Good Blood Pressure Control Research Articles

Matão Controlling Hypertension (MatCH) project: Rationale and design.

BackgroundHypertension is the main risk factor for most cardiovascular diseases. A coordinated and organized system from the Brazilian Ministry of Healthy involving Family Health Strategy (FHS), a program for the prevention of chronic disease, and the Popular Pharmacy Program (PPP), which subsidizes medications for the population, could allow an earlier identification and better blood pressure (BP) control. Matão Controlling Hypertension (MatCH) is a community-based population project that aims to apply an organized, integrated and coordinated program in the city of Matão, Brazil, involving FHS and PPP in order to actively search, treat and follow-up hypertensive subjects.MethodThis is a population community-based, interventional, follow-up study where all subjects aged ≥ 40 years assisted by the FHS program in Matão will have BP assessed monthly by trained Community Health Agents (CHA) during a domiciliary visit. Identified hypertensive subjects will be referred to FHS physicians for nonpharmacological and pharmacological treatment. Most of the hypertensive drugs used will be available through the PPP. Prevalence of hypertension, awareness, demographics and risk factors will be correlated with BP control. The population study is expected to involve approximately 18.600 subjects. The study period will be four years.DiscussionConsidering that hypertension is asymptomatic in most cases, to reduce the population burden of BP-related deaths and diseases it is essential to detect and treat early all hypertensive patients. If we achieve our large-scale BP control, this program can be applied to other populations from developing countries.

Posterior reversible encephalopathy syndrome (PRES) induced by pazopanib, a multi-targeting tyrosine kinase inhibitor, in a patient with soft-tissue sarcoma: case report and review of the literature

SummaryPosterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by acute neurological symptoms such as severe headache, seizures, and visual disturbance, and by typical reversible lesion on brain magnetic resonance (MR) images. Since PRES is thought to be caused by vascular endothelial injury due to cytotoxic agents or acute systemic hypertension, the number of reports on PRES associated with angiogenesis inhibitors has been increasing. Although five cases that developed PRES due to pazopanib for renal cell carcinoma have already been reported, none of PRES due to pazopanib for soft-tissue sarcoma has been reported thus far. We describe a case of a 49-year-old woman with retroperitoneal soft-tissue sarcoma who developed PRES during pazopanib administration. Pazopanib at 800 mg/day was administered as her third-line treatment at relapse. After 38 days of pazopanib, she was admitted to our hospital with severe headache, vomiting, and systemic hypertension. The next day, she developed consciousness deterioration and visual disturbance together with exacerbated systemic hypertension. Brain MR images revealed hyper-intense signals on FLAIR sequences in the bilateral occipital lobes and the left thalamus. Intravenous nicardipine injection was immediately started to control her blood pressure and pazopanib was discontinued. Her symptoms gradually improved and disappeared on the fifth hospital day. After 2 weeks, hyper-intense signals on a FLAIR sequence disappeared completely. She restarted a low dose of pazopanib under good blood pressure control and experienced no subsequent recurrence of PRES.

Knowledge, adherence and control among patients with hypertension attending a peri-urban primary health care clinic, KwaZulu-Natal.

BackgroundDespite hypertension being a common condition among patients attending primary health care (PHC) clinics, blood pressure (BP) control is often poor. Greater insight into patient-related factors that influence the control of hypertension will assist in the development of an intervention to address the issues identified.AimThe aim of the study was to assess patient-related variables associated with hypertension control among patients attending a peri-urban PHC clinic.SettingThe setting for this study was a peri-urban PHC clinic in KwaZulu-Natal.MethodThis was an observational, descriptive and cross-sectional study with 348 patients selected over a 1-month period. A validated questionnaire was used to collect data on patients’ hypertension knowledge and self-reported adherence, and BP recordings from their medical record were recorded to ascertain control.ResultsOf the 348 participants, only 49% had good BP control and 44% (152/348) had concurrent diabetes mellitus. The majority of patients had moderate levels of knowledge on hypertension and exhibited moderate adherence. There was a significant relationship between knowledge and reported adherence, between reported adherence and control, but not between reported knowledge and control.ConclusionDespite over 90% of the study population having moderate knowledge, and 62% with moderate reported adherence, BP was well controlled in only less than 50% of the study population. These findings suggest a need to emphasise adherence and explore new ways of approaching adherence.

