Good Blood Pressure Control Research Articles

The Impact of Timing of Fixed Dose Triple Antihypertensive Combinations on Ambulatory Blood Pressure Monitoring Parameters

ABSTRACT Introduction Re-establishing “dipping” physiology significantly reduces cardiovascular events. The aim was to investigate the effect of timing of fixed dose triple antihypertensive combinations on blood pressure (BP) control. Methods One hundred sixteen consecutive patients (62.7 ± 10.7 years, 38 men) with grade II hypertension were randomized into four groups. Group 1 and Group 2 patients were given angiotensin converting enzyme inhibitor-based triple antihypertensive pills to be taken in the morning or evening, respectively while Group 3 and Group 4 patients were given angiotensin receptor blocker (ARB) based triple antihypertensive pills to be taken in the morning or evening, respectively. All patients underwent 24-h ambulatory BP monitoring 1 month after the initiation of treatment. Results There were not any significant differences in the characteristics, BP values and loads among groups. All patients in each group had good BP control. Dipping pattern in systolic BP was observed significantly less in Group 3 patients taking ARB in the morning (3 patients) compared to other groups (12 patients) in each group, [P = .025]. Similarly, dipping pattern in diastolic BP was observed significantly less in Group 3 patients (4 patients) compared to others (13 patients) in Group 1 and 15 patients in Group 2 and Group 4, [P = .008]. Nondipping pattern was significantly associated with taking ARB in the morning, even when adjusted by age, sex, and other comorbidities. Conclusion Fixed dose triple antihypertensive drug combinations enable good BP control regardless of the timing of drug while ARB-based ones may be taken in the evening to ensure dipping physiology.

Characterizing the hypertensive cardiovascular phenotype in the UK Biobank.

To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations. We studied 39 095 (51.5% women, mean age: 63.9 ± 7.7 years, 38.6% hypertensive) participants with CMR data available. Hypertension status was ascertained through health record linkage. Associations between hypertension and CMR metrics were estimated using multivariable linear regression adjusting for major vascular risk factors. Stratified analyses were performed by sex, ethnicity, time since hypertension diagnosis, and blood pressure (BP) control. Results are standardized beta coefficients, 95% confidence intervals, and P-values corrected for multiple testing. Hypertension was associated with concentric left ventricular (LV) hypertrophy (increased LV mass, wall thickness, concentricity index), poorer LV function (lower global function index, worse global longitudinal strain), larger left atrial (LA) volumes, lower LA ejection fraction, and lower aortic distensibility. Hypertension was linked to significantly lower myocardial native T1 and increased LV ejection fraction. Women had greater hypertension-related reduction in aortic compliance than men. The degree of hypertension-related LV hypertrophy was greatest in Black ethnicities. Increasing time since diagnosis of hypertension was linked to adverse remodelling. Hypertension-related remodelling was substantially attenuated in hypertensives with good BP control. Hypertension was associated with concentric LV hypertrophy, reduced LV function, dilated poorer functioning LA, and reduced aortic compliance. Whilst the overall pattern of remodelling was consistent across populations, women had greater hypertension-related reduction in aortic compliance and Black ethnicities showed the greatest LV mass increase. Importantly, adverse cardiovascular remodelling was markedly attenuated in hypertensives with good BP control.

Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto

Introduction and aimsDuring clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. Patients and methodsThe study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. ResultsOf the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). ConclusionsThe fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications.

