Effective Antihypertensive Therapy Research Articles

Comparison of carotid intima media thicknesses of hypertension patients with normal coronary artery who are under effective antihypertensive therapy with the normal population

Aims: In this study, we aimed to compare the carotid intima media thickness in patients with treatment-regulated hypertension without coronary artery disease with the normal population. Methods: A total of 62 patients with normal coronary arteries detected after elective coronary angiography; 32 patients without hypertension and 30 patients with hypertension regulated by drug therapy were enrolled in the study. Results: In this study we conducted in our clinic, no statistically significant difference was found between carotid intima media thickness in the group whose hypertension was regulated by treatment, and in the control group. Conclusion: The fact that the carotid intima media thicknesses of patients with treatment-regulated hypertension without coronary artery disease were not found to be different compared to the healthy patient group suggests to us that effective antihypertensive therapy may slow down the atherosclerotic process.

Rapid Drop in Coronary Heart Disease Mortality in Czech Male Population-What Was Actually behind It?

The high mortality of coronary heart disease (CHD) among Czech men-one of the highest worldwide-began to decline in 1991 soon after the abolition of government subsidies to all foodstuffs rich in animal fat. As participants in the WHO MONICA Project, we were able to analyze the CHD risk factors just before and after this major economic change. We had previously documented that the originally subsidized prices decreased animal fat consumption and consequently non-HDL cholesterol concentrations in the population. By the early 1990s, no progress had been made in the treatment of acute myocardial infarction, statins were unavailable as was not the currently more effective antihypertensive therapy. Our recent research proved a close relationship between cholesterolemia and proinflammatory macrophages in adipose tissue and accelerated macrophage polarization with increased palmitate and palmitoleate contents in cell membrane phospholipids. By contrast, the proportion of proinflammatory macrophages decreases with increasing presence of n-3 fatty acids in the cell membrane. The combination of non-HDL cholesterol drop and a decreased proportion of proinflammatory macrophages due to replacement of alimentary fat decreased CHD mortality immediately.

Clinical efficacy of combination therapy of arterial hypertension in patients with chronic glomerulonephritis with different blood pressure salt sensitivity

Arterial hypertension is the main factor in the progression of CKD of any etiology; therefore, effective antihypertensive therapy is a crucial task of healthcare practice. In this work, the authors aim to study the comparative effectiveness of various types of combined antihypertensive therapy in patients with different blood pressure salt sensitivity.

Раміприл у пацієнтів з артеріальною гіпертензією як монотерапія або в комбінації з гідрохлортіазидом

На сьогодні розроблена ефективна антигіпертензивна терапія, що значно знижує ризик серцево-судинних ускладнень у пацієнтів з артеріальною гіпертензією (АГ). Одним із завдань терапії АГ є забезпечення контролю показників артеріального тиску нижче від цільових рівнів, що сприяє зниженню ризику серцево-судинної захворюваності та смертності. Застосування інгібіторів ангіотензинперетворювального ферменту є виправданим завдяки їх високій ефективності при лікуванні та профілактиці артеріальної гіпертензії, серцевої недостатності, захворювань нирок, а також діабетичної нефропатії. Основні дослідження з вивчення антигіпертензивної ефективності та безпеки використання раміприлу в пацієнтів із м’якою та помірною АГ довели переваги його призначення як препарату вибору в таких пацієнтів. Діуретики як клас стали практично ідеальними агентами при необхідності призначення другого препарату, оскільки вони потенціюють дію агентів усіх інших класів. Тому комбінація раміприлу з гідрохлортіазидом може розглядатися як одна з найбільш оптимальних у лікуванні пацієнтів з АГ.

Redukcja wahań ciśnienia za pomocą molekuły telmisartanu, w szczególności w kombinacji z antagonistą kanału wapniowego

1.28 billion people suffer from hypertension, and its complications cause 10 million deaths each year. Effective antihypertensive therapy is therefore one of the priority tasks of health care. Achieving good BP control depends on many factors, but one of the primary ones is the use of maximally effective therapy in the simplest possible regimen. Amlodipine in combination with telmisartan in the single-pill combination, through its high smoothness index, makes it possible to achieve a satisfactory hypotensive effect lasting 24 h when taken once daily. This combination is also a good alternative for cardiovascularly burdened patients who cannot use angiotensin-converting enzyme inhibitors and for elderly patients, especially after stroke

Soluble Klotho and Incident Hypertension.

