Control Of High Blood Pressure Research Articles

Chronic kidney disease and the use of drugs

Chronic kidney disease occurs insidiously and is usually diagnosed in advanced stages when its evolution is more difficult to control. Frequently, it is favored by inadequately controlled hypertension and/or insufficiently controlled diabetes mellitus, exacerbating their consequences. The complications of chronic kidney disease are manifested by edema, electrolyte and acid-base disorders, cardiovascular damages, anemia, and bone disorder. The most severe form of the condition is end-stage renal disease, when life cannot be sustained without renal replacement therapy – i.e., dialysis or kidney transplantation. Diet and the pharmacological control of high blood pressure and diabetes can slow the progression rate of chronic kidney disease. Disease-specific complications can also be addressed. Renal impairment affects the elimination of many medicines from the body, so the patient with chronic kidney disease should not be given contraindicated drugs for kidney failure and the doses for may drugs should be properly adjusted.

Associations between birth outcomes with blood pressure level and risk of high blood pressure in childhood

To explore the associations between birth outcomes and blood pressure, and study the sex dimorphism of these associations. With a multistage cluster random sampling method, 62 168 children were recruited in seven provinces of China in September of 2013, with 32 064 boys and 30 104 girls, median age of 10.74 years and mean birth weight of 3.3 kg, 49 843 single birth(97%), 1339 twin(2.6%), 180 triplet or more(0.4%). Questionnaire investigation and physical examination were conducted in the present study. Weight, height and blood pressure were measured in the physical examination. Demographic characteristics, birth outcomes(including birth weight and number of births), dietary behavior, physical activities were measured by questionnaire. The widely used age-, gender-and height-specific high blood pressure standard developed by American CDC was used for the present study. Multivariate linear and logistic regression analysis were conducted to study the associations between birth outcomes and blood pressure level or high blood pressure(HBP), and also sex dimorphism of these associations was explored. A total of 5933 children were categorized as having high blood pressure in the 62 168 participants(9.5%). With stratified analyses by birth weight category, only in the low-birth-weight strata birth weight was significantly inversely associated with systolic blood pressure(SBP) and diastolic blood pressure(DBP) with potential covariates adjusted(SBP: b=-1.628, 95%CI-2.571--0.685, P=0.001; DBP: b=-1.463, 95%CI-2.186--0.740, P<0.001). While compared with the non-low birth weight children, low birth weight was not associated with higher risk of HBP(P>0.05). Compared with those boys born as singleton, boys born as one of the twins have a 36.4% higher risk of HBP(OR=1.364, 95%CI 1.049-1.774), while in girls no such significant association was found. Additionally, compared with a term birth, overdue birth and preterm birth was not associated with higher risk of HBP(P>0.05). Birth weight and singleton or not were associated with childhood blood pressure levels and higher risk of high blood pressure, and some associations were sex specific. Gender differences should be paid attention to in the prevention and control of high blood pressure in children and adolescents in the future, and the prevention and control should be focused on low-birth weight children or twin boys.

A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission to the surgical emergency room. The CT scan promptly demonstrated rupture of a large retroperitoneal hematoma with massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient underwent urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. Fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed with and treated for hypertension. Conclusion. Rupture of pseudoaneurysms followed by hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case, in which hypovolemic shock manifested itself before the admission. We would like to highlight the importance of high blood pressure control and the importance of regular check-ups.

