Effective Management Of Hypertension Research Articles

Abstract P372: Global Burden Of Chronic Kidney Disease Due To Hypertension In 38 Oecd Countries: A Benchmarking Analysis For The Global Burden Of Disease Study 2019

Background: Chronic Kidney Disease (CKD) due to hypertension (HTN) ranks as the leading cause of death among all types of CKD in Organization for Economic Cooperation and Development (OECD) countries. Method: Using the Global Burden of Disease methodology, CKD due to HTN prevalence, incidence, deaths, Disability adjusted life years were analyzed by age, sex, year across the 38 OECD countries between 1990-2019. Results: Total prevalence of CKD due to HTN doubled from 4933515 (95%UI4543,520-5382155) in 1990 to 10871399 (95%UI10055175-11754447) in 2019. Age-standardized incidence rate (ASIR) increased from 21/100000 in 1990 to 25/100000 in 2019. The highest ASMR was observed in Mexico (16/100000), ASIR in Turkey (36/100000) in 2019. The highest annual percentage of change (APC) increased in ASMR observed in Estonia 341% (0.8-3.6) per 100000 from 1990-2019. Conclusion: CKD due to HTN has remained a leading cause of deaths in OECD countries. The escalating prevalence of CKD due to HTN underscores the urgency for proactive strategies aimed at prevention, early detection, and effective management of HTN.

Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine.

Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.

Effectiveness of a Health Education Program in Hypertensive Patients with Dyslipidemia and/or Microalbuminuria: A Quasi-Experimental Study in Vinh Long Province, Vietnam.

Hypertension, a major health concern, is associated with significant mortality and disease burden worldwide, including Vietnam. Comprehensive interventions targeting medication, lifestyle modifications, dyslipidemia (DLP), and microalbuminuria (MAU) are vital for effective hypertension management and reducing the risk of cardiovascular disease complications (CDV). While medication interventions have proven efficacy, the evidence regarding the effectiveness of community-based health education interventions in managing DLP and MAU is limited. Therefore, this study aims to evaluate the effectiveness of community health education interventions in reducing hypertension risk factors and achieving hypertension management objectives, as well as managing DLP and MAU among hypertension patients. A quasi-experimental study was conducted on 330 hypertensive patients with dyslipidemia (DLP) and/or microalbuminuria (MAU) who were divided into a control group (n = 164) and an intervention group (n = 166). The control group received standard national hypertension management, while the intervention group received additional intensive health education provided by trained volunteers. The effectiveness of the intervention was assessed by comparing outcomes such as lifestyle factors, BMI control, treatment adherence, hypertension control, and DLP and MAU status between the two groups before and after a two-year intervention period. The health education intervention resulted in significant reductions in dietary risk factors, specifically in fruit and vegetable consumption (p < 0.001). There was a lower prevalence of high salt intake in the intervention group compared to the control group (p = 0.002), while no significant differences were observed in other dietary factors. Smoking habits and low physical activity significantly decreased in the intervention group, with a notable disparity in physical activity proportions (p < 0.001). Both groups showed significant improvements in achieving hypertension management targets, with the intervention group demonstrating superior outcomes. The intervention was effective in reducing the prevalence of risk factors, particularly treatment non-adherence, blood pressure control, and low physical activity. Additionally, the intervention group had a higher likelihood of achieving DLP and MAU control compared to the control group. This study underscored the additional positive impact of incorporating health education by non-professional educators in achieving favorable outcomes, including better control of BMI, blood pressure, medication adherence, and management of dyslipidemia (DLP) and microalbuminuria (MAU). Further research is warranted to fully explore the potential of health education in primary healthcare settings and maximize its effectiveness.

