Decrease In Blood Pressure Levels Research Articles

Statistical Analysis on the Effect of Treatment on Blood Pressure Before and After Treatment in General Hospital Takum Using Paired T-Test

Hypertension is a preval_ent health condition worldwide, posing a significant risk for cardiovascular diseases. This study investigates the effect of treatment on blood pressure in individuals with hypertension, aiming to compare blood pressure levels before and after treatment, eval_uate the effectiveness of different treatment modalities, and assess the impact of treatment on other health outcomes. A quasi-experimental design is utilized, with participants recruited through convenience sampling. Data on blood pressure measurements are collected from medical records, and descriptive statistics and paired t-tests are used for data analysis. The results indicate a significant decrease in blood pressure levels after treatment, supporting the effectiveness of lifestyle modifications and pharmacological interventions in managing, emphasizing the importance of early detection and individualized treatment plans. Future research should focus on exploring the long-term effect of treatment and optimizing treatment strategies for specific patient populations.

Cardioprotective Effects of Aloysia polystachya Essential Oil on a Rat Model with Multiple Cardiovascular Risk Factors.

Traditional medicine is a frequently utilized method to treat cardiovascular disease and its primary risk factors, including hypertension and dyslipidemia. Aloysia polystachya is a species that is commonly employed to treat various pathological conditions, and it has already been identified as having some cardioprotective effects. This study aimed to investigate the protective effects of the essential oil extracted from the leaves of A.polystachya in a rat model that simulates multiple cardiovascular risk factors. We evaluate the acute toxicity, as well as the cardioprotective effects, by giving different doses of A.polystachya essential oil (1.47 mg/kg, 4.40 mg/kg, and 13.20 mg/kg) over a period of 42 days. The control group was treated with rosuvastatin (5 mg/kg). At the end of the treatments, the renal function, electrocardiography, blood pressure, vascular reactivity, serum biochemical profile, and organ histopathology were evaluated. The main compounds identified in the essential oil of A.polystachya using gas chromatography coupled with mass spectrometry were beta-myrcene (1.08%), limonene (40.13%), and carvone (56.47%). The essential oil of A.polystachya not only lacks acute toxicity but also mitigates the reduction in the excretion of sodium, chloride, and creatinine in urine. Furthermore, it reduces electrocardiographic abnormalities and decreases blood pressure levels. Moreover, this treatment prevents an elevation in markers of inflammation and oxidative stress in the bloodstream. Our findings indicate significant cardioprotective effects of the essential oil of A.polystachya against multiple risk factors for cardiovascular diseases in hypertensive rats.

Association Between the Improvement of Knowledge, Attitude and Practice of Hypertension Prevention and Blood Pressure Control-A Cluster Randomized Controlled Study.

Hypertension-related knowledge, attitude and practice (KAP) of hypertensive patients can affect the awareness, treatment and control of hypertension. However, little attention has been paid to the association between the change of hypertension preventive KAP and blood pressure (BP) control in occupational population using longitudinal data. We assess the effectiveness of a workplace-based multicomponent hypertension intervention program on improving the level of KAP of hypertension prevention, and the association between improvement in KAP and BP control during intervention. From January 2013 to December 2014, workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20) using a cluster randomized control method. All employees in each workplace were asked to complete a cross-sectional survey to screen for hypertension patients. Hypertension patients in the intervention group were given a 2-year workplace-based multicomponent hypertension intervention for BP control. The level of hypertension prevention KAP and BP were assessed before and after intervention in the two groups. Overall, 3331 participants (2658 in the intervention group and 673 in the control group) were included (mean [standard deviation] age, 46.2 [7.7] years; 2723 men [81.7%]). After 2-year intervention, the KAP qualified rate was 63.2% in the intervention groups and 50.1% in the control groups (odds ratio = 1.65, 95% CI, 1.36∼2.00, P < .001). Compared with the control group decreased in the qualified rate of each item of hypertension preventive KAP questionnaire, all the items in the intervention group increased to different degrees. The increase of KAP score was associated with the decrease of BP level after intervention. For 1 point increase in KAP score, systolic blood pressure (SBP) decreased by .28mmHg and diastolic blood pressure (DBP) decreased by .14mmHg [SBP: β = -.28, 95%CI: -.48∼-.09, P = .004; DBP: β = -.14, 95%CI: -.26∼-.02, P = .024]. SBP and DBP was significantly in manual labor workers (SBP: β = -.34, 95%CI: -.59∼-.09, P = .008; DBP: β = -.23, 95%CI: -.38∼-.08, P = .003), workers from private enterprise, state-owned enterprise (SOE) (SBP: β = -.40, 95%CI: -.64∼-.16, P = .001; DBP: β = -.21, 95%CI: -.36∼-.06, P = .005) and a workplace with an affiliated hospital (SBP: β = -.31, 95%CI: -.52∼-.11, P = .003; DBP: β = -.16, 95%CI: -.28∼-.03, P = .016). The improvement of knowledge (SBP: β = -.29, 95%CI: -.56∼-.02, P = .038; DBP: β = -.12, 95%CI: -.29∼.05, P = .160), as well as attitude (SBP: β = -.71, 95%CI: -1.25∼-.18, P = .009; DBP: β = .18, 95%CI: -.23∼.59, P = .385) and behavior (SBP: β = -.73, 95%CI: -1.22∼-.23, P = .004; DBP: β = -.65, 95%CI: -.97∼-.33, P < .001) was gradually strengthened in relation to BP control. This study found that workplace-based multicomponent hypertension intervention can effectively improve the level of hypertension preventive KAP among employees, and the improvement of KAP levels were significantly associated with BP control. Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

