Effective Management Of Hypertension Research Articles

Exploring the association of adverse drug reactions with medication adherence and quality of life among hypertensive patients: a cross-sectional study.

Effective hypertension management requires medication adherence to prevent complications. However, adverse drug reactions (ADRs) can undermine adherence and negatively affect patients' quality of life. Limited research has explored the association between ADRs, medication adherence, and health-related quality of life (HRQoL) in individuals with hypertension. To investigate the association between ADRs, medication adherence, and HRQoL among patients with hypertension. A cross-sectional study using telephone interviews and medical record reviews was conducted in 11 primary care facilities in Indonesia. The causality of reported ADRs was assessed using the Naranjo algorithm, validated by a panel of experts in pharmacy practice and medication safety. The severity of ADRs was classified using the Hartwig scale. Adherence to antihypertensive drugs was estimated using the Medication Adherence Report Scale-5 (MARS-5). The EuroQoL EQ-5D-5L was used to measure HRQoL. The association between ADRs and medication adherence was assessed using multivariate logistic regression, while the association with HRQoL was evaluated through the Tobit regression model. A total of 507 patients were included in this study. We found that 20.32% (n = 103) of the patients experienced ADRs, with the most commonly reported ADRs being polyuria and urgency, gastrointestinal symptoms, leg swelling, dizziness/hypotension, palpitations, and dry cough. The majority experienced mild ADRs (n = 75, 72.82%), while 27.18% (n = 28) had reactions of moderate severity. Experiencing ADRs was associated with reduced medication adherence (adjusted odds ratio (OR) 7.15, 95% CI 4.07-12.55) and decreased HRQoL (coefficient: - 0.037). Patients experiencing ADRs were seven times more likely to be non-adherent to their medication regimen and reported a reduced quality of life compared to those without ADRs, placing them at a higher risk of suboptimal treatment outcomes. This finding highlights the need for additional monitoring and education for patients affected by ADRs, particularly through more frequent clinical and laboratory assessments, timely management of ADRs, and personalized education on the importance of adherence to prevent hypertension-related complications.

Effect of bioactive compounds of Mucuna pruriens on proteins of Wnt/β catenin pathway in pulmonary hypertension by in silico approach.

Modulation of theWnt/β-catenin signaling pathway may aid in discovering new medications for the effective management of pulmonary artery hypertension (PAH). Given the therapeutic potential of Mucuna pruriens in several diseases, the present study aimed toanalyze interactions of different bioactive compounds of Mucuna pruriens plant seeds with Wnt/β-catenin pathway targeting its various components like Wnt 3a, Frizzled 1, LRP 5/6, β-catenin, Disheveled, cyclin D1 by in silico analysis. The proposed work is based on computational analysis including ADME/T properties, by a Swiss ADME server. To understand the molecular interaction pattern Schrodinger, suit a stand-alone software was used to predict the interaction of bioactive molecules of Mucuna Pruriens with target proteins that are involved in Wnt/ β catenin pathway. Further, the simulation pattern of the top docked complex was subjected to MD simulation in Desmond for 100ns. Bioactive molecules from Mucuna Pruriens have drug-like properties and minimal toxicity. Further, the docking study revealed that among the nine compounds, three compounds (Gallic acid, L-dopa, and β-sitosterol) showed good interaction with target proteins. As gallic acid showed good interaction with all target proteins, the docked complex was subjected to MD simulation which was stable throughout the simulation time in terms of RMSD and RMSF. These findings suggest that the bioactive molecules of Mucuna pruriens compounds have potential therapeutic value in the treatment of pulmonary vascular disease. Further, in vivo and in vitro studies are necessary to determine its efficacy and validate its pharmacological activity conclusively.

