Good Blood Pressure Research Articles

Integrated metabolomics analysis reveals mechanistic insights into variability in blood pressure response to thiazide diuretics and beta blockers.

Hypertensive patients with a higher proportion of genetic West African ancestry (%GWAA) have better blood pressure (BP) response to thiazide diuretics (TDs) and worse response to β-blockers (BBs) than those with lower %GWAA, associated with their lower plasma renin activity (PRA). TDs and BBs are suggested to reduce BP in the long term through vasodilation via incompletely understood mechanisms. This study aimed at identifying pathways underlying ancestral differences in PRA, which might reflect pathways underlying BP-lowering mechanisms of TDs and BBs. Among hypertensive participants enrolled in the Pharmacogenomics Evaluation of Antihypertensive Responses (PEAR) and PEAR-2 trials, we previously identified 8 metabolites associated with baseline PRA and 4 metabolic clusters (including 39 metabolites) that are different between those with GWAA <45% versus ≥45%. In the current study, using Ingenuity Pathway Analysis (IPA), we integrated these signals. Three overlapping metabolic signals within three significantly enriched pathways were identified as associated with both PRA and %GWAA: ceramide signaling, sphingosine 1- phosphate signaling, and endothelial nitric oxide synthase signaling. Literature indicates that the identified pathways are involved in the regulation of the Rho kinase cascade, production of the vasoactive agents nitric oxide, prostacyclin, thromboxane A2, and endothelin 1; the pathways proposed to underlie TD- and BB-induced vasodilatation. These findings may improve our understanding of the BP-lowering mechanisms of TDs and BBs. This might provide a possible step forward in personalizing antihypertensive therapy by identifying patients expected to have robust BP-lowering effects from these drugs.

MAY MEASURE MONTH 2022 IN ITALY: RESULTS OF A NATIONWIDE SURVEY

Objective: By affecting approximately 45% of the world's population, hypertension is the main risk factor for cardiovascular diseases (CVD). Of note, only half of hypertensive patients manage to have good blood pressure (BP) control. Relevant reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients’ side, and therapeutic inertia on physicians’ side. Design and method: During the global BP screening campaign “May Measure Month” (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults &gt;= 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures. Results: A total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About one in two participants was sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension; not being on a fixed-dose combination of antihypertensive drugs and not measuring their BP at home were common features in this setting. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%). Conclusions: This survey identified a certain degree of therapeutic inertia and poor patients’ involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to increase risk factors awareness to reduce CV risk.

Practice Facilitation and Peer Coaching for Uncontrolled Hypertension Among Black Individuals

Rural Black participants need effective intervention to achieve better blood pressure (BP) control. Among Black rural adults with persistently uncontrolled hypertension attending primary care clinics, to determine whether peer coaching (PC), practice facilitation (PF), or both (PCPF) are superior to enhanced usual care (EUC) in improving BP control. A cluster randomized clinical trial was conducted in 69 rural primary care practices across Alabama and North Carolina between September 23, 2016, and September 26, 2019. The participating practices were randomized to 4 groups: PC plus EUC, PF plus EUC, PCPF plus EUC, and EUC alone. The baseline EUC approach included a laptop for each participating practice with hyperlinks to participant education on hypertension, a binder of practice tips, a poster showing an algorithm for stepped care to improve BP, and 25 home BP monitors. The trial was stopped on February 28, 2021, after final data collection. The study included Black participants with persistently uncontrolled hypertension. Data were analyzed from February 28, 2021, to December 13, 2022. Practice facilitators helped practices implement at least 4 quality improvement projects designed to improve BP control throughout 1 year. Peer coaches delivered a structured program via telephone on hypertension self-management throughout 1 year. The primary outcome was the proportion of participants in each trial group with BP values of less than 140/90 mm Hg at 6 months and 12 months. The secondary outcome was a change in the systolic BP of participants at 6 months and 12 months. A total of 69 practices were randomized, and 1209 participants' data were included in the analysis. The mean (SD) age of participants was 58 (12) years, and 748 (62%) were women. In the intention-to-treat analyses, neither intervention alone nor in combination improved BP control or BP levels more than EUC (at 12 months, PF vs EUC odds ratio [OR], 0.94 [95% CI, 0.58-1.52]; PC vs EUC OR, 1.30 [95% CI, 0.83-2.04]; PCPF vs EUC OR, 1.02 [95% CI, 0.64-1.64]). In preplanned subgroup analyses, participants younger than 60 years in the PC and PCPF groups experienced a significant 5 mm Hg greater reduction in systolic BP than participants younger than 60 years in the EUC group at 12 months. Practicewide BP control estimates in PF groups suggested that BP control improved from 54% to 61%, a finding that was not observed in the trial's participants. The results of this cluster randomized clinical trial demonstrated that neither PC nor PF demonstrated a superior improvement in overall BP control compared with EUC. However, PC led to a significant reduction in systolic BP among younger adults. ClinicalTrials.gov Identifier: NCT02866669.

