Effective Treatment Of Hypertension Research Articles

Adherence to antihypertensive medication and its associated factors among patients with hypertension attending a tertiary hospital in Kathmandu, Nepal.

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of premature mortality and morbidity globally. Despite the evidences of the availability of effective treatment for hypertension, its management remains suboptimal. Medication adherence is the most crucial factor for blood pressure control. It is important to identify the factors associated with adherence to antihypertensive treatment for better management. Hence, this study assessed the level of antihypertensive medication adherence and its associated factors among patients with hypertension visiting a tertiary-level hospital in Kathmandu, Nepal. An analytical cross-sectional study was carried out among 308 diagnosed patients with hypertension who were prescribed antihypertensive medication. The Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence. Data was collected through face-to-face interviews and analysed using SPSS v26. A bivariate and multivariate logistic regression model was used to assess the factors associated with low medication adherence. More than half (61%) of the study participants had moderate to high levels of medication adherence. Upon bivariate analysis, there was a significant association between presence of side effects, blood pressure status, forgetfulness, high cost, fear of taking medicine lifelong and irregular follow-up with a low level of adherence. Upon multivariate the logistic regression analysis, forgetfulness [Adjusted Odd's Ratio (AOR) 22.5, 95% Confidence Interval(CI) 10.56-47.86], high cost (AOR 3.8, 95%CI 1.25-11.60) and fear of taking medicines lifelong (AOR 6.04, 95%CI 2.96-12.33) were found to be associated factors of low level of adherence. There is an urgency to develop evidence-based strategies to improve the level of adherence to antihypertensive medications among patients with hypertension. Strategies like reminder messaging, setting alarms, expanding the scope of national health insurance and proper counselling to reduce fear could help to improve medication adherence. Hence, the feasibility and effectiveness of such intervention should be explored in future studies.

Sacubitril/valsartan as an effective hypertension treatment option in those with chronic type B aortic dissection.

Sacubitril/valsartan as an effective hypertension treatment option in those with chronic type B aortic dissection.

User-Centered Data Display for Clinicians to Diagnose and Manage Hypertension.

The accurate diagnosis and effective treatment of hypertension are hindered by challenges stemming from limited access to comprehensive blood pressure (BP) data and the need for clinical context surrounding BP readings. Using handwritten tables for home-monitored BP exacerbates issues related to integration of electronic health records (EHRs) and trend analysis. This study employs user-centered design principles to develop prototypes for BP data visualization, with the primary goal of harmonizing disparate BP data sources to empower clinicians in precise hypertension diagnosis and management.

Mixed Pluronic/lecithin micelles formulation for oral bioavailability of candesartan cilexetil drug: in vitro characterization and in vivo pharmacokinetic investigations

Objective This study aimed to develop a mixed polymeric micelle formulation incorporating candesartan cilexetil (CAND) drug to enhance its oral bioavailability for the better treatment of hypertension. Methods A Box–Behnken design was utilized to optimize the CAND-incorporated mixed polymeric micelles formulation (CAND-PFLC) consisting of Pluronics (P123 and F68) and lecithin (LC). The optimized CAND-PFLC micelles formulation was characterized for size, shape, zeta potential, polydispersity index (PDI), and entrapment efficiency (%EE). An in vitro release study, ex vivo permeability investigation, and an in vivo pharmacokinetic analysis were carried out to evaluate the performance of the formulation. Results The optimized CAND-PFLC micelles formulation demonstrated a spherical shape, a particle size of 44 ± 2.03 nm, a zeta potential of −7.07 ± 1.39 mV, a PDI of 0.326 ± 0.06, and an entrapment efficiency of 87 ± 3.12%. The formulation exhibited excellent compatibility, better stability, and a noncrystalline nature. An in vitro release study revealed a faster drug release of 7.98% at gastric pH in 2 hrs and 94.45% at intestinal pH within 24 hrs. The ex vivo investigation demonstrated a significantly enhanced permeability of CAND, with 94.86% in the micelle formulation compared to 9.03% of the pure drug. In vivo pharmacokinetic analysis showed a 4.11-fold increase in oral bioavailability of CAND compared to the marketed formulation. Conclusion The CAND-PFLC mixed micelle formulation demonstrated improved performance compared to pure CAND, indicating its potential as a promising oral drug delivery system for the effective treatment of hypertension.

