragroup comparison of mean DBP in patients receiving IV Labetalol 0. 15 mg/Kg, it was significant at 5 and 10 mins. In a comparison of changes in DBP and MAP at various predetermined time intervals i. e., at intubation, it was statistically significant. In an intragroup comparison of mean RPP in in patients receiving IV Labetalol 0. 3mg/Kg in comparison to the baseline, it was significant at 10 mins.
 
 CONCLUSIONS
 Both doses of IV Labetalol (0. 15 mg/Kg and 0. 3 mg/Kg), given 5 mins before endotracheal intubation are effective in attenuating the hemodynamic response to laryngoscopy and intubation in controlled hypertensive patients. In comparison to the IV Labetalol dose of 0. 15 mg/Kg, attenuation of hemodynamic response to laryngoscopy and endotracheal intubation was more in IV Labetalol 0. 3 mg/Kg.

PS-C09-6: FEATURES OF DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE

Purpose of the study: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Materials and methods of the study: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicomcombi device (Russia). Results of the study: Among the examined patients, preserved renal function of CKDC1 (eGFR> 90 ml/min/1.73 m2) was observed in 20.8% (n = 25); CKDC2 (eGFR 60–89 ml/min/1.73m2) in 50.8% (n = 61); CKDC3A (eGFR 45–59 ml/min/1.73m2) in 19.2% (n = 23); CKDC3B (eGFR 30–44 ml/min/1.73m2) in 9.2% (n = 11) p < 0.001. CKDC4 and terminal stages were not detected. When analyzing ambulatory blood pressure monitoring (ABPM), it was revealed that according to increasing of degree of CKD, values of the average daily SBP (122.52 ± 9.25 vs 122.13 ± 12.30 vs 121.74 ± 9.43 vs 134.36 ± 15.32 mm Hg, p < 0.013) average daytime SBP (123.56 ± 8.99 vs. 124.00 ± 611.89 vs 123.74 ± 9.73 vs 134.27 ± 15.12 mmHg, p < 0.04), mean night SBP (119.80 ± 13.39 vs 116.75 ± 14.59 vs 116.09 ± 12, 04 vs 135.09 ± 16.66 mm Hg, p < 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values. Index of SBP daytime: 13.00 ± 14.05 vs 15.43 ± 21.22 vs 10.70 ± 15.04 vs 35.10 ± 34.14% respectively, p < 0.01. Index of SAP nighttime were 33.75 ± 29.35 vs 26.04 ± 31.07 vs 26.58 ± 27.87% vs 66.10 ± 36.05% respectively,p < 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP p < 0.01; DBP p < 0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKDC3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group, p < 0.02. In the group of patients with CKDC3b, individuals with a daily profile of SBP/DBP “night-pickers” significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP p < 0.001, in DBP p < 0.001. There was a significant increase in patients with a daily profile of “over-dipper” according to DBP in patients with CKDC3b:0% vs 4.91% vs 13.04% vs 27.27% p < 0.001. Conclusion: AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.

To evaluate the stress response to tracheal intubation by macintosh laryngoscope and intubating laryngeal mask airway

Aim: To evaluate the hemodynamic changes and side effects during endotracheal intubation with Macintosh laryngoscope and intubating laryngeal mask airway. Materials and methods: A prospective, simple randomized, comparative study on 100 patients 18 years - 60 years of age, divided into two groups: Group A comprising intubation with Macintosh laryngoscope and Group B intubation through ILMA. Results: Total intubation time (in seconds) of group A was 24.38 + 3.26 seconds and of the group, B was 42.94 + 1.24 seconds. At 2,4 and 6, a higher rise in mean heart rate was noted in group A (p < 0.05). At 2,4,6 and 8 minutes difference in mean SBP and mean DBP of the two groups was statistically significant with a p - value of < 0.05 with a significant increase of mean SBP and mean DBP in patients of group A. The difference for all complications was not significant between the two groups. Conclusion: Intubation via intubating laryngeal mask airway can be done as an alternative to direct laryngoscopy using a Macintosh blade as intubation via intubating laryngeal mask airway has shown to have lesser hemodynamic changes.

