Decrease In Systolic Blood Pressure Research Articles

MONITORING OF CEREBRAL PERFUSION PRESSURE IN PATIENTS WITH ACUTE ISCHEMIC STROKE

we studied patients with ischemic stroke with antihypertensive medication for high arterial hypertension. Material and methods:we studied 28 patients in the general intensive care unit of multidisciplinary TMA with acute cerebral ischemia syndrome caused by ischemic-type ACCD. The age of the patients was on average 61±7 years. There were 20 males and 8 females. The level of consciousness was assessed using the Glasgow scale. It ranged from 4 to 10 points. Results:the given data clearly indicate a more pronounced decrease of SBP, DBP, ICP during intravenous infusion of Tahiben at the stages of the study. A significant difference in the duration of drug effects in the studied groups was noted. Thus, when using Tahiben, the target level of SBP and DBP could be maintained up to 220±54 minutes, while in the standard treatment group it was maintained for 68±8 minutes. Conclusions:intravenous administration of Tahiben (urapidil) at the early hospital stage in patients with arterial hypertension against the background of standard baseline therapy of ACCD is an effective and safe method of urgent therapy, providing dosage BP reduction by 15-25% of the initial one.

Systematic review/meta-analysis and a cross-sectional study to assess effects of potassium supplementation on the renin-angiotensin-aldosterone system (RAAS) and blood pressure

Abstract Introduction Nutritional medicine plays a key role in disease prevention and treatment, and we pharmacists must consider our contribution beyond our role in dispensing. Apart from the Dietary Approaches to Stop Hypertension (DASH) diet1, there is a paucity of data on the benefits of nutritional interventions in hypertension with no clear recommendation on potassium in the NICE guidelines. Potassium has been an area of interest in clinical medicine over the decades because of its effect on cardiovascular disease. However, its mechanism of action is poorly understood, and it is unclear it differs between different ethnic groups. Dietary potassium decreases blood pressure (BP) but can also stimulate aldosterone production2. However, the magnitude of potassium-dependent regulation of aldosterone secretion in humans is not fully characterised and it is not clear whether this is mediated by activation of the renin-angiotensin-aldosterone system (RAAS) as a result of a reduction in BP or other mechanisms. Aim To perform a (1) systematic review and meta-analysis of clinical trials assessing effects of potassium on plasma aldosterone and renin in adult individuals alongside a (2) cross-sectional multi-ethnic study to explore the relationship between potassium intake and aldosterone in hypertension. Methods (1) This study was carried out in accordance with PRISMA guidelines3. The full protocol can be found on the PROSPERO database. (2) Self-defined black or white hypertensives were recruited from the hypertension outpatient clinic at St. Thomas’ Hospital and had aldosterone, renin and a 24-hour urinary potassium collected. The systematic review and meta-analysis on already approved clinical trials and did not require ethnical approval. The cross-sectional study was approved by the local Research Ethics Committee in the UK and written informed consent was obtained from all patients. Results 6395 articles were retrieved, and 124 full-text articles were assessed for eligibility. 36 met the prespecified inclusion/exclusion criteria. Potassium supplementation caused a significant decrease in systolic BP (- 3.69 mmHg [-4.91, -2.46], P<0.001) and increase in serum potassium (+0.37 [0.23, 0.52] mmol/L, P<0.001). There was an increase in plasma aldosterone (standardised difference 0.414 [0.291, 0.537], P<0.001) but no effect on plasma renin activity (+0.033 [-0.07, 0.14], P=0.538]. Meta-regression showed a significant positive correlation between change in plasma aldosterone and change in serum potassium (P<0.001). (2) In 469 subjects (72% black), there was a positive association between the measured 24-hour potassium excretion and aldosterone in black (β = 0.200, P = 0.014) but not in white individuals (P = 0.531). Discussion/Conclusion Potassium supplementation increases plasma aldosterone but not renin. The increase in aldosterone correlates with the raise in serum potassium. In subjects with hypertension, potassium intake is related with aldosterone concentration only in black subjects. Overall, the data supports a RAAS-independent potassium regulation of aldosterone which could be particularly relevant in African origin subjects. Limitations: 1. the systematic review results could not be stratified by ethnicity because most of the studies were performed in Caucasian subjects, 2. Use of background therapy in some studies, variable doses of potassium supplementation and duration of supplementation.