Telmisartan Plus Amlodipine as the Preferred Initial Combination in Newly Diagnosed Indian Patients with Hypertension: An Expert Consensus Statements.

Hypertension (HTN) remains one of the most important risk factors for cardiovascular (CV) diseases and a leading cause of mortality worldwide. Despite improvement in detection and treatment, poor blood pressure (BP) control rates are observed globally. The situation in India is alarming with only 22.5% of patients maintaining their BP under control. Initiating early and effective treatment for HTN helps control BP within normal limits and reduces associated health risks. In India, currently, there are no guidelines on the choice of dual combination treatment that can be considered an initial treatment for newly diagnosed HTN patients to achieve effective BP control and reduce CV risks. To provide consensus recommendations for preferred initial combinations in newly diagnosed Indian patients with HTN. A core group of 100 experts with HTN expertise conceptualized and formulated the four key questions based on answerability, effectiveness, potential for translation to clinical practice, novelty, and potential impact on the healthcare burden. A mix of Delphi and Child Health and Nutrition Research Initiative (CHNRI) methods was adopted for acceptance or refusal of recommendations. Likert scale 1-9 was used for scoring. A score of ≥7 was considered "statement accepted," >6.50 "near to acceptance" and <6.50 "not accepted." A vote of ≥7 by at least two-thirds of the experts (66.66%) was mandatory for acceptance of the recommendation. Combination therapy could be necessary for a majority of newly diagnosed Indian patients for effective BP control. It can manage HTN with better clinical outcomes. Based on mean rating scores from experts, telmisartan plus amlodipine can be considered the preferred initial combination in the management of newly diagnosed Indian patients with HTN to achieve better BP control and improve CV outcomes.

Losartan: A Pharmacotherapy in Cardiovascular Disease

Background: A recently published article confirmed that in 2019, around 523 million people suffered from cardiovascular disease (including 18.6 million deaths) worldwide. Losartan, a drug, was patented 35 years ago and approved for medical use in the United States in 1995 (28 years ago). As an effective treatment for hypertension, losartan blocks the interaction of angiotensin II with its receptor by inhibiting the renin-angiotensin system. Objective: This article aims to review the available literature and recent studies demonstrating the efficacy, safety, mechanism of action and drug-drug interactions of losartan in cardiovascular disease. Methods: This is a focused literature review with the keywords relevant to the terms performed in PubMed, Scopus and Web of Science through May 28, 2023, according to the PRISMA guidelines. Based on the PICO standard format, fifty-two relevant in-depth consequent guide approaches and evidence-based choices were selected associated with a knowledgeable collection of current, high-quality manuscripts. Results: After oral administration, time to reach maximum concentration is about 1-2 hours. With a 78% binding to protein, it has a bioavailability of 25-35%. Losartan is not removed by hemodialysis. For the full effect to occur, it may take up to 6 weeks. The drug is mainly prescribed for patients with high blood pressure, diabetic nephropathy, hypertension and left ventricular hypertrophy. The publication reported higher drug exposures and adverse reactions in women than men with antihypertensive medications. Losartan could improve changes in gut microbiota that might be associated with hypertension. In the high-risk group of renal transplant recipients with arterial hypertension, research reported well-controlled blood pressure with losartan monotherapy. Conclusion: In addition to the major losartan interactions with captopril, enalapril, lisinopril, and lithium, there are moderate interactions with aspirin, pregabalin, alprazolam, amitriptyline, baclofen, betamethasone, buspirone. Muscle cramps, respiratory infection, cough, hyperkalemia, anemia and stuffy nose are the main reported side effects. As polypharmacy could hide pharmacokinetics interaction due to cytochrome P450, therefore, the combination of losartan with drugs such as phenobarbital, rifampin or fluconazole needs vigilant attention regarding therapeutic drug monitoring.

Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study

IntroductionIn Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our...