PM2.5 is a risk factor of hypertension: A study on regression model for risk factors of hypertension

Objective: In this prospective observational research, we aimed to explore the association among PM2.5 concentration, hypertension and clinical factors in Taiyuan at different times by regression analysis. Methods: This prospective observational research enrolled 95 cases with hypertension and 98 healthy individuals who went to our hospital during March 2017 to September 2018. PM2.5 concentrations data were collected from the national urban air quality report released by China environmental monitoring station. Age, BMI and sex of all subjects were recorded. DBP, SBP, cytokines and VEGF, ANG-2, white blood cells (WBC), fibrinogen (Fib), fasting plasma glucose (FPG) and lipid metabolic factors levels of all subjects were collected in the first week of each month during November 2018 to October 2019. Results: The PM2.5 concentration of winter spring (WS) group were remarkably increased than that in summary autumn (SA) group. Meanwhile, the SBP and DBP of patients with hypertension in WS group were markedly elevated than that in SA group. Similar results were showed in the healthy volunteers. The TNF-α, IL-6, IL-1β, VEGF, Fib and TC levels of patients with hypertension in WS group were dramatically enhanced than the SA group. Positive correlation was observed between PM2.5 concentration and IL-6, VEGF, FPG, IL-1β and TC. PM2.5 concentration and FPG, TC, TG, IL-6, VEGF were the risk factors for hypertension. Conclusion: This study showed that SBP and DBP increased when PM2.5 concentration raised. PM2.5 concentration was related to the clinical factors of patients with hypertension.

Abstract 017: Dual Immune Checkpoint Inhibitor Therapy Is Associated With Increased Blood Pressure In Melanoma Patients

Background: Immune checkpoint inhibitor (ICI) therapy has revolutionized cancer therapy through activating immune cells to overcome tumor immune evasion. Increasing evidence suggests that adaptive immune cells play an important role in blood pressure elevations in the pathogenesis of hypertension. Whether ICI therapy enhances blood pressure remains unclear. Methods: We performed a retrospective cohort study of patients with advanced melanoma treated with ICIs in a single academic center. Baseline and 2-year blood pressure readings after initiation of ICI therapy were compared. To determine the relationship between the demographic and treatment variables and the change in blood pressure at two years, a multivariable linear regression model was used. Results: A total of 259 individuals were identified with 2-year follow-up. Of the entire cohort, 31% were treated with nivolumab, 47% with pembrolizumab, and 23% with ipilimumab and nivolumab combination therapy. In the total cohort, ICIs were not associated with significant changes in systolic (SBP) or diastolic (DBP) blood pressure at 2 years compared to baseline (132.2 mmHg vs . 133.2 mmHg, p=0.17, and 78.6 vs . 78.1 mmHg, p=0.50, respectively). There were also no statistically significant changes in SBP or DBP in patients treated with nivolumab or pembrolizumab alone. However, in those treated with ipilimumab and nivolumab as combination therapy, SBP increased by 5.5 mmHg (128.2 vs. 133.7 mmHg, p=0.005). After adjusting for age, sex, weight, ICI type and duration, steroid and tyrosine kinase inhibitor use, and antihypertensive medication use at baseline and 2-years, combination therapy with ipilimumab and nivolumab remained a significant predictor of SBP change at two years. Holding the baseline SBP constant, the predicted SBP was 6.2 mmHg (95% CI 0.08 - 12.0 mmHg, p=0.047) higher for combined therapy than nivolumab alone. Conclusions: Patients who received combination ICI therapy had a higher SBP compared to those treated with single agent therapy. These findings suggest immune cell activation with ICI therapy contributes to blood pressure elevations and that close follow-up of blood pressure is needed in cancer survivors, particularly those previously treated with combination ICI therapy.