From Riva-Rocci until Miocardial Intersticial Fibrosis: The Seven Errors Game in Arterial Hypertension -Misconceptions Review

Knowledge of cardiac, renal and vascular injuries that occur in Arterial Hypertension has been known for a long time, however, their correlation with high blood pressure levels can only occur after the dissemination of the measure developed by Riva-Rocci and perfected by Korotkoff at the beginning of the 20th century. This correlation was initially imagined with false assumptions, which led not only to inertia but also to an opposition to the decrease in blood pressure levels that lasted around five decades. These false assumptions are named and analyzed. Even after the definition that the drop in blood pressure levels should be an obligatory part of the treatment of this condition, other erroneous understandings of this pathology have continued to occur until today. In this review, which covers the last one hundred and thirty years, we found, enumerated and analyzed seven of these errors based on the current knowledge we have gained on Arterial Hypertension and exposed their differences, simulating a game of seven errors.

Analysis of microcirculatory blood flow parameters during a course of transcutaneous electrical stimulation in men with newly diagnosed arterial hypertension

Objective. To study the dynamics of microcirculatory blood flow in the skin during a course of use of the electrical stimulator AVR-051 in men of low and moderate cardiovascular risk with newly diagnosed arterial hypertension. Materials and methods. The single-center placebo-controlled study included 44 men of working age (30–60 years) with low and moderate cardiovascular risk with newly diagnosed hypertension, who were randomly divided into 2 groups. The control group (CG) included 30 men who underwent electrical stimulation with a commercial device. The placebo group (PG) included 14 men who used the AVR-051 device, with the electrostimulation function disabled. The study design included 3 visits. After visit 1 and randomization, the subjects underwent electrical stimulation/sham at home 2 times a day for 14 days. Visit 2 was carried out immediately after the end of the physiotherapy course, visit 3 was 14 days after visit 2. At each visit, a one-stage comprehensive study of microcirculation (video capillaroscopy, laser Doppler flowmetry and photoplethysmography) and 24-hour blood pressure monitoring on the left upper limb were performed. Results. In the CG, while blood pressure decreased at visits 2 and 3 by 5.5/3.5 and 7.5/3.5 mm Hg relative to the initial values, statistically significant changes at the level of the microvascular bed were recorded only at visit 3: an increase in the functional density of the capillary network by 10 cap/mm2, an increase in the amplitude of pulse oscillations of blood flow from 0.68 to 1.06 PU and the perfusion contribution of pulse oscillations from 3.89 to 8.22 %, a decrease in the augmentation index from 6.25 to 3.2 %, a decrease in the stiffness index from 7.45 to 7 cm/s and the reflection index from 37.4 to 30.2 %, respectively. In the GP, no reliable dynamics was recorded for any of the analyzed parameters. Conclusion. Positive dynamics at the level of the microvascular bed of the skin is a consequence of a decrease in blood pressure level against the background of systemic normalization of sympathetic tone. After the course of electrical stimulation, a hypotensive effect is observed in 86.7 % of men at early stages of the hypertension development, and in 20 % of them, a complete normalization of blood pressure level is observed.

Effects of Behavioral Interventions for Salt Reduction on Blood Pressure and Urinary Sodium Excretion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertension is a prevalent cardiovascular condition, with excessive sodium intake being a significant risk factor. Various studies have investigated measures to reduce salt intake, including integrated lifestyle interventions and health education. However, the effectiveness of behavioral interventions focused solely on salt reduction remains unclear. This systematic review and meta-analysis aimed to investigate the effects of a behavioral intervention based on salt reduction on blood pressure and urinary sodium excretion. A comprehensive search of the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, and Web of Science was conducted to identify relevant literature. Study and intervention characteristics were extracted for descriptive synthesis, and the quality of the included studies was assessed. A total of 10 studies, comprising 4,667 participants (3,796 adults and 871 children), were included. The interventions involved the provision of salt-restriction spoons or devices, salt-reduction education, self-monitoring devices for urinary sodium, and salt-reduction cooking classes. Meta-analysis results showed that behavioral interventions focused on salt reduction significantly reduced systolic blood pressure (SBP) (-1.17 mmHg; 95% CI, -1.86 to -0.49), diastolic blood pressure (DBP) (-0.58 mmHg; 95% CI, -1.07 to -0.08) and urinary sodium excretion (-21.88 mmol/24 hours; 95% CI, -32.12 to -11.64). These findings suggest that behavioral change interventions centered on salt reduction can effectively lower salt intake levels and decrease blood pressure levels. However, to enhance effectiveness, behavioral interventions for salt reduction should be combined with other salt-reduction strategies.