Interpretable Policies and the Price of Interpretability in Hypertension Treatment Planning

Problem definition: Effective hypertension management is critical to reducing the consequences of atherosclerotic cardiovascular disease, a leading cause of death in the United States. Clinical guidelines for hypertension can be enhanced using decision-analytic approaches capable of capturing complexities in treatment planning. However, model-generated recommendations may be uninterpretable/unintuitive, limiting their clinical acceptability. We address this challenge by investigating interpretable treatment plans. Methodology/results: We formulate interpretable treatment plans as Markov decision processes (MDPs) and analyze the problems of optimizing monotone policies, which prohibit decreasing treatment intensity for sicker patients, and class-ordered monotone policies, which generalize monotone policies. We establish that both policies depend on initial state distributions and that optimal monotone policies can be generated tractably for many treatment planning problems. Next, we propose exact formulations for optimizing interpretable policies broadly. Then, we analyze the price of interpretability, proving that the class-ordered monotone policy’s price of interpretability does not exceed the monotone policy’s price of interpretability. Finally, we formulate and evaluate MDPs for hypertension treatment planning using a large nationally representative data set of the U.S. population. We compare the structure and performance of optimal monotone policies and class-ordered monotone policies with optimal MDP-based policies and current clinical guidelines. At the patient level, optimal MDP-based policies may be unintuitive, recommending more aggressive treatment for healthier patients than sicker patients. Conversely, monotone policies and class-ordered monotone policies never deescalate treatment, reflecting clinical intuition. Across 66.5 million patients, optimized monotone policies and class-ordered monotone policies outperform clinical guidelines, saving over 3,246 quality-adjusted life years per 100,000 patients, with both policies paying a low price of interpretability. Sensitivity analysis illustrates that monotone policies and class-ordered monotone policies are robust to various definitions of “interpretability.” Managerial implications: Interpretable policies can be tractably optimized, drastically outperform existing guidelines, and perform near optimally—potentially increasing the acceptability of decision-analytic approaches in practice. Funding: L. N. Steimle and W. J. Marrero received support from the National Science Foundation Graduate Research Fellowship [Grant DGE 1256260]. J. B. Sussman received support from the National Institutes of Health [Grants R01NS102715 and RF1AG068410], the U.S. Department of Veterans Affairs [Grants 1I01-HX003304 and 1I50-HX003251], and the Michigan Department of Health and Human Services. Supplemental Material: The e-companion is available at https://doi.org/10.1287/msom.2021.0373 .

Community echocardiographic left ventricular hypertrophy and mortality in South Asians in the UK: E-ECHOES study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England. Background People of South-Asian origin have high cardiovascular morbidity, contributed by health inequalities. Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, but its scale in South Asian communities is unknown. Left ventricular hypertrophy (LVH) on echocardiography is a measure of target organ damage related to uncontrolled hypertension. The study aims to assess prevalence of LVH in South Asian community and its impact on mortality. This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Methods Left ventricular mass index (LVMI) was calculated using echocardiography. LVH was established as increased LVMI. Predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression. Results The study included 3200 South Asians (age 59±10, 52% women, 45% had a history of hypertension). There were 182 deaths, including 64 cardiovascular deaths during a 5.8±1.0-year follow-up. LVH was found in 1568 (49%). In those with LVH, 705 (45%) did not have a diagnosis of hypertension. On Cox regression LVH was independently associated with all-cause mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.01-1.88), cardiovascular mortality (HR 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%. Conclusion South Asians in the UK have a very high prevalence of hypertension which is often underdiagnosed and poorly controlled, leading to LVH and excess in overall and cardiovascular mortality. The findings call for more effective screening and management of hypertension with lower BP targets.

