Effects In Hypertensive Patients Research Articles

Exploratory study on the relationship between urinary sodium/potassium ratio, salt intake, and the antihypertensive effect of esaxerenone: the ENaK Study

Excessive salt intake is one of the causes of hypertension, and reducing salt intake is important for managing the risk of hypertension and subsequent cardiovascular events. Esaxerenone, a mineralocorticoid receptor blocker, has the potential to exert an antihypertensive effect in hypertensive patients with excessive salt intake, but evidence is still lacking, especially in clinical settings. We aimed to determine if baseline sodium/potassium ratio and baseline estimated 24-h urinary sodium excretion can predict the antihypertensive effect of esaxerenone in patients with essential hypertension inadequately controlled with an angiotensin receptor blocker (ARB) or a calcium channel blocker (CCB). This was an exploratory, open-label, interventional study with a 4-week observation period and a 12-week treatment period. Esaxerenone was orally administered once daily in accordance with the Japanese package insert. In total, 126 patients met the eligibility criteria and were enrolled (ARB subcohort, 67; CCB subcohort, 59); all were included in the full analysis set (FAS) and safety analysis. In the FAS, morning home systolic blood pressure (SBP)/diastolic blood pressure (DBP) significantly decreased from baseline to end of treatment (primary efficacy endpoint) (−11.9 ± 10.9/ − 6.4 ± 6.8 mmHg, both p < 0.001); a similar trend was observed in both subcohorts. Significant reductions were also shown in bedtime home and office SBP/DBP (all p < 0.001). Each BP change was consistent regardless of the urinary sodium/potassium ratio or estimated 24-h urinary sodium excretion at baseline. The urinary albumin-creatinine ratio (UACR) and N-terminal pro-brain natriuretic peptide (NT-proBNP) significantly decreased from baseline to Week 12 in the total population and both subcohorts. No new safety concerns were raised. Esaxerenone significantly decreased morning home, bedtime home, and office BP; UACR; and NT-proBNP in this patient population, regardless of concomitant ARB or CCB use. The antihypertensive effect of esaxerenone was independent of the urinary sodium/potassium ratio and estimated 24-h urinary sodium excretion at baseline.

Self-Measure Office Blood Pressure (SMOBP) and Home Blood Pressure Monitoring (HBPM) for white coat effect diagnosis among hypertension patients

Background: Hypertension is a critical factor in the deaths over the world among those who have cardiovascular diseases such as coronary artery disease, stroke, and chronic kidney disease.Purpose: This study aims to investigate the diagnosis capability of the white coat effect in hypertensive patients whose blood pressure was not on target.Methods: This study is an analytical study. Data were collected from 19 uncontrolled hypertension patients at Bang Si Thong health promoting hospital from August to December 2022. The geographic data are presented in the descriptive statistic terms of mean, difference, and standard deviation. The research outcome was analyzed by paired t-test.Results: The research results showed blood pressure measurement by SMOBP was more valuable in terms of statistical significance than Daytime HBPM (134±8.21 vs 125.5±6.74 p&lt;0.001), while it was statistically significantly lower than Office-measured (148.15±10.33 vs 134±8.21 p&lt;0.001), and there were participants whose blood pressures were going as a targeted by SMOBP 55% and HBPM 80%.Conclusion: Self-Measure Office Blood Pressure [SMOBP] can eliminate some of the white coat effect, but it could not be used instead of Home Blood Pressure Monitoring [HBPM] for the diagnosis of white coat hypertension. The SMOBP might be a choice for patients who have the white coat effect in socioeconomically disadvantaged areas.