EFFECTS OF LIFESTYLE ADVICE ASSOCIATED WITH BEETROOT-BASED NUTRACEUTICAL ON 24-HOUR BLOOD PRESSURE IN A POPULATION WITH HIGH-NORMAL BLOOD PRESSURE OR GRADE 1 HYPERTENSION

Objective: 2018 ESH hypertension guideline supports life-style changes as initial approach to be taken in both subjects with high-normal blood pressure (BP) and patients with grade 1 hypertension and low cardiovascular (CV) risk. Among many nutraceuticals, most with unproven or unlikely benefits, bioactive substances enriched with nitrates, sources of nitric oxide (i.e. red beets) exert proven vasodilator effects and may decrease BP levels. Aim: to evaluate the effect of lifestyle advice and beetroot-based nutraceutical on 24-h BP in a population with high-normal BP or grade 1 hypertension and low CV risk. Design and method: Longitudinal study on 43 consecutive subjects referred to two hypertension centers. A 24-h ambulatory BP monitoring (ABPM) was performed at baseline and after 3 month the introduction of lifestyle advice and beetroot-based nutraceutical [Cosmony, Servier, a nutraceutical based on Beta vulgaris L. (500 mg of dry beetroot extract)]. Results: Mean age: 49.9±10.7 years. Male prevalence: 53.5%. Median follow-up: 98 (92-121) days. Overweight/obese prevalence: 58.1%. The 62.8% of subjects had a grade 1 hypertension. At baseline, 24-h BP, daytime BP and night-time BP were 127.2±6.8/79.6±5.6 mmHg, 131.3±7.5/83.4±5.5 mmHg and 117.8±7.7/70.2±5.0 mmHg, respectively. At follow-up, all BPs showed a statistically significant decrease (all p&lt;0.005), except for diastolic night-time BP (p = 0.074) (-3.4±5.9/-2.2±3.7 mmHg for 24h BP; -3.9±6.0/-3.0±4.0 for daytime BP and -3.3±7.4/-1.3±4.7 for night-time BP). The percentage of subject with daytime BP &lt;130/85 mmHg had increased from 25.6% at baseline to 48.8% at follow-up. The decrease in BP was independent of gender and overweight/obesity, whereas it was more evident in the group of grade 1 hypertensives compared with the group with high-normal BP. Conclusions: Lifestyle advice in association with a nutraceutical, source of nitric oxide, may be a valid initial non-pharmacological therapy in subjects with high-normal BP or grade 1 hypertension and low CV risk.

BLOOD PRESSURE CONTROL WITH BENSON RELAXATION TECHNIQUE IN HYPERTENSIVE PATIENTS

Introduction: A person who has high blood pressure sometimes has difficulty controlling blood pressure. As a result of uncontrolled blood pressure will cause various complications. Efforts that may be made to control blood pressure and avoid depression can be done by using non-pharmacological techniques, one of which is by using relaxation techniques. To find out blood pressure before and after Benson's relaxation technique is carried out in patients with hypertension. Methods: The research design used was quasy experimental, where there were 2 groups, namely the treatment group and the control group. The population of people with hypertension was 38 respondents and simple random sampling technique. Respondents were divided into 2 groups. Insresearch instruments used observation sheets and Geriatric Depression Scale (GDS). Statistical test used wilcoxone Signed Rank Test. Results: It was found that 19 respondents (100%) were found to have decreased blood pressure levels. In the control group or the group that did not do Benson relaxation technique, there was a decrease in blood pressure in as many as 9 respondents (47%). The Geriatric Depression Scale (GDS) value is known that as many as 34 people with hypertension (89%) fall into the category of mild depression with a score of 10-19, the intervention group is 18 people (95%) and 16 people (84%). Benson's relaxation technique on blood pressure obtained a value of p = 0.000 which shows that the influence of Benson's relaxation technique with blood pressure in hypertensive patients. Conclusions:Benson's relaxation technique done regularly will help lower blood pressure and provide relaxation to the muscles so as to reduce muscle tension, reduce stress and calm mind.