FACTORS INFLUENCING TREATMENT NONCOMPLIANCE IN HYPERTENSION MANAGEMENT AMONG RURAL AND URBAN RESIDENTS

Introduction: Hypertension is a prevalent health concern in both rural and urban populations, with varying rates of prevalence and treatment outcomes. This study aims to examine the factors contributing to decreased adherence to antihypertensive therapy among patients living in rural and urban areas. Essential arterial hypertension or hypertension is the most common cardiovascular cause of death in the population. It develops in more than half of the world's population over the age of 50, and affects 65% of men and 75% of women over the age of 70. The prevalence of hypertension is higher among rural residents (36.3%) compared to urban residents (29.6%). However, achieving target blood pressure values is a challenge for both groups, with only 8% of rural patients and 15% of urban patients reaching their treatment goals as reported in 2010. According to practicing doctors, the main reason for failing to reach target blood pressure levels is the low adherence of patients to their prescribed antihypertensive therapy. This noncompliance with treatment poses a significant obstacle to effective hypertension management.&#x0D; The article presents findings from an analysis of treatment adherence among 152 patients categorized into three groups: essential arterial hypertension (Group 1), hypertension and coronary heart disease (Group 2), and comorbidity between hypertension, coronary heart disease and type 2 diabetes (Group 3). The study included both urban and rural residents. Adherence to treatment was assessed using the 2008 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaire.&#x0D; The analysis revealed distinct factors influencing adherence based on the patient's territorial affiliation. In the rural setting (Group 1), the primary reason for decreased adherence was patients independently discontinuing antihypertensive medication without notifying their doctor. In the urban setting (Group 1), patients tended to forget to take their medication as prescribed.&#x0D; In Group 2 (urban), challenges were observed in remembering the correct time for taking antihypertensive drugs, while rural patients in the same group tended to independently alter the dosage or discontinue medication. In Group 3 (urban), urban residents reported forgetting to take medication when away from home, whereas rural residents faced fewer difficulties in remembering their medication schedule.&#x0D; The research findings indicate that low adherence to antihypertensive therapy is not solely influenced by territorial affiliation or the specific course of hypertension. However, a notable factor affecting treatment adherence among both rural and urban residents is the more mobile lifestyle commonly observed in urban areas.&#x0D; Addressing the issue of low adherence to antihypertensive therapy requires tailored interventions that consider the unique challenges faced by rural and urban populations. Strategies should focus on improving patient education, enhancing medication reminders, and promoting better communication between patients and healthcare providers. By addressing these factors, it is possible to improve treatment adherence and subsequently enhance hypertension management outcomes for both rural and urban residents.

Evaluation of Glaucoma in Patients with Diabetes and Hypertension: A One-Year Observational Study

Background: Glaucoma is a group of eye diseases that damage the optic nerve, leading to vision loss. The elevated blood sugar levels in diabetes and high blood pressure in hypertension can both contribute to the development and progression of glaucoma. Effective management of both diabetes and hypertension can also help to reduce the risk of developing glaucoma. The aim of this study is to assess the evaluation of glaucoma in patients with diabetes and hypertension. Material Methods: This cross-sectional observational study was carried out in the admitted and outpatient department (OPD) patients in the Department of Ophthalmology, Dr. Sirajul Islam Medical College and Hospital Ltd, Dhaka, Bangladesh from January 2021 to December 2022. Total 160 patients with glaucoma were included in this study. Results: In our study, mean (±SD) age of the study subject were 50.5±9.25 years. Majority of the patients had (27.5%) followed by 22 (13.8%) had diabetes and 14 (8.8%) had both. For the group with DM and HTN, the mean IOP was 16.25 with a 95% Confidence Interval (CI) of 13.25 to 18.43, mean HVFA was -9.12 with a 95% CI of -16.78 to -1.31 and mean CDR was 0.69 with a 95% CI of 0.55 to 0.82. For the group without DM and HTN, the mean IOP was 15.62 with a 95% CI of 14.83 to 16.35, mean HVFA was -5.01 with a 95% CI of -5.86 to -3.75 and mean CDR for this group was 0.60 with a 95% CI of 0.53 to 0.68. In the patients with DM and HTN group, there are 13 patients (13.8%) with moderate/severe VFD and 1 patient (1.1%) with mild VFD. In the patients without DM and HTN group, there are 26 patients (26.7%) with moderate/severe VFD and 54 patients (57.4%) with mild VFD. There were statistically significant differences (p&lt;0.05) between the groups both moderate/severe and mild VFD. Conclusion: We determined that patients with HTN and DM had a greater extreme structure of glaucoma when in compared with the patients besides these risk factors. Hypertension was more common than diabetes.