A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose

ObjectivesTo determine whether addition of an intravenous bolus dose before continuous nicardipine infusion would improve blood pressure reduction in the hyperacute phase in patients with spontaneous intracerebral hemorrhage (ICH). DesignDouble-blind randomized controlled trial. SettingOne academic emergency department (ED) in Bangkok, Thailand. ParticipantsAdult patients with spontaneous ICH presented to the ED between June 30, 2022, and July 15, 2023. InterventionsThe bolus group (n = 31) received an intravenous bolus dose of nicardipine before nicardipine continuous infusion, whereas the non-bolus group (n = 31) was given a placebo and nicardipine continuous infusion. Main outcomesSystolic blood pressure (SBP) within the first hour (being measured every 5 min), neurological deterioration, and infusion dosage at 60 min were assessed. ResultsBasic characteristic features including the mean baseline SBP were not significantly different between the two groups. At 10 min after treatment initiation, the bolus group had a significant decrease in SBP (32.1 ± 13.6 vs 22.3 ± 18.5 mmHg; p-value = 0.020). Moreover, the target SBP of 180 mmHg could be achieved within 10 min in the bolus group compared with 15 min in the non-bolus group. However, the overall mean SBPs were not significantly different, with 152 ± 12 mmHg in the bolus group compared with 150 ± 15 mmHg in the non-bolus group (p-value = 0.564). None of the patients in both groups had neurological deterioration over the first hour of the treatment. The infusion dosages of nicardipine at 1 h were 6.2 mg/h (5.9, 7.7 mg/h) and 6.8 mg/h (5.9, 8.4 mg/h) in the bolus and non-bolus groups, respectively (p-value = 0.618). ConclusionsAdministering a 1-mg bolus dose of nicardipine before continuous nicardipine infusion notably reduces SBP at 10 min. However, the overall SBP does not exhibit a significant decline during the hyperacute phase of spontaneous intracerebral hemorrhage.

Prospective association of occupational and leisure-time physical activity with orthostatic blood pressure changes in older adults

Orthostatic hypotension (OH) is common in older people. We examined the influence of self-reported occupational-related physical activity (PA) and leisure-time physical exercise (PE) on orthostatic response in a sample of older people over a 2 year period. Supine and orthostatic systolic blood pressure (sBP), diastolic blood pressure (dBP), and mean blood pressure (mBP) were assessed in response to Active Stand (AS) test in 205 older subjects (> 60 years old) at baseline and 2-year follow-up. OH was found in 24 subjects (11.71%) at baseline and 20 subjects (9.76%) after 2 years, with a significant degree of variability in the occurrence of OH after 2 years. Twenty-two subjects who had OH at baseline were free of it after 2 years, two subjects had persistent OH at baseline and after 2 years. After 2 years, adults with occupational PA showed no significant decrease of blood pressure in response to AS test, while lack of undertaking an occupation-related PA was significantly related with a greater decrease in sBP and mBP in response to AS testing in the 1st min. Occupation-related PA and leisure-time-related PE were related to an increase in the response of BP on AS in change between baseline and after 2 years. High between-subjects variance in OH over 2 years was noted. Occupations that involved continuous physical activity and leisure-time physical exercise in middle age were both protective for BP decline on orthostatic stress test within 2 years.

Dose-response association between physical activity and blood pressure among Chinese adults: a nationwide cross-sectional study.