Effectiveness of Atenolol on the Basis of Pattern of Side Effects in Hypertensive Patients

Hypertension plays a significant role in changing Insulin parameter. They are taken as valid diagnostic markers in determining side effects of anti-hypertensive drugs. These parameters are grossly affected by the use of beta blockers which are used to control hypertension. Objective: To determine the effects of atenolol, a beta blocker on insulin when taking alone in hypertensive patients. Methods: A total of 80 patients participated in this study of which 43 patients were taking atenolol alone while 37 were taking atenolol in combination with other anti-hypertensive drugs and 20 healthy controls were included of all age groups population to make a comparison and to find variation in values of insulin levels, in patients experiencing hypertension. Medical efficacy was evaluated on the basis of variations in insulin levels upon use of anti-hypertensive medications. ELISA technique was used for conducting insulin levels. Results: We found significant results of insulin values because atenolol cause hyperglycemia Atenolol was non-significant in both groups of patients having low insulin levels due to use of atenolol alone or use of atenolol in combination therapy. Other anti-hypertensive drugs did not affect the insulin levels therefore variation is basically because of atenolol so the main focus of our study was atenolol. Conclusions: Atenolol prove efficacy but it also causes the disturbance in insulin levels therefore we recommend use of any other drug in conjunction with atenolol to avoid insulin variation due to atenolol. Further these results may be employed on large patient population for strengthening our evidences.

Sinovac COVID-19 Side Effects in Hypertensive Patients: An Observational Study From Pakistan.

Background The most important factor in combating the coronavirus disease 2019 (COVID-19) pandemic was the provision ofsafe and effective vaccines. The acceptance of vaccines is impacted by several variables, including beliefs about the vaccine's safety and adverse effects. Vaccine side effects can vary depending on the type, but they are often moderate, localized, transient, and self-limiting. Therefore, this study aimed to assess the prevalence of side effects experienced after receiving the Sinovac vaccine by participants hypertensive and non-hypertensive participants. Methodology This was a cross-sectional, multicenter study that was performed using non-probability sampling. The study duration was six months from May 1, 2022, to October 31, 2022. The study involved 600 individuals who had either received the first or second dose of the Sinovac vaccine. For categorical data, frequencies and percentages were documented. The chi-square test was applied to determine the association between local and systemic side effects among hypertensive and non-hypertensive participants. Results The study findings showed that out of 600 participants, there were 187 (62.3%) males and 113 (37.7%) females with hypertension, and 222 (74.0%) males and 78 (26.0%) females without hypertension, with a significant association(p = 0.002). Following the first dose of the Sinovac vaccine, fever was the most commonly reported side effect in 153 (51.0%) hypertensive participants and 62 (20.7%) non-hypertensive participants, with a significant association(p < 0.001). Similarly, following the second dose of the Sinovac vaccine, fever was the most commonly reported side effect in 108 (36.0%) hypertensive participants and 57 (19.0%) non-hypertensive participants, with a significant association(p < 0.001). Conclusions This study concluded that the presence of hypertension significantly increased the manifestations of local and systemic side effects compared with non-hypertensive participants. Moreover, fever, pain, and swelling at the injection site were the most commonly reported side effects after receiving the first and second doses of the Sinovac vaccine.

Long-term effectiveness and safety of cilostazol versus clopidogrel in secondary prevention of noncardioembolic ischemic stroke.

Cilostazol is a widely used antiplatelet drug for secondary stroke prevention in Asia, but its comparison with clopidogrel is not well understood. This study aims to investigate the effectiveness and safety of cilostazol compared to clopidogrel for the secondary prevention of noncardioembolic ischemic stroke. This retrospective comparative effectiveness research analyzed 1:1 propensityscorematched data from insured individuals between 2012 and 2019, using administrative claims data in Health Insurance Reviewand Assessment in Korea. Patients with diagnosis codes for ischemic stroke without cardiac disease were included and divided into two groups, those receiving cilostazol and those receiving clopidogrel. The primary outcome was a recurrent ischemic stroke. Secondary outcomes included all-cause death, myocardial infarction, hemorrhagic stroke, and a composite of these outcomes. The safety outcome was major gastrointestinal bleeding. The study analyzed 4,754 patients in the propensityscorematched population and found no statistically significant difference in recurrent ischemic stroke (cilostazol group vs clopidogrel group, 2.7% vs 3.2%; 95% CI, 0.62-1.21), the composite outcome of recurrent ischemic stroke, all-cause death, myocardial infarction, and hemorrhagic stroke (5.1% vs 5.5%; 0.75-1.22), and major gastrointestinal bleeding (1.3% vs 1.5%; 0.57-1.47) between patients receiving cilostazol and those receiving clopidogrel. In subgroup analysis, cilostazol was associated with a lower incidence of recurrent ischemic stroke compared to clopidogrel in hypertensive patients (2.5% vs 3.9%; interaction P = 0.041). This real-world study suggests that cilostazol is effective and safe for noncardioembolic ischemic stroke and may be associated with better effectiveness in hypertensive patients compared to clopidogrel.