Hypertension Related Knowledge and Its Relationship with Control of High Blood Pressure in Pakistan

Introduction: High blood pressure (HBP) is a leading major risk factor for chronic diseases such as CKD, CADx, and deaths. The prevalence of patients with hypertension (HT) has risen from 600 million in 1980 to one billion in 2008.
 Aims and Objectives: The basic aim of the study is to find the relationship of knowledge about hypertension with the control of blood pressure.
 Methodology of the Study: This cross sectional study was conducted in Mayo hospital Lahore from January 2021 to July 2021. The data was collected from 100 patients with high blood pressure who visited the OPD of our hospital. A questionnaire was prepared by the researchers in accordance with the literature to measure the level of knowledge about HT.
 Results: The data was collected from 100 patients of both genders. On comparison of questions related to knowledge, there was a statistically significant difference in; meaning of hypertension (p <0.001), target SBP (p0.001), target DBP (p 0.001), importance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure (p 0.003), hypertension being a lifelong disease (<0.001), lifelong treatment with anti-hypertensives (<0.001) and high blood pressure being part of aging (<0.001).
 Conclusion: It is concluded that patients who were aware that elevated BP levels lead to reductions in life expectancy had a higher compliance level with medication use and follow-up visits than patients without this awareness.

Blood pressure control in the general and high risk populations, longitudinal trends

Abstract Introduction Despite better control of high blood pressure (BP) in the general as well as high cardiovascular (CV) risk populations as a factor contributing to the decrease in CV mortality since 1990, the targets set by the guidelines may not have been reached. Purpose We analysed longitudinal trends in BP control in the general and high risk populations, to assess implementation of guidelines and to identify subpopulations with still unsatisfactory BP control. Methods Analysis of seven independent surveys of the general population (Czech MONICA and post-MONICA studies, 1985–2017) and five independent surveys of patients with stable manifest coronary heart disease (CHD) 1995–2017 (Czech samples of the EUROASPIRE I-V surveys). Results A total of 15 000 persons (Czech MONICA) and 2 098 patients (Czech EUROASPIRE) were investigated. In the 1985–2017 period, mean systolic BP decreased in the general population (MONICA) from 134 to 128 mmHg (p<0.001) and diastolic BP from 84 to 82.5 mmHg (p<0.01), hypertensive levels of BP (>140/90mmHg) were found in 45% in 1995 but only in 27.5% in 2017, and the prevalence of uncontrolled severe hypertension (BP>180/110 mmHg) decreased from 3 to 1%. The proportion of properly controlled hypertension increased from 13.2 to 53% (p<0.0001). In the 1995–2017 surveys of the high-risk population (EUROASPIRE) systolic BP decreased from 144.1 to 135.5 mmHg (p<0.001), diastolic BP from 87.5to 83.5mmHg (p<0.01), higher than recommended BP (>140/90mmHg, >140/85mmHg in diabetics) was found in 66.2% in 1995, still present as much as in 54.4% in 2017. Proportion of patients with very high BP (BP>180/110 mmHg) decreased from 18.4 to 1% only. Drugs with a potentially antihypertensive effect were used in 79.9 and 95.3% of patients in 1995 and 2017, respectively (p<0.0001). Population BP levels ceased to decline since 2000/01 survey, in the CHD population since the 2012/13 survey. This is obviously due to considerable increase in prevalence of obesity, and an increasing prevalence of diabetes, both in the general and high-risk populations. The more intensive medical high BP treatment seems to have a beneficial effect on hypertension control, even more in the general than in the high risk population. Conclusions The recent trend in BP levels, both in the general and high-risk populations, are far from satisfactory, with the main causative factor suggested to be the increasing prevalence of obesity and diabetes. While there has been progress in hypertension control, more in the general nad limited in high-risk population, truly effective BP control may be illusory without comprehensive CV risk factor control. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic

Trend of ischemic heart disease mortality attributable to metabolic, behavioral, and environmental risk factors in the past two decades