GASTROINTESTINAL ANGIONEUROTIC EDEMA AS A CONSEQUENCE OF ANGIOTENSIN – CONVERTING ENZYME INHIBITOR TREATMENT

Objective: To report a case of unusual severe adverse reaction to an angiotensin-converting enzyme inhibitor (ACEI). Design and method: A 33-year-old male with a history of hypertension for 10 years, asthma, and atopy was admitted to a local emergency department due to diffuse abdominal pain with vomiting and diarrhea for about 3 days. A few days earlier, the patient had blood pressure (BP) lowering treatment modified due to suboptimal BP control, with introduction of perindopril. The first ACEI dose was followed by lower abdominal pain, urge to have bowel movement, and difficulty passing stool. 24 hours later, the next dose was followed by severe, gradually increasing, diffuse abdominal pain, nausea, vomiting, and diar-rhea. With signs of peritonitis present on admission, a surgeon suspected an acute abdomen and or-dered abdominal computed tomography (CT) due to unclear etiology. CT showed diffuse infiltrates within the small intestine and its mesentery, with free abdominal fluid but no perforation. The patient was not operated and seen by an internist who suspected gastrointestinal angioneurotic edema related to ACEI. On admission to the medical unit, the patient was moderately unwell, conscious, with BP 185/110 mmHg, HR 128 bpm, SaO2 99% on room air, and no fever. Abdomen examination showed reduced bowel sounds, abdominal guarding, tenderness on palpation, especially in the mid-abdomen, and rebound tenderness. Laboratory tests showed elevated WBC (16,800/mm3) and CRP (19 mg/L). Results: Perindopril was withdrawn, the patient received antihistamines, analgesics, and intravenous fluids, with improvement of the patient's condition and reduction of pain and inflammation markers. Follow-up abdominal CT after 5 days showed resolution of small intestinal edematous lesions. The patient was discharged home in good condition, without abdominal pain, and with good BP control. The final diag-nosis was gastrointestinal angioneurotic edema associated with ACEI treatment. Conclusions: One condition may mimic another and thus unclear clinical presentations require cautious diagnostic and therapeutic decisions. In the presented case, angioneurotic edema following introduction of perin-dopril was unusually located in the gastrointestinal tract and its manifestations imitated an acute abdo-men.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME DUE TO HIGH BLOOD PRESSURE PEAK AFTER HEART TRANSPLANT

Objective: Posterior reversible encephalopathy syndrome (PRES) is a reversible subcortical vasogenic cerebral oedema involving parieto-occipital regions in patients with acute neurological symptoms. The aim of this study is to analyse an interesting case of PRES after heart transplant. Design and method: A heart transplant was performed in a 53-years-old woman affected by arrhythmogenic cardiomyopathy. She had history of atrial fibrillation and ventricular fibrillation requiring an implantable cardioverter defibrillator, chronic renal insufficiency with frequent acute episodes, heart failure and stasis hepatopathy. After the transplantation, the patient required femoral extracorporeal membrane oxygenator for three days, mediastinal revision for bleeding, two runs of continuous veno-venous hemofiltration, and a pericardial drainage for effusion. After fifty days the patient was stable, but she suddenly experienced a high blood pressure peak of 180 mmHg and tachycardia, followed by limb stiffening, limb colonies resolved with diazepam, verbal blockade, and sphincter release. Results: A cerebral computer tomography was immediately performed showing a bilateral parieto-occipital oedema suggestive of PRES (Figure 1). The patient was treated by brivaracetam and the immunosuppressive therapy was switched from cyclosporine to tacrolimus. Subsequently, she experienced amelioration of symptoms. Ten days later, electroencephalography did not show any epileptic signs and oedema was regularly evolving on cerebral imaging. PRES usually appears in the setting of blood pressure fluctuations, cytotoxic drugs, and renal failure. In the case presented, the time link between symptoms and typical brain images could show that the high blood pressure peak after heart transplant could have been a trigger for the syndrome in a patient with chronic renal disease treated with cyclosporine, which are both risk factors for PRES. According to literature, PRES syndrome could be due to endothelial injury related to abrupt blood pressure changes, breaking down blood-brain barrier and generating cerebral oedema. Conclusions: This case showed that PRES is a possible complication after heart transplant in patient with predisposing risk factors and blood pressure sudden variations. It is very important to have a good blood pressure control after heart transplant and to choose the property immunosuppressive therapy in these patients.