Renal denervation decreases susceptibility of the heart to ventricular fibrillation in a canine model of chronic kidney disease.

What is the central question of this study? Renal denervation (RDN) has been shown to be effective and safe, resulting in better control of blood pressure and an improvement in left ventricular hypertrophy in chronic kidney disease (CKD) patients. Ventricular arrhythmias and sudden cardiac death are common causes of death in CKD patients, but previous studies pay almost no attention to the effects of RDN on the risk of ventricular fibrillation associated with CKD. What is the main finding and its importance? Renal denervation could decrease susceptibility of the heart to ventricular fibrillation in a canine CKD model. Improvement of left ventricular hypertrophy, sympathetic activation and inflammation by RDN may be responsible for its beneficial effects. Renal denervation (RDN) has been shown to have therapeutic value in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether RDN could decrease the susceptibility of the heart to ventricular fibrillation in a canine model of CKD. Twenty-one dogs were used. Chronic kidney disease was produced by subtotal nephrectomy in 16 dogs with RDN treatment (CKD+RDN group, n=8) or sham RDN (CKD group, n=8). Another five dogs underwent sham operation and sham RDN to serve as controls (CTR group). Parameters of renal function, blood pressure, echocardiography, ECG, noradrenaline and inflammation were measured at baseline and 6weeks after the surgical procedure. The ventricular fibrillation threshold (VFT) was determined at the end of the study. Subtotal nephrectomy successfully induced a canine CKD model. When compared with the CTR group, subtotal nephrectomy in the CKD group significantly elevated blood pressure; increased the left ventricular mass, end-diastolic left ventricular internal dimension, left ventricular end-diastolic posterior wall thickness and end-diastolic interventricular septum thickness; prolonged the QT interval, corrected QT interval, the interval from the peak to the end of the T wave (Tp-e) and the corrected Tp-e interval; and increased the QT dispersion and the Tp-e/QT ratio; decreased the VFT; and increased the serum concentrations of noradrenaline, C-reactive protein and interleukin-6. Renal denervation significantly attenuated these changes induced by CKD. The study demonstrated that RDN could decrease the susceptibility of the heart to ventricular fibrillation in this CKD model. Improvement of left ventricular hypertrophy, sympathetic activation and inflammation by RDN may be responsible for its beneficial effects.

Comparison of hypertension control in patients with diabetes and hypertension and patients with hypertension without diabetes depending on the stage of chronic kidney disease

Diabetes and hypertension are plagues of the begin­ning of the 21st century. Both of these conditions lead to significant deterioration in quality of life and reduc­tion of patient’s life expectancy. The aim of the work was to answer the questions: what is the all day, daily and night systolic and diastolic blood pressure in pa­tients with hypertension and in patients with diabetes and hypertension, depending on the stage of chronic kidney disease, and whether there are significant dif­ferences in the control of day and night systolic and diastolic blood pressure between the patients with diabetes mellitus and hypertension. 300 patients have been admitted to the Department of Internal Diseases, Diabetology and Nephrology due to hypertension decompensation. In the first place all subjects were divided into two groups: the ones with diabetes and hypertension and patients with hypertension but with­out diabetes. Afterwards the patients were divided in 5 subgroups depending on the stage of chronic kidney disease. It was shown that patients with diabetes and hypertension are significantly less likely to have their blood pressure controlled properly (24 hours a day, during the day and at night) in relation to patients with hypertension without diabetes and that, with increased renal failure, diabetes and hypertension and hypertensive patients without diabetes do not have good blood pressure control, especially for diabetics and hypertension. (Clin Diabetol 2017; 6, 3: 81–89)

Sex differences in risk factor management of coronary heart disease across three regions

ObjectiveTo investigate whether there are sex differences in risk factor management of patients with established coronary heart disease (CHD), and to assess demographic variations of any potential sex differences.MethodsPatients with...

Cushing's Disease: Subclinical Left Ventricular Systolic and Diastolic Dysfunction Revealed by Speckle Tracking Echocardiography and Tissue Doppler Imaging.