Waist-to-Height Ratio Is a Stronger Mediator in the Association between DASH Diet and Hypertension: Potential Micro/Macro Nutrients Intake Pathways

Several studies have demonstrated that adhering to the Dietary Approaches to Stop Hypertension (DASH) diet may result in decreased blood pressure levels and hypertension risk. This may be an effect of a reduction in central obesity. In the current study, we explored the mediation role of multiple anthropometric measurements in association with DASH score and hypertension risk, and we investigated potential common micro/macro nutrients that react with the obesity-reduction mechanism. Our study used data from the National Health and Nutrition Examination Survey (NHANES). Important demographic variables, such as gender, race, age, marital status, education attainment, poverty income ratio, and lifestyle habits such as smoking, alcohol drinking, and physical activity were collected. Various anthropometric measurements, including weight, waist circumference, body mass index (BMI), and waist-to-height ratio (WHtR) were also obtained from the official website. The nutrient intake of 8224 adults was quantified through a combination of interviews and laboratory tests. We conducted stepwise regression to filter the most important anthropometric measurements and performed a multiple mediation analysis to test whether the selected anthropometric measurements had mediation effects on the total effect of the DASH diet on hypertension. Random forest models were conducted to identify nutrient subsets associated with the DASH score and anthropometric measurements. Finally, associations between common nutrients and DASH score, anthropometric measurements, and risk of hypertension were respectively evaluated by a logistic regression model adjusting for possible confounders. Our study revealed that BMI and WHtR acted as full mediators between DASH score and high blood pressure levels. Together, they accounted for more than 45% of the variation in hypertension. Interestingly, WHtR was found to be the strongest mediator, explaining approximate 80% of the mediating effect. Furthermore, we identified a group of three commonly consumed nutrients (sodium, potassium, and octadecatrienoic acid) that had opposing effects on DASH score and anthropometric measurements. These nutrients were also found to be associated with hypertension in the same way as BMI and WHtR in univariate regression models. The most important among these nutrients was sodium, which was negatively correlated with the DASH score (β = −0.53, 95% CI = −0.56~−0.50, p &lt; 0.001) and had a positive association with BMI (β = 0.04, 95% CI = 0.01~0.07, p = 0.02), WHtR (β = 0.06, 95% CI = 0.03~0.09, p &lt; 0.001), and hypertension (OR = 1.09, 95% CI = 1.01~1.19, p = 0.037). Our investigation revealed that the WHtR exerts a greater mediating effect than BMI on the correlation between the DASH diet and hypertension. Notably, we identified a plausible nutrient intake pathway involving sodium, potassium, and octadecatrienoic acid. Our findings suggested that lifestyle modifications that emphasize the reduction of central obesity and the attainment of a well-balanced micro/macro nutrient profile, such as the DASH diet, could potentially be efficacious in managing hypertension.

EFEKTIVITAS SENAM ANTIHIPERTENSI DAN SENAM YOGA TERHADAP PERUBAHAN TEKANAN DARAH PADA LANSIA

Objective:. The purpose of this study is to compare the effectiveness of antihypertensive and yoga exercises against changes in blood pressure in the om elderly.Methods: The design of this study used Experimental Quasy. The sampling method used Random Sampling. Samples were taken as many as 14 respondents antihypertensive and yoga exercises. The independent variable was the influence of antihypertensive exercises, carried out with a mondification of Hernawan’s theory (2017) and yoga exercise out with a modification of Hendarti’s theory (2018). The dependent variable was a decrease in blood pressure, data taken used a spignomano meterResults: It can be concluded that antihypertensive and yoga exercises are both more effective against changes in blood pressure in the elderly. The Mann whiney statistical test results obtained a sign value of two tailed p = 0.169 (p sign &lt;0.05) so that H1 was rejected, meaning there was no difference in the decrease in blood pressure level between the antihypertensive and yoga exercises.Conclusion:This research is expected to make antihypertensive and yoga exercises as an intervention in changing blood pressure in the elderly.

Pathophysiology of the Nondipping Blood Pressure Pattern.

The nondipping blood pressure (BP) pattern corresponds to a disruption in the circadian BP rhythm with an insufficient decrease in BP levels during nighttime sleep as observed using 24-hour ambulatory BP monitoring. Patients with nondipping BP pattern have poorer renal and cardiovascular outcomes, independent of their average 24-hour BP levels. The pathophysiology of nondipping BP is complex and involves numerous mechanisms: perturbations of (1) the circadian rhythm, (2) the autonomic nervous system, and (3) water and sodium regulation. This review provides an outline of the pathways potentially involved in the nondipping BP profile in different conditions. A recent hypothesis is also discussed involving the role of gut microbiota in the dipping/nondipping patterns, via the fecal diet-derived short chain fatty acids.