The Association Between Medication Adherence and Blood Pressure Control in End-Stage Renal Disease Patients with Hemodialysis

End-Stage Renal Disease (ESRD) is a severe kidney disorder that contributes to an increased risk of mortality in the world. This condition is often related with hypertension. Low medication adherence was affecting uncontrolled blood pressure in ESRD. The research aimed to analyze the association between medication adherence and blood pressure control in ESRD patients. This cross-sectional study with 77 respondents was conducted in September 2020 at the Dialysis Unit of the Private Hospital “X” Buleleng Bali by purposive sampling technique. The respondents must be ≥18 years, diagnosed with ESRD and hypertension, underwent hemodialysis (HD) twice a week, received the same antihypertensive for 3 months, have complete medical record data, and signed the informed consent form. Patients with cognitive impairment, unable to communicate, pregnant or breastfeeding, and received the Erythropoiesis Stimulating Agent (ESA) treatment were excluded. Kruskal-Wallis test was used in data analysis. Most of the patients were <65 years (80.52%), male (70.13%), primary education (57.14%), without complications (57.1%), and duration of illness <5 years (89.61%). Patients were in the high adherence (61.04%) and 66.23% of patients had uncontrolled blood pressure. The association between medication adherence and blood pressure control was not significant (p=0.478). However, these results show that high medication adherence could impact on good blood pressure control.

NOVEL TECHNIQUE OF SHORT-ACTING SPINAL ANAESTHESIA FOR FRACTURE NECK OF FEMUR SURGERY ALLOWING EARLY MOBILIZATION, REDUCING MORBIDITY AND MORTALITY, AND IMPROVING OVERALL FUNCTIONAL OUTCOME

Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and anaesthesia may have an implication on early post-operative mobilisation.Aim was to evaluate perioperative blood pressure measurements (duration of fall of systolic BP below the critical level of 90mmHg) and effect on the post-operative renal profile with the newer short acting spinal anaesthetic agent (prilocaine and chlorprocaine) used alongside the commonly used regional nerve block. 20 patients were randomly selected who were given the newer short acting spinal anaesthetic agent along with a regional nerve block between May 2019 and February 2020. Anaesthetic charts were reviewed from all patients for data collection. The assessment criteria for perioperative hypotension: Duration of systolic blood pressure less than 90 mm of Hg and change of pre and post operative renal functions.Only one patient had a significant drop in systolic BP less than 90mmHg (25 minutes). 3 other patients had a momentary fall of systolic BP of less than 5 minutes. None of the above patients had mortality and had negligible change in pre and post op renal function. Only one patient in this cohort had elevation of post-operative creatinine levels but did not have any mortality. Only 1 patient died on day 3 post operatively who had multiple comorbidities and was under evaluation for GI cancer. Even in this patient the peri-operative blood pressure was well maintained (never below 90mmHg systolic) and post-operative renal function was also shown to have improved (309 pre-operatively to 150 post-operatively) in this patient.The use of short-acting spinal anaesthesia has shown to be associated with a better control of blood pressure and end organ perfusion, less adverse effects on renal function leading to early mobilisation and a more favourable patient outcome with reduced mortality, earlier mobilisation, shorter hospital stay and earlier discharge in this elderly patient cohort.

Stretching Exercise as a Rehabilitation Modality for Hypertension: A Brief Review

Hypertension is the major risk factor for different cardiovascular diseases like ischemic heart disease, congestive heart failure, stroke and chronic kidney disease. Best estimates suggest that 57% of stroke and 24% of coronary artery disease-related deaths are due to hypertension. Various physical exercises such as aerobic exercises, resistance exercises, high intensity interval training performed regularly can help with management of blood pressure, quality of life and cardiovascular complications. Static stretching of the skeletal muscles accrues the benefits of exercise without its accompanying physical stress as in case of aerobic exercise and resisted exercises. Studies have supported that stretching could results in better control of blood pressure in normotensive patients. Also, few studies have been done on hypertensive patients, but have multiple limitations. Studies conducted till date could not conclude definitive conclusion for framing a definitive protocol of stretching exercises in patients with hypertension. Hence, in order to establish a definitive stretching protocol in patients with hypertension further researches needs to be conducted. Keywords: Hypertension, Stretching, Systolic blood pressure, Diastolic blood pressure.