Novel echocardiographic techniques, such as speckle tracking echocardiography (STE) and tissue Doppler imaging, are sensitive tools for assessing left ventricular (LV) performance. LV global longitudinal strain (GLS), assessed by STE, is a sensitive marker of myocardial systolic function. Cardiovascular complications in patients with Cushing's disease (CD) determine a higher mortality than that in an age- and gender-matched population. Cardiac systolic dysfunction may be detected in early stages by STE. Thus, the aim of this study was to investigate the usefulness of STE in detecting subclinical LV dysfunction in three groups of patients: CD group, arterial hypertension group (AHG), and healthy volunteers (HV). Echocardiographic assessments of LV systolic and diastolic function were performed in 171 subjects (CD: 22, AHG: 114, HV: 35) with no symptoms of heart failure. A statistical comparison included separate analyses for men and women. CD patients showed good blood pressure (BP) control (below 140/90 mmHg in 82% of cases). However, in comparison AHG and HV groups they exhibited: (1) significantly lower LV contractility expressed by GLS (CD group: -17.7%, AHG group: -19.2%, HV: -20.0%; p = 0.004) and (2) higher prevalence of LV diastolic dysfunction (45.0, 14.2, 0.0%, respectively; p < 0.00001). Men with CD showed significantly more pronounced LV diastolic dysfunction. Cortisol excess in women was related to impaired LV systolic function. CD, even with well-controlled BP, is associated with LV dysfunction which depends individually on sex. These hemodynamic alterations can be detected by modern non-invasive diagnostic tools and may become potential therapeutic objectives.

PP.01.19] PREDICTORS OF CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH HIGH CARDIOVASCULAR RISK

Objective: Hypertension is a major risk factor for cardiovascular events. Patients at high risk are particularly vulnerable and require adequate treatment and control. The treatment is complex and requires good control of blood pressure and all modifiable risk factors associated with the protection of target organ damage. The goal of this study is to determine which factors have predictive significance of cardiovascular events in patients with hypertension and high cardiovascular risk. Design and method: We studied 258 participants (60% females). Each participant underwent asymptomatic organ damage: 12-lead electrocardiogram examinations, two-dimensional and Doppler echocardiographs, Doppler sonography of the carotid arteries, and laboratory investigations were prospectively followed for fatal and non-fatal cardiovascular event and total mortality over a median of 7 years. Results: Mean age in the beginning of the study was 62.7 ± 9 years, body mass index of 28.9 ± 4. kg/m2, office blood pressure of 150.3 ± 20/87.6 ± 13 mmHg, left ventricular mass index (LVMI) of 129.8 ± 29 g/m2, carotid intima -media thickness (IMT) of 0.92 ± 0.2 mm. Diabetes mellitus (DM) was in 28% patients, mean total cholesterol 5.74 ± 1 mmol/l. At a follow-up, the incidence of non-fatal and fatal cardiovascular events was 18.2%, and total mortality was 4.7%. Major cardiovascular events were more common in men (p = 0.019) and were highly correlated with systolic blood pressure (SBP) at the beginning of the study (p = 0.038), with cholesterol at the beginning of the study(p = 0.019) and at the end of the study (p = 0.028), glucoses at the beginning of the study(p = 0.004), DM at the beginning (p = 0.001) and at the end (p = 0.006), LVMI (p < 0.001) and IMT (p < 0.001) at the beginning. Patients with a cardiovascular death were significantly older (p = 0.002), had higher SBP at the beginning (p = 0.017) and higher IMT (p = 0.017). During the study 7.4% of participants got cancer and its positive correlation with DM was determined at the end of the study (p = 0.002) and with IMT at the end of the study (p = 0.037). Conclusions: Main predictors of major cardiovascular events among patients with hypertension and high risk are: age, male sex, SBP, DM and IMT.

Relationship Between Blood Pressure Variability and Cognitive Function in Elderly Patients With Good Blood Pressure Control.