Sustainable chromatographic quantitation of multi-antihypertensive medications: application on diverse combinations containing hydrochlorothiazide along with LC–MS/MS profiling of potential impurities: greenness and whiteness evaluation

Cardiovascular disorders are among the leading causes of death worldwide, especially hypertension, a silent killer syndrome requiring multiple drug therapy for appropriate management. Hydrochlorothiazide is an extensively utilized thiazide diuretic that combines with several antihypertensive drugs for effective treatment of hypertension. In this study, sustainable, innovative and accurate high performance liquid chromatographic methods with diode array and tandem mass detectors (HPLC–DAD and LC–MS/MS) were developed, optimized and validated for the concurrent determination of Hydrochlorothiazide (HCT) along with five antihypertensive drugs, namely; Valsartan (VAL), Amlodipine besylate (AML), Atenolol (ATN), Amiloride hydrochloride (AMI), and Candesartan cilextil (CAN) in their diverse pharmaceutical dosage forms and in the presence of Chlorothiazide (CT) and Salamide (DSA) as HCT officially identified impurities. The HPLC–DAD separation was achieved utilizing Inertsil ODS-3 C18 column (250 × 4.6 mm, 5 μm) attached with photodiode array detection at 225.0 nm. Gradient elution was performed utilizing a mixture of solvent A (20.0 mM potassium dihydrogen phosphate, pH 3.0 ± 0.2, adjusted with phosphoric acid) and solvent B (acetonitrile) at ambient temperature. Linearity ranges were 0.1–100.0 µg/mL for HCT, VAL, AML and CAN, 0.05 –100.0 µg/mL for both ATN and AMI and 0.05–8.0 µg/mL for both CT and DSA. Additionally, this work describes the use of liquid chromatography–electrospray–tandem mass spectrometry for the accurate detection and quantification of the impurities; CT and DSA in the negative mode utilizing triple quadrupole mass spectrometry. The linearity ranges for those impurities were 1.0–200.0 ng/mL and 5.0–200.0 ng/mL for CT and DSA, respectively. Developed methods’ validation was achieved in accordance with International Conference on Harmonization (ICH) guidelines. Upon applying liquid chromatographic techniques for the drug analysis, a green and sustainable assessment have to be handled due to the consumption of energy and many solvents. Through the use of the HEXAGON, Analytical Greenness (AGREE) and White Analytical Chemistry (WAC) tools, greenness and sustainability have been statistically assessed. The optimized HPLC–DAD and LC–MS/MS methods were fast, accurate, precise, and sensitive, and consequently could be applied for conventional analysis and quality control of the proposed drugs in their miscellaneous dosage forms for the purpose of reducing laboratory wastes, time of the analysis time, effort, and cost.Graphical

Abstract P3008: A Computational Model Predicts Sex-specific Responses To Calcium Channel Blockers In Mesenteric Vascular Smooth Muscle

The electrical activity of smooth muscle cells underlies the regulation of the diameter of small resistance arteries and arterioles to control blood flow and blood pressure. Historically, measurements of pressure in blood vessels and their responses to drug interventions have been based entirely on data from male animals. Recently, experiments have indicated sex-specific differences in smooth muscle. We hypothesize that the fundamental differences in ion channel expression measured in male and female cells may underlie variable responses to antihypertensive drugs between males and females. To determine if this hypothesis is plausible, we developed a computational model to investigate the effects of measured sex-specific differences in the electrophysiology and Ca 2+ signaling of vascular smooth muscle cells. Contrary to established models suggesting that K V 1.5 channels are the most prominent K V channels regulating membrane potential, our model predicts that K V 2.1 channels play an unexpectedly primary role in the control of membrane potential in female but not in male cells. In addition, we found that sex-specific differences in the amplitude and voltage dependencies of L-type Ca V 1.2 currents between males and females cause higher Ca 2+ influx and higher [Ca 2+ ] i , in female than in male mesenteric smooth muscle cells. To simulate sex differences in the regulation of resistance arteries and arterioles, we developed an idealized vessel model by connecting smooth muscle cells through simulated resistances to represent gap junctional coupling. The model predictions suggest that female arterial smooth muscle is more sensitive to clinically used Ca 2+ channel blockers than male smooth muscle. Our computational framework initiates the first steps toward the investigation of the potential sex-specific impact of antihypertensive drugs, which may lead to more effective treatment for hypertension.