Time in target range of systolic blood pressure and clinical outcomes in atrial fibrillation patients: results of the COOL-AF registry

We aimed to investigate the relationship between time in target range of systolic blood pressure (SBP-TTr) and clinical outcomes in patients with atrial fibrillation (AF). We analyzed the results from multicenter AF registry in Thailand. Blood pressure was recorded at baseline and at every 6 monthly follow-up visit. SBP-TTr were calculated using the Rosendaal method, based on a target SBP 120–140 mmHg. The outcomes were death, ischemic stroke/systemic embolism (SSE), major bleeding, and heart failure. A total of 3355 patients were studied (mean age 67.8 years; 41.9% female). Average follow-up time was 32.1 ± 8.3 months. SBP-TTr was classified into 3 groups according to the tertiles. The incidence rates of all-cause death, SSE, major bleeding, and heart failure were 3.90 (3.51–4.34), 1.52 (1.27–1.80), 2.2 (1.90–2.53), and 2.83 (2.49–3.21) per 100 person-years, respectively. Patients in the 3rd tertile of SBP-TTr had lower rates of death, major bleeding and heart failure with adjusted hazard ratios 0.62 (0.48–0.80), p < 0.001, 0.64 (0.44–0.92), p = 0.016, and 0.61 (0.44–0.84), p = 0.003, respectively, compared to 1st SBP-TTr tertile. In conclusion, high SBP-TTr was associated with better clinical outcomes compared to other groups with lower SBP-TTr. This underscores the importance of good blood pressure control in AF patients.

The influence of optimal blood pressure control on the progression of chronic kidney disease

Background/Aim: Chronic kidney disease (CKD) has seen a rapid increase worldwide in recent decades, now recognised as a global health issue of the 21st century. Optimal, continuous control of hypertension represents a crucial part of treatment capable of slowing the progression of CKD. The aim of this study was to demonstrate that optimal regulation blood pressure control in patients with essential and secondary hypertension, along with CKD, slows the progression of CKD. Methods: The research was conducted at the University Clinical Centre of the Republic of Srpska, Banja Luka, Internal Clinic Nephrology Department. A retrospective-prospective study was blind for patients and lasted for 24 months. It included 97 patients, aged 18 and above, of both genders, hypertensive, in the 3rd or 4th stage of CKD (creatinine clearance of 15-59 mL/min). Assess the outcome of CKD, a "complex (undesirable) clinical outcome" was taken - one of three fundamental clinically undesirable events: double increase in serum creatinine values at the end of 24 months, onset of terminal renal insufficiency, or patient death. Patients were classified into three groups: I group - 30 patients with essential hypertension and CKD with optimally regulated blood pressure; II group - 32 patients with secondary hypertension and CKD with optimally regulated blood pressure; III control group - 35 patients with hypertension of various causes and CKD who did not achieve target blood pressure values. Blood pressure control was measured from month 0 to month 24 - once a month. Laboratory tests were taken every 3 months (red blood cells, haemoglobin, glycaemia, cholesterol, urea, creatinine, uric acid, sodium, potassium in serum and urine). Results: There was a highly statistically significant difference in glomerular filtration rate in the first group compared to the third group and in the second group compared to the third group. No statistically significant difference in glomerular filtration rate between the first and second groups was observed, where good blood pressure regulation was achieved. Conclusion: Optimal blood pressure control in the examined groups, regardless of the cause of CKD, was responsible for slowing the progression of CKD compared to the group with unregulated blood pressure.

THE IMPACT OF HYPERTENSION ON COVID-19 SEVERITY: A GLOBAL REVIEW

Hypertension, also known as high blood pressure, is a prevalent medical condition that can exacerbate the severity of coronavirus disease 2019 (COVID-19). Studies from around the globe have shown that hypertensive patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tend to experience more severe symptoms and have poorer outcomes. A meta-analysis of eight studies from China found that hypertensive patients were over twice as likely to develop severe COVID-19 illness that requires intensive care unit admission, mechanical ventilation or results in death. Several other analyzes of data from China, Italy, and the United States have come to similar conclusions, showing roughly double the risk of adverse outcomes in hypertensive patients. In summary, hypertension appears strongly linked to worse COVID-19 outcomes across the world. Patients should maintain good blood pressure control and take recommended precautions to avoid SARS-CoV-2 infection. Clinicians should closely monitor hypertensive patients diagnosed with COVID-19 due to their increased risk of critical illness. Continued research on how hypertension influences COVID-19 severity can help guide therapeutic approaches for this high-risk population.

