Greater Reduction In SBP Research Articles

Trends in hypertension prevalence and control in England over the last 3 decades: Health Survey of England 1994-2019

Abstract Globally, raised blood pressure (BP) contributes to more than 10.8 million avoidable deaths from cardiovascular (CV) and renal disease. Understanding national BP control trends amongst hypertensive patients will help inform the effectiveness and gaps in existing pathways and policies. We used data from 13 nationally representative health surveys in England between 1994-2019 to compare nationwide trends in BP control and hypertension awareness over 25 years. We used ‘period’ definitions to define hypertension and BP control (i.e. using existing guidance at the time of the survey) to account for changes in BP targets and definitions. Analyses were also conducted using ‘current definitions’ (i.e. definition of hypertension and BP control targets as per NICE 2023), applied across the entire duration. Sample weights, accounting for oversampling and survey nonresponse, and other relevant transformations were applied. Python and STATA 18 were used to conduct analyses and Join Point regression software was used to compare trends. In England, between 1994-2019, the prevalence of hypertension initially increased sharply by 8% from 23.3% when the BP cut off was lowered in 1999. Thereafter for the next 12 years it remained static at 32-34%, and since 2011 has plateaued at 31-32%, showing only marginal improvement of 1.5% over this 25-year period (Figure 1). This is consistent with population-wide mean systolic (S) and diastolic (D) BPs, and amongst those with and without hypertension. Population-wide there was a reduction in SBP (8.5mmHg) and DBP (3.8mmHg) over the period. There was significantly greater reduction in SBP (11.9 vs 9.5mmHg) and DBP (4.1 vs 2.5mmHg) amongst those with diagnosed hypertension as compared to those without. Using the current target of below 140/90mmHg when evaluating BP control over this period suggests that we have improved. However, when we use ‘period definitions’ of BP targets at that time, it seems that over last 25 years there has been ‘no change’ in the proportion of diagnosed hypertensives with uncontrolled BPs (Figure 2). Additionally, although appearing to increase over the period, there has been no significant change in proportions of those with hypertension who are unaware of this condition since BP cut-offs were lowered in 1999. These findings indicate that in England, over last 25 years, whilst there have been some improvements in population wide mean SBP and DBP with slight reduction in hypertension prevalence, the proportions of those with known hypertension with uncontrolled BPs have remained static. This is despite improvement in medications and practice. Furthermore, there has been little progress in detection of those hypertensive patients who are unaware about and untreated for their condition. Clearly, these call in question the effectiveness of the current policies and clinical practice pathways and provide huge opportunity to improve population wide CV riskSytolic and Diastolic BP trendsTrends in the prevalence of BP control

Effectiveness of a Patient-Family Carer Partnership Intervention on Blood Pressure Control for People with Hypertension in Rural Communities: A Randomised Controlled Trial

Objectives. To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China. Design. A randomised controlled trial. Methods. A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants’ health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes. Results. Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer’s dyadic relationship and health-related quality of life at T1 and T2. Conclusion. The patient-family (carer) partnership intervention has the potential to improve hypertensive people’s BP control and family dyad’s dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087.

ENGAGEMENT AND ATTRITION IN A TELEHEALTH SERVICE FOR HYPERTENSIVE PATIENTS. A SINGLE CENTER EXPERIENCE

Objective: To investigate engagement with blood pressure telemonitoring and counselling (BPTM) in patients with hypertension (HTN) and its predictors. Design and method: Patients with uncontrolled HTN (office systolic (S) BP >140 mm Hg) were recruited consecutively in a large reference center. Only patients who were motivated and willing to participate were included. The telehealth system consisted of a home BP telemonitoring service and an on-demand text chat with the patient's attending physician. The BPTM continued for 3 months with mandatory baseline and follow-up visits, as well as completion of the HYPE (HYpertension imPact quEstionnaire) to assess quality of life. Patients who did not report BP readings for 2 weeks + after 2 alerts were termed ’quit’. Others comprised the ’continued’ group. Results: A total of 92 patients were included in the final analysis (median age 43 years, 69 men, 49 at low-intermediate CVD risk). At baseline, median office SBP was 155 mm Hg (150;162) and office diastolic (DBP) was 95 mm Hg (90;102). Over the 3 months, SBP and DBP decreased significantly (-16 and -11 mm Hg, respectively; p <0.001 for both). There was a greater reduction in SBP at home (-8 mm Hg from 1 week to 3 months, p <0.001). A total of 43 patients continued BPTM and 48 patients discontinued BP telemonitoring (85% of them after 1 month). The groups were well matched for age, sex, and baseline BP. The δSBP did not differ between the two groups, nor did the median number of questions (3 consultations/patient). Higher baseline office SBP (β = 0.03, p = 0.043) and male sex (β = 1.15, p = 0.041) were predictors of high engagement with the telehealth service after adjustment for other covariates. Quality of life at 3 months was higher in the ’continuing’ patients. (δ+8 points HYPE). Conclusions: Telemonitoring and remote counseling are effective in patients with HTN. Even when patients are motivated to use telehealth, more than half of them discontinue during the first months, predominantly female patients with mild uncontrolled HTN. Patients who continue BPTM experience a higher quality of life.