Impact of Non-Compliance with Antihypertensive Medication on Stroke Incidence

Background: Hypertension is a major risk factor for stroke. Effective management of hypertension through medication adherence is crucial in preventing stroke events. However, non-compliance with antihypertensive medication remains a significant challenge, leading to adverse health consequences. Aim of the study: The aim of this study was to evaluate the impact of non-compliance with antihypertensive medication on stroke incidence. Methods: This descriptive cross-sectional study was conducted in Department of Medicine and Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh from March 2010 to August 2010. Total 120 patients who were diagnosed with stroke were selected for the study. Result: The majority of participants were aged 51-60 (35.8%) and the mean age was 54.6 years (SD 4.3). Males (57.5%) outnumbered females (42.5%), with a male-to-female ratio of 1.38:1. Age and sex distributions were significantly different (p < .001). Cerebral infarction was the most common stroke type (62.5%). Most participants (65.0%) were known hypertensive, with 11.7% newly diagnosed and 23.3% normotensive. Among hypertensive patients, non-compliance was high (71.8%). In hypertensive stroke patients, non-compliance was associated with higher rates of cerebral infarction (37.2% vs. 20.5%) and cerebral hemorrhage (33.3% vs. 6.4%). Subarachnoid hemorrhage and hemorrhagic transformation were rare. The overall Chi-square test was significant (p < .001). Recurrent stroke was more common in non-compliant patients (68.8% vs. 31.3%). The Chi-square test was significant (p < .001). Conclusion: Non-compliance was strongly associated with increased risk of both cerebral infarction and cerebral hemorrhage, underscoring the importance of consistent medication adherence.

Control of arterial hypertension in the context of metabolically-associated disease: challenges and opportunities in Ukraine

Abstract Background/Introduction Arterial hypertension is a prevalent, but modifiable cardiovascular (CV) risk factor. Effective control of blood pressure (BP) is associated with decreased rates of CV morbidity and mortality, as was convincingly demonstrated in randomized clinical trials. There is a substantial gap between BP control in clinical trials and real clinical practice due to multiple factors – e.g. lack of awareness, low medication compliance, side effects of medications, and insufficient availability of medical care – to name the few. The association between poor BP control and metabolically associated disease (MAD) like diabetes and obesity is widely acknowledged and considered the key challenge in effective management of arterial hypertension. Purpose To determine patterns of awareness and control of arterial hypertension in the context of MAD in Ukrainian outpatient patient sample. Methods We enrolled 309 subjects (108 with MAD and 201 without MAD). MAD was defined as the presence of type 2 diabetes and/or overweight/obesity. All subjects were consented for the structured interview and triple sitting BP measurement with an automated device. Results MAD-positive and MAD-negative groups were comparable by age (54.4±1.34 vs 51.8±1.2 years, p=0.29), systolic BP (141.3±2.0 vs 137.4±1.6 mm Hg, p=0.082), diastolic BP (85.2±1.2 vs 82.5±0.9 mm Hg, p=0.13). Presence of MAD was associated with increased odds of having BP>139/89 mm Hg (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.04-2.67, p=0.035), better awareness on hypertension (OR 2.65, CI 1.64-4.28, p=0.0001), and less prevalent normotension (OR 0.51, CI 0.31-0.84, p=0.008). Among MAD-positive patients without history of HTN, 50% actually had elevated office BP, although it did not reach statistical significance as compared to MAD-negative subjects (OR 1.32 CI 0.68-2.56, p=0.42, see Picture 1). Less MAD-positive patients did not take any antihypertensive drugs (37.0% vs 56.7%, difference -19.7%, CI -8.03 to -30.51%, p=0.001), and more of them were taking 3 antihypertensive drugs (17.6% vs 7.5%, difference 10.1% CI 2.58-18.85. p=0.007). Only 53.7% of MAD-positive subjects and 39.8% of MAD-negative subjects claimed they were taking BP-lowering medications on a regular basis (p=0.02). There was no difference in achievement of BP control between MAD-positive and MAD-negative groups (39.2 vs 38.7% for subjects who were aware of HTN, 31.9 vs 31.3% of all hypertensive individuals, p=NS for both). More MAD-positive than MAD-negative subjects admitted they consume alcohol several times per week or daily (22.2 vs 12.4%, p=0.025). Conclusions MAD disease is associated with more prevalent HTN and better awareness on elevated BP. MAD requires more intensive BP-lowering therapy to achieve target BP, but the compliance to medications is suboptimal.Patterns of awareness and BP control