The aim of this study was to examine the dose-response associations of physical activity with blood pressure (BP) and hypertension risk among Chinese adults. Derived from the national community-based China Hypertension Survey database during 2012--2015, a total of 203 108 residents aged at least 18 years were included. Individual-level physical activity was evaluated using a standardized questionnaire, and minutes of metabolic equivalent tasks per week (MET-min/week) were calculated, integrating domain, intensity, frequency, and duration. Multivariable linear and logistic regressions were used to estimate associations of physical activity with BP and hypertension risk, and restricted cubic spline regressions were performed for their nonlinear dose-response relationships. Overall, the median total physical activity (TPA) was 3213.0 MET-min/week and the prevalence of physical inactivity was 14.8%. TPA was negatively associated with BP. Increasing TPA levels was related to a steep decrease in systolic BP, up to approximately 2500 MET-min/week, with more modest benefits above that level of TPA. Higher levels of domain-specific and intensity-specific physical activity were found to be associated with lower BP levels and hypertension risk, except for the association between vigorous-intensity physical activity and systolic BP. We found that TPA within the range of 2000--4000 MET-min/week, a higher frequency and shorter duration were inversely associated with diastolic BP levels. Total, domain-specific, and intensity-specific physical activity were inversely related to BP levels, respectively, in a dose-response fashion. Of a given amount, higher-frequency, shorter-duration, and lower-intensity physical activity produced more beneficial effects.

Anaphylactic shock

Anaphylactic shock is an acute circulatory failure as a result of anaphylaxis, manifested by a decrease in systolic blood pressure (BP) below 90 mm Hg or by 30 % from baseline and leading to hypoxia of vital organs. Etiological factors include medical preparations and materials, most often medicines (31.2–46.5 %), food products (23.3–31 %), and poison of Hymenoptera insects (14.9–20 %). Life-threatening anaphylaxis can develop as a reaction to the venoms of other animals, such as snakes. Antibiotics for parenteral administration (including beta-lactam antibiotics — penicillins and cephalosporins), non-steroidal anti-inflammatory drugs (NSAIDs), radiopaque iodine-containing substances, muscle relaxants, and latex are among the medical preparations and materials that cause AS most often.

Hypotension in heart failure is less harmful if associated with high or increasing doses of heart failure medication: Insights from the Swedish Heart Failure Registry.

Heart failure (HF) medication may reduce blood pressure (BP). Low BP is associated with worse outcomes but how this association is modified by HF medication has not been studied. We evaluated the association between BP and outcomes according to HF medication dose in HF with reduced ejection fraction (HFrEF). We studied HFrEF patients from the Swedish HF registry (2000-2018). Associations between systolic BP (SBP) and cardiovascular death (CVD) and/or HF hospitalization (HFH) were analysed according to doses of renin-angiotensin system (RAS) inhibitors, beta-blockers and mineralocorticoid receptor antagonists (MRA). Among 42 040 patients (median age 74.0), lower baseline SBP was associated with higher risk of CVD/HFH (adjusted hazard ratio [HR] per 10 mmHg higher SBP: 0.92, 95% confidence interval [CI] 0.92-0.93), which was less high risk under optimized RAS inhibitor and beta-blocker doses (10% decrease in event rates per 10 mmHg SBP increase in untreated patients vs. 7% decrease in patients at maximum dose, both adjusted p < 0.02). Among the 13 761 patients with repeated measurements, 9.9% reported a SBP decrease >10 mmHg when HF medication doses were increased, whereas 24.6% reported a SBP decrease >10 mmHg with stable/decreasing doses. Decreasing SBP was associated with higher risk of CVD/HFH in patients with stable (HR 1.10, 95% CI 1.04-1.17) or decreasing (HR 1.29, 95% CI 1.18-1.42) HF medication dose but not in patients with an increase in doses (HR 0.94, 95% CI 0.86-1.02). The association of lower SBP with higher risk of CVD/HFH is attenuated in patients with optimized HF medication. These results suggest that low or declining SBP should not limit HF medication optimization.

Effect of carotid corrected flow time combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients: a prospective cohort study.