Abstract P116: Differences In Shared Decision Making Among Patients With Hypertension

Background: Shared decision-making (SDM) is sanctioned by US legislation and promoted by hypertension guidelines. However, evidence is scarce for ethnically diverse groups. We aimed to examine the relationships between SDM, blood pressure, self-identified race/ethnicity, and baseline characteristics among patients with hypertension. Methods and results: Secondary data analysis of a pragmatic clinical trial with individuals with uncontrolled hypertension using linear regression and generalized estimating equations. Participants (n=1426) were predominantly middle-aged (mean 60 years ± 11.6), female (59.4%, 847), non-Latino Black people (59%, 844), and high school graduates or below (65%, 931). SDM was averaged at 7.2 (±2.6) out of 9, SBP at 152.2 (±12.0), and DBP at 85.3 (±12.1) mmHg. We found a greater reduction in SBP over time with higher SDM mean score (B -0.44, p 0.032). Positive association was found between SDM and patient activation (B 0.01, p=0.001), considering taking blood pressure medication as very important (B 0.56, p=0.022), and patients’ self-reported race/ethnicity. Non-Latino Black people had 0.74 points higher mean SDM score (p<0.001) than Non-Latino White people. On the contrary, the association was negative for knowing that high blood pressure is the same as hypertension (B -0.35, p 0.046), and education. Those with more than high school education had lower mean SDM (B -0.44, p 0.045). Conclusions: Future research should further explore SDM differences among racial/ethnic groups to better align care with needs of patients with hypertension. Our results offer actionable information to enhance clinical practice and policy development.

Efficacy and safety analysis of angiotensin receptor neprilysin inhibition(ARNI)in patients with heart failure: a real-world retrospective study

BackgroundIn a large randomized controlled trial (PARADIGM-HF), ARNI has been shown to significantly reduce cardiovascular mortality and hospitalization for patients with reduced ejection fraction in heart failure. This study analyzed the efficacy and safety of ARNI on the basis of various types of heart failure patients in southwestern Sichuan Province.MethodsThis study included patients with heart failure who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. This study analyzed the efficacy and safety of ARNI in the treatment of heart failure, and analyzed the risk factors for readmission after ARNI treatment.ResultsAfter propensity score matching, a total of 778 patients were included in the study. The readmission rate for heart failure in patients treated with ARNI (8.7%) was significantly lower than that in the standard treatment group (14.5%) (P = 0.023). Both the proportion of patients with increased LVEF and with decreased LVEF were higher in the ARNI treatment group than in the conventional therapy group. Compared with receiving standard medical treatment, combined ARNI treatment resulted in a greater reduction in SBP (-10.00, 95%CI: -24.00-1.50 vs. -7.00, 95%CI: -20.00-4.14; P = 0.016) in HF patients. Combination ARNI therapy did not increase the risk of adverse events. The study found that age (> 65 vs. ≤65 years) (OR = 4.038, 95%CI: 1.360-13.641, P = 0.013) and HFrEF (OR = 3.162, 95%CI: 1.028–9.724, P = 0.045) were independent predictors of readmission in HF patients treated with ARNI.ConclusionPatients with heart failure treated with ARNI can improve clinical symptoms and reduce the risk of readmitted hospital admission. Age > ~ 65 years and HFrEF were independent predictors of readmission in HF patients treated in ARNI group.