Systematic Review: Comparative Efficacy and Safety of Losartan vs. Candesartan for the Treatment of Hypertension

Hypertension is one of the most significant modifiable risk factors for cardiovascular disease (CVD) and remains a leading cause of morbidity and mortality globally. Effective management of hypertension is essential for preventing comp lications such as stroke, myocardial infarction, and heart failure. Angiotensin II receptor blockers (ARBs) like losartan and candesartan are well-established therapeutic options for blood pressure (BP) control and are widely prescribed due to their favorable side-effect profiles and organ-protective properties. Despite being members of the same drug class, these ARBs differ in their pharmacokinetics, receptor binding affinity, and clinical efficacy. This systematic review aims to provide a detailed comparison of the efficacy and safety of losartan versus candesartan in managing hypertension. We conducted a comprehensive search of the PubMed, Embase, and Cochrane databases, retrieving studies published from 2000 to 2024 that compared the two ARBs directly in hypertensive populations. A total of 25 randomized controlled trials (RCTs) and observational studies, comprising more than 12,000 participants, were included in the analysis. The primary outcomes evaluated were the reduction in systolic and diastolic blood pressure, cardiovascular event prevention, and adverse event profiles. The results suggest that both losartan and candesartan effectively lower BP, but candesartan consistently demonstrated greater reductions in both systolic and diastolic BP compared to losartan. Candesartan also appeared to have superior cardiovascular outcomes, with a lower incidence of major cardiovascular events such as stroke, myocardial infarction, and heart failure hospitalizations. The safety profiles of both drugs were comparable, though losartan was associated with a slightly higher incidence of cough and discontinuation due to adverse events. Overall, candesartan may offer a slight clinical advantage over losartan, particularly in patients requiring more potent or sustained BP control. However, both drugs remain valuable options in the management of hypertension. Further long-term studies are recommended to confirm these findings and to investigate the potential benefits of each drug in specific patient subgroups.

Analysis of medication adherence of chronic hypertensive patients in Pakistani community via open survey method

Aim: Hypertension, a prevalent chronic condition, significantly contributes to cardiovascular diseases worldwide. Effective management of hypertension is highly dependent on patient adherence to prescribed medications, as the correct dose at the right time can lead to desirable therapeutic results. This study aims to analyze medication adherence among hypertensive patients in Islamabad and Rawalpindi through an open survey. Methods: A prospective cross-sectional study was conducted from 17th March 2024 to 30th May 2024, targeting hypertensive populations in Islamabad and Rawalpindi. 246 patients were recruited using a sample size formula, and a General Medication Adherence Scale (GMAS) questionnaire was used to collect data. All the tests were conducted as two-sided, with a significance level of P < 0.05 using Python. Results: Among 246 participants (mean age 57.1 years), most were married, literate, and living with families, 63% were from Islamabad, and 78.9% were employed. The study found high adherence in behavior-related areas but low adherence due to costs. Gender showed a statistically significant correlation (P = 0.03) by independent t-test. At the same time, ANOVA tests revealed that educational level (P = 0.02), monthly income (P = 0.001), family support (P = 0.04), and medication costs (P = 0.001) significantly impacted adherence, while factors like social status, employment status, and smoking did not have a considerable influence. Conclusions: 72.4% of patients adhered to their prescribed therapy, and 27.6% did not highlight a critical issue that requires urgent intervention. Variables like gender, educational status, social status, occupation, and living with family are strongly associated with adherence. Common problems include taking multiple medications, lack of awareness about the importance of adherence, and financial constraints.