Hypotension often occurs following the induction of general anesthesia in elderly patients undergoing surgery and can lead to severe complications. This study assessed the effect of carotid corrected flow time (FTc) combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients. The prospective cohort study was divided into two parts. The first part (Part I) consisted of 112 elderly patients. Carotid FTc was measured using Color Doppler Ultrasound 5min before anesthesia induction. Hypotension was defined as a decrease of greater than 30% in systolic blood pressure (SBP) or a decrease of greater than 20% in mean arterial pressure (MAP) from baseline, or an absolute SBP below 90mmHg and MAP below 60mmHg within 3min after induction of general anesthesia. The predictive value of carotid FTc was determined using receiver operating characteristic (ROC) curve. The second part (Part II) consisted of 65 elderly patients. Based on the results in Part I, elderly patients with carotid FTc below the optimal cut-off value received perioperative fluid therapy at a volume of 8ml/kg of balanced crystalloids (lactated Ringer's solution) in 30min before induction. The effect of carotid FTc combined with perioperative fluid therapy was assessed by comparing observed incidence of hypotension after induction. The area under the ROC for carotid FTc to predict hypotension after induction was 0.876 [95% confidence interval (CI) 0.800-0.952, P <0.001]. The optimal cut-off value was 334.95ms (sensitivity of 87.20%; specificity of 82.20%). The logistic regression analysis revealed that carotid FTc is an independent predictor for post-induction hypotension in elderly patients. The incidence of post-induction hypotension was significantly lower ( P <0.001) in patients with carotid FTc less than 334.95ms who received perioperative fluid therapy (35.71%) compared to those who did not (92.31%). Carotid FTc combined with the perioperative fluid therapy could significantly reduce the incidence of hypotension after the induction of general anesthesia in elderly patients.

Impact of sleeping in a forest on sleep quality and mental well-being

Forest ecosystems have been acknowledged as a viable intervention for mitigating mental stress. However, there is a scarcity of research investigating the impact of forest environments on sleep. This study primarily investigated the physiological and psychological effects of sleep in a forest environment. It included a sample of 50 Chinese young adult students. A comparative analysis was conducted to examine the impact of sleeping in a forest environment as opposed to a controlled room setting (control). The researchers collected data on blood pressure, electroencephalography (EEG), and psychological markers. There was a statistically significant decrease in systolic blood pressure after the participants slept in a forest environment compared to when they slept in a room (control). Moreover, a notable increase in alpha- and beta-wave frequencies was detected in the forest environment. A more pronounced reduction in anxiety scores was observed in those exposed to a forest environment compared to those in the control group. The physiological and psychological data presented in this study demonstrate that engaging in forest leisure positively affects both physical and mental relaxation in young adults.

Effectiveness of avocado leaf extract (Persea americana Mill.) as antihypertensive

Background Avocado leaves (Persea americana Mill.) have been traditionally used as antihypertensive. Various studies have tested the benefits of the Persea americana Mill. in treating hypertension but still using extracts not yet using nanoparticles. Therefore, this study aims to study the effectiveness of avocado leaf extract, including the nanoparticles, on salt-induced hypertensive Wistar rats in inhibiting the ACE enzyme, which causes decreasing systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as increasing urine volume. Methods This study used an experimental in vivo study design involving 24 white male Wistar rats (Rattus norvegicus), aged 2–3 months, weighing 130–250 g, and of a healthy condition with active movement. The samples were randomly divided into six treatment groups and post-test only research design with control group design. Results The result of the study showed that the extract contained a quercetin of 1129.597 ppm and 10 mineral compounds, including potassium, with the highest content. The analysis of antioxidant activity using the 2,2-diphenyl-1-picrylhydrazyl method showed that the antioxidant activity at IC50 was 44.734 ppm. The P. americana leaf extract nanoparticles had the most significant result in reducing blood pressure in Wistar rats induced by 16% NaCl for 14 days SBP to normal was by 68.75 mmHg (175.00±21.57 mmHg to 106.25±9.21 mmHg) and 55.25 mmHg (128.42±25.75 mmHg to 73.17±15.75 mmHg), respectively. Also, avocado leaf extract caused the decrease of SBP from 164.92±7.16 mmHg to 116.83±6.36 mmHg and DBP from 118.42±16.24 mmHg to 82.83±6.47 mmHg. The P. americana leaf extract nanoparticles resulted in the most urine volume at 13.5 ml, with the highest DAI value of 2.25. The ACE inhibitor test using the ELISA method showed that the P. americana leaf extract and the nanoparticle extract inhibition against the ACE enzyme were 60.0±12.1 % and 59.5±3%, respectively. The mean serum nitrate as a result of P. americana leaf extract (K4) and nanoparticles of P. americana leaf extract (K5) were 44.0±9.0 μmol/L and 41.1±11.5 μmol/L, respectively. The mean of serum nitrite was led by P. americana leaf extract (K4), and nanoparticles of P. americana leaf extract (K5) were 83.7±24.0 μmol/L and 81.0±23.2 μmol/L, sequentially. Conclusions The study showed that the leaf extract and nanoparticle extract of Persea americana Mill. was effective as an antihypertensive.