Although higher blood pressure (BP) levels and BP variability have been associated with cognitive impairment, data are sparse regarding the relationship between BP variability and cognitive function in elderly patients with well BP control. We analyzed 232 ambulatory patients with one or more cardiovascular risk factors. All patients underwent ambulatory BP monitoring and the Japanese version of the Montreal Cognitive Assessment (MoCA-J). The mean age was 77.7 ± 8.3 years; 33.6% were male, and 85.3% were taking antihypertensive drugs. The average 24-hour BP level was 118.7 ± 10.0/68.3 ± 6.4 mm Hg. When we divided the weighted SD of systolic BP (SBP) as a measure of BP variability into quartiles, the top quartile group (≥19.6 mm Hg) had a significantly lower total MoCA-J score (15.4 [95% confidence interval 14.2-16.7] vs. 17.9 [17.2-18.6], P = 0.001) and lower scores on several domains, visuoexecutive (2.2 [1.9-2.6] vs. 2.8 [2.6-2.9], P = 0.012), abstraction (1.0 [0.7-1.2] vs. 1.3 [1.1-1.4], P = 0.015), attention (2.8 [2.4-3.1] vs. 3.6 [3.4-3.8], P = 0.001), and naming (2.1 [1.9-2.3] vs. 2.5 [2.4-2.6], P = 0.001) than quartiles 1 through 3 combined, after adjustment for age and 24-hour SBP. These associations were not found in the quartiles of 24-hour SBP. In elderly patients with well ambulatory BP control, higher BP variability but not average ambulatory BP level was associated with cognitive impairment.

Prescription pattern of antihypertensive medications and blood pressure control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria.

The prevalence of hypertension and attendant cardiovascular disease burden is increasing globally. Auditing antihypertensive prescriptions and assessing patients with hypertension for blood pressure (BP) control are important steps on the path to reducing hypertension-related morbidity, mortality, and health expenditure. This study assessed the prescription pattern of antihypertensive medications and BP control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria. This was a cross-sectional descriptive study that involved 224 hypertensive patients. Information obtained from participants included sociodemographic data, duration of hypertension, history of diabetes mellitus, and number and classes of antihypertensive medications used. Good BP control was defined as a mean BP less than 140/90mmHg. The mean age of hypertensive subjects was 59.6 ± 12.2 years, with a male:female ratio of 1:1.9 and a median duration of hypertension of 5 years. Twenty-four participants (10.7%) had both hypertension and diabetes. The common classes of antihypertensive medications used were diuretics, calcium channel blockers (CCB), and angiotensin converting enzyme inhibitors (ACEIs). Forty participants (17.8%) were on monotherapy, while the rest were on multidrug therapy. The most commonly prescribed antihypertensive combination was diuretic + ACEI/angiotensin receptor blocker (ARB), followed by diuretic + CCB + ACEI/ARB. Good BP control was observed in 120 participants (53.6%). The proportion of patients with good BP control was largest among patients on monotherapy and those with tertiary education, though these observations were not statistically significant. The pattern of prescribed antihypertensive medications complied with recommended guidelines. Blood pressure control amongst hypertensive patients was unsatisfactory. More efforts should be geared towards better BP control.

Precarious encounter with Paraganglioma during cystoscopic excisional biopsy of urinary bladder tumour

Tumours secreting catecholamine are a known perioperative anaesthetic challenge. However, extra adrenal location of such tumors can cause sudden catastrophe in unprepared patients. A 45 year old, 50 kg female patient scheduled for transurethral cystoscopic resection of bladder tumour of suspected neoplastic aetiology, developed sudden, severe tachycardia, hypertension, and arrhythmias followed by hypotension under general anaesthesia. Tumour biopsy obtained during first surgery confirmed diagnosis of Paraganglioma (PGL). This was supported with normal vanillyl mandelic acid (VMA), 6.5mg/24hrs (normal 2-8mg/24hrs) and a large polypoidal mass on CT in a patient with episodic symptoms of headache and blackout associated with micturition; a classical triad reported about this tumour category. Findings of MIBG (Meta iodo benzyl guanidine) 131I scan that reported no MIBG avid disease, were equivocal. Accurate diagnosis, good perioperative control of blood pressure and volume status using invasive monitoring and cascade of drugs to manipulate circulation when required, formed the essence of successful management of the patient during her second surgery.