The Evolving Management and Treatment Options for Patients with Pulmonary Hypertension: Current Evidence and Challenges.

Pulmonary hypertension may develop as a disease process specific to pulmonary arteries with no identifiable cause or may occur in relation to other cardiopulmonary and systemic illnesses. The World Health Organization (WHO) classifies pulmonary hypertensive diseases on the basis of primary mechanisms causing increased pulmonary vascular resistance. Effective management of pulmonary hypertension begins with accurately diagnosing and classifying the disease in order to determine appropriate treatment. Pulmonary arterial hypertension (PAH) is a particularly challenging form of pulmonary hypertension as it involves a progressive, hyperproliferative arterial process that leads to right heart failure and death if untreated. Over the last two decades, our understanding of the pathobiology and genetics behind PAH has evolved and led to the development of several targeted disease modifiers that ameliorate hemodynamics and quality of life. Effective risk management strategies and more aggressive treatment protocols have also allowed better outcomes for patients with PAH. For those patients who experience progressive PAH with medical therapy, lung transplantation remains a life-saving option. More recent work has been directed at developing effective treatment strategies for other forms of pulmonary hypertension, such as chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary hypertension due to other lung or heart diseases. The discovery of new disease pathways and modifiers affecting the pulmonary circulation is an ongoing area of intense investigation.

Plant-food-derived Bioactives in Managing Hypertension: From Current Findings to Upcoming Effective Pharmacotherapies.

A sedentary lifestyle has evoked a high risk of cardiovascular (CV) disease, diabetes, and obesity, all of them with high morbimortality rates and with a common denominator, hypertension. Numerous pharmacological drugs have been used for the treatment of hypertension. However, the side effects associated with the use of existing pharmacological therapies have triggered a demand for plant-based medications. In this connection, the aim of this review was to provide an in-depth analysis of the use of plant-derived bioactives for the effective management of hypertension. Phytoconstituents from leaves, bark, stem, roots, seeds, and fruits of medicinal plants grown in our different regions of the globe have been highly searched. Among them, polyphenols (e.g., flavonoids as quercetin, anthocyanins as cyanidin, tannins as ellagic acid, stilbenes as resveratrol, lignans as honokiol and others as hydroxytyrosol or curcumin), organosulfur compounds (e.g. s-allyl cysteine and allicin), fatty acids (e.g. α-lipoic acid, DHA and oleic acid), alkaloids (e.g. berberine or tetrandrine) and some terpenes have been intensively investigated for the management of hypertension, with effective ability being stated in controlling high blood pressure and related health problems both in vivo and in vitro studies. Some of the activities presented by these bioactive compounds are reducing oxidative stress, renin-angiotensin system control, SIRT1 activation, regulating platelet aggregation and COX activity, anti-atherogenic effects, anti-inflammatory properties, vasorelaxation and other results that translate into the prevention or control of hypertension. The knowledge of these bioactive compounds is important in developing countries where traditional medicine is the majority, but it can also give rise to new approaches in hypertension therapy.

A Pilot Study- The Impact of Health Education on Knowledge of Blood Pressure ControlIschaemic Heart Disease Patients

Increased Blood Pressure is one of the main causes for ischemic heart disease, and effective management of Hypertension as a key to preventing both primary and secondary Ischemic heart disease. In primary prevention, keeping blood pressure at or below 140/90 mmHg is advised; in secondary prevention, levels of 130/85 mmHg were previously advised. In addition to acting alone to increase Ischemic heart disease (IHD) risk, hypertension also multiplies the likelihood of negative outcomes when it coexists with the other major IHD risk factors mentioned above. Numerous research and guideline recommendations had published over the past 20 years with the goals of explaining the pathophysiology of IHD, identifying an ideal blood pressure (BP) threshold at which to start pharmacotherapy, and defining the ideal pharmacologic components of a treatment plan. The goal blood pressure for IHD patients is generally agreed to be less than 140/90 mmHg. The prescribed pharmaceutical class (or classes) will vary depending on the coexisting conditions that each patient has. It is expected that 1.56 billion adults would have hypertension in 2025. In the South-East Asia region, hypertension claims the lives of up to 1500000 people per year; consequently, it is the world’s biggest cause of death (WHO). The study’s objective is to assess people who have ischemic heart disease (IHD awareness of blood pressure control). The pre-experimental research design for the project was authorized. Patients with ischemic heart disease (IHD) and stage I hypertension made up the study’s sample population. This pilot study’s findings demonstrate the effectiveness of lifestyle modification education on blood pressure control among patients with ischemic heart disease (IHD) who have primary hypertension in particular hospitals.