Hypertension is associated with significant morbidity and mortality despite effective antihypertensive therapies. Soluble klotho is a circulating protein that in preclinical studies is protective against the development of hypertension. There are limited studies of klotho and blood pressure in humans. Within the Health, Aging, and Body Composition Study, a cohort of well-functioning older adults, soluble klotho was measured in serum. We evaluated the cross-sectional and longitudinal association between klotho and blood pressure, prevalent hypertension, incident hypertension, and BP trajectories. Analyses were adjusted for demographics, cardiovascular disease and kidney disease risk factors, and measures of mineral metabolism including calcium, phosphate, parathyroid hormone, 25(OH) vitamin D, and fibroblast growth factor 23. The median klotho concentration was 630 pg/ml (478-816, 25th to 75th percentile). Within the cohort, 2093 (76%) of 2774 participants had prevalent hypertension and 476 (70%) of the remaining 681 developed incident hypertension. There was no association between klotho and prevalent hypertension or baseline systolic BP, but higher klotho was associated with higher baseline diastolic BP (fully adjusted β=0.92 mmHg, 95% confidence interval, 0.24 to 1.60 mmHg, higher per two-fold higher klotho). Higher baseline serum klotho levels were significantly associated with a lower rate of incident hypertension (fully adjusted hazard ratio, 0.80; 95% confidence interval, 0.69 to 0.93 for every two-fold higher klotho). Higher klotho was also associated with lower subsequent systolic BP and diastolic BP (-0.16, 95% confidence interval, -0.31 to -0.01, mmHg lower systolic BP per year and -0.10, 95% confidence interval, -0.18 to -0.02, mmHg lower diastolic BP per year, for each two-fold higher klotho). Higher klotho is associated with higher baseline diastolic but not systolic BP, a lower risk of incident hypertension, and lower BP trajectories during follow-up.

Анализ гиполипидемической терапии у больных артериальной гипертензией

Артериальная гипертензия (АГ) и нарушения липидного обмена являются одними из главных причин неблагоприятного сердечно-сосудистого прогноза, каждая из которых способствует развитию и прогрессированию заболеваний, связанных с атеросклерозом. У многих пациентов эти факторы риска присутствуют вместе. В статье на основании клинического случая обоснована необходимость назначения статинов больному с артериальной гипертензией. Приведены клинический случай наблюдения и лечения АГ у 47-летнего пациента с дислипидемией на разных временных этапах с последующим анализом современной информации о комбинации статинов и антигипертензивных средств — сартанов в процессе ведения пациентов высокого кардиоваскулярного риска. После нескольких лет эффективного антигипертензивного лечения артериальное давление больного стабилизировалось на целевых уровнях. Он бросил курить, нормализовал массу тела. Осталась асимптомная дислипидемия, которую он медикаментозно не контролировал. Во время предпоследнего визита у пациента был обнаружен неокклюзивный атеросклероз сосудов нижних конечностей, протекающий асимптомно. С учетом признаков сосудистого атеросклероза пациент попадает в группу высокого кардиоваскулярного риска. Ему нужно назначить интенсивную статинотерапию. В этом случае важно выбрать наиболее эффективный и безопасный препарат и соответствующую дозу. При просмотре клинического случая комбинированного лечения нашего пациента кандесартаном (Кантаб) и аторвастатином (Толевас) следует обратить внимание на два момента, спровоцировавшие развитие периферического атеросклероза. Во-первых, к нам обратился пациент молодого возраста с симптомами гипертонии, которые считались основными для постановки диагноза и выбора терапии. В результате он и получал достаточно эффективное антигипертензивное лечение. Сопутствующая дислипидемия имела субклинический характер, и пациент самостоятельно перестал принимать статины. Высокий общий холестерин считался только фактором риска. Во-вторых, в своих медицинских рекомендациях мы руководствовались критериями оценки степени кардиоваскулярного риска у больных с АГ (Приказ МЗ Украины от 24.05.2012 № 384) и поэтому не настаивали на некоторых этапах лечения интенсивной статинотерапии, как это рекомендуется европейскими и североамериканскими рекомендациями 2017 года.