Assessment of self-care practices & associated factors among hypertensives in urban slum areas of Mysuru city: A community-based cross-sectional study.

Background & objectives Hypertension is a significant modifiable risk factor for cardiovascular diseases (CVDs) and premature mortality worldwide, particularly affecting low- and middle- income countries (LMICs). This study focused on evaluating self-care practices among hypertensive affected individuals in urban slum areas of Mysuru city, India, and explore associated factors and their relationship with hypertension control levels. Methods A community based cross-sectional study was carried out from March 2022 to August 2023, enrolling 650 hypertensive affected individuals from 63 urban slums of Mysuru city. Data on sociodemographic characteristics, self-care practices, and hypertension control were collected using structured questionnaires and standardized scales. Descriptive statistics and chi-square tests were used for data presentation and analyses. Results Among the participants, 62.9 per cent reported poor self-care awareness, and only 37.1 per cent had good self-care awareness. Factors such as age group, education, occupation, type of family, marital status, socioeconomic status, and hypertension control showed significant associations with self-care scores (P≤0.001). However, no significant association was found between gender and self-care scores. Interpretation & conclusions This study highlights the critical need for comprehensive interventions integrating self-care awareness into existing health programmes to address the growing burden of hypertension, particularly in urban slum populations. By prioritizing self-care education and empowerment, healthcare stakeholders can equip individuals with the necessary knowledge and skills for effective hypertension management, thus improving health outcomes at individual level and also reducing public health impact of hypertension.

Efektivitas Leaflet dalam Meningkatkan Pengetahuan Hipertensi pada Lansia di Desa Gandatapa

Introduction: Hypertension is a significant global health issue that often presents without symptoms, leaving many individuals unaware of their condition. Effective management and prevention of hypertension require increased awareness and education, particularly among the elderly population, who are at higher risk. Objective: This study aims to evaluate the effectiveness of health counseling using leaflets in improving hypertension knowledge among the elderly at Integrated service post (Posyandu) community association (RW) 4 Gandatapa. Method: This descriptive quantitative study employed a pre-post design. Health counseling was conducted using leaflets at Integrated service post (Posyandu) community association (RW) 4 Gandatapa on July 16, 2024, involving 44 elderly participants aged 65-70 years. Knowledge levels were assessed using pre-test and post-test questionnaires. The intervention included distributing leaflets and conducting a discussion session to reinforce the information provided. Result:The study observed a significant increase in participants' knowledge about hypertension, with average knowledge scores rising from 43% in the pre-test to 63% in the post-test. Conclusion: The findings suggest that health counseling using leaflets is an effective method for improving hypertension knowledge among the elderly. However, to optimize the impact, future interventions should consider additional support methods, especially for those with limited literacy or visual impairments.

The Effect of Zikr Meditation on Anxiety, Stress Levels and Blood Pressure in Hypertensive Patients

Background: Hypertension, a prevalent chronic condition, poses significant health risks when left untreated. Psychological factors like stress and anxiety are known contributors to high blood pressure. Effective management of hypertension may benefit from non-pharmacological interventions that address these psychological elements. Purpose: This study aims to evaluate the impact of Zikr meditation, a spiritual mindfulness practice, on reducing anxiety, stress, and blood pressure in individuals with hypertension. Methods: A double-blind randomized controlled trial was conducted with 60 hypertensive patients, randomized into intervention and control groups. The intervention group participated in 20-minute Zikr meditation sessions for four weeks daily, while the control group engaged in a placebo activity. Anxiety and stress levels were measured using the Hamilton Anxiety Rating Scale (HAM-A) and the Perceived Stress Scale (PSS), respectively. Blood pressure readings were taken before and after the intervention. Results: Participants in the Zikr meditation group showed a significant reduction in anxiety and stress levels compared to the control group. Additionally, there was a notable decrease in systolic and diastolic blood pressure among those practicing Zikr meditation. Conclusions: Zikr meditation effectively reduces anxiety and stress, leading to lower blood pressure in hypertensive patients. These findings suggest that incorporating Zikr meditation into standard hypertension management could offer a valuable, non-pharmacological approach to improving cardiovascular health. Further research is recommended to examine Zikr meditation's long-term effects and broader applicability in hypertension care.