PS-C10-9: EFFECTIVENESS OF AMLODIPINE ON 24-HOUR AMBULATORY BLOOD PRESSURE IN ADULT PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION: A MULTICENTRE OBSERVATIONAL, REAL-WORLD STUDY

Objective: Inadequate 24-hour blood pressure control could cause complications, especially in high-risk hypertensive individuals. Hence, it is recommended that the targeted blood pressure levels be maintained round the clock. This prospective, observational study assessed the 24-hour ambulatory blood pressure (ABP) control with 8-week amlodipine therapy 5/10 mg/day in patients with hypertension. Methods: Adult patients (62 m, 42 f) with mild-to-moderate essential hypertension received oral amlodipine 5 mg/day (n = 68) or 10 mg/day (n = 36) for 8 weeks. The study was approved by the independent ethics committee and informed consent was obtained from all participants. Primary outcome was change at 8 weeks from baseline in mean 24-hr ABP (systolic and diastolic), and secondary outcomes were change from baseline in mean morning, daytime, night-time, and last 6-hr dosing interval ABP. A repeat measures analysis of covariance (ANCOVA) was done for changes in ABP over 8 weeks, with age, gender, BMI and associated comorbidities as covariates. Nocturnal dippers were assessed as those greater than or equal to 10% reduction in ABP at 8 weeks. Sub-groups were created based on age, duration of hypertension, occupation, baseline BMI and amlodipine dose. Safety was evaluated based on clinical adverse events and 12-lead electrocardiogram. Results: Of the 104 patients from 2 study centers, 49 completed 8-weeks therapy and were included for per-protocol analysis. Significant reductions in the mean 24-hr blood pressure were seen for both SBP and DBP (figure 1). The mean 24-hr. reduction was -10.82 and -6.25 mmHg with 5 mg amlodipine and -19.81 and -11.19 mmHg with 10 mg amlodipine for SBP and DBP respectively (p < 0.0001). The mean morning, daytime, night-time, and last 6-hr reductions in SBP were -14.06, -18.63, -20.42, and -13.51 respectively (p < 0.0001), and DBP reductions were -7.78, -10.27, -11.07, and -6.44 respectively (p < 0.0001). Significant reduction in ABP was seen in all sub-groups (p < 0.0001). Greater reduction in SBP and DBP were observed in patients with stage-2 hypertension. At baseline, there were 30 (61.2%) non-dippers which decreased to 18 (36.7%) at 8 weeks. At the end of the study, 40% of non-dippers were converted to dippers by Amlodipine, whereas none of the dippers were converted to non-dippers. No adverse effects were reported. Conclusion: Amlodipine significantly reduces the 24-hr. mean morning, daytime, night-time, and last 6-hr. ABP and converted non dippers to dippers in adult patients with mild to moderate essential hypertension. The Study highlights the consistent effects of amlodipine on both quantity and quality of 24 hours BP control which is important for associated CV risk reduction.

Electroacupuncture Decreases Chronic Inflammation, Sympathetic Activities, and Blood Pressure in Dahl Salt‐Sensitive Hypertensive Rats