ASSOCIATION BETWEEN HYPERTENSION AND CHILD BURNS

Abstract Objective: Although systemic arterial hypertension has been recognized as a common complication of thermal injury. In children, its pathophysiological characteristics have not been defined. The aim of this study was to assess the incidence of hypertension in such patients and identify the risk factors for its development and its influence on the clinical outcome. Design and method: We conducted a retrospective study in the national burn center of the Hospital University IBN ROCHD of Casablanca between September 2019 and January 2020 including 120 childs suffering from different types of burns. Results: 24 patients developed hypertension (20%) wich occurred most frequently in boys and in the age group of 7 to 12 years. The incidence increases with the severity of the burn up to a total surface area of 40%. Four of the 30 patients developed hypertensive encephalopathy and epileptic seizures. We didn’t found any correlation between hypertension and mortality in our study. And according to our results hypertension could not be related to the location of the burn, drug treatment or differences in transfusions. Conclusions: Monitoring daily blood pressure showed that hypertension is limited to the phase treatment of burns and blood pressure levels normalized after complete autologous transplantation. Encephalopathy and seizure problems seek the need for careful monitoring of blood pressure and effective antihypertensive therapy in children with burns.

ASSOCIATION OF ARTERIAL HYPERTENSION AND BLOOD PRESSURE WITH MORTALITY AMONG POPULATION AGED 55 YEARS AND OLDER, ACCORDING TO ANTIHYPERTENSIVE TREATMENT

Objective: Objective: to evaluate relationship of arterial hypertension (AH), elevated blood pressure (BP) and all-cause and cardiovascular disease (CVD) mortality among Muscovites aged 55 years and older according to antihypertensive therapy. Design and method: Methods: data of 1876 Muscovites 55 years and older (47.9% males) from the prospective population-based cohort study named the Stress, Aging and Health in Russia (SAHR) was used. The elevated BP was defined as BP > = 140/90 mmHg. AH was diagnosed according to European Society of Cardiology Guidelines. The treatment of hypertension was defined as the current use of a prescribed medication intended to lower BP, the effective treatment – as the presence of SBP < 140 mmHg and DBP <90 mmHg among treated participants. During the follow-up period (mean – 8,5 years) 547 deaths, including 330 from CVD, were identified. Hazard proportional risk model (Cox) was applied for hazard risks (HR) evaluation with 95%CI. Results: Results: the prevalence of AH and elevated blood pressure was 73,9% and 53,4%, respectively. After adjusting for age and sex AH had no significant associations with all-cause and CVD mortality (HR = 1,2; 95% CI: 0,98–1,5; p = 0,07; HR = 1,24; 95% CI: 0,94–1,64; p = 0,1). Whereas elevated BP was significantly associated with all-cause and CVD mortality (HR = 1,31; 95% CI: 1,10–1,55; p = 0,003, HR = 1,40; 95% CI: 1,12–1,75; p = 0,004). Moreover there was the strong contribution of elevated BP to all-cause mortality (HR = 1,39; 95% CI: 1,10–1,77; p = 0,006) and CVD mortality (HR = 1,55; 95% CI: 1,14–2,10; p = 0,005) among those who received antihypertensive therapy after adjustment to sex and age. Receiving antihypertensive therapy had no associations with all-cause and CVD mortality (p > 0,05). At the same time, the effective antihypertensive therapy reduced risk of all-cause and CVD mortality by 28% and 35%, respectively (HR = 0,72; 95% CI: 0,57–0,91; p = 0,006; HR = 0,65; 95% CI: 0,48–0,88; p = 0,005). Conclusions: Although AH is an important risk factor of CVD, among population aged 55 years and older only the elevated levels of BP and antihypertensive therapy efficacy were associated with all-cause and CVD mortality.