Improving Hypertension Outcomes: Assessing Caregivers’ Knowledge, Attitude and Practices in Rural Malawi

Introduction: Hypertension is a major global health issue, significantly contributing to the burden of cardiovascular diseases, particularly in low- and middle-income countries (LMICs) like Malawi. Caregivers play a crucial role in managing hypertension in these settings, yet their knowledge, attitudes, and practices (KAP) are not well-documented. Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) of caregivers for hypertensive patients in rural Malawi, as well as to identify any disparities in these areas. Methods: A descriptive cross-sectional study was conducted from November 2023 to February 2024 at Lisungwi Community Hospital and Neno District Hospital in Neno, Malawi. A total of 422 caregivers were conveniently sampled, with 248 from Lisungwi and 174 from Neno. Data were collected using a validated pre-tested questionnaire, assessing KAP on hypertension. Descriptive, one-way ANOVA and linear regression statistical analyses were performed using SPSS version 22.0. Results: In both Lisungwi and Neno hospitals, the majority of participants were female, accounting for 63.7% and 62.6%, respectively. The mean age of participants was 44.7 years (± 10.3) in Lisungwi and 45.3 years (± 9.3) in Neno, with average care durations of 4.1 years (± 3.3) and 4.2 years (± 3.2). Notably, 94.4% of caregivers at Lisungwi and 94.3% at Neno exhibited poor knowledge of hypertension; however, all caregivers maintained a positive attitude toward its prevention and management. Significant differences in practice scores were observed (p < 0.001), with caregivers in Lisungwi performing better. Additionally, factors such as education, age, and occupation influenced Knowledge, Attitude, and Practices (KAP) scores, while gender impacted practices alone. Conclusions: The findings of poor knowledge highlight the urgent need for enhanced educational interventions, gender-specific support, community engagement, and a context-specific approach to improve the knowledge and practices of caregivers, which are critical for effective hypertension prevention and management in rural setting.

Prevalence of Hyperkalemia and Familial Hyperkalemic Hypertension in 5100 Patients Referred to a Tertiary Hypertension Unit.

Hyperkalemia is a frequent electrolyte alteration whose prevalence varies widely, depending on the adopted cutoff, the setting (inpatients versus outpatients), and the characteristics of the study population. Familial hyperkalemic hypertension (FHH) is a rare cause of hypertension, hyperkalemia, and hyperchloremic metabolic acidosis. In this retrospective observational study, we investigated the prevalence of hyperkalemia (serum K+ >5.2 mmol/L on 2 repeated measurements) in 5100 referred patients affected by arterial hypertension, the potential causes, and the associated cardiovascular risk profile. Overall, 374 (7.3%) patients had hyperkalemia. This was associated with drugs known to increase K+ levels (74.6%), chronic kidney disease (33.7%), or both (24.3%). Among the 60 patients with unexplained hyperkalemia, 3 displayed a clinical and biochemical phenotype suggestive of FHH that was genetically confirmed in 2 of them (0.04% in the entire cohort). FHH prevalence rose to 3.3% in patients with unexplained hyperkalemia and up to 29% (2/7) if they had serum K+>5.8 mmol/L. The genetic cause of FHH was a missense variant affecting the acidic motif of WNK1 in 1 family and a rare CUL3 splicing variant, whose functional significance was confirmed by a minigene assay, in another. Finally, we observed a significant association between hyperkalemia and the occurrence of cardiovascular events, metabolic syndrome, and organ damage, independent of potential confounding factors. The identification of hyperkalemia in patients with hypertension has prognostic implications. A timely diagnosis of FHH is important for effective management of hypertension, electrolyte imbalance correction with tailored treatment, and genetic counseling.