Low grade chronic inflammation is detected in hypertensive patients. The dahl salt‐sensitive hypertensive (DSS HTNive) rat model has been investigated on different pathways how excessive salt intake induces elevation in blood pressure (BP). Previous studies have demonstrated low grade chronic inflammation and elevated sympathetic outflow in DSS HTNive rats. We have shown in series of studies that sympathoinhibitory electroacupuncture (SI‐EA) at acupoints ST36‐37 suppresses sympathoexcitatory cardiovascular responses and reduces BP in HTNive rats and patients. Other researchers reported that EA at acupoints SP6‐7 as well as ST 36‐37 decreases inflammation. Therefore, we hypothesized that combined EA (cEA) at ST36‐37 and SP6‐7 induces greater reduction in BP than SI‐EA through the modification of chronic inflammation and elevated sympathetic activity in DSS HTNive rats. DSS rats (n=36) were fed with 4% salt diet and treated with SI‐EA, cEA or Sham‐EA (without electrical stimulation) twice weekly for five weeks once the rats developed moderate HTN (SBP 160±5 mmHg). Systolic/diastolic BP (SBP/DBP) and heart rate (HR) were measured by weekly tail‐cuff non‐invasively. Upon completion of different treatments, cardiac perfusion was performed under anesthesia, and plasma samples were collected to measure the concentration of high‐sensitivity c‐reactive protein (hs‐CRP), an indicator of low‐grade chronic inflammation, and norepinephrine (NE) by ELISA. We observed that DSS rats fed with 4% salt diet developed moderate HTN (SBP 163±3.8 mmHg) in five weeks compared to those fed with standard rat chow (SBP 129±5.4 mmHg). After five weeks of treatments, the EA treated rats displayed significantly lowered SBP (138±4.7 mmHg for cEA group, 147±4.2 mmHg for SI‐EA group) compared to the Sham‐EA treated rats (SBP 191±6.8 mmHg). The cEA group showed greater reduction in SBP by 28% than the SI‐EA group (23%) compared to Sham‐EA group. The DBP but not HR among the groups exhibited similar trends. Furthermore, we observed that plasma NE concentrations showed greater reduction in the cEA group by 24.5% than the SI‐EA group (11.4% decrease) compared to the Sham‐EA group. In addition, the rats treated with cEA displayed lowest concentration of plasma hs‐CRP (225 ug/mL) in the three hypertensive groups. As such, our findings suggest that cEA at ST36‐37 and SP6‐7 induces larger BP‐lowering effect than SI‐EA in DSS HTNive rats and was associated with reduction of biomarkers of chronic inflammation and sympathetic outflow.

Blood pressure, organ dysfunction, and mortality in preterm neonates with late-onset sepsis

The objective of this study was to investigate the association between systolic, diastolic, and mean blood pressures (SBP, DBP, and MBP) and adverse outcomes in preterm neonates with late-onset sepsis (LOS). This is a two-center retrospective study over 6 years. Neonates <35 weeks gestational age (GA) with blood ± cerebrospinal fluid culture positive for organisms other than coagulase-negative Staphylococcus at >72 h age were included. Outcome measures were organ dysfunction (ODF) using the predefined criteria and post-ODF mortality (≤7 days from LOS onset). The lowest noninvasive blood pressures (BPs) recorded at baseline (24-48 h pre-LOS) and 0-12, 13-24, 25-36, and 37-48 h post LOS were analyzed. Of 147 neonates, ODF occurred in 70 (48%), of which 20 (29%) died. ODF was associated with a drop in all BP components, starting 0-12 h post-LOS onset (p < 0.01 for all); BPs remained unchanged in the non-ODF group. Mortality was associated with a greater reduction in SBP [-13 (-19, -8) vs. -4 (-8, 0); p < 0.01] and MBP [-9 (-13, -5) vs. +1 (-1, +4); p = 0.03] 0-12 h post-LOS onset. SBP had a higher area under the curve for mortality than MBP and DBP (0.83, 0.81, and 0.78, respectively). An inverse relation may exist between corrected GA and percentage reduction in SBP from baseline for equivalent risk of death. Reduction in BPs early in illness may identify preterm neonates at the highest risk of ODF and mortality from LOS. Drop in BPs from baseline starting in the immediate post-illness onset period may identify preterm neonates at the highest risk of developing ODF and mortality in LOS. Lowest systolic followed by mean BP measured during the first 12 h of illness provided the highest discriminating ability for LOS-related mortality. Absolute BPs recorded during the first 12 h of illness performed better than relative change from baseline for identifying neonates at risk of LOS-related mortality. The specific BP thresholds identified in this study may inform future therapeutic trials.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

PurposeHypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce. MethodsStudents enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005–2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS. ResultsOf 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (−4.0 vs. 2.8 mmHg, p < .001) and DBP (–3.3 vs. .8 mmHg, p < .001) than normal BP students. ConclusionsAbnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Variation of uncoupling protein 2 (–866G/A), dietary fat intake and blood pressure: an Indonesian Nutrigenetic Cohort