PS-P15-8: EFFICACY AND SAFETY OF ESAXERENONE IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES AND RECEIVING SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (EAGLE-DH STUDY)

Objective: Hypertensive patients with type 2 diabetes mellitus (T2DM) who respond inadequately to antihypertensive therapy are at high risk for cardiorenal events and require effective treatment options. Clinical trials have shown that esaxerenone, a non-steroidal mineralocorticoid receptor blocker, has favorable antihypertensive and renoprotective effects in hypertensive patients with various characteristics including T2DM and albuminuria. However, clinical evidence is lacking regarding the concomitant use of esaxerenone and sodium-glucose cotransporter 2 (SGLT2) inhibitors in hypertensive patients with T2DM. The study aimed to evaluate the efficacy and safety of esaxerenone and SGLT2 inhibitor combination therapy in Japanese hypertensive patients with T2DM who had an inadequate response to blood pressure (BP)-lowering treatment with renin angiotensin system (RAS) inhibitor or calcium channel blocker (CCB) monotherapy or combined therapy. Design and method: EAGLE-DH (jRCTs031200273) was a multicenter, open-label, interventional study in hypertensive patients (age, ≧ 20 years) with T2DM. Inclusion criteria were previous use of antihypertensive therapy (a RAS inhibitor, CCB, or RAS inhibitor plus CCB) and oral hypoglycemic drugs (a SGLT2 inhibitor with or without one or two other oral hypoglycemic drugs) for ≧ 12 weeks; morning home systolic BP (SBP) 125 to &lt; 160 mmHg and/or diastolic BP (DBP) 75 to &lt; 100 mmHg; and eGFRcreat ≧ 30 mL/min/1.73m2 at baseline. Over the 24-week study period, esaxerenone dose was started at 1.25 or 2.5 mg/day, and based on the individual patient's condition, the dose could be titrated at weeks 4 and 8 to a maximum of 5 mg/day. The primary endpoints were change in morning home BP from baseline to weeks 12 and 24. Secondary endpoints included change in bedtime home BP and office BP, proportion of patients achieving target SBP/DBP (home, &lt; 125/75 mmHg; office, &lt; 130/80 mmHg), change in urine albumin-to-creatinine ratio (UACR), and safety variables including adverse events, eGFR, and serum potassium. Results: The study population comprised 93 patients. Baseline characteristics were mean age, 66.3 years; male, 68.8%; mean morning home SBP/DBP, 136.4/82.3 mmHg; mean UACR 145.3 mg/g creatinine; one RAS inhibitor use, 33.3%; one CCB inhibitor use, 19.4%; RAS inhibitor plus CCB, 47.3%; mean HbA1c 6.8%; mean serum potassium, 4.2 mEq/L; and mean eGFRcreat 66.8 mL/min/1.73m2. Efficacy and safety results will be presented at the conference. Conclusions: EAGLE-DH will provide the first evidence from clinical practice for the efficacy of esaxerenone plus SGLT2 inhibitor in reducing morning/bedtime home and office BP with improving albuminuria as well as for its safety profile in Japanese hypertensive patients with T2DM.

Effectiveness of 8 weeks of vestibular exercises on stress, sleep, and cognitive parameters in hypertensive patients