Scleroderma nephropathy: unsolved problems

Kidney injury is a common pathology in the group of patients with systemic sclerosis. At least half of the patients show histological signs of it. Acute condition is known as scleroderma renal crisis. Although discussions regarding the risk factors for scleroderma renal crisis are open, most researchers consider the following factors: female sex, previous proteinuria and hypertension, the presence of anti-RNA polymerase III antibodies, and a decrease in lung diffusion capacity ≤75%. Diagnostic criteria for scleroderma renal crisis include an acute increase in blood pressure, accompanied by acute renal failure and abnormalities in the urinary sediment, anemia, and thrombocytopenia. Treatment of scleroderma renal crisis entails decreasing blood pressure, mainly with short-acting angiotensin-converting enzyme inhibitors, followed by selecting effective antihypertensive therapy. Further research of new treatment approaches is being carried on: the use of endothelin receptor antagonists (bosentan), monoclonal antibodies against the complement component 5 (eculizumab). Despite the approved strategies for identifying risk factors for scleroderma renal crisis development and treatment approaches, this group of patients is still characterized by high rates of mortality, the need for renal replacement therapy, and kidney transplantation. Thus, the problem of kidney injury in systemic sclerosis remains relevant.

Indian Nationalism and its Challenges in the Right-Wing Era of Politics

Background: As a leading cause of morbidity and mortality, Hypertension is a pressing global concern. Adherence to antihypertensive is a cornerstone of effective antihypertensive therapy. However, suboptimal medication adherence is widespread. Mobile health technology i.e. text messaging is a promising tool that can promote medication adherence with a wide-reaching effect on population health. Aims: To critically assess the effectiveness of text-based messaging interventions for improving medication adherence among community-dwelling adults with Hypertension. Methods: Studies were identified through a detailed search of six databases by two independent reviewers: PubMed, Embase, Cochrane, PsycINFO, CINAHL and Scopus. Studies included were: (1) published in English, since 2000; (2) randomised controlled trials; (3) done on community-dwelling adults diagnosed with Primary/ Essential Hypertension; (4) utilised 1 or 2-way text messaging, tailored text messaging, interactive voice response and text-based mobile applications; and (5) with medication adherence-related outcomes. Data extraction was conducted based on the Cochrane Handbook for Systematic Reviews of Intervention, and relevant studies underwent a study appraisal using the Cochrane Risk of Bias Tool. Results: Twelve studies were included in the final review. Text-based messaging interventions exhibited a small statistically significant effect on medication adherence scores and systolic blood pressure reduction while the effect on controlled blood pressure and adherence remains uncertain. Subgroup analyses revealed having a multifaceted content on Hypertension management may be more effective than solely medication adherence content and or reminders. Significance of the study: There is limited evidence that text messaging-based interventions resulted in improved medication adherence and blood pressure control as a result of adherence. With the rise of mobile health, future studies exploring the cost effectiveness and feasibility of tailored and interactive text messaging interventions are warranted to influence the use of public health resources into the development of communication tools as a public health strategy for promoting medication adherence.

Three-year dynamics of left ventricular structural parameters in patients with resistant arterial hypertension on four-component therapy