PATIENTS WITH RESISTANT HYPERTENSION AND ATRIAL FIBRILLATION ARE THE BEST RESPONDERS FOR RENAL DENERVATION

Objective: The search for the ideal candidate for renal denervation (RDN) is one of the priority treatments of patients with resistant hypertention (RH). Our objective was to identify the predictors of the efficiency of renal denervation. Design and method: The study included 112 patients with RH. The average age of patients was 53 [19; 69] years. Twenty-four (21.4%) patients had atrial fibrillation (AF). Four (16.7%) patients had chronic AF, 8 (33.3%) patients had persistent AF, and 12 (50%) – paroxysmal AF. All patients underwent RDN. Procedure was performed by an experienced electrophysiologist at the renal arteries using specialized electrode Symplicity Flex (Medtronic): ablation power = 8 - 10 W at 55°C, 4 – 10 points for each renal artery (including brunches), 2 minutes per point. Office BP and 24-hour ambulatory BP, 24-hour ECG monitoring, arrhythmia chronocard diaries were measured before, at 6 and 12 months of follow-up. A logistic regression analysis included the following parameters: gender, age, body mass index, office and 24-hour ambulatory systolic blood pressure (SBP), diabetes mellitus and the AF presence. Results: baseline office SBP and DBP in patients with RH were 185.4 ± 29.19 and 109.96 ± 17.95 respectively. Office BP decreased by 29.8 /14.1 mmHg at 12 month after RDN (p < 0.001). 24-hour ambulatory SBP decreased from 161.3 ± 25.9 mm Hg to 148.1 ± 21.3 mm Hg at 12 months after the intervention, DBP from 94.3 ± 16.4 mm Hg to 87.2 ± 15.9 mmHg (p < 0,001). It was found that all patients (100%) with RH and AF were responders to renal denervation. This response is defined as a reduction of office SBP of less than 10 mmHg following RDN. Whereas 17.2% of non-AF group patients were non-responders. The number of symptomatic AF paroxysms significantly decreased from 9 [2; 11] to 2 [1; 3] one year after RDN (p = 0.001). Conclusions: Patients with RH and AF are among the best candidates for RDN. It may help to improve the selection of patients with arterial hypertension for the RDN.

Effect of dietary sodium restriction on blood pressure in type 2 diabetes: A meta-analysis of randomized controlled trials

AimsAlthough current guidelines recommend reduction of salt intake in patients with diabetes, the benefits of reducing salt intake in people with type 2 diabetes mellitus (T2DM) lack clear evidence. Therefore, we performed a meta-analysis of available randomized controlled trials (RCTs) of sodium restriction and blood pressure (BP) in patients with T2DM. Data synthesisWe performed a systematic search of the online databases that evaluated the effect of dietary sodium restriction on BP in patients with T2DM. Sodium intake was expressed by 24 h urinary sodium excretion (UNaV). Q statistics and I2 were used to explore between-study heterogeneity. A random-effects model was used in the presence of significant heterogeneity; otherwise, a fixed-effects model was applied. Eight RCTs with 10 trials (7 cross-over and 3 parallel designs) were included in the meta-analysis. Compared with ordinary sodium intake, dietary sodium restriction significantly decreased UNaV (weighted mean difference, WMD: −38.430 mmol/24 h; 95% CI: −41.665 mmol/24 h to −35.194 mmol/24 h). Sodium restriction significantly lowered systolic BP (WMD: −5.574 mm Hg; 95% CI: −8.314 to −2.834 mm Hg; I2 = 0.0%) and diastolic BP (WMD: −1.675 mm Hg; 95% CI: −3.199 to −0.150 mm Hg; I2 = 0.0%) with low heterogeneity among the studies. No publication bias was found from Begg's and Egger's tests. ConclusionsSodium restriction significantly reduces SBP and DBP in patients with T2DM.

Effects of Probiotics on Patients with Hypertension: a Systematic Review and Meta-analysis