An Expert Opinion on the Role of the Rosuvastatin/Amlodipine Single Pill Fixed Dose Combination in Cardiovascular Prevention.

Current cardiovascular disease prevention strategies are based on the management of cardiovascular risk as a continuum, redefining the therapeutic goals for each individual based on the estimated global risk profile. Given the frequent clustering of the principal cardiovascular risk factors, such as hypertension, diabetes and dyslipidaemia, in the same individual, patients are required to take multiple drugs to achieve therapeutic targets. The adoption of single pill fixed dose combinations may contribute to achieve better control of blood pressure and cholesterol compared to the separate administration of the individual drugs, mostly due to better adherence related to therapeutic simplicities. This paper reports the outcomes of an Expert multidisciplinary Roundtable. In particular, the rational and potential clinical use of the single pill fixed dose combination "Rosuvastatin-Amlodipine" for the management of concomitant hypertension/hypercholesterolemia in different clinical fields are discussed. This Expert Opinion also illustrates the importance of an early and effective management of total cardiovascular risk, highlights the substantial benefits of combining blood pressure and lipid-lowering treatments in a single-pill fixed dose combination and attempts to identify and overcome the barriers to the implementation in clinical practice of the fixed dose combinations with dual targets. This Expert Panel identifies and proposes the categories of patients who may benefit the most from this fixed dose combination.

Unintentional Weight Loss from Metformin Despite Good Glycaemic Control in a Newly Diagnosed Diabetic Patient

Aim: To present a case of unintentional weight loss from Metformin despite good glycaemic control in a newly diagnosed diabetic patient.
 Case Presentation: A 60-year-old previously diagnosed hypertensive and recently diagnosed type 2 diabetic patient with good glycaemic and blood pressure control presented with progressive weight loss in the last one year while on medication. Her normal state weight was 84.6kg, height 1.70m2 (BMI 29.27kg/m2) which dropped to 70kg (BMI 20.26Kg/mg2) at the point she was diagnosed with type 2 diabetes mellitus (T2DM). She was counselled about dietary and lifestyle modification. She was then commenced on Metformin and she achieved a good blood glucose level control but her weight dropped further to 58kg despite adherence with diet and lifestyle. She was then changed to Sulphonylurea (Glipizide). She had a significant improvement in her weight which she had maintained with good glycaemic control.
 Discussion: Oral hypoglycemic agents (OHAs) are the most common initial pharmacologic treatments for type 2 diabetes and they are associated with changes in weight. Sulphonylureas (SUs) are widely used in routine clini­cal practice, not only in combination with metformin, but also as first-line monotherapy. Patients often gain weight due to the side effects of current therapies, particularly SU, insulin and glitazone therapies.
 Conclusion: It is important for clinicians to consider not only the antihyperglycemia effects of selected medications used in the treatment of diabetes, but also the effect they may have on the patient’s body weight.

Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study

In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ≥18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension.

Abstract Number ‐ 138: Complex symptomatic dissecting pseudoaneurysm with inflow zone stenosis required angioplasty before flow‐diversion‐a technical report.