Association of Gonadotropin-Releasing Hormone Agonists for Prostate Cancer With Cardiovascular Disease Risk and Hypertension in Men With Diabetes

Men with type 2 diabetes have an increased risk of cardiovascular disease (CVD). Meanwhile, gonadotropin-releasing hormone (GnRH) agonists used in prostate cancer (PCa) are associated with increased risk of CVD. To evaluate the association between GnRH agonist use, PCa diagnosis per se, and CVD risk in men with type 2 diabetes. This nationwide population-based cohort study identified men with type 2 diabetes by use of data in the Prostate Cancer Data Base Sweden version 4.1 and the Swedish National Diabetes Register, with longitudinal data from 2006 to 2016. These data were used to create 2 cohorts, 1 including men with and without PCa and the other including men with PCa who received and did not receive GnRH agonists. Data analysis was conducted from January 2006 to December 2016. Treatment with GnRH agonists and PCa diagnosis were the primary exposures. Primary outcome was a 10% increase in predicted 5-year CVD risk score. Secondary outcome was worsening hypertension as defined by the European Society of Hypertension Guidelines. Cox proportional hazards regression models were used to analyze the association. The PCa exposure cohort included 5714 men (median [IQR] age, 72.0 [11.0]), and the non-PCa cohort included 28 445 men without PCa (median [IQR] age, 72.0 [11.0]). The GnRH agonist-exposure cohort included 692 men with PCa who received a GnRH agonist, compared with 3460 men with PCa who did not receive a GnRH agonist. Men with PCa receiving GnRH agonists had an increased estimated 5-year CVD risk score compared with men without PCa (hazard ratio [HR], 1.25; 95% CI, 1.16-1.36) and compared with men with PCa not receiving GnRH agonists (HR, 1.53; 95% CI, 1.35-1.74). Men receiving GnRH agonists had decreased blood pressure compared with men without PCa (HR, 0.70; 95% CI, 0.61-0.80) and compared with men with PCa not receiving GnRH agonists (HR, 0.68; 95% CI, 0.56-0.82). In this population-based cohort study, there was an increased risk of CVD in men with type 2 diabetes who received a GnRH agonist for PCa. These findings highlight the need to closely control CVD risk factors in men with type 2 diabetes treated with GnRH agonists. The association between GnRH agonist use and decreased blood pressure levels warrants further study.

Elevated Cardiac Troponin I following Asymptomatic Intradialytic Hypotension: A Pilot Study with a 2-Year Follow-Up.

Background Intradialytic hypotension (IDH) has been recognized as a serious and frequent complication during hemodialysis (HD) of end-stage renal disease (ESRD) patients, but the effect of asymptomatic IDH on cardiac troponin I (cTnI) levels is not definitively elucidated. Methods 70 asymptomatic HD patients with negative predialysis cTnI were included. They were on maintenance HD thrice weekly. All patients were monitored during the HD session for hemodynamic changes and symptoms related to IDH. Patients were followed for two years, and their outcomes are noted as an acute coronary syndrome (ACS), cardiac death, no ACS, noncardiac death, and kidney transplant. Results Compared with the baseline blood pressure values, there was a drop in systolic blood pressure for all subjects, but according to the 2007 European Best Practice Guidelines on hemodynamic instability, asymptomatic IDH was defined in 27 (38.6%) patients. The results demonstrated a significant correlation (r = 0.492) (p < 0.05) between asymptomatic IDH and elevated postdialysis levels of cTnI. In 2-year follow-up of patients, ACS and cardiac death happened more in patients with elevated cTnI. Conclusion The results of our study suggest that asymptomatic IDH affects cTnI levels. Given that cTnI is a marker of myocardial damage and a predictor of cardiovascular mortality in ESRD patients, these findings recommend that considering the asymptomatic decrease in blood pressure levels during HD is very important and critical.

Intrauterine L-NAME Exposure Weakens the Development of Sympathetic Innervation and Induces the Remodeling of Arterial Vessels in Two-Week-Old Rats.

Nitric oxide (NO) has been shown to stimulate differentiation and increase the survival of ganglionic sympathetic neurons. The proportion of neuronal NOS-immunoreactive sympathetic preganglionic neurons is particularly high in newborn rats and decreases with maturation. However, the role of NO in the development of vascular sympathetic innervation has never been studied before. We tested the hypothesis that intrauterine NO deficiency weakened the development of vascular sympathetic innervation and thereby changed the contractility of peripheral arteries and blood pressure level in two-week-old offspring. Pregnant rats consumed NOS inhibitor L-NAME (250 mg/L in drinking water) from gestational day 10 until delivery. Pups in the L-NAME group had a reduced body weight and blood level of NO metabolites at 1–2 postnatal days. Saphenous arteries from two-week-old L-NAME offspring demonstrated a lower density of sympathetic innervation, a smaller inner diameter, reduced maximal active force and decreased α-actin/β-actin mRNA expression ratio compared to the controls. Importantly, pups in the L-NAME group exhibited decreased blood pressure levels before, but not after, ganglionic blockade with chlorisondamine. In conclusion, intrauterine L-NAME exposure is followed by the impaired development of the sympathetic nervous system in early postnatal life, which is accompanied by the structural and functional remodeling of arterial blood vessels.