This meta-analysis and systematic review was conducted to evaluate the effect of probiotics on blood pressure, body mass index (BMI), and blood glucose changes in patients with hypertension. We searched the PubMed, Cochrane, Embase, and ProQuest databases using a combination of MeSH and free text, from the inception of these databases to 20 January 2020, with no language restrictions. The quantitative Physiotherapy Evidence Database (PEDro) scale method was used to assess the quality of the included studies. We used the random effects models to estimate the outcomes, with heterogeneity among the studies assessed using Cochran's Q statistic. Fourteen included studies published between 2002 and 2019 were included in the meta-analysis, reporting results of 846 hypertension participants. A significant reduction in SBP by - 2.05mmHg (95% CI - 3.87, - 0.24, P = 0.03), DBP by - 1.26mmHg (95% CI - 2.51, - 0.004, P = 0.047), BMI by - 1.03 (95% CI - 1.28, - 0.97, P < 0.01), and blood glucose by - 0.18mmol/L (95% CI - 0.30, - 0.05, P = 0.007) was observed following probiotic intervention. Our meta-analysis showed a modest but a significant reduction in SBP and DBP in patients with hypertension, particularly in those with diabetes mellitus, following probiotic supplementation. This effect was associated with treatment duration, dosage, and the age of subject, but was not associated with single or multiple strains usage. Additionally, probiotic supplement had a beneficial effect in reducing BMI and blood glucose.

Effects of Probiotics on Patients with Hypertension: a Systematic Review and Meta-Analysis.

This meta-analysis and systematic review was conducted to evaluate the effect of probiotics on blood pressure, body mass index (BMI), and blood glucose changes in patients with hypertension. We searched the PubMed, Cochrane, Embase, and ProQuest databases using a combination of MeSH and free text, from the inception of these databases to 20 January 2020, with no language restrictions. The quantitative PEDro scale method was used to assess the quality of the included studies. We used the random effects models to estimate the outcomes, with heterogeneity among the studies assessed using Cochran's Q statistic. Fourteen included studies published between 2002 and 2019 were included in the meta-analysis, reporting results of 846 hypertension participants. A significant reduction in SBP by - 2.05mmHg (95% CI - 3.87, -0.24, P = 0.03), DBP by - 1.26mmHg (95% CI - 2.51, - 0.004, P = 0.047), BMI by - 1.03 (95% CI -1.28, - 0.97, P < 0.01), and blood glucose by - 0.18mmol/L (95% CI - 0.30 - 0.05, P = 0.007) was observed following probiotics intervention. Our meta-analysis showed a modest but a significant reduction in SBP and DBP in patients with hypertension, particularly in those with diabetes mellitus, following probiotic supplementation. This effect was associated with treatment duration, dosage, and the age of subject but was not associated with single or multiple strains usage. Additionally, probiotic supplement had a beneficial effect in reducing BMI and blood glucose.

Renal Denervation in the Management of Hypertension: A Meta-Analysis of Sham-Controlled Trials

IntroductionSympathetic renal denervation (RD) can potentially reduce blood pressure (BP) in people with resistant hypertension (RH) and uncontrolled hypertension (UH). While a large sham-controlled trial (SCT) showed similar outcomes of RD vs. sham control, in the recent trials, RD was effective in reducing BP in hypertensive people. We performed a meta-analysis of SCTs of RD vs. sham in hypertensive patients. MethodsMultiple electronic databases were searched since inception through September 2018 for SCTs that compared RD vs. sham. Change in 24-hour, daytime and nighttime ambulatory and office BP were efficacy outcomes. Various adverse events were safety outcomes. ResultsA total of 7 SCTs were included in the analysis. RD vs. sham significantly reduced 24-hour ambulatory SBP by 3.45 mmHg [95% CI (−5.01, −1.88); P < 0.0001] and DBP by 1.87 mmHg [(−3.59, −0.15); P = 0.01], office DBP by 2.97 mmHg [(−4.76, −1.18); P = 0.001] and daytime ambulatory SBP by 4.03 mmHg [(−6.37, −1.68); P = 0.0008] and DBP by 1.53 mmHg [(−2.69, −0.37); P = 0.01]. RD vs. sham caused non-significant reduction in office SBP by 3.99 mmHg [(−8.10, 0.11); P = 0.06] and nighttime ambulatory SBP by 3.05 mmHg [(−6.86, 0.75), P = 0.12] and DBP by 1.03 mmHg [(−3.01, 0.96); P = 0.31]. There was no difference in the risk of hypertensive crisis/emergency [0.62; 0.24–1.60; P = 0.33] between the two strategies. ConclusionsCurrent meta-analysis shows that RD reduces ambulatory BP and office DBP in patients with hypertension. Future trials with longer follow-up should confirm these findings.