Background: It was hypothesized that vestibular stimulation causes beneficial effects in hypertensive patients as so as in diabetic individuals. Aims and Objectives: The present study was undertaken to observe the effectiveness of 8 weeks of vestibular exercises on stress, sleep, and cognitive parameters in hypertensive patients. Materials and Methods: A total of eighty male and female stage 1 hypertensive individuals were part of the study after obtaining voluntary, written informed consent. Vestibular exercises comprising three steps with a time period of 45 min per session were administered to the participants of the intervention group. Two sessions per week were administered as mentioned in the literature. Stress levels were assessed by the perceived stress scale. Sleep was assessed by the insomnia severity index. A spatial and verbal memory test was used to assess the spatial and verbal memory scores. Results: There was no significant difference in the demographical parameters of the control and intervention groups. There is no significant difference in stress, sleep scores, and spatial and verbal memory scores among the control and intervention groups. There was a significant decrease in the stress scores and insomnia scores, and a significant improvement in the spatial and verbal memory scores in the intervention group after the intervention when compared with the control group. Conclusion: The present study results suggest that vestibular exercises have a positive impact on reducing stress and improving sleep and cognition in hypertensive individuals. The study highlights the need for further detailed studies in this area to recommend the inclusion of vestibular exercises as adjunctive therapy in the management of hypertension.

Abstract 15824: Microvascular Endothelial Kir2.1 Channels Play Important Role in Flow-Induced Dilation During Hypertension in Humans

Hypertension is associated with decreased endothelial function through reduced contributions of NO. Our recent study discovered that flow-induced generation of NO in resistance arteries of mice and humans, and flow-induced vasodilation (FIV), a hallmark of the endothelial response to flow, critically depend on endothelial inwardly-rectifying K+ channels (Kir2.1). The goal of this study was to establish whether these channels contribute to the impairment of endothelial function in peripheral resistance arteries of humans with hypertension. We measured microvascular function in vessels extracted from subcutaneous fat biopsies isolated from 28 subjects: normotensive (n=19; 30.6±4.4yo; systolic blood pressure-SBP: 115.2±5.7mmHg; diastolic blood pressure-DBP: 75.3±11.3mmHg) and hypertensive (n=9; 50±5.2yo; SBP: 147.1±6.1 mmHg; DBP: 93.1±16.8mmHg). Consistent with previous studies, we find that FIV is impaired in hypertensive subjects as demonstrated by a significant reduction in dilation when compared to the normotensive group. Furthermore, our data suggest that the impairment of FIV in this cohort can be partially attributed to a Kir-dependent vasodilation. Specifically, we show that blocking Kir channels with a specific inhibitor, ML133, or functionally downregulating with endothelial-specific adenoviral vector containing dominant-negative Kir2.1 (dnKir2.1) result in significant decrease in FIV in normotensive subjects and smaller effect in hypertensive patients. The Kir2.1-dependent vasodilation was negatively correlated to both SBP and DBP indicating that Kir contribution reduces as blood pressure increases. In addition, we show that exposing normotensive vessels to acute high pressure, which is known to impair FIV, results in loss of Kir channel contribution, as high-pressure impairs vasodilation in normotensive vessels but no effect is seen when these vessels were incubated with dnKir2.1. Overexpressing WTKir2.1 in endothelium resulted in some improvement in vasodilation in arteries from all participants, with a greater recovery in hypertensive patients. Our data suggest that hypertension-induced suppression of Kir2.1 is an important mechanism underlying endothelial dysfunction in hypertension.

The music therapy effectiveness in hypertensive patients with acute myocardial infarction after previous coronary artery bypass surgery; 18-year experience of the MUSIC study

Abstract Patients who have clinical evidence of hypertension (HT) after coronary artery bypass surgery (CABS) have a poor prognosis in expression of acute myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. The purpose of this study was to evaluate the effectiveness of music therapy on prognosis of patients with HT and AMI, after CABS. Methods 314 patients (males 78.4%, mean age 59.8±1.2 yrs) with AMI after previous CABS have been selected from the patients consecutively submitted from January 2003 to January 2019. HT was registered in 166 (53.0%) pts with AMI after previous CABS. All patients with HT were randomized and divided in 2 groups: Study group of 83 patients treated with music therapy and Control group of 83 patients with no music therapy. Each patient in study group underwent two sessions of medical therapy (12 minutes) in a day. Both groups were similar in baselines, post-AMI characteristics and post-AMI medical therapy. The plasma cytokine and catecholamine were measured in both groups. Results In the Study group, heart rate was significantly decreased by music therapy (p=0.0196). In the Control group, there were no significant changes in heart rate. Among cytokines (p=0.0160), plasma interleukin-6 (IL-6) (p=0.0179) in the Study group was significantly lower than those in the Control group, as well as plasma adrenaline (p=0.0162) and noradrenalin (p=0.0218) levels. Conclusion This study provides support for the use of musical therapy in patients with HT and AMI after previous CABS. The positive effects of music therapy, in these patients, are probably because of enhanced of parasympathetic activities and reduction of plasma cytokine and catecholamine levels. Funding Acknowledgement Type of funding sources: None.