Abstract P321: Team-Based Care: A Winning Strategy for Managing Hypertension

Hypertension is a serious health condition that can lead to heart disease. Despite available methods for managing hypertension, blood pressure (BP) control in the US is declining, highlighting a gap between expert recommendations and real-world practice. Our clinic initiative aimed to create a specialized workflow and team, which included resident physicians, pharmacists, and health counselors focused on underserved communities. We also provided blood pressure cuffs and encouraged patients to monitor their blood pressure at home. This approach, coupled with the 'Knowing Your Numbers' campaign, has significantly improved outcomes, promoted continuity of care, and built resilience within care communities for vulnerable populations. 110 patients with poorly controlled hypertension were provided with BP monitors to track their blood pressure. Demographic data and office BP readings before and after the monitors were distributed were collected from patient charts. The results were analyzed using descriptive statistics and paired t-tests. The study included 58% female participants with an average age of 59. The racial distribution was 51% black, 35% white, 10% unreported/unknown, 2% Asian, and 2% American Indian/Alaska native. Most participants (70%) reported feeling empowered in their healthcare. Female participants who received a blood pressure cuff and engaged in shared decision-making experienced a significant reduction in their systolic BP by 17.6 mm Hg (P<0.05) and diastolic BP by 7.9 mm Hg (P<0.05). In comparison, males saw a reduction in their systolic BP by 10.6 mm Hg (P<0.05) and diastolic BP by 7.1 mm Hg (P<0.05). The average weight for both genders falls under the obese category, with females having an average BMI of 32.4 and males having an average BMI of 32.6. Providing loan-free blood pressure monitoring cuffs for clinic patients or blood pressure machines through insurance can improve patient engagement and health outcomes. Removing cost barriers can significantly impact in-office blood pressure reduction, monitoring, and patient satisfaction. This initiative highlights the importance of implementing patient-centered approaches to healthcare that address the financial and logistical barriers that can hinder effective hypertension management. Future research is needed to confirm these findings, but this study supports implementing similar programs to improve patients' health and well-being.

Abstract P319: Organizational Determinants to Hypertension Management: A Qualitative Examination at Two Academic Learning Health Systems

Background: Hypertension management is a national priority. However, hypertension control rates are suboptimal and vary across clinics, even among those in the same health system and geographic region. Objective: To identify organizational barriers and facilitators that impact hypertension management at the provider- and clinic-level. Design: Semi-structured interviews were conducted with primary care providers (N=25) and patients with uncontrolled hypertension (N=22). Participants were recruited from thirteen family and internal medicine clinics across two academic learning health systems. Participants: Twenty-five providers and twenty-two patients were recruited from clinics across North Carolina and Kansas. Approach: Interviews were analyzed using both inductive and deductive coding methodologies. A health equity framework scaffolded interview guide design and codebook development, with thematic analysis employed to categorize emergent themes across the four framework domains. Key Results: Participants discussed organizational and clinic-level barriers and facilitators that impact hypertension management, with health systems’ resource centralization being frequently mentioned. Some participants lauded centralized interventions for improving patient access and increasing touchpoints, while others lamented reductions in their clinic’s staffing to accommodate centralized workflows. Insufficient in-clinic staffing and blood pressure (BP) measurement equipment, limited exam rooms, short appointment duration, and hurried clinic environments were all mentioned as challenges to hypertension management, particularly as they hindered adherence to BP recheck policies. Appointment availability was mentioned as a barrier, however providers referenced clinics’ use of virtual and/or nurse-specific visits as a mechanism to increase patient access. Multiple providers noted that tasks central to hypertension management, like BP telemonitoring and MyChart correspondence, go unaccounted for on their schedules and can lead to unpaid work, which they linked with increased stress and burnout. Conclusions: Primary care clinics experience multiple interrelated organizational barriers to effective hypertension management. Future studies should examine the impact of different clinic staffing models, including multidisciplinary care teams, telemedicine, and remote BP monitoring, on BP outcomes in diverse primary care settings.