Randomized trial protocol for remote monitoring for equity in advancing the control of hypertension in safety net systems (REACH-SNS) study

BackgroundSelf-measured blood pressure monitoring (SMBP) is essential to effective management of hypertension. This study aims to evaluate effectiveness and implementation of SMBP that leverages: cellular-enabled home BP monitors without a need for Wi-Fi or Bluetooth; simple communication modalities such as text messaging to support patient engagement; and integration into existing team-based workflows in safety-net clinics. MethodsThis study will be conducted with patients in San Francisco who are treated within a network of safety-net clinics. English and Spanish-speaking patients with diagnosed hypertension will be eligible for the trial if they have recent BP readings ≥140/90 mmHg and do not have co-morbid conditions that make home BP monitoring more complex to manage. This study will implement a three-arm randomized controlled trial to compare varying levels of implementation support: 1) cellular-enabled BP monitors (with minimal implementation support), 2) cellular-enabled BP monitors with protocol-based implementation support (text reminders for patients; aggregated BP summaries sent to primary care providers), and 3) cellular-enabled BP monitors and pharmacist-led support (pharmacist coaching and independent medication adjustments). ResultsFor the main analysis, we will use mixed effects linear regression to compare the change in primary outcome of systolic BP. Secondary outcomes include BP control (<140/90 mmHg), medication intensification, patient-reported outcomes, and implementation processes (i.e., engagement with the intervention). DiscussionThis study will design and test a digital health intervention for use in marginalized populations treated within safety net settings, evaluating both effectiveness and implementation to advance more equitable health outcomes.

Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study.

Pediatric hypertension become an early marker of cardiovascular diseases, but their antihypertensive drug use patterns are rarely known. To investigate the epidemiological characteristics of pediatric hypertension and the use of antihypertensive drugs in the real world in China. In this study, the demographic, diagnosis, and medication prescription data including the antihypertensive drug types and comorbidities, were analyzed. The antihypertensive drugs use were evaluated according to the Chinese guidelines for hypertension. 1301 prescriptions (number of visits) containing 1880 antihypertensive medical orders were collected. The average number of antihypertensive drugs per prescription was 1.45 (±0.75). The patients aged 16 to 18 (70.18%) accounted for the highest proportion. Kidney diseases (33.28%) were the most common comorbidities. Calcium channel blocker (CCB), angiotensin II receptor blocker (ARB), and β receptor blocker (BB) were the most used antihypertensive drugs. The most frequent monotherapy was CCB, while that of two and three drugs combination were ARB+CCB and ARB+BB+CCB, respectively. Metoprolol (11.44%), nifedipine (10.64%), amlodipine (10.59%), valsartan (6.12%) were the most commonly used antihypertensive drugs. The utilization rate of fixed compound preparations was 7.34%. However, the percentage of recommended antihypertensive drugs was just 14.20%, while the recommended drug combination was 84.93% according to the guidelines. For the first time ever we reported the antihypertensive prescription analysis in children in a large area of China. Our data provided new insights into the epidemiological characteristics and drug use in hypertensive children. We found that the guidelines for medication management in hypertensive children were not routinely followed. The wide use of antihypertensive drugs in children and those with weak clinical evidence raised concerns regarding its rational use. The findings could lead to more effective management of hypertension in children.