Aim. To study the three-year dynamics of left ventricular (LV) structural parameters with the four-component antihypertensive therapy in patients with resistant arterial hypertension (RAH). Material and methods. A total of 102 patients with true RAH were included. The duration of the treatment was 3.2 ± 0.1 years. Patients received triple single-pill combination of antihypertensive drugs (TSPC), which was alternately added by spironolactone, eplerenone, moxonidine, torasemide, or nebivolol for three-months treatment. Than patients received the TSPC with an addition of the most effective of the four medications listed. Office and ambulatory blood pressure (BP) measurements and echocardiography were performed, clinical characteristics; specifics of neurohumoral and proinflammatory status were assessed. Results. The patients were divided into 2 groups according to the changes in LV mass index (LVMI) within three years. The 1 st group included 68 patients who demonstrated regression of LV hypertrophy (LVH). The 2 nd group included 28 patients who had LVMI unchanged or increased. LVMI was normalized in 38.2 % of patients, and a degree of LVH was reduced from severe to moderate in 61.8 % of patients in achieving the target BP level in 44 % of patients and restoring the physiological 24-hour BP rhythm in 39 % of patients. In the 2 nd group, 28.6 % of patients achieved BP targets; a large proportion of them were patients with concomitant coronary heart disease (42.3 %) and chronic kidney disease (64.3 %). Conclusions. Effective antihypertensive therapy providing 24-hour BP control and restoring the physiological 24-hour BP rhythm contributes to LVH regression in 66.7 % of patients with RAH. Higher baseline LVMI (β = 0.655; P < 0.0001) and plasma active renin (β = 0.442; P = 0.005), lower 24-hour urinary albumin excretion rate (β = -0.475; P < 0.0001) are independent predictors of LVH regression in RAH patients.

Association of renal cyst and type A acute aortic dissection with hypertension

BackgroundType A acute aortic dissection (TA-AAD) has high mortality, with 50% of patients dying before hospital admission. Hypertension is the most common comorbidity for acute aortic dissection, and effective antihypertensive therapy is still unable to predict the risk of aortic rupture at the medium- and long-term stages. While the presence of renal cyst has been found to increases the risk of thoracic aortic disease, the correlation between renal cyst and TA-AAD with hypertension remains poorly understood. Thus, this study aimed to determine the relationship of renal cyst and TA-AAD with hypertension.MethodsA retrospective analysis was performed in 464 hypertension patients from August 2014 to August 2019. A total of 230 TA-AAD patients were enrolled in the AD with hypertension group (age 53.79±11.31 years, male 90.87%), and matched by age, sex, and hypertension control to 234 patients without TA-AAD who were enrolled in the non-AD with hypertension group. Patients were divided into three subgroups according to the numbers of renal cysts: no renal cyst, single renal cyst, and multiple renal cysts.ResultsIn this study, the AD with hypertension group had significantly more single renal cyst and multiple renal cyst cases than did the non-AD with hypertension group. The mean age of the multiple renal cyst subgroup was significantly older than that of the single renal cyst subgroup (57.25±13.00 vs. 51.57±10.75 years) in the AD with hypertension group. There was significantly different distribution of dissection starting points and dissection ending points across three renal cyst subgroups. Multivariate logistic regression analysis indicated that having no renal cyst significantly decreased the risk of TA-AAD in middle-aged and elderly patents, but showed no correlations with those of younger ages. Single renal cyst status also significantly decreased the risk of TA-AAD in elderly patients [odds ratio (OR) =0.129, 95% confidence interval (CI): 0.029–0.575, P=0.007].ConclusionsRenal cyst status correlates with the risk of TA-AAD with hypertension in middle-aged and elderly patients, and exhibits different degrees of vascular lesion in aortic dissection. We therefore suggest that different antihypertensive standards should be adopted in different renal cyst status to more effectively prevent aortic dissection.

Relationship between the expression of angiotensin II receptors type 1 and vasoactive regulators in arterial hypertension