Introduction 16.4 percent of patients diagnosed with fibromuscular dysplasia (FMD) are found to have internal carotid artery (ICA) dissection [1] which may lead to life threatening ICA dissecting pseudoaneurysm (ICADPA). Endovascular repair of ICADPA may be urgent when ICADPA is symptomatic, potential for rupture with no good alternatives. Tortuous anatomy with FMD and ICADS can represent a significant endovascular challenge, especially if there is an aneurysmal inflow‐zone stenosis.Objective: We present a unique case of right ICADPA with an inflow‐zone parent artery stenosis underwent angioplasty and repair with surpass evolve flow diverter (SEFD). Methods Case report and chart review. Results 49‐year‐old man history of hypertension, hyperlipidemia, and left ICADPA status post stenting/stent‐assisted coiling in 2017, who presented with right‐sided pulsatile tinnitus after a facial injury. Cerebral angiography revealed a tortuous right ICA with FMD, and presence of a right ICADPA at the skull base measuring 16×8 mm with inflow zone stenosis and a post‐stenotic dilatation. An emergency repair was performed with an informed consent under general anesthesia. In order for the SEFD to deploy properly, an angioplasty of inflow‐zone parent artery stenosis was performed with a 3×20mm Maverick balloon. Subsequently, a SEFD measuring 5×40 mm was deployed to cover the dissecting pseudoaneurysm, and a second SEFD measuring 5×20 mm was deployed covering the ICADS resulting in good apposition of SEFD and securement of ICADS.Use of a metal self‐deployable stent prior to flow diversion was not an option due to the presence of extreme tortuosity and acute angulations on the parent artery.patient was discharged home after 24 hours with 325 mg of aspirin and 75 mg of clopidogrel and good blood pressure control. 90‐days follow‐up, demonstrated good recovery with modified Rankin score of 0 with no symptoms. Conclusions ICADPA with aneurysmal inflow zone parent artery stenosis and the presence of extream tortuosity and acute angulations, may require angioplasty prior to the flow diversion for successful repair. Further studies are required.

S-09-3: ROLE OF SACUBITRIL/VALSARTAN IN THE CONTROL OF BLOOD PRESSURE

Sacubitril/valsartan an angiotensin receptor-neprilysin inhibitor has been shown to reduce the risk of cardiovascular risk death or heart failure hospitalization and improve symptoms among patients with chronic heart failure with reduced ejection fraction. The drug was born initially as an antihypertensive agent and showed an excellent capacity to decrease blood pressure superior to that of angiotensin receptor antagonists. Theoretically the combination seemed to be particularly suitable for difficult to control or resistant hypertension. Unfortunately the administration of sacubitril could translate into increased amyloid beta deposition albeit it was not fully confirmed. In fact John McMurray presented in the meeting of the European Society of Cardiology (25/aug/2022) the double blind trial PERSPECTIVE devoted to fully assess the long neurocognitive effects of sacubitril /valsartan versus valsartan that demonstrated that there was no difference in the cognitive capacity between the two groups of patients. These data permit to consider that the use of sacubitril/valsartan is not accompanied by relevant potential concerns. It opens then the use of this combination in hypertension that requires unlike heart failure longer periods of treatment. The clinical data available and the fact the the drug is being used in Japan in daily clinical prsctice facilitates the consideration of opening many other countries to the combination leading to a better control of blood pressure accompanied by simultaneous cardiorenal protection.

Manpower cost for a hypertension health campaign: A cross-sectional study.

The overall prevalence of hypertension is high, and many people are unaware of their condition. Screening campaigns can effectively identify this group of patients. The study aimed to determine the cost of manpower for a health campaign for detecting undiagnosed hypertension and the prevalence of hypertension. This cross-sectional study was conducted at two health centres. Sociodemographic characteristics, hypertension and treatment statuses were recorded. Blood pressure (BP) was measured by either doctors or nurses using automated BP machines. The cost of manpower was calculated as the average salaries of manpower during the 3-day health campaign divided by the total number of days. The final sum was the cost of detecting undiagnosed hypertension. A total of 2009 participants median age = 50 (IQR = 18-91) were included in the study. The overall prevalence of hypertension was 41.4% (n=832). Among the patients with hypertension, 49.2% (n=409) were unaware of their hypertension status. Conversely, 21.1% (n=423) were known to have hypertension, among whom 97.4% (n=412) were on medications. Among those who were on medications, 49% (n=202) had good BP control. The average total cost of manpower during the 3-day health campaign was RM 5019.80 (USD 1059). The cost of detecting an individual with elevated BP was RM 12.27 (USD 2.59). The prevalence of hypertension and unawareness is high. However, the average cost of manpower to detect an individual with elevated BP is low. Therefore, regular public health campaigns aiming to detect undiagnosed hypertension are recommended.