Resposta hiper-reativa da pressão arterial durante teste de esforço em pacientes cardiometabólicos

Introdução: A Hiper-reatividade da pressão arterial (HRPA) caracteriza-se pelo aumento de forma abrupta da pressão arterial sistólica e/ou diastólica durante teste ergométrico (TE). Objetivo: Delinear o perfil de pacientes com HRPA durante TE e fatores associados a essa resposta. Métodos: Estudo observacional desenvolvido a partir de análise documental de TE de pacientes com HRPA. Aplicados Teste de Correlação de Spearman e Regressão Linear Múltipla (forwoard), p0,05. Resultados: Observou-se correlações negativas e moderadas para consumo máximo de oxigênio (VO2máx.) com variação da PAS, PAD e IMC (p0,001, r=-0,675; p0,001 r=-0,643; p0,001, r=-0,504 respectivamente); variação da PAD com consumo de oxigênio pelo miocárdio (MVO2; p0,001, r=-0,483) e peso (p=0,004, r=0,540). Verificou-se que o VO2máx. correlacionou-se com a frequência cardíaca máxima atingida durante o TE (p=0,004, r=0,421). Ainda, o VO2máx. foi responsável por 53,56%, peso por 10,62% e MVO2 por 4,88% da variação da PAD. Conclusão: O VO2máx. apresentou maior influência sobre o comportamento hiper-reativo da PAD em pacientes com doenças cardiometabólicas.

Influence of additional risk factors on the antihypertensive efficacy of eprosartan and telmisartan in patients with essential hypertension

Objective. The aim of this study is to determine the effect of additional risk factors on blood pressure parameters, cardiovascular remodeling and the state of vegetative balance of the heart rhythm in patients with stage II essential hypertension (EH) under treatment with eprosartan and telmisartan.Materials and methods. The study included 100 patients with stage II essential hypertension (EH), 1–2 degrees with a low and moderate risk of developing cardiovascular complications. The smoker's status was 30.0 %, hypercholesterolemia more than 5 mmol/l – 69.0 %, overweight and obesity – 82.0 % of patients with EH. By randomisation, half of the patients received eprosartan in a daily dose of 600 mg, the rest received telmisartan at a daily dose of 80 mg for 6 months. Before the start of treatment and after 6 months of therapy, all the patients were subjected to the evaluation of general physical examinations, calculation of body mass index, determination of serum TC level, ECG Holter monitoring with analysis of heart rate variability, ambulatory blood pressure monitoring, echocardiography and duplex pulsed wave dopplerography of extracranial and intracranial vessels. Two weeks before the study, the patients did not take any antihypertensive drugs. Results. In patients with EH with additional risk factors using of eprosartan for 6 months is accompanied by a significant decrease in office SBP by 30.0 %, DBP by 21.6 %, PBP by 41.4 % and avg. BP by 25.5 %, regression of myocardial hypertrophy and improvement of diastolic function of the left ventricle. Eprosartan demonstrated a high antihypertensive efficacy on the effect on SBP in patients with EH with the presence/absence of tobacco smoking. However, the effect of eprosartan on DBP was better in patients with EH who do not have the status of a smoker. All the patients with EH, regardless of the presence or absence of an elevated level of total cholesterol, reached the target level of SBP under the influence of eprosartan. The antihypertensive effect of eprosartan against SBP was independent of the presence/absence of obesity in patients with EH. Eprosartan resulted in a significant increase in the maximum linear velocity in the left internal carotid artery by 2.8 % and in the vertebrobasilar region by 24.3 %. The total power of the spectrum under the influence of treatment significantly increased by 14.3 %.Antihypertensive therapy with telmisartan within half a year causes a significant decrease in office SBP by 24.8 %, DBP by 20.0 %, PBP by 31.8 %, avg. BP by 22.2 % In patients with EH who have/do not have the status of smoker and in all 100 % of patients with normal and elevated total cholesterol telmisartan was equally effective in achieving the target level of SBP. Obesity or its absence also did not significantly affect the effectiveness of antihypertensive therapy with telmisartan in patients with EH. Telmisartan, like eprosartan, causes regression of left ventricular hypertrophy. Telmisartan has a positive effect on carotid blood flow and does not affect the blood flow of the vertebrobasilar region. There were no changes in the parameters of the vegetative balance under the influence of telmisartan.Conclusion. In patients with EH with additional factors of cardiovascular risk using both eprosartan and telmisartan for half a year is accompanied by a significant decrease in blood pressure, regression of myocardial hypertrophy and improvement of diastolic function of the left ventricle, improvement of blood flow in the carotid region. In contrast to telmisartan, eprosartan increases the total power of the heart rate variability spectrum and does not affect the level of total cholesterol. The influence of telmisartan on the blood flow in the vertebrobasilar region is absent. Smoking, obesity, hypercholesterolemia do not reduce the antihypertensive efficacy of telmisartan and eprosartan against SBP and DBP. However, eprosartan is less effective in reducing DBP in patients with EH who smoke.