Abstract 17563: Serial ABPM, Antihypertensive Drug Treatment, and Pregnancy Outcomes in Women With Hypertension Found Early During Pregnancy

Introduction: Few data are available on serial ambulatory blood pressure monitoring (ABPM) throughout pregnancyand antihypertensive drug treatment required for good blood pressure (BP) control in hypertensivepregnant women. Hypothesis: Evaluation of BP control, antihypertensive drug treatment intensity, and pregnancy outcomes in patients with hypertension (HTN) found early during pregnancy. Methods: We studied 49 consecutive pregnant patients (mean age 33.4±4.8 years, BMI before pregnancy24.5±3.7 kg/m2) referred for office HTN found early during pregnancy who gave birth to 50 children (1 twin pregnancy) in 2011-2015. Gestational HTN was previouslydiagnosed in 39 women, and 9 women had a history of previous miscarriage or stillbirth, with multipleprevious pregnancies lost in some patients. ABPM was repeated at 5-10-15-20-25-30-33-35-37 weeksof pregnancy. We calculated overall antihypertensive treatment intensity in standard daily drug doses per patient (standard doses: labetalol 200 mg, methyldopa 750 mg, metoprolol 50 mg, nifedipine 20mg, verapamil 120 mg). Statistical analysis was performed using ANOVA. Results: All children were born alive (24 vaginal delivery, 26 cesarean section) and are well at follow-up.Gestational age was 38.0±2.5 (range 29-40) weeks, and birth weight was 3215±653g (range 955-4200). Preeclampsia/eclampsia occurred in 10/3 patients. Four patients had normal BP values by ABPM throughout pregnancy and did not receive antihypertensive drugs. Most patients were treatedwith labetalol and methyldopa. Throughout pregnancy, BP remainedwell controlled (24h mean SBP/DBP 120.3-126.0/75.3-77.1 mmHg), the number of treated patientsincreased from 25 at 5 weeks to 42 at 25-35 weeks, and the average number of daily antihypertensivedrug doses in treated pts increased from 1.82 at 5 weeks to 2.98 at 37 weeks. Conclusions: Serial ABPM-guided antihypertensive drug treatment started early during pregnancywas associated with favorable outcomes. The number of patients requiring treatment increased throughout the pregnancy. No physiological BP fall atthe end of 1 st trimester was observed. Our findings help estimate the expected treatment intensity required in pregnant patients with preexisting hypertension.

Relationship between the Level of Spirituality and Blood Pressure Control among Adult Hypertensive Patients in a Southwestern Community in Nigeria

Background: Spirituality has been strongly associated with good blood pressure control as it forms a strong coping mechanism in hypertensive patients. This hospital-based cross-sectional study was done to determine the relationship between spirituality and blood pressure control among adult hypertensive patients in rural Southwestern Nigeria to achieve good blood pressure control. Method: The selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of spirituality was assessed using the Spiritual Perspective Scale. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p ≤ 0.05. Results: The mean age of the respondents was 61.1 ± 11.1 years. More than half (52.6%) had a high level of spirituality and more than two-thirds (67.1%) of respondents had controlled blood pressure. Respondents with a high level of spirituality were 4.76 times more likely to have good blood pressure control {p &lt; 0.001, 95% CI (1.05-14.99)} than those with a low level of spirituality. Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients’ holistic care with the aim of achieving better blood pressure control among hypertensive patients.

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 &lt;65 years (80.52%), male (70.13%), primary education (57.14%), without complications (57.1%), and duration of illness &lt;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.

Rational Prescribing and Deprescribing of Antihypertensive Medications in Older People, a Three-Part Narrative Review, Part 3.