PS-P10-8: RELATIONSHIP BETWEEN BLOOD PRESSURE AND PRESENCE OF TREATMENT FOR HYPERURICEMIA

Background: Uric acid is strongly associated with hypertension. However, it is unclear whether drug treatment for hyperuricemia decreases blood pressure or not. Methods: This study is a cross-sectional study using the data from 13,087 participants (4,698 female) who had annual health check-up at the Health Management Center and Diagnostic Imaging Center, Toranomon Hospital, Tokyo in 2017. We compared systolic and diastolic blood pressure between participants with and without drug therapy for hyperuricemia. Moreover, we compared systolic and diastolic blood pressure between more than 7 mg/dL and 7 mg/dL and less of serum uric acid levels in participants with drug therapy for hyperuricemia. The presence or absence of drug therapy for hyperuricemia was confirmed by questionnaire methods. Results: The number of hyperuricemic participants was 18 in female and 642 in male. The number of hyperuricemic female was very small, and therefore, this study analyzed only hyperuricemic male. Of the 642 male, 153 participants were hyperuricemia without drug therapy and 489 participants were hyperuricemia with drug therapy. Serum uric acid levels and systolic and diastolic blood pressure in hyperuricemic participants with drug therapy is lower than those without drug therapy (serum uric acid levels 6.23 ± 1.01 mg/dL versus 7.25 ± 1.15 mg/dL; systolic blood pressure 124.2 ± 12.4 mmHg versus 125.1 ± 13.7 mmHg; diastolic blood pressure 79.13 ± 8.83 mmHg versus 79.69 ± 8.83 mmHg), even though the drug therapy group was significantly older than absence of drug therapy group (59.7 ± 9.7 years old versus 56.8 ± 11.2 years old, p = 0.002). In the drug therapy group, those with more than 7 mg/dL of serum uric acid (N = 79) had higher systolic and diastolic blood pressure than those with 7 mg/dL and less of serum uric acid (N = 410) (systolic blood pressure 125.2 ± 11.2 mmHg versus 124.0 ± 12.7 mmHg; diastolic blood pressure 80.52 ± 8.78 mmHg versus 78.86 ± 8.48 mmHg), even though those with more than 7 mg/dL of serum uric acid were significantly younger than those with 7 mg/dL and less of serum uric acid (57.3 ± 9.8 years old versus 60.2 ± 9.6 years old, p = 0.015). Conclusion: Drug therapy for hyperuricemia is associated with lower systolic and diastolic blood pressure compared with absence of drug therapy for hyperuricemia. Adequate hyperuricemia control could lead to good blood pressure control. Further randomized controlled trials are desired to reveal the relationship between blood pressure and presence of treatment for hyperuricemia.

Patient Engagement Using Telemedicine in Primary Care during COVID-19 Pandemic: A Trial Study.

The correct treatment of most non-transmissible diseases requires, in addition to adequate medication, adherence to physical activity and diet guidelines, as well as health data monitoring and patient motivation. The restrictions caused by the COVID-19 pandemic made telemedicine tools and mobile apps the best choice for monitoring patient compliance. The objective of this study was to analyze the benefits of an m-Health solution designed specifically for chronic patients during the COVID-19 pandemic. A pragmatic clinical trial with pre-post measurements of a single group was carried out with 70 patients (aged 40+) with one or more chronic conditions. Patients were provided with an ad hoc mobile app and health data measuring devices according to their diseases. The health status of the patients was monitored remotely by health professionals who could also modify the patient's objectives according to their evolution. The results obtained show an average fulfillment of objectives of 77%. Higher fulfillment values: medication adherence (98%) and oxygen saturation (82%); lower fulfillment values: weight (48%), glucose (57%), and distance walked (57%). Globally, the ad hoc app was rated 8.72 points out of 10 (standard deviation 1.10). Concerning the pre-post analysis, there were significant improvements vs. prior apps used by the participants in the following items: improved physical activation and better control of blood pressure, diet, weight, glucose, and oxygen saturation. In conclusion, the telemedicine tool developed was useful in increasing patient engagement and adherence to treatment.