PS 01-04] CYP3A4*1G and CYP3A5*3 gene polymorphism alter the antihypertensive efficacy of Amlodipine in hypertensive patients after renal transplantation

Objective: In this study, our objective was to analysis the association of CYP3A4* 1G, CYP3A5* 3 and MDR1 C3435T gene polymorphisms with the antihypertensive efficacy of amlodipine in hypertensive patients after renal transplantation. Design and Method: Blood samples were collected from 76 patients on amlodipine (5 mg/d) therapy. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and gene sequencing were applied to detect CYP3A4* 1G, CYP3A5* 3 and MDR1 C3435T gene polymorphism and antihypertensive effects were analyzed according to genotype. At the same time, blood pressure values were detected per week and recorded. Results: After 4- weeks treatment, the blood pressure of 79% patients were controlled to standard. And the efficacy of amlodipine in patients with CYP3A5 *3*3 genotype was significantly higher than others (P < 0.05). In addition, the reduction of DBP in patients with CYP3A5*3*3 genotype was significantly higher than others (P < 0.05), the reduction of DBP in patients with CYP3A4*1G*1G genotype was significantly lower than the othera (P < 0.05). As for a linkage disequilibrium exists between CYP3A4* 1G and CYP3A5* 3 allele, our study also observed that DBP reduction in GG GG genetypes was the highest in all genetypes. Conclusions: Our study demonstrates that amlodipine could control BP effectively for hypertensive patients after renal transplantation. CYP3A5* 3 polymorphisms affect antihypertensive efficacy of amlodipine in Chinese hypertensive patients after renal transplantation.

Abstract P252: Hypertension Educator: Evidence for an Interdisciplinary Approach

Purpose: Certified Diabetes educators have long been utilized to educate patients with diabetes on effective lifestyle changes and to assist in optimizing evidence based medication. Using the same interprofessional prospective to target HTN would be an effective tool in decreasing CV risk. This study demonstrates the efficacy of a clinical pharmacist in controlling BP through patient education and medication intervention within a level 3 medical home. Methods: This is a retrospective analysis of patients seen by a clinical pharmacist from 2013 to 2015 in a HTN clinic located in a level 3 medical home. Patients are referred to the clinic by primary care physicians. During the one hour initial consultation the clinical pharmacist reviews the patient’s prescription and over-the-counter medications, recommends medication optimization, and educates the patient on medication, lifestyle and HTN. Recommended medication changes, lab requests and specialty referrals are pended to the physician for approval. The patient has the opportunity to follow-up in the HTN clinic until BP is controlled. Impact of pharmacist intervention was assessed based on number of follow-ups to the clinic. Results: A significant change was noted in the SBP and DBP in patients seen within the HTN Clinic within the 1st, 2nd and 3rd follow-ups (p&lt;0.05) (table 1). There were 312 medication changes recommended by the pharmacist and approved by the PCP during the study period. Conclusion: This study provides evidence that incorporating pharmacists into medical homes can provide BP lowering benefits for patients and provide important preventative care.

The effects of passive leg raising and ultrafiltration stopping on blood pressure in hemodialysis patients.