What happens when you stop? This is the third of a three-part series on antihypertensive medication use in older people. In the first, we reviewed the importance of better blood pressure (BP) control, even in older people with hypertension. In the second, we discussed the limitations of the evidence favoring intensive therapy for some older people. For older people with advanced frailty or those with a limited life expectancy, medications taken for BP can actually be a source of morbidity. Guidelines encourage clinical judgment and rational prescribing. Sometimes the best action is to stop prescribing. De-prescribing of medical therapy is now considered good practice for a range of medications for suitable patients; should this include antihypertensives? In part three of this three-part series, we will review some of the evidence available thus far, demonstrating de-intensification of antihypertensive medications is not a new idea. We will offer a guide to identifying the most suitable patients for de-prescribing: cognitive impairment, frailty, when circumstances change, or when BP is (too) well-controlled. This is an area of equipoise and needs more research. There is a path forward that we hope to illuminate.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Impact of continued high blood pressure on the progression of diabetic nephropathy after 10 years: KAMOGAWA-HBP study.

Albuminuria is a prognostic marker of worsening renal outcomes in people with hypertension and type 2 diabetes. High home systolic blood pressure is associated with the development of diabetic nephropathy. We assessed the impact of chronic high home blood pressure on diabetic nephropathy progression 10 years after study entry. The participants measured their blood pressure three times in the morning for 14 days at study entry and 10 years after study entry. A retrospective cohort of 165 people with type 2 diabetes at a single hospital was classified into four groups (good control maintenance, improvement, deterioration, and continuous high blood pressure groups) according to a morning home systolic blood pressure ≥125 mmHg at study entry and 10 years after study entry. Logistic regression analysis was performed to determine the association between home blood pressure control and the progression of diabetic nephropathy. After 10 years of entry, the status of nephropathy improved for 5.5% of the participants, remained unchanged for 72.1%, and progressed for 22.4%. The odds ratio of the continuous high blood pressure group versus that of the good control maintenance group for the progression of diabetic nephropathy was 10.41 (95% CI, 1.26-86.15). After adjusting for the introduction of renin-angiotensin-aldosterone system inhibitors during the follow-up period, there was no significant difference in the odds ratio of worsening nephropathy between these groups. The deterioration and improvement groups did not have significant diabetic nephropathy progression compared to the good control maintenance group. Chronic high home blood pressure was associated with the progression of diabetic nephropathy, and RAAS inhibitors could attenuate the negative effect. We demonstrated that chronic home blood pressure was associated with the progression of diabetic nephropathy.

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.

Knowledge, attitude, and practices of high-blood-pressure patients attended at Mutare city clinics in Manicaland province in 2022–2023

Objective: The low socioeconomic status of Mutare city patients, shortage of medical staff, and lack of supported hypertension programs expose clients to poor or lack of counseling services; hence, the present study aimed to investigate the knowledge, attitude, and practices among those hypertensive patients. Materials and methods: A cross-sectional correlational investigation was conducted to find the amount of knowledge about hypertension on hypertensive clients and the association between hypertension knowledge and good blood pressure management. All the hypertensive patients who were diagnosed at least 2 months prior to the study were included. A sample of 88 participants was used for this study. Convenience quota sampling was used where every clinic out of the 8 clinics should have supplied 11 hypertensive clients. Data were collected using a structured interviewer administered questionnaire. Logistics regression analysis was done, and odds ratio was used to assess the relationship of variables. The statistical level of significance was set at P &lt; 0.05. Discussion and results: A total of 80% of the participants were concluded to have good hypertension knowledge. Those who had at least a discussion with a health worker were 9.31 (p-value 0.005) folds more prone to reflect good knowledge than patients who never had a discussion about hypertension. Those who were 50 years and above were less likely to possess good knowledge in comparison to clients below 50 years of age (odds ratio 0.21, P-value 0.049). Conclusion: There is a wrong belief of hypertensive medication causing diabetes, being addictive and traditional, with herbal medicines being cure to hypertension, and those with well-controlled blood pressure were found to have poorer knowledge compared to those with poorly controlled blood pressures.

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.

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,

A Randomized Double-blind Comparison of Phenylephrine and Norepinephrine for the Management of Postspinal Hypotension in Pre-eclamptic Patients Undergoing Cesarean Section

(Eur J Anaesthesiol. 2021;38:1077–1084) Phenylephrine is the vasopressor of choice during cesarean delivery (CD) with spinal anesthesia; however, it can cause reflex bradycardia. Norepinephrine is being investigated as an alternative due to its ability to maintain better blood pressure (BP), heart rate, and cardiac output compared with phenylephrine while still seeing similar neonatal outcomes. Studies involving pre-eclamptic women need to be conducted to determine norepinephrine’s effectiveness in this population. This study aimed to compare bolus doses of norepinephrine and phenylephrine for postspinal hypotension in pre-eclamptic women undergoing CD.