Association between intensity of glycemic control with GLP-1 receptor agonists and risk of atherosclerotic cardiovascular disease: a systematic review and meta-regression

Abstract Background Several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown to reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (DM). However, this reduction has not been consistent among different GLP-1 RAs. We conducted a systematic review and meta-regression analyses to evaluate the association between the intensity of glycemic control achieved byGLP-1 RAs therapy in patients with type 2 DM and the reduction of MACE as well as to identify potential mechanisms involved. Methods Electronic databases (MEDLINE, CENTRAL, SCOPUS) were searched through November 2022. Studies were considered eligible if they were cardiovascular outcomes randomized trials (CVOTs) comparing GLP-1 RAs versus placebo in type 2 DM patients. Trials including non-diabetic patients and GLP-1 RAs refused by European Medicines Agency or US Food and Drug Administration were excluded. The outcome of interest was 3-point MACE (CV death, MI, or stroke). Random-effects meta-analyses and meta-regression evaluated associations between glycemic control withGLP-1 RAs and study outcomes. Secondary meta-regression analyses were performed for body weight and blood pressure (BP) variation. Results Overall, 8 CVOTs were included, with a total of 60080 patients (30694 treated withGLP-1 RAs). GLP-1 RAs were associated with a lower incidence of 3P-MACE (RR 0.876; 95% CI 0.821-0.935, p&amp;lt;0.001). Mean HbA1C reduction was 0.57% in patients treated withGLP-1 RAs vs. placebo. Meta-regression showed that higher reductions of HbA1C levels were associated with lower risk of 3P-MACE (Log RR -0.286 [95% CI-0.512; -0.056], p=0.015), which translates into an estimated relative risk reduction of 25% for each 1% reduction in HbA1C (Figure 1A). There was a non-significant association between glycemic control and each of the 3P-MACE outcomes analysed separately. Body weight reduction was also associated with a lower risk of 3P-MACE (Log RR -0.067 [95% CI-0.134; 0.001], p=0.053), despite not meeting statistical significance (Figure 1B). Systolic BP decrease was not associated with reduced risk of 3P-MACE. Conclusions The better the glycemic control withGLP-1 RAs in type 2 DM patients, the greater the reduction in 3P-MACE. Body weight reduction may also play a potential role.Figure 1

Association between atmospheric air temperature and blood pressure among adult population in different seasons

BACKGROUND: The prevalence of hypertension in the Arkhangelsk region is steadily increasing. Despite the progress in the diagnostics and the availability of treatment, a half of the population are unaware of their hypertension and its potential consequences, and consequently, do not adhere to the prescribed medications. This lack of awareness, coupled with the challenging climatic conditions of the northern regions, can significantly increase the risk of acute myocardial infarctions and strokes among young adults.&#x0D; AIM: To study the association between atmospheric air temperature and blood pressure among the adult population in Arkhangelsk.&#x0D; MATERIAL AND METHODS: For the purpose of this study we used blood pressure data obtained from 2342 participants individuals aged 3569 years who participated in the Know your heart study in Arkhangelsk from November 1, 2015 to October 31, 2017. Every blood pressure measurement was linked to the time-corresponding readings of atmospheric air temperature recorded by the city meteorological station. The effect of the temperature on blood pressure was assessed using linear regression analysis separately for the warm (April 16October 15) and the cold (October 16April 15) seasons.&#x0D; RESULTS: In the warm season, in the group of participants without hypertension and in those with treated arterial hypertension, high values of atmospheric air temperature (17.526.5 С) relative to the average level (8.812.2 С) were associated with a decrease in systolic blood pressure at 7.9 mm Hg (p=0.004) and 8.5 mm Hg (p=0.012), respectively, and diastolic blood pressure by 5.1 mm Hg (p=0.002) and 4.5 mm Hg (p=0.021), respectively. In the group of participants with untreated arterial hypertension, changes in ambient air temperature above (12.317.2 С) and below (6.08.7 С) the average level for this period were associated with an increase in systolic blood pressure by 11.7 mm Hg (p=0.044) and 16.9 mm Hg (p=0.004), and diastolic blood pressure by 8.9 mm Hg (p=0.018) and 13.8 mm Hg (p 0.001), respectively. In the cold season, no effect of air temperature on blood pressure was found in persons without arterial hypertension. In persons with treated arterial hypertension, an increase in air temperature in the cold season to the levels of (1.31.1 С) relative to the average level (3.91.4 С) were associated with lower systolic blood pressure by 8.5 mm Hg (p=0.001).&#x0D; CONCLUSION: The results of the study demonstrate the association between the atmospheric air temperature and blood pressure. Patients with untreated hypertension are more susceptible to fluctuations in blood pressure parallel to changes in ambient air temperature.