Abstract Background/Introduction The uncoupling protein 2 (UCP2) is recently being recognized as an important molecule involved in the development of cardiovascular diseases such as vascular dysfunction, atherosclerosis, and hypertension. It was previously reported that the UPC2 –866 G/A gene variation was associated with obesity and hypertension. Purpose The objective of this study was to investigate the association between UCP2 –866 G/A gene variation on changes in blood pressure after 2 years of follow up. Additionally, we investigate the interaction between UCP2 –866G/A and dietary fat on changes in blood pressure. Methods This was a cohort study conducted in 503 men and women without chronic diseases in the city of Yogyakarta, Indonesia. Bodyweight, systolic (SBP) and diastolic blood pressure (DBP) were measured at baseline and after 2 years while the dietary intake was recorded once within 2 years period using a semi-quantitative food frequency questionnaire. Subjects were divided based on UCP2 gene variations: GG genotype and GA+AA genotypes. Results There was no difference in blood pressure at baseline between UCP2 genotypes (SBP AA+GA vs. GG: 130.5±26.3 vs. 127.2±24.9 mmHg, p=0.178; DBP AA+GA vs. GG: 80.9±16.1 vs. 78.9±13.8 mmHg, p=0.171). After 2 years, a total of 310 individuals were followed and measured (AA+GA n=197; GG n=113). In all subjects, there was a significant reduction in SBP (from 130.6±26.3 to 126.4±22.8 mmHg, p&amp;lt;0.001) and increment in DBP (from 80.9±15.5 to 82.2±13.7 mmHg, p=0.013). Subjects in GA + AA genotype group had a greater reduction in SBP (−5.3±15.4 vs. −1.5±18.0 mmHg, p=0.018) and lesser increment in DBP (0.7±10.6 vs. 2.7±12.2 mmHg, p=0.045). In this study, we showed that sex and age were not associated with changes in blood pressure (all p&amp;gt;0.05) but changes in body weight were positively correlated with SBP (r=0.219, p&amp;lt;0.001) and DBP (r=0.227, p&amp;lt;0.001). In all subjects, energy, protein, and carbohydrate intake were not correlated with changes in SBP and DBP (all p&amp;gt;0.05). By contrast, total fat intake (B=0.137, p=0.017), saturated fat (B=0.123, p=0.032) and MUFA (B=0.142, p=0.014) were positively correlated with increased SBP while PUFA, trans fat, and cholesterol were not correlated with SBP. There was no correlation between dietary intake and changes in DBP. Among subjects with GA+AA genotype, total fat, saturated fat and MUFA were positively correlated with changes in SBP (all p&amp;lt;0.05) but these correlations were not seen among subjects with GG genotype (all p&amp;gt;0.05). Conclusion We concluded that UCP2 –866G/A gene variation was associated with changes in blood pressure and those who have an A allele were more protected towards increased blood pressure. Total fat, saturated fat, and MUFA were positively correlated with blood pressure and those with A allele were more responsive to the hypertensive effect of dietary fat. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Universitas Gadjah Mada

Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management

It is unclear if helping patients meet resource needs, such as difficulty affording food, housing, or medications, improves clinical outcomes. To determine the effectiveness of the Health Leads program on improvement in systolic and diastolic blood pressure (SBP and DBP, respectively), low-density lipoprotein cholesterol (LDL-C) level, and hemoglobin A1c (HbA1c) level. A difference-in-difference evaluation of the Health Leads program was conducted from October 1, 2012, through September 30, 2015, at 3 academic primary care practices. Health Leads consists of screening for unmet needs at clinic visits, and offering those who screen positive to meet with an advocate to help obtain resources, or receive brief information provision. Changes in SBP, DBP, LDL-C level, and HbA1c level. We compared those who screened positive for unmet basic needs (Health Leads group) with those who screened negative, using intention-to-treat, and, secondarily, between those who did and did not enroll in Health Leads, using linear mixed modeling, examining the period before and after screening. A total of 5125 people were screened, using a standardized form, for unmet basic resource needs; 3351 screened negative and 1774 screened positive. For those who screened positive, the mean age was 57.6 years and 1811 (56%) were women. For those who screened negative, the mean age was 56.7 years and 909 (57%) were women. Of 5125 people screened, 1774 (35%) reported at least 1 unmet need, and 1021 (58%) of those enrolled in Health Leads. Median follow-up for those who screened positive and negative was 34 and 32 months, respectively. In unadjusted intention-to-treat analyses of 1998 participants with hypertension, the Health Leads group experienced greater reduction in SBP (differential change, -1.2; 95% CI, -2.1 to -0.4) and DBP (differential change, -1.0; 95% CI, -1.5 to -0.5). For 2281 individuals with an indication for LDL-C level lowering, results also favored the Health Leads group (differential change, -3.7; 95% CI -6.7 to -0.6). For 774 individuals with diabetes, the Health Leads group did not show HbA1c level improvement (differential change, -0.04%; 95% CI, -0.17% to 0.10%). Results adjusted for baseline demographic and clinical differences were not qualitatively different. Among those who enrolled in Health Leads program, there were greater BP and LDL-C level improvements than for those who declined (SBP differential change -2.6; 95% CI,-3.5 to -1.7; SBP differential change, -1.4; 95% CI, -1.9 to -0.9; LDL-C level differential change, -6.3; 95% CI, -9.7 to -2.8). Screening for and attempting to address unmet basic resource needs in primary care was associated with modest improvements in blood pressure and lipid, but not blood glucose, levels.