Metabolic effects of ramipril and indapamide in hypertensive patients with non-alcoholic fatty liver disease

Objective. To assess the effects of combined antihypertensive therapy with ramipril and indapamide on insulin resistance, carbohydrate, lipid and purine metabolism, as well as the structure and function of the liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD).Design and methods. In a pre-post study, we included 30 patients with hypertension (HTN) 1–2 degrees in combination with NAFLD (Fatty Liver Index (FLI) &gt; 60) aged 45 to 65 years. Patients discontinued antihypertensive therapy 5–7 days before the initial examination. After that one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) were prescribed along with the lifestyle and weight reduction recommendations (the Mediterranean type of diet, a decrease in calorie intake by 500–1000 kcal from baseline, and physical aerobic exercise at least 150 minutes per week). All patients underwent clinical examination, measurement of office blood pressure (BP), ambulatory BP monitoring (ABPM), anthropometric parameters, assessment of the visceral obesity index (VAI), anthropometric parameters, VAI, the degree of adipose tissue dysfunction (ATD), the percentage of visceral and subcutaneous fat by the bioelectrical impedance method. We also assessed lipid, carbohydrate, purine metabolism and the structural and functional state of the liver before and after the treatment.Results. After 24-week therapy with a fixed combination of ramipril and indapamide (average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) HTN patients with NAFLD achieved target BP. There was a decrease in both office systolic BP (SBP) (p &lt; 0,001) and office diastolic BP (DBP) (p = 0,007) in 100 % of patients, as well as in ABPM indices. We observed a decrease in waist and hip circumferences (p ≤ 0,001 and p ≤ 0,001, respectively), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,002) fat. The number of patients with normal ATD increased (p = 0,030), while the proportion of patients with dysfunction decreased (p = 0,039). There was also a significant increase in high-density lipoprotein cholesterol (p = 0,027) and a decrease in insulin resistance (p = 0,002) and metabolic index (p = 0,030). We also found an improvement in carbohydrate metabolism with no change in purine metabolism. There was a favorable effect on the liver structure and function, and the number of patients with high alaninaminotransferase &gt; 40 U/L decreased (5 (16,7 %) vs 0, p = 0,026).Conclusions. Twenty-fourweek treatment with a fixed combination of ramipril and indapamide, together with recommendations for lifestyle changes and weight loss, led to a significant decrease in BP levels, the severity of insulin resistance, and visceral obesity. In addition, the treatment had a beneficial effect on the parameters of carbohydrate and lipid metabolism, as well as liver structure and function (decreased severity of steatosis and fibrosis).

THE EFFECTS OF CARDIAC REHABILITATION ON HYPERTENSIVE BURDEN AND ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS. A RANDOMIZED CROSSOVER STUDY

Objective: To investigate the effect of continuous versus intermittent exercise on hypertensive burden as well as the correlation of pulse wave velocity (PWV) with various parameters of CPX testing. Design and method: A randomized crossover study that will enroll 150 hypertensive patients. Patients will be randomized on continuous or intermittent exercise program for three months, then will follow a month of wash out period and the patients will be cross over from continuous to intermittent and vice versa for another three months of exercise. In all subjects, routine blood chemistry, including SUA determination, echocardiographic examination, office and 24 h ambulatory blood pressure (BP) as well as 24 h ambulatory PWV and central (BP) measurement as well as CPX testing will be performed in all study stages. Results: We present the preliminary results of 32 hypertensive patients (mean age 65.1 ± 11.3 years). A negative correlation was found between PWV and Peak VO2 (r = -0.540, p = 0.002), (r = -0.508, p = 0.045) at baseline and after 3 months of exercise. Peak VO2 was inversely correlated with PWV (r = -0.512, p = 0.003) and positive with diastolic BP (r = 0.469, p = 0.008), but not with systolic BP levels (p = ns). Eighteen patients until now have completed the 3 months of exercise. PWV, systolic and diastolic BP levels were decreased while Peak VO2 levels were increased between baseline and after 3 months of exercise but with no statistically significant differences. Specifically, the mean baseline PWV was 9.26 (±1.60) m/sec and the final PWV was 9.23 (±1.60) m/sec (p = 0.769). The mean of systolic and diastolic BP 127.59 (±7.94)/ 78.12 (±8.57) and 124.59 (±7.57)/ 77.24 (±8.57) mmHg for baseline and after three months of exercise (p = ns). The mean of Peak VO2 levels were 21.63 (±4.61) and 22.24 (±3.97) ml/kg/min for baseline and after three months of exercise (p = 0.394). It has to be mentioned however that in 6 patients (33%) the antihypertensive drug regiment was reduced. Conclusions: PWV was significantly correlated with functional capacity levels irrespectively of the levels of systolic BP. Cardiac rehabilitation may decrease BP levels or the number of antihypertensive drugs.

Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review

Many systematic reviews and meta-analyses have assessed the efficacy of dietary patterns on blood pressure (BP) lowering but their findings are largely conflicting. This umbrella review aims to provide an update on the available evidence for the efficacy of different dietary patterns on BP lowering. PubMed and Scopus databases were searched to identify relevant studies through to June 2020. Systematic reviews with meta-analyses of randomized controlled trials (RCTs) were eligible if they measured the effect of dietary patterns on systolic (SBP) and/or diastolic blood pressure (DBP) levels. The methodological quality of included systematic reviews was assessed by A Measurement Tool to Assess Systematic Review version 2. The efficacy of each dietary pattern was summarized qualitatively. The confidence of the effect estimates for each dietary pattern was graded using the NutriGrade scoring system. Fifty systematic reviews and meta-analyses of RCTs were eligible for review. Twelve dietary patterns namely the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Nordic, vegetarian, low-salt, low-carbohydrate, low-fat, high-protein, low glycemic index, portfolio, pulse, and Paleolithic diets were included in this umbrella review. Among these dietary patterns, the DASH diet was associated with the greatest overall reduction in BP with unstandardized mean differences ranging from -3.20 to -7.62 mmHg for SBP and from -2.50 to -4.22 mmHg for DBP. Adherence to Nordic, portfolio, and low-salt diets also significantly decreased SBP and DBP levels. In contrast, evidence for the efficacy of BP lowering using the Mediterranean, vegetarian, Paleolithic, low-carbohydrate, low glycemic index, high-protein, and low-fat diets was inconsistent. Adherence to the DASH, Nordic, and portfolio diets effectively reduced BP. Low-salt diets significantly decreased BP levels in normotensive Afro-Caribbean people and in hypertensive patients of all ethnic origins. This review was registered at PROSPERO as CRD42018104733.

Motivational interviewing to reduce blood pressure in hypertensive patients: randomized clinical trial

Abstract Background Uncontrolled hypertension is the leading risk factor for cardiovascular disease. This factor is often due to poor self-care; however, patients find lifestyle modifications difficult to achieve. Motivational interviewing has been proposed as an approach to enhance intrinsic motivation to change, develop autonomy, and promote healthy behaviors, but few randomized controlled trials have explored this approach, especially in hypertension. Purpose To evaluate the effectiveness of motivational interviewing in reducing blood pressure and improving self-care behaviors and medication adherence in patients with hypertension. Methods Single-center, parallel, randomized clinical trial with outcome-assessor blinding. The study included 120 adult patients diagnosed with hypertension who received regular follow-up in an outpatient hypertension clinic in Southern Brazil. Patients were allocated to one of two groups: the intervention group (IG), which received motivational interviewing by a trained nurse, and the control group (CG), which received standard care. All patients in the IG and the CG were assessed face-to-face once monthly for 6 months. The primary outcome was the reduction in systolic blood pressure and changes in mean blood pressure measured by 24-hour ambulatory blood pressure monitoring; secondary outcomes included self-care behaviors, measured with the Self-Care of Hypertension Inventory, and medication adherence, measured with Medication Assessment Questionnaire. Outcomes of interest were measured at baseline and at 6-month follow-up. Results The sample consisted largely of white (72%) females (70%), with a mean age of 62 years (SD=10), and a median duration of hypertension of ≥13 years. There were no statistically significant differences between groups at baseline. Over time, a statistically significant decrease in blood pressure levels occurred in the motivational interviewing group, except for daytime systolic blood pressure. The magnitude of change was greatest for nighttime systolic blood pressure (−6.4 mmHg) and 24h systolic blood pressure (−5.3 mmHg). Furthermore, patients in the IG showed improvement in all dimensions of the self-care score (P&amp;lt;0.05). Medication adherence improved in the IG (within-group analysis), but not in controls (P&amp;gt;0.05). Conclusion Motivational interviewing is effective in reducing blood pressure and improving self-care and medication adherence in patients with hypertension. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior- Brasil (CAPES)- Finance code 001.