BOX-BEHNKEN DESIGN FOR OPTIMIZATION OF FORMULATION VARIABLES FOR CONTROLLED RELEASE GASTRORETENTIVE TABLET OF VERAPAMIL HYDROCHLORIDE

Objective: To develop a Verapamil hydrochloride controlled release gastro-retentive (CRGR) tablet for once-daily dosing using the response surface Box-Behnken Design (BBD) approach for the improvement of bioavailability and reduction in dosing frequency to overcome the issues related to the conventional tablet formulation. Methods: For the optimization, 33Box-Behnken design was used. The independent variables were selected, the amount of Compritol 888 ATO (A), HPMC K15M (B), and Sodium bicarbonate (C). The dependent variables were Cumulative % drug release in 1.5 h (Q1.5), 8 h (Q8), 24 H (Q24) and floating lag time (FLT). Flow properties of pre-compressed powder, physical characteristics, drug content, floating lag time, total floating time and in vitro dissolution study of all formulation were assessed. In vitro dissolution study of optimized formulation that was prepared experimentally was performed and compared with predicted data obtained from the software. Drug release kinetics of the optimized formulation was also assessed to know the mechanism of drug release from the CRGR tablets. Results: Responses of experimental runs were found as Q1.5: 12.78-33.62 (%), Q8: 43.03-64 (%), Q24: 78.77 to 103.57 (%) and floating lag time as 3.01 min to 5.08 min. The predicted optimized formula with the highest desirability value of 0.963 containing amount 126.030 mg, 160.00 mg and 80.955 mg of Compritol 888 ATO, HPMC K15M and Sodium biarbonate respectively was prepared and evaluated. The experimental values from optimized formulation were obtained as Q1.5: 23.397%, Q8; 57.744%, Q24: 97.150% and FLT: 3.12 min. Predicted and experimental results were found comparable for all the responses. The release data from the optimized formulation were best fitted in the Higuchi (r2 = 0.999) and the Korsmeyer-Peppas ((r2 = 0.998, n=0.54) model. The in vitro drug release studies indicated that the Verapamil hydrochloride gastroretentive tablet releases the drug in controlled manner for 24 h. Conclusion: This study found that using Box-Behnken Design with the response and variable relation, it is possible to achieve an optimum formulation with desirable characteristics. This study also established the suitability of Compritol 888 ATO-HPMC K15M combination with Sodium bicarbonate to increase the gastric residence time tablet formulation had once-daily dosing of the Verapamil Hcl with improved bioavailability for effective management of hypertension.

JS-WHL-ISH-LANCET-4: VALIDITY OF AUTOMATED BPMD IN CLINICAL PRACTICE AND PUBLIC HEALTH. A GLOBAL NEED FOR HYPERTENSION MANAGEMENT

HEARTS in the Americas is the flagship program to improve population hypertension control and to reduce the CVD burden. Currently, the initiative is being implemented in 2095 primary health care facilities in 24 countries. Accurate BP measurement is key to effective management of hypertension and is one of the six strategic pillars of HEARTS. A pivotal action to facilitate the progress of the agenda was to examine the regulatory frameworks related to BPMDs in participating countries. Study found that most countries had an existing medical devices law, or the foundation for such a law, that stipulated a regulatory bodies responsibilities. However, only six countries had regulations that applied explicitly to BPMDs, and just two had regulations that mandated accuracy and precision validation criteria as a condition of premarket approval. Seven countries had government bodies responsible for enforcing medical device regulations, and seven had mechanisms to remove devices from the market that did not comply with regulations. Seven countries had a centralized system of acquiring BPMDs, but the acquisition was only regulated in six of these countries. In summary, BPMDs can be approved for sale in most countries without the manufacturer providing evidence of passing an internationally accepted clinical validation standard. The efforts to improve access to validated automated BPMDs are different for each country, in line with its priorities, health system maturity including regulatory, economic, and political conditions. Indeed, most of the facilities implementing HEARTS began to use accuracy-validated automated BPMDs. The general achievements showed in concrete actions are twofold: sectors of governments have been investing politically and administratively in modifications to regulations that do not require a substantive legislative process; and improved procurement toward exclusive access of validated automated BPMDs has been at least partially achieved. The improvement of procurement mechanisms has focused on defining technical specifications that include accuracy validation. The challenges that the countries face to reach the goal of exclusive use of validated BPMDs in PHC are enormous and multifactorial. This confirms the need for a robust regulatory framework and comprehensive strategic approach to exclusive use of clinically validated automated BPMDs at regional level. The successful implementation of the initiative depends on a coordinated effort across government and other stakeholders that will contribute to better diagnosis and management of hypertension in the Americas.