Identification of patient-related, healthcare-related and knowledge-related factors associated with inadequate blood pressure control in outpatients: a cross-sectional study in Serbia

ObjectivesTo determine rate of blood pressure (BP) control and to analyse patient-related, medication-related and healthcare system-related factors associated with poor BP control in outpatients with hypertension (HT).DesignCross-sectional study.SettingTwo study sites...

Home Blood Pressure Self-monitoring plus Self-titration of Antihypertensive Medication for Poorly Controlled Hypertension in Primary Care: the ADAMPA Randomized Clinical Trial

BackgroundPatient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure.ObjectiveThis study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients.DesignThe ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain.ParticipantsHypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018.InterventionParticipants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration.Main MeasureThe primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months.Key ResultsPrimary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was −2.9 mmHg (95% CI, −5.9 to 0.1, p=0.061), while the AMD in DBP was −1.9 mmHg (95% CI, −3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events.ConclusionSelf-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events.Trial RegistrationEudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov, NCT03242785.

Novel antihypertensive agents for resistant hypertension: what does the future hold?

Finding complementary compelling novel therapeutic agents for better control of blood pressure in people with resistant hypertension is moving into unchartered territory. The latest therapeutic developments explore approaches in the clinical arena that were either not examined or could only be examined in animal models two decades ago. Four main mechanisms have now been explored and operationalized in drug development: (a) mineralocorticoid receptor blockade using a nonsteroidal structure with many fewer side effects, (b) an aminopeptidase A inhibitor that has central effects on vasopressin, (c) a combined endothelin A and B receptor blocker and (d) an aldosterone synthase inhibitor devoid of glucocorticoid activity. All these agents are either completing Phase II development and starting Phase III or are involved in the ongoing recruitment of Phase III trials. Additionally, novel agents use antisense inhibition to block angiotensinogen development in the liver. These agents are discussed only for completeness, as they are still in Phase II trial development. Last, another agent that was initially being developed as an antihypertensive and once the data were reviewed by the company clearly showed efficacy as a heart failure agent was sacubitril/valsartan, which was ultimately approved. However, there are some discussions about reinvigorating the quest for an indication for hypertension, although no such steps have been formally initiated.

Raised Blood Pressure as a Risk Factor of Post-Operative Seroma Formation in Patients of Modified Radical Mastectomy

Despite seroma is rarely potentially lethal and is typically harmless, it can cause considerable sequelae such as flap necrosis, wound dehiscence, predisposes to infection. The objective of the study was to determine the association of raised blood pressure as a risk factor of development of seroma after MRM in breast cancer patients. Material Methods: In this case control study, all women of age 30 to 70 years with MRM done for carcinoma of the breast of stage T2 and lymph nodes N2 were enrolled and followed for 3 days after MRM surgery for seroma formation. Out of total 122 patients, 64 patients were cases and 58 controls. Patients with disease upto N2 had level 2 clearances with upfront surgery. Age, history of essential hypertension, compression bandage applied, serum albumin level, seroma formation and volume of seroma on 3rd post-operative day was documented. Results: Mean age of the patients was 51.2 + 9.5 years and 53.5 + 10.8 years in case and control, respectively. Majority of the patients were of the age group 40 to 50 year’s age group. 56.3% (n=36) cases and 43.8% (n= 28) controls had history of essential hypertension. Seroma formation was seen in cases 51% (n=31) as compare to controls 13% (n= 8) with odd ratio OR 1.48. Drainage volume among two groups was analyzed as in case group, the drainage volume was 148.1 + 76.4 ml (range 50 to 290) while in control group the drainage volume was 130 + 56.9 ml (60 to 250) and was statistically significant with p-value &lt;0.001. Conclusion: Although the pathogenesis of seroma remains controversial, hypertension is the most consistent significant risk factor for seroma formation subsequent to modified radical mastectomy for carcinoma breast. Good pre, peri and post-operative blood pressure control can reduce the risk of seroma formation and the associated morbidity. Keywords: MRM, Seroma, nodal clearance, breast cancer,