Hemodialysis-associated hypotension, one of the more serious issues in hemodialysis patients, can be treated by passive leg raising (PLR) and ultrafiltration (UF) stopping. We investigated the effects of PLR and UF stopping on blood pressure in hemodialysis patients. The study was conducted in 76 end-stage renal disease patients. After the second hour of dialysis, systolic and diastolic blood pressure (SBP and DBP) of the patients who did not develop intradialytic hypotension (IDH) were measured in the supine position. Thereafter, PLR was performed by raising the legs 20°; and after 3min, SBP and DBP were measured again. UF was then stopped in the PLR position; SBP and DBP were repeated 3min later. The same procedure was performed during IDH in the patients that developed IDH. A mean 5-mmHg (p<0.05) increase in SBP and a mean 2-mmHg increase in DBP (p<0.05) were observed by PLR in the supine position. UF stopping during PLR increased SBP by a mean of 1mmHg (p<0.05) while no change was observed in DBP (p=ns). IDH occurred in 19 (25%) patients. PLR positioning increases SBP and DBP by a mean of 8mmHg (p<0.05) and 3mmHg (p<0.05), respectively, in the supine position during IDH. During IDH, UF stopping in the PLR position did not significantly increase SBP and DBP in patients as compared to the PLR position. SBP and DBP increase during PLR. UF stopping during PLR does not lead to a higher increase in blood pressure as compared to PLR positioning.

Study of the Correlation between the Level of CRP and Chemerin of Serum and the Occurrence and Development of DN.

The aim of the study was to find the correlation between CRP and chemerin in development of DN. We choose 90 type-2 diabetic patients between February 2010 and February 2013, who were then divided into DN group and healthy control group. The results of BP showed that there is no difference in SBP and DBP of patients in the three groups. HDL-C of patients in diabetic group and DN group is lower compared with control. CRP in diabetic group and DN group is higher than that of patients in control group. Comparing the patients in DN group with that in diabeteic group, CRP was significantly higher. Chemerin level in the diabetic group and DN group is higher than control group. When comparing the patients in DN group with those in diabeteic group, serum level of chemerin was significantly higher. Serum level of chemerin is negatively correlated with HDL-C and positively correlated with FPG, HbA1c, LDL-C, BUN and Scr. Serum CRP is negatively correlated with HDL-C and positively correlated with FPG, HbA1c, LDL-C, BUN and Scr. Serum level of chemerin is positively correlated with CRP (r=0.701, P<0.05). CRP and chemerin of the DN patients rose significantly, and may participate in the occurrence and development of DN.

Acupuncture for Essential Hypertension: A Meta‐Analysis of Randomized Sham‐Controlled Clinical Trials

Background. Acupuncture is frequently advocated as an adjunct treatment for essential hypertension. The aim of this review was to assess its adjunct effectiveness in treating hypertension. Methods. We searched PubMed, the Cochrane Library, EMBASE, and the Chinese databases Sino-Med, CNKI, WanFang, and VIP through November, 2012, for eligible randomized controlled trials that compared acupuncture with sham acupuncture. Outcome measures were changes in diastolic (DBP) and systolic blood pressure (SBP). Results. A total of 4 randomized controlled trials were included. We found no evidence of an improvement with the fact that acupuncture relative to sham acupuncture in SBP change (n = 386; mean difference = −3.80 mmHg, 95% CI = −10.03–2.44 mmHg; I 2 = 99%), and an insignificant improvement in DBP change (n = 386; mean difference = −2.82 mmHg, 95% CI = −5.22–(−0.43) mmHg; I 2 = 97%). In subgroup analyses, acupuncture significantly improved both SBP and DBP in patients taking antihypertensive medications. Only minor acupuncture-related adverse events were reported. Conclusions. Our results are consistent with acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. We did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

Day-to-day variability of 24-h mean values of SBP and DBP in patients monitored for 7 consecutive days

Výsledky ukazaly velkou proměnlivost průměrných dennich a nocnich hodnot systolickeho a diastolickeho TK a naznacily, že sledovani krevniho tlaku po dobu několika dnů je vhodnějsi pro diagnostiku a lecbu hypertenze.