Management of hypertension across the cardiovascular-renal continuum

A high incidence of cardiovascular risk misclassification and underestimation of high-risk patients prevails among primary care physicians. In addition, it has been observed that treatment goals of hypertension as recommended by guidelines are not followed in the primary healthcare setting. Therefore, there exists a large percentage of the population with uncontrolled hypertension in India. We aimed at developing a framework for the effective management of hypertension and cardiovascular-renal risk in the presence of comorbidities for clinicians/healthcare providers. An online advisory board meeting with eminent cardiologists from across India was conducted to understand their perspectives on the management of hypertension across the cardiovascular-renal continuum. The outcomes of the meeting were summarized following a literature review of cardiorenal disorders, stroke, and heart failure risk in hypertensive patients. Furthermore, optimal treatment of hypertension in patients with a high risk of coronary artery disease, stroke, and chronic kidney disease and the choice of angiotensin receptor blockers in these patients were suggested. The advisory board meeting provided management strategies for patients with hypertension across the cardiovascular-renal continuum considering the increased risk of heart failure and death in the Indian setting.

Formulation and Optimization of Propranolol Bilayer Tablets: A Potential Approach for Effective Management of Hypertension

The purpose of this investigation is to formulate and evaluate the antihypertensive drug propranolol hydrochloride sustained-release bilayer tablets. In this formulation, one layer provides a loading dose through the immediate release of the drug and the other layer provides a maintenance dose for up to 12 h through controlled release. Different quantities of polymers such as Kyron T-314, Hydroxypropyl methylcellulose- K4M, and ethyl cellulose were used to make bi-layer tablets by direct compression. The compatibility study of pharmaceutical excipients was conducted through Fourier transform infrared spectroscopy studies and no interaction was found. The pre-compression parameter for the angle of repose, bulk density, tapped density and compressibility index was assessed on the produced granules and the findings were good. The tablets were evaluated for the post-compression parameters for thickness, hardness, friability and in vitro release studies. In vitro dissolution study was approved out for 12 h using United States Pharmacopeia dissolution apparatus I using phosphate buffer of pH 1.2 and 6.8 as dissolution medium. Hydroxypropyl methylcellulose- K4M and ethylcellulose were used in combination in all formulations but optimized formulation propranolol hydrochloride tablet 4 showed a higher rate of drug release up to 12 h as compared to the other formulation and optimized formulations propranolol hydrochloride tablet 4 follows the Higuchi model with non-fickian diffusion based on regression coefficient of the kinetics data of cumulative drug release from the dosage form.

Hypertension in Young Adults: Causes, Management and Lifestyle Modification

Hypertension, or high blood pressure, is a growing concern among young adults. While traditionally seen as a condition affecting older individuals, recent studies have shown an alarming increase in hypertension prevalence in young adults. This has prompted the need for understanding the causes, consequences, and management of hypertension in this age group. Lifestyle modifications, such as adopting a healthy diet, regular exercise, stress reduction, limiting alcohol and tobacco use, and maintaining a healthy weight, are key to managing hypertension. Medications may be prescribed if necessary, and regular monitoring of blood pressure is important. Collaboration with healthcare providers, patient education, and long-term follow-up are crucial for successful management. Overall, taking a comprehensive approach tailored to young adults' specific needs and circumstances is essential for effective hypertension management and the prevention of complications.