In the pathogenesis of arterial hypertension (AH), the renin-angiotensin-aldosterone system plays a key role in helping to maintain elevated blood pressure. At the same time, the state of angiotensin-II production (AT II) and the expression level of its receptors on target cells determine the formation of most of the effects underlying the pathogenesis of associated clinical conditions in such patients. Thus, the study of the pathogenesis of AH, namely the study of the role of the AT II axis, the AT II receptor, is an actual scientific and practical task.&#x0D; Aim. Given the important role of type 1 receptors for AT II in the formation of pathological changes in arterial hypertension, the purpose of this study was to study the peculiarities of the effect of their expression on biochemical processes in patients with arterial hypertension.&#x0D; Material and methods. In the course of the clinical study, 60 patients of both sexes with hypertension aged 45 to 55 years old were admitted to the clinic for planned treatment. Depending on the initial level of expression of receptors for AT II (AT1R), determined by the serum concentration of the soluble form of type 1 receptors for AT II, the patients were divided into two subgroups with conditionally low (corresponding to the concentration of the soluble form of the receptor for AT II 0.66 ng/ml) and conditionally high (1.57 ng/ml) expression. The analysis showed that high expression of AT1R is associated with elevated plasma levels of renin by 30.8% (p=0.0005), AT II by 48.1% (p=0.00001), E-selectin by 47.9% (p=0.0001), VCAM-1 by 29.1% (p=0.00001), ICAM-1 by 52.9% (p=0.00001), VE-cadherin by 50.9% (p=0.00001), endothelin-1 by 48.8% (p=0.0005), an ACE inhibitor by 13.6% (p=0.047), and CRP by 74.1% (p=0.00002 ) and endoperoxide by 29.7% (p=0.009). Against this background, there was a decrease in the level of apoA1 by 21.6% (p=0.027), ACE by 20.1% (p=0.1), the level of antioxidants by 22.3% (p=0.00001). The analysis showed that in the group with initially high expression of AT1R, there was an increased blood pressure, the level of which, on average, exceeded the values of patients with low expression of the indicated receptor by 24.5 mm Hg (p=0.011). Against the background of therapy in the group with high expression of AT1R, plasma renin activity decreased by 20.3% (p=0.013), endoperoxide by 8.4% (p=0.038), an ACE inhibitor by 14.6% (p=0.02). At the same time, the level of apoA1 increased by 8.5% (p=0.036), antioxidants by 8.6% (p=0.036), ICAM-1 by 5.3% (p=0.05), VE-cadherin by 2.5% (p=0.07). The level of the remaining factors was not statistically significant. In the subgroup with low expression of the AT II receptor, during treatment, there was a decrease in endoperoxide by 12.8% (p=0.031), an ACE inhibitor by 5.5% (p=0.044) without significant changes in other indicators.&#x0D; Conclusion. In hypertensive patients, higher expression of AT1R is associated with high activation of immune-inflammatory mechanisms, dyslipidemia, an imbalance of the lipid peroxidation system and antioxidant protection, as well as higher renin-angiotensin-aldosterone system activity and increased arterial pressure. On the background of antihypertensive therapy, partial compensation of the identified changes is achieved, including a moderate increase in the level of antioxidants, a decrease in the concentration of endoperoxide, renin activity and an increase in the level of apoA1, while maintaining an increased level of AT II, high expression of receptors to it. These changes indicate the need for further search for effective antihypertensive therapy strategies aimed at limiting the activity of renin-angiotensin-aldosterone system in patients with hypertension.

Abstract 15700: Targeted Nanoparticle Delivery of a Protein Arginine Deiminase-4 Inhibitor Limits Arterial Intimal Netosis and Preserves Endothelial Integrity in Mouse Arterial Erosion-like Injury

Introduction: Superficial plaque erosion has emerged as a growing cause of residual thrombotic complications of atherosclerosis in an era of effective lipid lowering, anti-hypertensive therapy, and smoking cessation. The mechanisms of plaque erosion remain poorly understood, and we currently lack validated effective diagnostics or therapeutics for superficial erosion. Lesions complicated by erosion have a rich extracellular matrix, sparse lipid, and few mononuclear cells, but do harbor neutrophil extracellular traps (NETs). We recently reported that NETs amplify and propagate the endothelial damage at the site of arterial lesions that recapitulate in mice elements of superficial erosion. We previously showed that genetic loss of protein arginine deiminase (PAD)-4 function inhibited NETosis and preserved endothelial integrity. Hypothesis: We hypothesized that Col IV-targeted NPs (Col IV-NPs) can deliver PAD4 inhibitors selectively to regions of EC sloughing and collagen IV-rich basement membrane exposure, and attenuate the amplification, persistence, and propagation of superficial erosion and consequent thrombosis. Methods: We developed Col IV-NPs to deliver PAD4 inhibitors selectively to regions of endothelial cell sloughing and collagen IV-rich basement membrane exposure using our validated experimental preparation that reproduces in mice some of the conditions ascribed to lesions associated with superficial erosion. Results and Conclusions: We first demonstrated the binding of the targeting ligand in vitro and evaluated Col IV NP targeting towards areas of denuded endothelium in vivo in this mouse preparation. Delivery of the PAD4 inhibitor GSK484 as cargo in these nanoparticles reduced NETs release at sites of eroded areas. Compared to non-targeted NPs, Col IV NPs showed a 1.8-fold increased accumulation at regions of endothelial injury (p&lt;0.0001). When loaded with the PAD4 inhibitor GSK484, Col IV NPs effectively reduced NET accumulation by 2.5 fold at sites of intimal lesions (p&lt;0.01) and preserved endothelial continuity (a 4-fold increase in endothelial continuity percentage, p&lt;0.001). These results indicate the feasibility of using nanotechnology to address the unmet need of specific therapy for superficial erosion.