Hypertension and retinal microvascular dysfunction (HyperVasc): protocol of a randomised controlled exercise trial in patients with hypertension

IntroductionHypertension is a global healthcare burden that affects the structure and function of the macrocirculation and microcirculation and induces disease-specific end-organ damage. Vascular biomarkers are essential to timely diagnose this...

Latihan Aktivitas Fisik Seperti Berjalan Setiap Hari pada Pasien Hipertensi

This study aims to determine the effect of walking physical activity on blood pressure in hypertension patients. This type of research is a systematic review, by reviewing several journals from the University of Indonesia library through CINAHL, Pubmed, Ebscohost, Springers, Wiley, and Scopus. The results of research from 11 literature searches that walking activity exercises can effectively reduce blood pressure levels, ranging from 6 minutes to 120 minutes per day, and 1200 minutes every week, can produce a better effect in hypertensive patients - the average decrease in SBP is significant between 2.6 mmHg and 22.6 mmHg. In conclusion, walking activity exercises are very useful and effective in reducing blood pressure levels, especially in hypertensive patients.&#x0D; &#x0D; Keywords: Physical Activity, Walking, Hypertension, Brisk Walking, Jogging

Washed Microbiota Transplantation Lowers Blood Pressure in Patients With Hypertension.

BackgroundAlthough transplantation of the fecal microbiota from normotensive donors has been shown to have an antihypertensive effect in hypertensive animal models, its effect on blood pressure in patients with hypertension is unclear. This study aimed to assess the effect of washed microbiota transplantation (WMT) from normotensive donors on blood pressure regulation in hypertensive patients.MethodsThe clinical data of consecutive patients treated with washed microbiota transplantation (WMT) were collected retrospectively. The blood pressures of hypertensive patients before and after WMT were compared. The factors influencing the antihypertensive effect of WMT in hypertensive patients and fecal microbial composition of donors and hypertensive patients were also analyzed.ResultsWMT exhibited an antihypertensive effect on blood pressure: the blood pressure at hospital discharge was significantly lower than that at hospital admission (change in systolic blood pressure: −5.09 ± 15.51, P = 0.009; change in diastolic blood pressure: −7.74 ± 10.42, P < 0.001). Hypertensive patients who underwent WMT via the lower gastrointestinal tract (β = −8.308, standard error = 3.856, P = 0.036) and those not taking antihypertensive drugs (β = −8.969, standard error = 4.256, P = 0.040) had a greater decrease in systolic blood pressure, and hypertensive patients not taking antihypertensive drugs also had a greater decrease in diastolic blood pressure (β = −8.637, standard error = 2.861, P = 0.004). After WMT, the Shannon Diversity Index was higher in six of eight hypertensive patients and the microbial composition of post-WMT samples tended to be closer to that of donor samples.ConclusionWMT had a blood pressure-lowering effect in hypertensive patients, especially in those who underwent WMT via the lower gastrointestinal tract and in those not taking antihypertensive drugs. Therefore, modulation of the gut microbiota by WMT may offer a novel approach for hypertension treatment.

Receptor Interactions of Angiotensin II and Angiotensin Receptor Blockers-Relevance to COVID-19.