Programa de Exercícios em Grupo Preventivo de Quedas Melhora Função Cardiovascular de Idosos

Objective: To analyze the influence of a kinesiotherapeutic program for the prevention of falls on the cardiovascular function in the elderly. Materials and Methods: The sample consisted of 18 community-living elderly with a mean age of 73.5 ± 8.8 years (14 women; 4 men) who participated in an exercise program for flexibility, strength, balance and proprioception. We measured systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) and double product (DP) before and after exercise. The coefficient of variation (CV) of the measures was used, as well as paired t test and Wilcoxon test for comparison between baseline and endpoint after exercise. Results: In 10 sessions, there was an average CV lower than 10% for SBP, DBP and HR. As an acute effect of exercise, there was a significant increase in SBP and DBP and a significant decrease in HR. Comparing the data of the 1st session of exercise to those of the 10th session, we observed that the values of the variables tended to be reduced (except the initial DBP), but with significance only for the final DP. There was a greater reduction in SBP, HR and DP over 20 sessions compared to 10 sessions. Conclusion: The program for the prevention of falls provided chronic effects that are beneficial to cardiovascular function in the elderly, which may also be indicated for the management of cardiovascular diseases. DESCRIPTORS: Aged. Exercises. Arterial Pressure. Heart Rate.

Simplified therapeutic intervention to control hypertension and hypercholesterolemia

Notwithstanding improving rates of hypertension control in North America, management of patients with both hypertension and dyslipidemia remains problematic. Based on evidence of improved control utilizing a simplified algorithm for management of hypertension (STITCH), we questioned whether a simplified comprehensive treatment algorithm featuring initial use of single-pill combinations (SPCs) would improve management of participants with both hypertension and dyslipidemia. We randomized 35 primary care practices in Ontario to either Guidelines-care (following current Canadian guidelines) or STITCH2-care (following a treatment algorithm featuring SPCs). Practices each enrolled up to 50 participants with at least one risk factor above target at entry based on Canadian guidelines for BP and LDL-cholesterol control. The primary endpoint was achieving targets for both hypertension and dyslipidemia control after 6 months, assessed at the practice level. The primary endpoint was achieved in 31.3% of participants in STITCH2-care practices, compared with 28.1% in Guidelines-care practices, yielding a difference of 3.2% (P = 0.63). Notably, STITCH2-care practices had a significantly greater reduction in SBP while LDL-cholesterol reduction was only marginally greater in STITCH2 practices. The STITCH2 algorithm resulted in significantly greater use of any SPC compared with Guidelines-care and greater use of the SPC of calcium channel blocker/statin. Unwillingness of the prescribing physician to advance treatment beyond a monotherapy threshold was found to be an important determinant for failing to achieve blood pressure control. In contrast, the more important determinant for failing to achieve LDL control appeared to be the unwillingness of the prescribing physician to initiate therapy with a statin.

Efficacy and Safety of Dual Calcium Channel Blockade for the Treatment of Hypertension: A Meta-Analysis

Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB = -4.0±3.5 vs. DHP = -2.0±1.5 and NDHP = -6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.