Long-term effects of 12-month integrated weight-loss programme for children with excess body weight- who benefits most?

The aim of the study was to assess long-term effects of the 12-month integrated weight-loss programme in children with excess body weight. We also attempted to identify the determinants of intervention effectiveness. Two groups were included in the analysis: 241 children with excess body weight who participated in the full 12-month intervention (full participation group) and 891 children with excess body weight who did not participate in the intervention (no participation group). Changes in BMI SDS, SBP SDS, DBP SDS and post-exercise HR with a follow-up period of 4 years between this groups were compared. In the full participation group, the reduction in mean BMI SDS was greater, we also observed significantly higher decrease in DBP SDS. Subgroup analysis by age category and sex showed a significant difference in the change in mean BMI SDS (from baseline to follow-up) in the subgroup of younger children and in the subgroup of younger girls. In the subgroup of younger girls significantly higher decrease in DBP SDS and SBP was also observed. Younger children, who participated in the intervention at age 6, particularly girls, benefited the most.

Effects of Linpan nature therapy on health benefits in older women with and without hypertension.

Nature therapy can significantly benefit the physiology and psychology of middle-aged and older people, but previous studies have focused on forest environments. The restoration potential of rural environments in urban fringe areas, which are more accessible to older people on a daily basis, has not been fully studied. This study assessed the effects of nature therapy on the physical and mental health of older women in a rural setting (locally known as Linpan) in the urban fringe area of Chengdu, China. We recruited a total of 60 older women (65.3 ± 5.5 years old) living in cities for 3 days of nature therapy in the winter (30 subjects) and spring (30 subjects), including 20 hypertensive patients. The results showed that the overall blood pressure, pulse and sleep dysfunction rating scores of the participants were significantly lower than the pretest levels, and the finger blood oxygen saturation, mid-day salivary alpha-amylase and cortisol were increased post-treatment. Increases in these biomarker indicates and increase in stress. There were significant differences in the changes in systolic blood pressure between the hypertension group (HTN) and the normal group (normal) (HTN decreased by 8.8%, normal decreased by 5.4%), salivary alpha-amylase content (HTN decreased by 0.3%, normal increased by 16.9%), and sleep dysfunction rating scores (HTN decreased by 59.6%, normal decreased by 54%). The decreases in systolic blood pressure and pulse in the winter group were higher than those in the spring group by 1.8 and 4.4%, respectively, while the increases in salivary alpha-amylase content and salivary cortisol content were lower than those in the spring group by 11.7 and 11.2%, respectively, and the decrease in sleep dysfunction rating scores was lower than that in the spring group by 7.1%. Our study concluded that nature therapy based on various health activities in the Linpan has significant health effects on older women. It can regulate blood pressure and pulse in older women, relieve cardiovascular disease, improve sleep quality. Meanwhile, older women with high blood pressure experienced a more significant effect than the healthy group.