Angiotensin II (Ang II) may contain a charge relay system (CRS) involving Tyr/His/carboxylate, which creates a tyrosinate anion for receptor activation. Energy calculations were carried out to determine the preferred geometry for the CRS in the presence and absence of the Arg guanidino group occupying position 2 of Ang II. These findings suggest that Tyr is preferred over His for bearing the negative charge and that the CRS is stabilized by the guanidino group. Recent crystallography studies provided details of the binding of nonpeptide angiotensin receptor blockers (ARBs) to the Ang II type 1 (AT1) receptor, and these insights were applied to Ang II. A model of binding and receptor activation that explains the surmountable and insurmountable effects of Ang II analogues sarmesin and sarilesin, respectively, was developed and enabled the discovery of a new generation of ARBs called bisartans. Finally, we determined the ability of the bisartan BV6(TFA) to act as a potential ARB, demonstrating similar effects to candesartan, by reducing vasoconstriction of rabbit iliac arteries in response to cumulative doses of Ang II. Recent clinical studies have shown that Ang II receptor blockers have protective effects in hypertensive patients infected with SARS-CoV-2. Therefore, the usage of ARBS to block the AT1 receptor preventing the binding of toxic angiotensin implicated in the storm of cytokines in SARS-CoV-2 is a target treatment and opens new avenues for disease therapy.

Comparison of effect of spinal anesthesia on heart rate and blood pressure between hypertensive patients on beta-blockers or calcium channel blockers and normotensive patients: A prospective observational cohort study

Background: Hypertensive patients develop wide swings in blood pressure intraoperatively, especially after spinal anesthesia. Long term antihypertensive agents can modify this effect by controlling blood pressure. This study was undertaken to evaluate the haemodynamic effect in hypertensive patients on regular treatment with calcium channel blockers and beta-blockers who are undergoing elective surgery under spinal anesthesia and compared with normotensives. Methodology: 183 patients were included in the study; 61 patients were normotensives (Group A) and 61 patients were hypertensive who were regularly on calcium channel blockers (Group C) and 61 patients on beta-blockers (Group B). Both the groups continued the drug on the day of surgery. The baseline blood pressure and heart rate were recorded. After spinal anesthesia, the blood pressure and heart rate were noted at 2 min, 4 min, 6 min, 8 min, 10 min, 15 min, 20 min, 25 min, 30 min, 45 min, 60 min, 75 min, 90 min, 120 min, 150 min, and at 180 min. Statistical analysis: One way ANOVA with POSTHOC TUKEY test for comparison of the groups and CHI SQUARE test is used for categorical variables. P<0.05 was considered as statistically significant. Results: The hypotension was more in Group C compared to other groups, but is not statistically significant (P = 0.42), and requirement of vasopressor to treat hypotension is slightly more in Group C and is not statistically significant (P = 0.93). Bradycardia (heart rate<50) is seen more in Group B and were statistically significant (P<0.001). The usage atropine to treat bradycardia was more in study group and was statistically significant (P<0.002). Conclusion: Incidence of hypotension was slightly more with patients on calcium channel blockers which is slightly more than beta blocker and normotensive group. This does not warrant any discontinuation of calcium channel blocker prior to surgery, but incidence of bradycardia was seen more in patients on beta blockers who needed atropine. Anesthesiologists should anticipate and be adequately prepared for any untoward consequences.

Is there any Hope for Monitoring Adherence in an Efficient and Feasible Way for Resistant Hypertension Diagnosis and Follow-Up?

Non-adherence to antihypertensive treatment is highly prevalent and represents a major factor affecting their effectiveness in hypertensive patients, thus contributing to apparent treatment resistance. It is however often overlooked because the methods to assess non-adherence are mainly subjective, limiting their usefulness in clinical practice. Non-adherence to treatment affects daily patient management, resulting in inappropriate, costly, and potentially harmful treatments and loss of the expected benefits from antihypertensive drugs. Specialized centers now use a combination of objective screening tools. Firstly, snapshots of adherence levels can be provided by analytical drug detection in various biological matrixes using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and secondly electronic monitoring systems of drug delivery which provide longitudinal data on adherence. Routine utilization of those tools allows the detection of non-adherence in patients with resistant hypertension, thus enabling implementation of appropriate interventions to improve drug adherence and avoid unnecessary treatment intensification. Other complementary techniques, such as digital health feedback system with ingestible sensors, are currently evaluated. In the context of an increasing burden of uncontrolled and apparent treatment-resistant hypertension, detecting non-adherence to antihypertensive therapy is, as acknowledged by the latest guidelines, a top priority to implement in clinical practice but still faces medical conservatism and disbelief.