Managing hypertension in rural Gambia and Kenya: Protocol for a qualitative study exploring the experiences of patients, health care workers, and decision-makers

Background Hypertension is the single leading risk factor for premature death in Sub-Saharan Africa (SSA). Prevalence is high, but awareness, treatment, and control are low. Community-centred interventions show promise for effective hypertension management, but embedding such interventions sustainably requires a good understanding of the wider context within which they are being introduced. This study aims to conduct a systematic health system assessment exploring the micro (patients/carers), meso (health care workers and facilities), and macro (broader system) contexts in rural Gambia and Kenya. Methods This study will utilise various qualitative approaches. We will conduct (i) focus group discussions with people living with hypertensive to map a ‘typical’ patient journey through health systems, and (ii) in-depth interviews with patients and family carers, health care workers, decision-makers, and NCD partners to explore their experiences of managing hypertension and assess the capacity and readiness of the health systems to strengthen hypertension management. We will also review national guidelines and policy documents to map the organisation of services and guidance on hypertension management. We will use thematic analysis to analyse data, guided by the cumulative complexity model, and theories of organisational readiness and dissemination of innovations. Expected findings This study will describe the current context for the management of hypertension from the perspective of those involved in seeking (patients), delivering (health care workers) and overseeing (decision-makers) health services in rural Gambia and Kenya. It will juxtapose what should be happening according to health system guidance and what is happening in practice, drawing on the experiences of study participants. It will outline the various barriers to and facilitators of hypertension management, as perceived by patients, providers, and decision-makers, and the conditions that would need to be in place for effective and sustainable implementation of a community-centred intervention to improve the management of hypertension in rural settings.

Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study.

The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 "Non-invasive Sphygmomanometers-Part 2: Clinical investigation of automated measurement type." This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app's BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app's PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app's mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension.

Barriers to access to antihypertensive medicines: insights from the HEARTS initiative in latin American and Caribbean region.

Hypertension significantly impacts the global cardiovascular disease burden, presenting a pronounced challenge within Latin America and the Caribbean. The Pan American Health Organization's (PAHO) HEARTS initiative endeavours to meet this challenge by enhancing comprehensive cardiovascular risk management, inclusive of improved access to antihypertensive medications. This study scrutinises the challenges and barriers in accessing these medications, which are crucial for effective hypertension management in these regions. The research employed a two-phase approach: an initial analysis of National Essential Medicines Lists (NEMLs) from 22 countries involved in the HEARTS initiative for the presence of antihypertensive medications, followed by an in-depth pharmaceutical market analysis in six selected countries to evaluate the availability, pricing, and procurement practices of these medications. The study revealed notable inconsistencies in the inclusion of recommended antihypertensive medications across NEMLs, particularly the lack of fixed-dose combinations (FDCs). The market analysis brought to light significant limitations in medicine registration and substantial variations in pricing, which adversely impact the accessibility and affordability of essential antihypertensive treatments. Furthermore, an examination of procurement practices identified considerable diversity across countries, highlighting potential areas for optimisation, including the use of the PAHO Strategic Fund. The barriers to accessing essential antihypertensive medications in Latin America and the Caribbean are multifaceted, stemming from outmoded NEMLs, limited market availability of advised medications, and disparate procurement processes. Leveraging pooled procurement mechanisms such as the PAHO Strategic Fund, coupled with vital updates to NEMLs, stands to markedly improve both the accessibility and affordability of these treatments.