A functional variant of the NEDD4L gene is associated with beneficial treatment response with β-blockers and diuretics in hypertensive patients

The capability of the protein NEDD4L to reduce renal tubular expression of epithelial Na+ channel (ENaC) is influenced by a functional rs4149601 G→A NEDD4L polymorphism. As diuretics and β-blockers inhibit renal sodium reabsorption and renin release, respectively, we hypothesized that the β-blocker or diuretic-induced blood pressure reduction and prevention of cardiovascular disease would be greater in patients with the highest ENaC expression (rs4149601 G-allele), whereas there would be no such genetically mediated differences in treatment efficacy among patients treated with the vasodilator diltiazem. We related rs4149601 status to 6-month blood pressure reduction and risk of cardiovascular events in 5152 hypertensive patients (DBP ≥ 100 mmHg) from the Nordic Diltiazem Study (NORDIL) randomized to either β-blocker and/or diuretic-based treatment or diltiazem-based treatment. In patients on β-blocker or diuretic monotherapy, carriers of the G-allele had greater SBP reduction (19.5 ± 16.8 vs. 15.0 ± 19.3 mmHg, P < 0.001) and DBP reduction (15.4 ± 8.3vs. 14.1 ± 8.4 mmHg, P = 0.02) and during 4.5 years of follow-up among patients randomized to β-blockers and/or diuretics, carriers of the G-allele had greater protection from cardiovascular events [relative risk (RR) = 0.52, 95% confidence interval (CI) = 0.36-0.74, P < 0.001] as compared to AA homozygotes. Within the diltiazem group, there was no difference in blood pressure reduction or risk of cardiovascular events according to genotype. The functional NEDD4L rs4149601 polymorphism influences the efficacy of β-blocker and/or diuretic-based antihypertensive treatment both in terms of blood pressure reduction and cardiovascular disease protection, whereas diltiazem-based antihypertensive treatment efficacy is not influenced by this NEDD4L polymorphism.

Comparison of combination therapies, including the angiotensin receptor blocker olmesartan and either a calcium channel blocker or a thiazide diuretic, in elderly patients with hypertension

The blood pressure goals set for the treatment of hypertensive patients have been lowered in recent guidelines. To reduce blood pressure levels sufficiently, combination therapies are often needed, but there is little evidence about which combination should be chosen. The present study was carried out to compare the effects of combination therapies, including the angiotensin receptor blocker olmesartan and either a calcium channel blocker (CCB) or a thiazide diuretic, in elderly patients with hypertension. A total of 65 patients aged 65-85 years, with blood pressures of 140/90 mmHg or higher for those taking antihypertensive medication or 160/100 mmHg or higher for those not on medication, were randomly assigned to either the group treated with olmesartan plus a dihydropyridine CCB or the group treated with olmesartan plus a thiazide diuretic; 58 patients completed the treatment for 6 months. Systolic and diastolic blood pressures (SBP and DBP) were reduced during the treatment period in both the groups. The reductions in SBP at 1 and 6 months were significantly (P<0.05) greater in the CCB combination group than in the diuretic group (-29 vs. -18 mmHg, respectively, at 1 month; -32 vs. -23 mmHg, respectively, at 6 months). Despite greater reduction in SBP in the CCB group, the serum creatinine level and the estimated glomerular filtration rate (eGFR) remained unchanged, whereas in the diuretic group, creatinine was elevated (+0.06 mg per 100 ml, P<0.05) and eGFR was reduced (-4.5 mlmin(-1) per 1.73 m(2)). In addition, high-density lipoprotein cholesterol levels were reduced in the diuretic group (-5.0 mg per 100 ml, P<0.01). These results suggest that olmesartan plus a CCB is the preferable combination therapy in comparison with olmesartan plus a thiazide diuretic for elderly patients with hypertension.

Comparative effect of direct renin inhibition and AT1R blockade on glomerular filtration barrier injury in the transgenic Ren2 rat