Top Ten Breakthroughs in Clinical Hypertension Research in 2022

Hypertension is a major global public health concern whose disease burden affects an estimated 1.4 billion people worldwide and is associated with 10.8 million deaths annually. Despite substantial advances in medical care, the prevalence of hypertension has markedly increased, owing to population aging; poor treatment adherence; and increases in risk factors, such as excessive salt intake, and overweight and obesity. Consequently, the disability-adjusted life years have increased by 40%, primarily because of elevated risk of stroke, coronary atherosclerosis, heart failure, and kidney failure. Major outstanding problems associated with the treatment and management of hypertension include determining optimal blood pressure targets, developing innovative antihypertensive medications and devices, and implementing effective and feasible hypertension management strategies. To address these challenges, numerous clinical trials are currently underway. This article highlights the most influential ten clinical studies on hypertension in 2022. The rational use of antihypertensive medications is concluded to be important for effective hypertension management. Important considerations include medication types and dosing times; optimal blood pressure targets; the development of new drugs and therapeutic devices; specific community characteristics, such as village doctor-led care; and healthful diets.

An Evaluation of Anti-Hypertensive Property of Hibiscus sabdariffa

Hypertension is the primary worldwide cause of cardiovascular disease and early death. Because of the extensive use of anti-hypertensive treatments during the past 40 years, the mean blood pressure (BP) over the world has either decreased dramatically or remained constant. Contrastingly, hypertension has increased in prevalence, especially in low- and middle-income countries. There is evidence of decreasing the incidence rate of hypertension however, it has been noted that there are more and more side effects that are being discovered associated with high-cost chemical treatments. Therefore, Phyto-based traditional medicine is now being investigated for its safety and lowcost characteristics. One of the main phyto-based treatments for hypertension is Hibiscus sabdariffa, which has been used by different countries. However, a comprehensive approach for evaluating the efficacy of this plant, its extracts, and beverages is still lacking. Therefore, this study aims to provide a review and compilation of the clinical trials and animal studies documenting and evaluating the effectiveness of H. sabdariffa for the effective management of hypertension in individuals with low to severe hypertension issues. Thus, this study can pave the pathway for future research to focus on the limitations that are confronting harnessing the full potential of Hibiscus sabdariffa.

Barriers to effective hypertension management in rural Bihar, India: A cross-sectional, linked supply- and demand-side study.

Effective management of hypertension in low- and middle-income settings is a persistent public health challenge. This study examined supply- and demand-side barriers to receiving quality care and achieving effective hypertension management in rural Bihar, India. A state-representative household survey collected information from adults over 30 years of age on characteristics of the hypertension screening, diagnosis, and management services they received. A linked provider assessment determined the percent of providers who provided quality hypertension care (i.e., had a functioning BP measurement device, measured a patient's BP, could correctly diagnose hypertension, had at least one first-line antihypertension medication, and could prescribe correctly based on standard guidelines). Patients were linked with their provider to determine the quality-adjusted coverage of hypertension management and logistic regression analysis was conducted to determine characteristics associated with receiving quality care. A total of 14,386 patients and 390 providers were studied. Nearly a quarter (22.5%) of adults had never had their BP measured before and 8.1% of adults reported a previous hypertension diagnosis. Less than one third (31.0%) of all interviewed providers demonstrated ability to provide quality hypertension care, and quality varied between provider types (14.8% of private homeopathic, 25.2% of informal, 40.0% of private modern medicine, and 60.0% of public providers gave quality care). While 95.8% of diagnosed individuals received some treatment, only 10.9% of patients received care from quality local providers. Nearly 45% of individuals with hypertension received care from non-local providers. Individuals from the general caste with comorbidities living in villages with more high-quality providers were most likely to receive quality care from a local provider. Whereas the coverage of services for individuals diagnosed with hypertension is high, the quality of these services is suboptimal for economically and socially vulnerable populations, which limits effective management and control of hypertension in rural Bihar. Efforts should be targeted towards providers to initiate quality treatment upon diagnosis, including correct prescription of antihypertensives.