Effect of smoking cessation with varenicline on blood pressure control in hypertensive patients

Abstract Purpose The interaction between smoking and blood pressure (BP) is complex. Despite the strong association between cigarette smoking and cardiovascular disease (CVD) risk, there is paucity about the effect of pharmacotherapies for treating tobacco dependence on BP in already established arterial hypertension. Varenicline has been shown to be an effective and well-tolerated pharmaceutical intervention for smoking cessation. Aim of the study was to investigate the improvement in BP control in smokers with a diagnosis of hypertension who quit or reduced substantially their tobacco consumption by using varenicline and the association of nicotine dependence with BP changes. Methods A total of 89 (mean age:48±7, 52 males) regular smokers (28±9 pack-years) with a diagnosis of hypertension and on anti-hypertensive drugs were studied. All patients received low-intensity counseling and pharmacotherapy with varenicline (1 mg twice daily) for 12 weeks. Point prevalence smoking abstinence was defined by self-report of complete abstinence in the 7 days before the 12 week clinic visit (end of therapy). Office BP was measured at baseline and each follow-up visit (4 and 12 weeks) office BP. The Fagerström Test for Nicotine Dependence (FTND) was used for assessing nicotine dependence. High nicotine dependence (ND) was defined as a FTND score ≥6. Results At 12 weeks, 60 (67%) patients were abstinent from smoking and 14 (16%) were non-abstainers who reduced daily consumption to 50% of baseline. The mean time interval between the initiation of treatment with varenicline and smoking abstinence was 1.8±0.6 weeks. There were not significant differences in age, baseline BP level, severity of nicotine dependence and total cigarette consumption (pack-years) between the two groups. Systolic BP (SBP) and diastolic BP (DBP) decreased significantly in abstainers (by 7.2 and 5.5 mmHg at 12 weeks, P&amp;lt;0.01 and P&amp;lt;0.05, respectively) while the decrease in BP level in non-abstainers was minimal. Among patients with sustained tobacco abstinence, 18 were highly ND and 42 had mild and moderate ND. The two ND groups had similar age and BP levels at baseline. Changes in SBP and DBP from baseline in smokers with arterial hypertension between the two ND groups are illustrated in Figure. The observed reductions in SBP and DBP were significant (P&amp;lt;0.05, both for SBP and DBP) when comparing the high ND group to the mild/moderate ND group at 12 weeks. No severe adverse reactions were reported with varenicline use throughout the entire follow-up duration. Conclusion Varenicline may help smokers with arterial hypertension under antihypertensive therapy to remain abstinent from tobacco cigarette smoking. A novel and important message of this study is also the substantial improvements in office SBP and DBP in highly nicotine dependent sustained tobacco abstainers. ND-BP changes after varenicline therapy Funding Acknowledgement Type of funding source: None

SST2 is a promising biomarker in hypertensive patients undergoing renal denervation

Abstract Introduction Therapy resistant arterial hypertension (raHTN) is a major clinical burden. While therapeutic alternatives are still missing, novel interventional procedures like renal denervation (RD) are still evolving. Indeed, despite discoursing results of the Simplicity HTN-3 trial, new promising results resulted in a revival of this procedure. Therefore, predictors for the success of future interventions would be of great clinical benefit. The novel biomarker sST2 shows promising results for risk stratification of cardiovascular patient. While, sST2 belongs to the IL-1 receptor family, it has an influence on immunologic processes with consequent cardioprotective effects including prevention of myocardial hypertrophy and fibrosis indicating predictive potential in hypertensive heart disease. Nevertheless, clinical implementation of this promising biomarker was not investigated in patients with raHTN undergoing RD. Purpose To investigate a potential clinical relevance of sST2 in patients with raHTN undergoing RD. Methods We evaluated 58 patients with raHTN (age: 63±11 years, systolic blood pressure at baseline: 178±24mmHg) undergoing bilateral RD. If available, serum levels of sST2 were analyzed at baseline as well as at follow-up at one and/or three month. Results While RD was able to decrease blood pressure levels after one month (systolic blood pressure at one month: 158±21mmHg, p&amp;lt;0.01), on echocardiography a reduction of left ventricular mass (LVM) was observed at one month with a further significant reduction at three month (LVM at baseline: 233±68g, LVM at one month: 218±59g and LVM at three month: 181±59, p&amp;lt;0.01). This observation was accompanied by a significant decrease of sST2 levels at three month (sST2 baseline: 6322±3578pg/ml vs. sST2 three month: 4704±1586pg/ml, p=0.02). Furthermore, baseline sST2 was positively correlated with systolic blood pressure at one month, measured either at office (r=0.57, p&amp;lt;0.01) or invasively in the aorta (r=0.49, p=0.03) indicating a potential predictive value of this biomarker. Conclusion In patients with raHTN, RD is associated with a significant decrease of sST2 levels, indicating sST2 to be involved in remodeling processes after RD. Furthermore, sST2 levels at baseline might be a potential predictor of intervention success of RD. Further, studies need to investigate the association of sST2 levels and RD. Funding Acknowledgement Type of funding source: None