Renin-angiotensin system (RAS) activation contributes to kidney injury through oxidative stress. Renin is the rate-limiting step in angiotensin (ANG II) generation. Recent work suggests renin inhibition improves proteinuria comparable to ANG type 1 receptor (AT1R) blockade (ARB). Thereby, we investigated the relative impact of treatment with a renin inhibitor vs. an ARB on renal oxidative stress and associated glomerular structural and functional changes in the transgenic Ren2 rat, which manifests hypertension, albuminuria, and increased tissue RAS activity. Young Ren2 and age-matched Sprague-Dawley (SD) controls (age 6-9 wk) were treated with a renin inhibitor (aliskiren), an ARB (irbesartan), or vehicle for 21 days. Ren2 rats exhibited increases in systolic pressure (SBP), albuminuria, and renal 3-nitrotyrosine content as well as ultrastructural podocyte foot-process effacement and diminution of the podocyte-specific protein nephrin. Structural and functional alterations were accompanied by increased renal cortical ANG II, AT1R, as well as NADPH oxidase subunit (Nox2) expression compared with SD controls. Abnormalities were attenuated to a similar extent with both aliskiren and irbesartan treatment. Despite the fact the dose of irbesartan used caused a greater reduction in SBP than aliskerin treatment (P < 0.05), the effects on proteinuria, nephrin, and oxidative stress were similar between the two treatments. Our results highlight both the importance of pressor-related reductions on podocyte integrity and albuminuria as well as RAS-mediated oxidant stress largely comparable between ARB and renin inhibition treatment.

Efficacy and safety of a long-acting beta blocker, extended release metoprolol succinate, in hypertensive children

Clinical trial data on efficacy, safety, and tolerability of antihypertensive medications in the pediatric ages is emerging but remains limited. Even less data are available on the effects of the beta blocker class of antihypertensive drugs in children. To evaluate the dose range, safety, and blood pressure lowering effect of extended release metoprolol succinate (TOPROL-XL®, TXL). This multicenter clinical trial was a double-blind, placebo-controlled, randomized, parallel group study of children, age 6 to 16 years, with essential hypertension. Following a 2 week screening phase, each subject was randomized to one of a 4-arm treatment phase that lasted 4 weeks. The treatment arms were placebo or TXL (0.2 mg/kg, 1.0 mg/kg, or 2.0 mg/kg approximated by tablet strengths ranging from 12.5 to 200 mg). Data were analyzed using an intent-to-treat approach. Of 204 patients screened, 144 were randomized and 133 (92%) completed the treatment phase. 42% were <12 years, and 50% were < Tanner Stage 3. For the entire sample, mean age was 12.5 ± 2.8 yrs and mean baseline blood pressure (BP) was 132/78 ± 9/9 mmHg. Age, weight, and baseline BP were well balanced across the 4 treatment arms. Compared to placebo, there was a significantly greater reduction in SBP for the TXL 1.0 mg/kg dose and for all active doses combined, and in DBP at the TXL 2.0 mg/kg dose. There were no serious adverse events (AEs) or AEs requiring study drug discontinuation among patients receiving active therapy. Both SBP and DBP were lowered significantly, compared to placebo, following 4 weeks of TXL at doses within the range used in the study. In aggregate, these data indicate that TXL is an effective and well-tolerated treatment of hypertension in children, especially when a beta blocker is considered.

Sympathetic responses to Valsalva's manoeuvre following bed rest.

The purpose of this study was to examine whether 14 days of head-down tilt bed rest (HDBR) alters autonomic regulation during Valsalva's manoeuvre (VM) and if this would predict blood pressure control during a 60 degrees head-up tilt (HUT) test. To examine autonomic control of blood pressure, we measured the changes in systolic (delta SBP) and diastolic (delta DBP) blood pressure between baseline and the early straining (Phase IIE) period of VM (20 sec straining to 40 mmHg; N = 7) in conjunction with changes in muscle sympathetic nerve activity (MSNA; microneurography) burst frequency (B/min) and total activity (% delta) from baseline over the 20-sec straining period. MSNA data were successfully recorded from 6 of the 7 individuals. The averaged responses from three repeated VMs performed in the supine position were compared between the pre- and post-HDBR tests. Compared with the pre-HDBR test, a greater reduction in SBP, DBP, and MAP was observed during Phase IIE following HDBR, p < 0.05. The increase in MSNA burst frequency during straining was augmented in the post- compared with the pre-HDBR test, p < 0.0001, as was the Phase IV blood pressure overshoot, p < 0.05. Although all subjects completed the 20-min pre-HDBR tilt test without evidence of hypotension or orthostatic intolerance, the post-HDBR test was stopped early in 5 of the 7 subjects due to systolic hypotension. The responses during the VM suggest that acute autonomic adjustments to rapid blood pressure changes are preserved after bed rest. Furthermore, MSNA and blood pressure responses during VM did not predict blood pressure control during orthostasis following HDBR.