Comparative Study to Evaluate Efficacy &amp; Cost Effectiveness of Olmesartanversus Telmisartan, In Patients of Stage I Hypertension

Background: Hypertension is one of the most common diseases in the world. It is an important and independent risk factor for atherosclerosis, heart failure, renal disease, and peripheral arterial disease. It is directly responsible for 57% of all stroke deaths and 42% of coronary heart disease deaths in India. Aims and Objectives: To evaluate and compare efficacy and cost effectiveness in hypertensive patients receiving Olmesartan and Telmisartan in Stage I hypertensionSubjects and Methods:The present study was an open, prospective, randomized, parallel group comparative study conducted in 60 patients of stage I hypertension over a period of 16 weeks. Patients were randomly allocated to two, age and sex, matched groups of 30 patients each. Group I patients were started on Olmesartan at a dose of 20 mg &amp; Group II patients were put on Telmisartan at a dose of 40 mg. The BP lowering efficacy and cost effective analysis of Olmesartan versus Telmisartan was calculated &amp; compared. The data was entered in Microsoft excel and compiled. Statistical analysis was done using various tests.Results:Maximum patients in both the groups were in age group of 51-60 years. In group I there were 13 males and 17 females. In group II there were 14 males and 16 females. Both Olmesartan and Telmisartan are effective in lowering systolic &amp; diastolic BP in supine &amp; sitting positions &amp; mean BP is also lowerer, more in Olmesartan group. By cost effective analysis Telmisartan was found more cost effective. Incremental cost effective ratio was found to be 218.35.Conclusion: Both Olmesartan and Telmisartan belong to the same antihypertensive drug class, effectively reduce systolic and diastolic blood pressure at various visits. Taking into account Total cost Telmisartan was more cost effective than Olmesartan. ICER was found to be 218.35.

Epicardial adipose tissue is a predictor of ascending aortic dilatation in hypertensive patients, but not paracardial adipose tissue

BackgroundAscending aortic aneurysms are one of the major causes of mortality. In recent years, there is a growing interest of epicardial adipose tissue (EAT) and related diseases. The aim of this study was to investigate the relationship of EAT, and PAT with ascending aortic dilatation (AAD).MethodsWe included 934 patients with hypertension in this study. The patients were evaluated by a complete transthoracic echocardiographic examination, including measurements of EAT, PAT, and aortic dimensions. Aortic size index (ASI) was used for diagnosing AAD. The patients were divided into two groups: dilated ascending aorta diameter (ASI ≥ 21 mm / m2, n = 102) or normal aortic diameter (ASI < 21 mm / m2, n = 832) according to the ASI. Characteristics of these patients were compared before and after propensity score matching analysis.ResultsPatients with AAD were older (72.3 ± 11.6 vs. 61.7 ± 12.7 years, p < 0.001), had more female gender (66% vs. 54%,p = 0.021) than patients with normal ascending aorta (AA). After propensity score matching analysis (77 vs. 77), EAT [OR:1.461, %95CI (1.082–1.974), p = 0.013] was independently associated with AAD in multivariate logistic regression analysis. In ROC curve analysis, EAT > 0.45 cm had 51.9% sensitivity and 62.3% specificity [AUC = 0.617, P = 0.012, 95% CI (0.529–0.707)].ConclusionBased on our findings, increased EAT may be suggested as an independent risk factor for AAD due to local or systemic effects in hypertensive patients.

Relation of short-term blood pressure variability to early renal effects in hypertensive patients with controlled blood pressure.