MANAGEMENT OF PRE-ECLAMPSIA: ISSUES FOR ANAESTHETISTS

The role of anaesthetist for anaesthetic management for preeclamsia is very crucial. Anaesthetist's responsibility starts before the surgery at the moment of stabilizing patient's hemodynamic status and guiding to an obstetrician about administration of antihypertensives and seizure prophylaxis. The anaesthetic problems in these may be due to the effects on the cardiovascular, respiratory, neurologic, renal, haematologic, hepatic and uteroplacental systems. Labetolol, hydralazine, diazoxide and nifedipine is considered as the most common used drugs. Magnesium sulphate is the most effective agent for seizure prophylaxis. Platelet transfusion threshold is determined as 50000/mm3 in acutely bleeding patient. Cerebral haemorrhage remains the commonest cause of death in this group and hence rapid and effective treatment of hypertension to prevent haemorrhagic stroke is needed in these patients. As aetiology is largely unknown, preventative measures and screening tools are lacking and management is directed at the control of clinical manifestations. Delivery remains the only denitive treatment.

A Selective and Accurate LC-MS/MS Method for Simultaneous Quantification of Valsartan and Hydrochlorothiazide in Human Plasma

The fixed dose combination of valsartan (VAL) and hydrochlorothiazide (HCTZ) is the most commonly prescribed medicine for the effective treatment of hypertension. In this study, a simple sensitive and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the simultaneous quantitation of VAL and HCTZ in human plasma by using irbesartan (IRB) and hydroflumethiazide (HFMZ) as their specific internal standards (ISs). HLB cartridge-based solid-phase extraction was used for the extraction of analytes and ISs. The chromatographic separation was achieved on Lichrocart RP Select (125 × 4 mm), 5 nm with the mobile phase composition of acetonitrile: 10 mM ammonium acetate buffer: 95:05, v/v, at flow rate of 0.5 mL/min. The turbo ion electrospray ionization in negative mode was used as ion source for the sample ionization. The precursor to product ion transitions were 434.10 &gt; 179.10 (VAL), 295.70 &gt; 204.90 (HCTZ), 427.10 &gt; 192.90 (IRB), and 329.90 &gt; 302.40 (HFMZ) for detection and quantification of analytes and their ISs. The retention times of VAL and HCTZ were 1.90 min and 2.30 min, respectively. The range for the calibration curves of VAL and HCTZ were 50.2–6018.6 ng/mL and 1.25–507.63 ng/mL, respectively, with good linearity having correlation coefficient values of ≥0.995 for both VAL and HCTZ. All validation parameter results (selectivity, precision and accuracy, matrix effects and stabilities) were within the acceptable range as per USFDA guideline for bioanalytical method validation. The intra-day and inter-day accuracy data for VAL were within the range of 105.68–114.22% and 98.41–108.16%, respectively, whereas for HCTZ they were 87.01–101.18% and 95.16–99.37%, respectively. The ion suppression effects produced for VAL and ion enhancement effects produced for HCTZ were insignificant according to the proposed sample cleanup procedure. The developed LC-MS/MS method was successfully applied to bioequivalence study on healthy volunteers.

RAG-AMERICAS-4: THE FUTURE OF HYPERTENSION RESEARCH: PRECISION MEDICINE

Outline: Medicine is transitioning from the traditional reactive care based on symptoms, diagnosis and treatment to a system that targets the disease before it occurs and when disease is present, then treats it in a personalized manner. Chronic diseases such as arterial hypertension are suitable for precision medicine since patients with the same blood pressure (BP) values differ from one another, for instance, in terms of arterial hemodynamics and therefore, respond differently to the same treatment. From an epidemiological perspective, BP lowering is broadly effective, requiring little or even no information about individuals. The success of public health interventions that do not involve personalized medicine raises the question to what extent will personalizing the treatment of hypertension impact the health of patients. In general, there is a trade-off between simplicity of one-drug for most hypertensive patients and the addition of more information about individuals for personalized clinical decision-making. More precise treatment strategies create the most value for patients in whom simple strategies with low information is ineffective. A usual clinical scenario is resistant hypertension. Our research has shown that when hypertension subtypes are considered, BP reduction with current antihypertensive medications considerably differs. Both systolic and diastolic hypertensives exhibit the best antihypertensive response to vasodilators while insolated forms of systolic or diastolic hypertension respond much less to this kind of first line treatment of hypertension. A new taxonomy based on patient's clinical information, BP subtypes, genetic and epigenetic factors will identify hypertensive phenotypes beyond classical BP based approach, which will lead to a more precise and effective hypertension treatment.