Effectiveness of a fixed combination of amlodipine/indapamide in hypertensive patients in real clinical practice

Objective. To assess the possibility of obtaining and the degree of additional antihypertensive effect, the dynamics of vascular wall stiffness parameters, vascular age indicators in patients with uncontrolled hypertension (HTN) when transferring from previous therapy to a fixed combination of amlodipine/indapamide in typical outpatient practice.Design and methods. Twenty-five patients with 1–3 degree HTN who got a prescription of a fixed combination of amlodipine/indapamide (ARIFAM 5/1,5 or 10/1,5 mg, Servier) were included in the study. The follow-up duration was 2 months and included the following methods: clinical assessment (systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate), with titration of the drug dose every two weeks; double assessment (at the beginning and at the end of the study) of arterial stiffness based on the determination of the cardio-ankle vascular index (CAVI), biological age of vessels using the VaSeraVS‑1500N volumetric sphygmography device, as well as quality of life indicators (SF‑36 questionnaire). The reliability of changes in the studied parameters during active outpatient management of patients was assessed.Results. Combined pharmacotherapy using a fixed combination of amlodipine/indapamide was well tolerated by all patients. We recorded a significant decrease in SBP on average by 31,0 ± 10,6 mmHg, DBP by 11,0 [7,0; 20,0] mmHg, and the achievement of the target SBP level at the end of the 2nd month was shown in 17 (68 %) patients, the target DBP level was found in 100 % of patients. A significant decrease in vascular wall stiffness parameters was shown as a decrease in the CAVI index (p = 0,034), a decrease in AI (p = 0,0001) and the PEP/ET ratio of the Veissler coefficient (p = 0,009), as well as in the calculated vascular age indicator (p = 0,00001). Significant (p = 0,0001) changes were recorded for most data of quality of life (SF‑36) in patients with HTN, with the exception of the social functioning scale.Conclusions. Combined pharmacotherapy of patients with 1–3 degree HTN with the inclusion of a fixed combination drug amlodipine/indapamide with prolonged release has a clear positive effect, i. e. improved hemodynamic parameters, a significant reduction in vascular stiffness, a decrease in vascular age and improved quality of life.

Evidence-Supported Interventions for Reducing Secondary Stroke Risk in Sub-Saharan Africa: A Systematic Review.

The study set out to perform a systematic literature review of evidence-based interventions that target the reduction of secondary stroke risk in Africa. The review analyzed longitudinal intervention studies conducted in Sub-Saharan Africa, focusing on adult participants who had suffered a prior stroke. It encompassed publications and peer-reviewed papers sourced from reputable databases, including PubMed, Ovid, Cochrane, and Web of Science. Three randomized clinical trial (RCT) studies were included with sample sizes ranging from 16 to 400 participants, mean age ranged between 50 and 66 years, with 64.5% male participants. All studies applied multidisciplinary team interventions of enhanced patient follow-up involving care givers, nurse educators, physicians, and social workers. Interventions ranged from comprehensive patient education, tracking of medication adherence and enforcing healthy lifestyle behaviors (regular exercise, regular BP checks, and dietary changes). We found a decrease in Systolic Blood Pressure over time in 2 of 3 treatment groups, an improvement in medical adherence in all treatment groups, and a decrease in cholesterol levels in 1 treatment group. Evidence-based interventions involving multidisciplinary teams and comprehensive patient education were found to demonstrate promising results in reducing secondary stroke risk in Africa, leading to significant improvements in medical adherence and reductions in systolic blood pressure in the majority of treatment groups. However, more research is required to confirm the influence of these interventions on cholesterol levels and to establish their lasting advantages in preventing strokes among African communities.

The Indian REgistry on Current Patient PrOfiles and TReatment TrenDs in Hypertension (RECORD): Final Outcomes of the Real-world Observational Study.