Microalbuminuria is a common early hypertension-mediated organ damage, which correlates with the overall cardiovascular risk and development of end-stage renal damage. Lately, blood pressure variability has shown an additive value over traditional BP measurement in prediction of cardiovascular and renal involvement. Investigate the relation between short-term blood pressure variability and microalbuminuria in controlled hypertensive patients. Ninety non-diabetic hypertensive patients with controlled blood pressure and normal estimated glomerular filtration rate had 24-hour ambulatory blood pressure monitoring with calculation of short-term blood pressure variability indices (SD, coefficient of variation and average reading variability of systolic and diastolic blood pressure for 24-hour, daytime and nighttime], and measurement of the albumin/creatinine ratio. Patients were classified into group 1 (61 patients without microalbuminuria) and group 2 (29 patients with microalbuminuria). No significant difference was observed between both groups regarding age, sex, body mass index, office blood pressure, average 24-hour ambulatory blood pressure monitoring readings and dipping status, but significantly longer duration of hypertension in group 2. All blood pressure variability indices were significantly higher in group 2, which showed strong positive correlations with microalbuminuria level. Multivariate analysis represented an average reading variability of 24-hour systolic blood pressure as the most powerful independent predictor for microalbuminuria (r = 0.516, P = 0.001). Receiver operating characteristic curve analysis revealed that average reading variability of 24-hour systolic blood pressure (>12.55) could predict microalbuminuria (sensitivity = 89.7%, specificity = 88.5%, area under curve = 0.949, P = 0.001). Short-term blood pressure variability correlated well with early renal effects in controlled hypertensive patients. Average reading variability of 24-hour systolic blood pressure was the strongest predictor for microalbuminuria in such patients.

Irbesartan Ameliorates Lipid Deposition by Enhancing Autophagy via PKC/AMPK/ULK1 Axis in Free Fatty Acid Induced Hepatocytes.

Irbesartan has shown significant therapeutic effects in hypertensive patients with non-alcoholic fatty liver disease (NAFLD). To determine the underlying mechanisms of its action, we established an in vitro model of NAFLD by treating human and mouse hepatocytes with free fatty acids (FFAs) and angiotensin (Ang) II. Irbesartan significantly reversed AngII/FFA-induced lipid deposition and mitochondrial dysfunction by restoring ATP production and the mitochondrial membrane potential (MMP), and decreasing the levels of reactive oxygen species (ROS) and inflammatory markers. In addition, irbesartan also increased the autophagy flux, in terms of increased numbers of autolysosomes and autophagosomes, and the upregulation and mitochondrial localization of the autophagic proteins Atg5 and LC3BII/I. Activation of protein kinase C (PKC) and inhibition of the autophagic flux exacerbated mitochondrial dysfunction in the steatotic hepatocytes. Furthermore, AngII upregulated PKC which inhibited AMPK phosphorylation via direct interaction with the AngII receptor AT1-R. Irbesartan inhibited PKC and activated AMPK and its downstream effector ULK1, thereby inducing autophagy, decreasing lipid deposition, and restoring mitochondrial function. Taken together, irbesartan triggers autophagy via the PKC/AMPK/ULK1 axis to ameliorate the pathological changes in the steatotic hepatocytes.

Genome-wide association study of white-coat effect in hypertensive patients

Background: White-coat effect (WCE) confounds diagnosis and treatment of hypertension. The prevalence of white-coat hypertension is higher in Europe and Asia compared to other continents suggesting that genetic factors could play a role.Methods: To study genetic variation affecting WCE, we conducted a two-stage genome-wide association study involving 1343 Finnish subjects. For the discovery stage, we used Genetics of Drug Responsiveness in Essential Hypertension (GENRES) cohort (n = 206), providing the mean WCE values from up to four separate office/ambulatory recordings conducted on placebo. Associations with p values <1 × 10−5 were included in the replication step in three independent cohorts: Haemodynamics in Primary and Secondary Hypertension (DYNAMIC) (n = 182), Finn-Home study (n = 773) and Dietary, Lifestyle and Genetic Determinants of Obesity and Metabolic Syndrome (DILGOM) (n = 182).Results: No single nucleotide polymorphisms reached genome-wide significance for association with either systolic or diastolic WCE. However, two loci provided suggestive evidence for association. A known coronary artery disease risk locus rs2292954 in SPG7 associated with systolic WCE (discovery p value = 2.2 × 10−6, replication p value = 0.03 in Finn-Home, meta-analysis p value 2.6 × 10−4), and rs10033652 in RASGEF1B with diastolic WCE (discovery p value = 4.9 × 10−6, replication p value = 0.04 in DILGOM, meta-analysis p value = 5.0 × 10−3).Conclusion: This study provides evidence for two novel candidate genes, SPG7 and RASGEF1B, associating with WCE. Our results need to be validated in even larger studies carried out in other populations.