Case Report on Rauwolfia Induced Parkinsonismma

Rauwolfia serpentina is a safe and effective treatment for hypertension. The objective of this case report is to enhance awareness for medical practitioners concerning Rauwolfia induced Parkinsonism, because recognition and appropriate management can enable proper treatment and prevent serious adverse outcomes. We report a patient, who is a known case of Systemic hypertension10 years ago and was taking 5 drops of Rauwolfia syrup, this caused the patient to suffer with rigidity and after discontinuation of Rauwolfia syrup, and full recovery was observed. The appraisal of the ADR reported, in this case, was done by applying the Naranjo probability scale of adverse drug reaction (ADR). For this patient, the Naranjo probability score of 6 was reported.

Black-white Differences in Left Ventricular Hypertrophy Rates Among Young Adults with Ischemic Stroke

ObjectivesFew studies have addressed Black-White differences in left ventricular hypertrophy (LVH) in young stroke patients without a history of hypertension. MethodsA case-only cross-sectional analysis performed in 2019 of data from the Stroke Prevention in Young Adults Study, a population-based case-control study of ischemic stroke patients ages 15–49. The main outcomes were hypertension indicators at the time of stroke hospitalization: self-reported history of hypertension, LVH by echocardiography (Echo-LVH) and LVH by electrocardiogram (ECG-LVH). The prevalence of Echo-LVH was further determined in those with and without a history of hypertension. Adjusted odds ratios and 95% confidence intervals comparing blacks and whites were calculated by logistic regression. ResultsThe study population included 1028 early-onset ischemic stroke patients, 48% Black cases, 54% men, median age 43 years (interquartile range, 38–46 years). Overall, the prevalence of hypertension history, Echo-LVH and ECG-LVH were 41.3%, 34.1% and 17.5%, respectively. Each of the hypertension indicators were more frequent in men than in women and in Black cases than in White cases. Black patients without a history of hypertension had higher rates of Echo-LVH than their white counterparts, 40.3% vs 27.7% (age and obesity adjusted OR 1.8; 95% CI 1.02–3.4) among men and 20.9% vs 7.6% (adjusted OR 2.7; 95% CI 1.2–6.2) among women. ConclusionsLVH was common in young patients with ischemic stroke, regardless of self-reported history of hypertension. These findings emphasize the need for earlier screening and more effective treatment of hypertension in young adults, particularly in the Black population.

ESTIMATES ON MEDICATION COST OF DRUG DOSE SPECIFIC TREATMENT PROTOCOL FOR HYPERTENSION MANAGEMENT IN PUBLIC AND PRIVATE HEALTHCARE SECTORS IN INDIA

Objective: Hypertension is a major public health challenge in most low- and middle-income countries and calls for prioritization of large-scale hypertension control programs. Adoption of drug and dose specific treatment protocols as recommended by the WHO-HEARTS is crucial for scaling up effective hypertension treatment in resource-limited settings. This study estimated the annual cost of medication per patient using three such protocols in India. Design and method: The medication requirement was simulated with a range of hypertension control assumptions for the selected protocols based on preliminary observations from sentinel sites of a large-scale hypertension control program in the public sector. Two five-step single molecule and a single pill combination (SPC) based antihypertensive treatment protocols were selected for this study and the approximate medication costs was calculated based on Indian prices in the public and private sectors. Result: The approximate annual cost of antihypertensive medication per patient ranged from $33.88–58.44 in the private sector when using a single molecule drug protocol and from $51.57–68.83 when using a SPC drugs protocol. The cost of medication was lower in the generic stores ranging between $5.78–9.57 for single molecule protocols and $7.35–9.89 for protocol with SPC. The cost of medication for patients covered by the public sector was the lowest at $2.05–3.89 for single molecule protocols and $2.94–3.98 for SPC. Conclusion: At less than $4 per patient per annum, scaling up hypertension control program with drug and dose specific treatment protocols is a potentially cost-effective public health intervention to save lives and reduce expenses associated with cardiovascular complications in India. Generic drug prescription enforcement and the development of low-cost generic retail networks would increase affordability in the private sector. The cost of treatment with SPCs is comparable to the single molecule protocol, and therefore SPC based treatment protocol can be adopted in a public health program considering the advantage of simplified logistics, reduced pill burden, improved treatment adherence and blood pressure control.