Occupational burnout and empathy influence blood pressure control in primary care physicians

BackgroundGood physician-patient communication can favor the adoption of healthy lifestyle habits, which is essential in high blood pressure (BP) management. More empathic physicians tend to have lower burnout and better communication skills. We analyzed the association between burnout and empathy among primary care physicians and nurses and investigated the influence on BP control performance.MethodsDescriptive study conducted in 2014 investigating burnout and empathy levels in 267 primary care physicians and nurses and BP control data for 301,657 patients under their care. We administered the Maslach Burnout Inventory and the Jefferson Scale of Physician Empathy and defined good BP control as a systolic BP <130 mmHg.ResultsLow burnout and high empathy were observed in 58.8% and 33.7% of practitioners, respectively. Burnout and empathy were significantly negatively associated (p < 0.009). Practitioners with high empathy and low burnout had significantly better BP control and performance than those with low empathy and high burnout (p < 0.05).ConclusionsLow burnout and high empathy were significantly associated with improved BP control and performance, possibly in relation to better physician/nurse-patient communication.

Impact of the Management of Type B Aortic Dissection on the Long-Term Blood Pressure

Ambulatory blood pressure (BP) measurement (ABPM) is recommended to assess optimal BP control, and we studied its influence after an acute type B aortic dissection (ATBAD). We retrospectively collected data from 111 patients with ATBAD from January 2004 to September 2014. Controlled BP group was defined according to a 24-hour BP under 130/80mm Hg during chronic phase. The population consisted of 85 men, with a mean age of 61±13years and mean body mass index of 28±6kg/m2. The median delay between ambulatory BP measurement and ATBAD was 2 (0.3 to 4) months. The mean 24-hour BP of the entire population was 124/71±15/8.8mm Hg. BP was not controlled in 41 patients (37%). The treatment score at discharge was 3.9±1.4. The mean glomerular filtration rate was 83±28ml/min/1.73m2, with no difference between groups. Visceral stent implantation in the acute phase (odds ratio [OR] 3.857 [1.199 to 12.406], p= 0.023), higher left ventricular ejection fraction (OR 1.092 [1.005 to 1.187], p= 0.038), and higher platelet count at discharge (OR 1.064 [1.018 to 1.112], p= 0.006) were identified as predictors of good BP control by multivariate analysis. The analysis showed that nighttime systolic BP was associated with aortic events during follow-up (hazard ratio [HR] 5.2 [1.01 to 27.2], p= 0.049), particularly for a threshold of 124mm Hg or more (HR 1.967 [1.052 to 3.678], p= 0.0341). Nighttime pulse pressure showed also its significance (HR 20.1 [1.4 to 282.7], p= 0.026). In conclusion, subclinical renal malperfusion revascularization seems to improve BP control. A greater nighttime systolic BP was associated with the risk of new aortic events during follow-up.

Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study.

BackgroundCurrent guidelines recommend use of the aldosterone‐renin ratio (ARR) for the case detection of primary aldosteronism followed by confirmatory tests to exclude false‐positive results from further diagnostic workup. We investigated the hypothesis that this could be unnecessary in patients with a high ARR value if the quantitative information carried by the ARR is taken into due consideration.Methods and ResultsWe interrogated 2 large data sets of prospectively collected patients studied with the same predefined protocol, which included the captopril challenge test. We used an unambiguous diagnosis of aldosterone‐producing adenoma as reference index. We also assessed whether the post‐captopril ARR and plasma aldosterone concentration fall furnished a diagnostic gain over baseline ARR values. We found that the false‐positive rate fell exponentially, and, conversely, the specificity increased with rising ARR values. At receiver operating characteristics curves and diagnostic odds ratio analysis, the high baseline ARR values implied very high positive likelihood ratio and diagnostic odds ratio values. The baseline and post‐captopril ARR showed similar diagnostic accuracy (area under the receiver operating characteristics curve) in both the exploratory and validation cohorts, indicating lack of diagnostic gain with this confirmatory test (between‐area under the curve difference, 0.005; 95% CI, −0.031 to 0.040; P=0.7 for comparison, and 0.05; 95% CI, −0.061 to 0.064; P=0.051 for comparison, respectively).ConclusionsThese results indicate that the ARR conveys key quantitative information that, if properly used, can simplify the diagnostic workup, resulting in saving of money and resources. This can offer the chance of diagnosis and ensuing adrenalectomy to a larger number of hypertensive patients, ultimately resulting in better control of blood pressure.

Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients

Objective/BackgroundCarotid endarterectomy (CEA) prevents future stroke, but this benefit depends on detection and control of high peri-operative risk factors. In symptomatic patients, diastolic hypertension has been causally related to procedural stroke following CEA. The aim was to identify risk factors causing peri-procedural stroke in asymptomatic patients and to relate these to timing of surgery and mechanism of stroke.MethodsIn the first Asymptomatic Carotid Surgery Trial (ACST-1), 3,120 patients with severe asymptomatic carotid stenosis were randomly assigned to CEA plus medical therapy or to medical therapy alone. In 1,425 patients having their allocated surgery, baseline patient characteristics were analysed to identify factors associated with peri-procedural (< 30 days) stroke or death. Multivariate analysis was performed on risk factors with a p value < .3 from univariate analysis. Event timing and mechanism of stroke were analysed using chi-square tests.ResultsA total of 36 strokes (27 ischaemic, four haemorrhagic, five unknown type) and six other deaths occurred during the peri-procedural period, resulting in a stroke/death rate of 2.9% (42/1,425). Diastolic blood pressure at randomisation was the only significant risk factor in univariate analysis (odds ratio [OR] 1.34 per 10 mmHg, 95% confidence interval [CI] 1.04–1.72; p = .02) and this remained so in multivariate analysis when corrected for sex, age, lipid lowering therapy, and prior infarcts or symptoms (OR 1.34, 95% CI 1.05–1.72; p = .02). In patients with diastolic hypertension (> 90 mmHg) most strokes occurred during the procedure (67% vs. 20%; p = .02).ConclusionIn ACST-1, diastolic blood pressure was the only independent risk factor associated with peri-procedural stroke or death. While the underlying mechanisms of the association between lower diastolic blood pressure and peri-procedural risk remain unclear, good pre-operative control of blood pressure may improve procedural outcome of carotid surgery in asymptomatic patients.

Changes of blood pressure patterns and target organ damage in patients with chronic kidney disease

Blood pressure (BP) control is the most established practice for preventing the progression of chronic kidney disease (CKD). We examined the BP control and nocturnal dipping pattern changes in hypertensive patients with CKD and their effects on target organ damages. We recruited 378 hypertensive CKD patients from four centers in Korea. The patients underwent clinic and ambulatory BP monitoring at the time of enrollment and 1 year later. The BP control states at the two time points were as follows: true controlled (16.5, 17.5%), white-coat (2.9, 0.4%), masked (50.0, 53.3%), and sustained uncontrolled (30.6, 28.8%) hypertension. The dipping states at two time points were as follows: extreme-dipping (11.4, 10.8%), dipping (22.2, 20.5%), nondipping (31.3, 34.7%), and reverse-dipping (35.0, 34.0%). When we divided the patients according to the median estimated glomerular filtration rate (eGFR) and proteinuria changes, more stable changes in eGFR and proteinuria were associated with better (to true controlled and white-coat) initial and follow-up BP control statuses. Moreover, better BP control and dipping (to dipper) changes were also associated with more stable eGFR and proteinuria changes. Good initial and follow-up BP control statuses were associated with less left ventricular hypertrophy. Also, masked and sustained uncontrolled hypertension was associated with more cardio-cerebrovascular events in the univariate analysis. A large majority of Korean hypertensive CKD patients had uncontrolled BP and abnormal dipping patterns. Furthermore, better BP control and dipping status changes were associated with better renal function and proteinuria, and also less cardio-cerebrovascular damages.