In vivo assessment, formulation, characterization and enhancing pharmacotherapy of encapsulated mini tablets for immediate release Sildenafil citrate and sustained release Bosentan

The purpose of this study was to prepare and evaluate multiple unit mini tablets (MTs) of prolonged released (PR) bosentan (BSN) and fast release (FR) sildenafil citrate (SDC) on the basis of encapsulation method for the effective management of pulmonary artery hypertension. The system consists of MTs are in the form of uncoated tablets containing the superdisintegrating agents where as the PRMTs contains the polymer with film coating. All the units are prepared by direct compression method and encapsulated using size 1 hard gelatin capsule shells. The formulations were evaluated for differential scanning calorimetry, dissolution test and post compression studies for their quality attributes and it was found that all the parameters were in the acceptable limits. The optimized formulation for BSN PRMTs i.e BS3 which contains 5 % HPMC K15M shows a promising sustained release profile of 82.31 % in 24 h similarly FRMTs of SDC of formulation SD6 that having 3 % of magnesium aluminium silicate shows about 90 % of drug release within 15 min. The in-vivo pharmacokinetic characterization of the system was carried out using wister rats where the AUC value for SDC FRMTs and BSN PRMTs was found to be 94256.88625 ± 123.65 ng h/mL and 142438.084 ± 324.11 ng h/mL respectively. The other pharmacokinetics are also determined and found to be satisfactory. The six months stability samples showed no significant change in the drug content, hardness and uniformity of the content of the optimized formulations.

Peningkatan Kesadaran Kesehatan melalui Deteksi Dini Hipertensi dan Penyuluhan Kesehatan

Hypertension can lead to serious complications such as heart disease, stroke, and kidney damage. The prevalence of hypertension often goes undetected due to minimal symptoms, so many individuals are unaware of it. Early detection through routine blood pressure measurements and health education is important for risk identification and effective management of hypertension. Blood pressure checks and health education are important first steps in raising public health awareness. This activity aims to identify individual health conditions and provide the knowledge necessary to maintain optimal health. From the data obtained, 14% of participants showed symptoms of hypotension, 66% had normal blood pressure, and 20% already had hypertension. These results show the need for continuous efforts in blood pressure monitoring and health education to reduce the risk of blood pressure-related diseases. This service emphasizes the importance of early detection and increased public understanding of the importance of keeping blood pressure within the normal range to prevent further health complications.

Assessment of Medication Adherence Among Patients With Hypertension and Diabetes Mellitus in a Tertiary Healthcare Center: A Descriptive Study.

Introduction Effective management of diabetes and hypertension requires a comprehensive approach, including dietary adjustments, physical activity, routine screening for complications, and adherence to medication. Proper adherence to pharmacotherapy is essential for maintaining glycemic control and managing blood pressure. Non-adherence can result in increased complications, higher healthcare costs, and greater morbidity and mortality. This study aimed to evaluate the sociodemographic profile and medication adherence among adults with diabetes and hypertension, focusing on those undergoing treatment. The objective was to determine the extent of adherence and identify factors that influence adherence among patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods A community-based study was conducted on patients with T2DM and/or hypertension in both rural and urban areas of Bhopal, specifically those attending JK Hospital, Bhopal, Madhya Pradesh, India. Participants were selected using a simple random sampling method. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), a validated tool for measuring patient adherence behavior. Results The study included 300participants, of whom 68% (n=204) were maleand 32% (n=96) were female. The average age of the participants was 57.52±10.3 years. Among the 300patients, 9% (n=27) had high adherence to medication, 24.7% (n=74) had moderate adherence, and 66.3% (n=199) had low adherence. Conclusions Effective strategies must include targeted patient education on medication costs, side effects, and the long-term benefits of adherence. Integrating technological aids like smartphone apps may enhance adherence. Patients who adhere closely to their regimens are more likely to achieve better control over blood pressure and glycated hemoglobin (HbA1c) levels, underscoring the critical importance of adherence in managing chronic conditions effectively.

Obesity and risk of hypertension in preadolescent urban school children: insights from Pakistan

BackgroundChildhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in urban Karachi, Pakistan.MethodsThis is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescents aged 6–11 years, attending two private schools conducted from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension.ResultsAnalysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension at followup (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) at follow up in the final model.ConclusionThis study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension or prehypertension at followup within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.