Determinants of arterial hypertension control in the hypertensive population receiving medical therapy

Highlights. The leading factor of ineffective arterial hypertension (AH) control in the population taking medications was the number of metabolic risk factors (RF). In addition, in men, the odds of reaching the blood pressure targets were lower if there was a history of kidney disease and bronchitis, and higher, if statins and hypotensive drugs were taken together, respectively. In women, heart rate equal or higher than 75 beats/min and total carotid atherosclerotic plaque thickness were associated with lower and a visit to a physician in the past year - with higher odds of effective hypertension control, respectively.Aim. Analysis of factors associated with reaching blood pressure targets in hypertensive population taking medications.Methods. We examined men and women of 25-64 y.o., randomly drawn from general population, having hypertension and receiving medications. All participants underwent standardized cardiac screening, including a survey on a number of socio-demographic, psychosocial, behavioral variables, traditional and metabolic cardiovascular risk factors, life quality. We measured anthropometric and blood pressure variables, "intima-media" thickness, presence and total thickness of carotid atherosclerotic plaques. Analysis included data from 480 respondents. Parametric and nonparametric statistics were used. To analyze relationships, multivariable logistic regression was used. An error probability &lt;5% was considered statistically significant.Results. After adjustment for age, wealth level, cardio-vascular deseases and the number of antihypertensive drugs, the following factors increased the chances of effective treatment for hypertension in men - statins, positive answer to the question “Do you feel pain or discomfort?” on the EQ5D scale. Lower odds for detecting target blood pressure levels were associated to the count of metabolic syndrome components according to IDF criteria except arterial hypertension (0-4), kidney disease, previous bronchitis, age. A direct association with the effectiveness of treatment for hypertension in women was shown by a visit to the doctor during the past year, and the opposite - the number of metabolic syndrome components, heart rate ≥75 per minute and the total thickness of carotid atherosclerotic plaques, respectively.Conclusion. Lack of hypertension control was associated to metabolic risk factors count, age, kidney disease, heart rate ≥75 per minute, previous bronchitis, lack of visit to a doctor over the past year, as well as total thickness of carotid atherosclerotic plaques. The situation can be improved by deliberately losing weight, taking statins by all people at very high and high risk, and seeing a doctor regularly. It is necessary to further study the factors that hinder achievement of blood pressure targets, as well as methods aimed at the prevention and effective correction of metabolic disorders.

Relationship between Cost of Care and Medication Adherence among Hypertensive Patients Attending a Tertiary Health Facility in Ekiti State, Nigeria

Background: The economic burden of care is a barrier to effective treatment of hypertension as affordability of drugs may affect medication adherence. This study assessed the cost of care and level of medication adherence among patients with hypertension attending a tertiary hospital in Ekiti State, Nigeria.Methods: This was a descriptive cross-sectional study that used a systematic sampling technique to select eligible patients. Data was collected with an interviewer-administered questionnaire. Medication adherence was assessed with eight-item Morisky Medication Adherence Scale (MMAS-8). Data entry and analysis were done using IBM SPSS version 22.0. p-value &lt; 0.05 was considered statistically significant.Results: The median age (Interquartile Range) of respondents was 55.0 (20.3) years with male to female ratio of 1:1.2. The mean monthly cost of care of hypertension was ₦15,964.76 (US$44.35). Only 47 (34.1%) respondents were adherent (MMAS score of ≥8) to their medications. Medication adherence was inversely associated with total cost of admissions (p=0.024) and cost of admission drugs/consumables (p=0.028). Male gender (AOR=12.561;95%CI=2.248–70.189), middle-age (45-64years) (AOR=11.577;95%CI=1.015- 131.998), being unmarried (AOR=0.006;95%CI=0.000–0.300), exercising &lt;3days per week (AOR=0.055;95%CI=0.006–0.489), employment in informal and formal occupations (AOR=0.024,0.022; 95%CI=0.001–0.590,0.001–0.591) and living with someone (AOR=0.000;95%CI=0.000–0.086) were significant predictors of medication adherence.Conclusion: Medication adherence was suboptimal and negatively associated with total cost of admissions and cost of admission drugs/consumables. Attention should therefore be given to developing and implementing measures such as subsidy on drugs and increasing coverage of health insurance that would limit the impact of these costs on the patients.&#x0D; Keywords: Cost of care; Medication adherence; Hypertension; Ekiti