Blood Pressure Control among Hypertensive Stroke Survivors in Nigeria

Hypertension is the dominant risk factor for first-ever and recurrent stroke. The objective of the present study was to assess control of blood pressure (BP) among hypertensive stroke survivors seen at 2 tertiary hospitals in Nigeria. Using a cross-sectional design, stroke survivors with hypertension as a risk factor were consecutively recruited in the outpatient clinics of the participating hospitals. After the necessary demographic and clinical information had been obtained, participants had their BP assessed in a standardized manner. A BP of <140/< 90 mmHg was defined as good control. Univariate binary logistic regression analysis was performed to determine the predictors of good BP control. There were 284 subjects with a mean age of 59.0 ± 13.1 years. The overall mean systolic blood pressure was 142.7 ± 22.5 mmHg (male 144.9 ± 22.7, female 138.4 ± 21.6; P > .05) while the overall mean diastolic blood pressure was 85.6 ± 14.5 mmHg (male 85.8 ± 14.6, female 85.2 ± 14.4; P > .05). In spite of the fact that 270 (95.1%) of the subjects were on antihypertensives, only 39.8% (male 37.0%, female 44.1%; P > .05) had good BP control. In univariate analysis, having at least 12 years of formal education (OR 1.672, 95% CI 1.035-2.699; P < .05) and good compliance to antihypertensive medications (OR 9.732, 95% CI 3.391-27.930; P < .001) were the only variables associated with good BP control. Control of BP is poor among Nigerian hypertensive stroke survivors and is associated with the level of formal education and drug compliance. Urgent measures are needed to improve on this poor BP control as these may potentially reduce stroke recurrence rate.

Efficacy of various antihypertensive drugs in the treatment of hypertension in the patients of end-stage renal disease leading to hemodialysis: a retrospective study

Background: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients.Methods: A retrospective study was carried out on the patients who attended the hemodialysis unit of Hakeem Abdul Hamid Centenary hospital from July 2015 to June 2016 (one year), data on antihypertensive drugs and blood pressure control (pre-dialysis and post-dialysis) were recorded and analyzed.Results: 68.75% patients on hemodialysis were suffering from hypertension and were on antihypertensive medication. A combination of Amlodipine and clonidine were the most frequently prescribed antihypertensive agents. Muscle cramps an acute rise in blood pressure and hypotension were the most frequently encountered intradialytic complications in these patients.Conclusions: Although a combination of amlodipine and clonidine was most frequently prescribed antihypertensive medication in these patients these drugs were associated with intradialytic complications like muscle cramps and hypotension. Amlodipine with beta-adrenoceptor blocker (metoprolol or bisoprolol) provided best control of blood pressure in these patients with least intradialytic complications.

Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria.

Hypertension is a leading cause of kidney disease worldwide, and chronic kidney disease (CKD) is a known cause of secondary hypertension. Blood pressure (BP) control is a main-stay in the management of CKD because it retards the progression of established CKD. To determine BP control and its associated factors in predialysis CKD patients in a tertiary hospital setting. CKD patients who attended the renal outpatient clinic during the period from December 2013 to June 2014 were recruited into the study. Demographic and clinical information were obtained from their case records. The average of the three most recent clinic BPs was calculated for each patient. Good BP control was taken as an average BP of <140/90 mmHg. One hundred and three patients (53 males and 50 females) met inclusion criteria for the study. The mean age of the patients was 40.6 ± 17.4 years. Estimated glomerular filtration rate was <60 ml/min in 49.5% of patients. Good BP control was seen in 57 (55.3%) patients. Poor BP control was associated with middle age, proteinuric CKD, and prescription of 3 or more BP medication. BP control in predialysis CKD patients still needs to be optimized. Special attention should be given to middle-aged patients who have proteinuric CKD and those on multiple BP drugs without optimal BP control.

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients. Methodology: A retrospective study was carried out on the patients who attended the Haemodialysis unit of Hakeem Abdul Hamid Centenary hospital from July 2015 to June-2016 (one year), data on antihypertensive drugs and blood pressure control (pre-dialysis and post-dialysis) were recorded and analyzed. Result: 68.75% patients on haemodialysis were suffering from hypertension and were on antihypertensive medication. A combination of amlodipine and clonidine were the most frequently prescribed antihypertensive agents. Muscle cramps an acute rise in blood pressure and hypotension were the most frequently encountered intradialytic complications in these patients. Conclusion: Although a combination of Amlodipine and Clonidine was most frequently prescribed antihypertensive medication in these patients these drugs were associated with intradialytic complications like muscle cramps and hypotension. Amlodipine with beta-adrenoceptor blocker (metoprolol or bisoprolol) provided best control of blood pressure in these patients with least intradialytic complications.