Effective antihypertensive therapy: focus on adherence management

High medical adherence is a prerequisite for achieving goals in the treatment of hypertension (HTN). The majority of patients with HTN showed low adherence to treatment, which requires finding ways to solve this problem. This review describes the factors influencing adherence, ways of its assessment, and analyzes methods of increasing medical adherence in hypertensive patients. Noteworthy is the lack of publications describing the effectiveness of methods for increasing long-term (&gt;2 years) adherence in hypertensive patients. The review also describes a not fully clear individualized approach, which consists in choosing a therapy regimen based on levels of medical adherence, medical follow-up and lifestyle modification.

Patients' Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study.

BackgroundWorldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support.ObjectiveThe aim of this study is to explore patients’ experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension.MethodsA qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data.ResultsParticipants’ age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients’ experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence.ConclusionsThe study’s findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study’s findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients.

Prevalence and Characteristics of Blood Pressure Phenotypes in Patients with Hypertension and Chronic Respiratory Diseases (Study of Ambulatory Practice Data of a Cardiologist)

Diagnosis of the blood pressure (BP) phenotype is the most important indication for its ambulatory measurement because BP phenotype is associated with cardiovascular complications and death. The study of BP phenotypes is important for patients with hypertension (HT) and comorbidity, including asthma and chronic obstructive pulmonary disease (COPD). The combination of HT with these lower airway diseases (LAD) leads to the mutual influence of pathologies creates difficulties in the drugs choice and may affect BP phenotype in HT patients.Aim. To compare in the prospective investigation various characteristics of BP phenotype in HT patients considering LAD (asthma or COPD).Material and methods. The prospective cohort study of ambulatory patients with HT (n=156) was carried out. The part of these patients had asthma or COPD (n=69). The clinical measurements and 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, standard examination were performed, initially and after 12 months. BP phenotype were determined by the ratio of clinical BP and ambulatory BP considering their threshold values. Standard statistical methods and multivariate analysis were used.Results. Patients with LAD had 2 times more often prognostically unfavorable phenotypes: ineffective antihypertensive therapy (AHT) 37.3% vs 15.7% and masked AHT inefficiency 7.5% vs 4.5%; white coat HT on treatment (WCH) and effective AHT were less common(29.9% vs 42.7%; 25.5% vs 37.1%, respectively, p 148 mm Hg (b=2.733, p=0.040), LAD (b=1.015, p=0.011), serum total cholesterol (b=0.350, p=0.043), degree of nighttime diastolic BP decrease (for 13.1-18.0% b=-2.130, p=0.004; for 18.1-24.0% b=-2.509, p=0.001). The factors associated with masked AHT inefficiency in comparison to effective AHT were heart rate in orthostasis &gt;87 beats/min(b=3,512, p=0.006) and SBP in orthostasis 141-148 mm Hg (b=3.405, p=0.004).Conclusion. The prevalence of prognostically unfavorable BP phenotypes (ineffective AHT and masked AHT inefficiency) is two times higher in HT patients with LAD. The first is associated with LAD presence, sex, and serum cholesterol; both phenotypes interrelated with hemodynamic parameters including degree of nighttime diastolic BP decrease. We found no association between AHT and LAD therapy with the BP phenotypes in this study. However, larger works in this area are required, including analysis of outcomes in long-term prospective studies.