Objectives: The Indian Registry on Current Patient Profiles and Treatment Trends in Hypertension (Record) evaluated the current trends and outcomes related to hypertension (HTN) management at 3, 6, 12, and 24 months in India. This study highlights and evaluates the outcomes and trends noted at 24 months. Materials and methods: The detailed study methodology is provided in the earlier publication (interim analysis at 12 months). Aspects such as changes in the quality of life (QOL), percentage of patients reaching target blood pressure (BP), treatment pattern among patients with comorbid conditions, and difference in treatment patterns between public and private healthcare settings, at 24 months, were evaluated in the current study. Results: The study population included 2,000 patients (55.7% males) with a mean age of 54.45 years. Telmisartan (43.7%) and amlodipine + telmisartan (16.4%) were the most prescribed monotherapy and combination therapy among patients with newly diagnosed HTN. A significant decrease in both systolic BP (SBP) and diastolic BP (DBP) was noted in the overall patient population at 24 months (p < 0.001). The mean change in SBP and DBP was slightly higher at 24 months compared to 12 months. This was more evident among patients on combination therapy. A significant improvement in QOL was noted at 24 months. Conclusion: Treatment strategies in HTN management are changing and are associated with effective HTN control and improvements in QOL. However, there is a further need for improved awareness regarding the optimal usage of combination therapy for better management of uncontrolled HTN. How to cite this article: Rajadhyaksha GC, Reddy H, Singh AK, et al. The Indian REgistry on Current Patient PrOfiles and TReatment TrenDs in Hypertension (RECORD): Final Outcomes of the Real-World Observational Study. J Assoc Physicians India 2023;71(11):43-49.

A lifestyle intervention to prevent hypertension in primary healthcare settings: A Saudi Arabian feasibility study

BackgroundHypertension is a leading cause of morbidity and mortality in Saudi Arabia, causing a significant public health challenge in the kingdom. In this study, we aimed to assess the feasibility of the Blood pressure LifeStyle Management (BLSM) program for preventing hypertension by making a significant changes in lifestyle interventions through controlling some risk factors such as behavior, diet, physical activities, and weight in Primary Care. AimThe aim of this study is to evaluate the effectiveness of the Blood pressure LifeStyle Management (BLSM) program in reducing blood pressure. MethodsThis is a cohort of three-month period feasibility study in a primary care setting in a before-and-after study design. ResultsA total of 100 individuals were recruited for the study, and 73 have completed the program. The overall systolic (SBP) and diastolic (DBP) blood pressure showed an increment of 0.75 and 1.67 mmHg, respectively. The subgroup analysis exhibited a decrease in SBP (−6.5 mmHg) for patients with hyperlipidemia, while a DBP average increased (+2 mmHg). Females showed a decrease in SBP (−1.04 mmHg) compared to males, who increased in their SBP (+1.69). Smokers showed a significant improvement in SBP and DBP with p < 0.05. ConclusionLifestyle intervention can improve and control blood pressure in primary care settings. The program can be tailored to include more participants, the length of the program could be modified, and the frequency of follow-ups could be increased to enable participants to change their habits and incorporate better life choices in their daily routines.

The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation

The Fontan Udenafil Exercise Longitudinal (FUEL) trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n=200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p=0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.

Impact of Using Blood Warmer During Continuous Kidney Replacement Therapy in Patients With Acute Kidney Injury.

We investigated the impact of blood warmer use on hypotensive episodes in patients with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT). We included patients with AKI undergoing CKRT between January 1, 2012, and January 1, 2021, at a tertiary academic hospital. Hypotensive episodes were defined as mean arterial pressure (MAP) <60 mm Hg or a decrease in MAP by ≥10 mm Hg, systolic blood pressure (SBP) < 90 mm Hg or a decrease in SBP by ≥20 mm Hg, or increased vasopressor requirement. These were analyzed by Poisson regression with repeated-measures analysis of variance using generalized estimation equation. There were 669 patients with AKI that required CKRT. Use of blood warmer on first day of CKRT was in 324 (48%) patients. Incidence rate ratio of hypotensive episodes during the first 24-h of CKRT in patients where a blood warmer was used was 1.06 (95% confidence interval [CI]: 0.98-1.13) compared to those where blood warmer was not used. This did not change in adjusted model. Overall, the within-subject effect of temperature on hypotensive episodes showed that higher temperature was associated with fewer episodes (0.94, 95% CI: 0.9-0.99 per 10 degrees increase, P = .007). Blood rewarming was not associated with hypotensive episodes during CKRT.