Preparation and Optimization of Quick/Slow-release Bilayered Tablets of Prazosin HCl using DoE and PCA

The study aimed to develop once a day bilayer tablet of Prazosin HCl (PZH) for the effective treatment of hypertension with a quick-release layer to provide a loading dose while a slow-release layer as a maintenance dose. A statistical approach employing face-centred central composite design and principal component analysis (PCA) to develop bilayer tablets of PZH and scrutinize the critical responses was implemented. Independent factors in the study included the amount of guar gum (X1) and the a

The Effect of Progressive Muscle Relaxation Using Audio-Visual Media on Blood Pressure Reduction in Elderly Hypertension Patients

Introduction: Hypertension is one of the deadliest diseases in the world. Progressive muscle relaxation is one way of lowering blood pressure; this technique can control tension and anxiety by training patients to relax their body muscles deliberately. Choosing videos as a medium for health education is very suitable because the public can well receive them. This media offers an education that is more interesting and less monotonous. Objective: The study aimed to determine the effect of progressive muscle relaxation on blood pressure reduction in older adults with hypertension using audio-visual media. Method: This study used a pre-experimental method with one group pretest-posttest design. A total sample of 24 respondents was recruited using the purposive sampling technique. Result: The results found that the systolic blood pressure (p<0.001) and diastolic blood pressure (p<0.05) were significantly different before and after receiving the intervention. Conclusion. The progressive muscle relaxation affects blood pressure reduction in older people with hypertension with audio-visual media in the urban village linggarsari. Recommendation: Further studies are expected to be used as the basis for further research on the Effect of Progressive Muscle Relaxation with a combination of music or guided imagery on Blood Pressure Reduction. Clinical practice is expected to be used as a reference for more effective treatment of hypertension.

Effects of enalapril folic acid combined with levamlodipine on incidence of cardiovascular and cerebrovascular events in patients with essential hypertension

Essential hypertension (EP) is a chronic disease. Effective treatment of hypertension is one of most crucial preventions of cardiovascular (CV) and cerebrovascular (CBV) events. Enalapril folic acid combined with levamlodipine is an effective therapy to treat EP, but its effect on CV and CBV events in hypertensive patients is unknown. This study set out to assess the effects of enalapril folic acid combined with levamlodipine on incidence of CV and CBV events in patients with EP. We randomly assigned 172 patients with EP enrolled in our hospital between April 2017 and September 2018 to receive Levoamlodipine Maleate Dispersible Tablets alone (the control group, n = 85) or Levoamlodipine Maleate Dispersible Tablets combined with Enalapril Maleate and Folic Acid Tablets (the combination group, n = 87). All patients received basic treatment. After 4 weeks of treatment, we recorded the clinical outcomes and adverse reactions of all patients and compared the blood pressure before and after the treatment. The CV and CBV events happening in the two groups within 3 months after the treatment were also recorded. After 4 weeks of treatment, in contrast to the control group, the combination group had a higher marked response rate and lower moderate response rate and non-response rate (P &lt;0.05). The two groups displayed no great disparity in complication rate (P &gt;0.05). Before treatment, the two groups did not differ in pulse pressure (PP), diastolic blood pressure (DBP), and systolic blood pressure (SBP) (P &gt;0.05). After 4 weeks of treatment, both groups showed decreased PP, DBP, and SBP (P &lt;0.05), with lower PP, DBP, and SBP in the combination group (P &lt;0.05). The main CV and CBC events happening in the two groups during the 3-month follow-up included heart failure, stroke, unstable angina pectoris, transient cerebral hemorrhage, acute coronary syndrome, and accelerated heart rate, devoid of fatality. The control group obtained 22 cases (25.88%) of CV and CBC events, which was remarkably higher than the combination group that had 8 cases (9.20%) (P &lt;0.05). In conclusion, the enalapril folic acid combined with levamlodipine therapy is clinically valuable since it can better control blood pressure and reduce the incidence of CV and CBC events in patients without increasing the risk of adverse reactions.