Renin angiotensin system inhibition attenuates adipocyte-breast cancer cell interactions

Obesity is a significant breast cancer (BC) risk factor and is associated with 20–40% increased risk in obese post-menopausal women compared to their lean counterparts. Several obesity-related metabolic dysregulations have been linked to BC risk, including overactivation of the renin-angiotensin system (RAS). Currently, RAS inhibitors including angiotensin converting enzyme inhibitor (ACEi) and AT1 receptor blockers (ARBs), are used as safe and effective anti-hypertensive therapies in BC patients. However, it is uncertain how inhibition of RAS in adipose tissue impacts obesity-BC crosstalk. We hypothesized that adipose RAS inhibition will reduce BC cell motility and inflammation. We determined (1) the direct effects of Ang II, ACEi (captopril; Cap) or ARB (telmisartan; Tel) on receptor positive MCF-7 and receptor triple negative MDA-MB-231 cells; and (2) the effects of conditioned media (CM) from human mesenchymal stem cells differentiated into adipocytes, which were pretreated with RAS inhibitors, on BC cells. We demonstrated that direct treatments of BC cells with Ang II, Cap or Tel did not alter inflammatory cytokines in either BC cell line. However, CM from Ang II-pretreated adipocytes significantly increased secretion of pro-inflammatory markers at protein level. RAS inhibitors reduced their secretion in MDA-MB-231, but not in MCF-7 cells. Additionally, CM from adipocytes treated with RAS inhibitors significantly reduced markers of inflammation, fat synthesis, and angiogenesis in both BC cell lines. Furthermore, CM from ACEi pretreated adipocytes reduced cell motility in both BC cell lines. Findings from our study indicate an important role of adipose RAS inhibition in adipocyte and BC cell crosstalk.

Barriers to effective outpatient hypertension treatment: a view of physicians and patients

Aim. To study the opinion of primary care physicians and hypertensive (HTN) outpatients with different compliance rate on factors preventing effective antihypertensive therapy (AHT).Material and methods. Primary care physicians and HTN outpatients were questioned. Questionnaires for physicians and patients included informative and survey parts, with a list of possible factors aggravated adherence to treatment. The assessment was carried out using visual analogue scale. The patient questionnaire also included questions about AHT and the eight-item Morisky Medication Adherence Scale (MMAS-8). The calculation was carried out with a 95% confidence interval (CI).Results. The survey involved 298 physicians and 517 patients. Among patients, about 1% had a high compliance rate, 34% — moderate, 65% — low. In all groups, AHT did not significantly differ and was characterized by a low frequency of prescribing fixeddose combinations (27,1%). According to physicians, the most significant and equivalent are the economic aspects of treatment — 7,9±2,1 (95% CI: 7,51-8,38), the need for lifestyle change — 7,9±2,4 (95% CI: 7,37-8,38) and, to a slightly lesser extent, psychological aspects 6,8±2,2 (95% CI: 5,43-6,43). The economic aspects of treatment and need for lifestyle change were also most significant factors according to patients with high (8,8±1,8 (95% CI: 7,23-10,37) and 8,4±1,7 (95% CI: 6,93-9,87), respectively) and low (95% CI: 6,4±3,0 (5,65-7,07) and 6,2±2,8 (95% CI: 5,5-6,82) respectively) compliance rates. For patients with moderate compliance rate, the most significant and almost equivalent factors were the need for lifestyle change — 5,6±3,3 (95% CI: 4,53- 6,71), the need for regular visits — 5,6±3,1 (95% CI: 4,53-6,58) and the need for selfmanagement — 5,6±2,8 (95% CI: 4,63-6,48).Conclusion. The results obtained make it possible to forecast the compliance rate of patients with HTN, and, therefore, direct more efforts to those with a low rate, thereby increasing the effectiveness of AHT.