Abstract Background Ischemic heart diseases (IHD) is the leading cause of mortality, worldwide. Understanding of the status of risk factors contributing to IHD and mortality helps control this public health issue. Purpose This study aims to provide global, regional, and national estimates of the trend of IHD burden and deaths attributable to the modifiable risk factors, from 1990 to 2019. Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the IHD incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). IHD deaths attributable to the different metabolic, behavioral and environmental risk factors were estimated based on risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on 2010 to 2019. Results Globally, there were 21·2 million (95% uncertainty interval [UI] 18·8–23·7) new cases, 9·1 million (8.4–9·7) deaths, and 182·0 million (170·2–193·5) DALYs due to IHD, in 2019. From 1990 to 2019, IHD incident cases, deaths and DALYs increased globally by 29.1·9% (27.0–31·3), 32·4% (25.3–37·8), and 53.9% (42·7–64·3), respectively. Although high SDI regions succeeded to reduce DLAYs due to IHDs by −36.7% (−33.8 to −39.2), low SDI regions faced an increase in DALYs due to IHDs by +104.4% (+75.0 to +135.3). In 2019, the five leading risk factors of deaths due to IHDs were; high systolic blood pressure [2.2 million deaths (1.7–2.7)], high LDL cholesterol [1.7 million deaths (1.2–2.3)], high fasting plasma glucose [1.1 million deaths (0.6–1.8)], high body-mass index [0.8 million deaths (0.5–1.1)], and diet low in whole grains [0.6 million deaths (0.2–0.8)]. From 1990 to 2019, high SDI regions succeeded to reduce the age standardized death rate of IHDs attributable to metabolic risk factors by −60.1% (−61.9 to −57.7), behavioral risk factors by −61.2% (−62.8 to −59.2) and environmental risk factors by −65.8% (−71.4 to −59.3). During the same period, the age standardized IHD death rate attributable to environmental risk factors decreased by −16.0% (−30.4 to −1.6), while the age standardized IHD death rate attributable to metabolic and behavioral risk factors didn't change significantly, in low SDI regions. Conclusions During the past two decades despite steadily increase in incident cases of IHDs, the age standardized burden of IHDs has decreased in high SDI regions most probably due to control of attributable risk factors. However, burden of IHDs has increased dramatically in low SDI regions. Preventive measures such as “polypills” for high blood pressure control programs and life-style modification should be prioritized in these settings. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Bill & Melinda Gates Foundation Age-standardized DALY rates of IHD

The Relationship Between Racial/Ethnic Concordance and Hypertension Control.

Given the increasing impact of the healthcare cost of hypertension on the economy, understanding the control of high blood pressure is warranted, particularly as it pertains to racial/ethnic disparities in hypertension control. To understand the relationship between hypertension control and racial/ethnic concordance, we investigated whether the racial/ethnic concordance between a patient's race/ethnicity and that of the individual's provider is a predictor of high blood pressure control. Data was collected for 612,524 patients from Kaiser Permanente Southern California who were at least 18 year old and received a diagnosis of hypertension between January 1, 2016 and December 31, 2019. A multiple regression analysis was carried out to assess the correlation between hypertension control and patient-provider concordance. The independent variables proxying for patient-provider relationship are positive and statistically significant at the 5% level. Out of the 3 types of concordance, language has the highest standardized estimate, followed by gender and race. We found correlations between racial/ethnic patient-provider concordance and hypertension control. Consistent with previous studies, we found that Asian patients experience more time in hypertension control. By contrast, Black and Hispanic patients have less time in hypertension control. Having the same primary care provider for a longer span of time is also positively correlated with length of hypertension control. Correlation between racial/ethnic concordance, length of time under the primary provider's care, and length of time spent in hypertension control suggests that the patient-provider relationship remains a critical component of health outcomes.

Global and national high blood pressure burden and control

High blood pressure is a leading modifiable cause of premature death and one of WHO's global targets for the prevention of non-communicable diseases. Monitoring high blood pressure globally while understanding what is happening at a country level is important to identify tangible and customised solutions for local, national, and global polices to address high blood pressure. As reported in The Lancet by the NCD Risk Factor Collaboration (NCD-RisC),1 the number of people with hypertension globally in 2019 was over 1 billion and this number has doubled since 1990.

Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

BackgroundNepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal.MethodsWe conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach.ResultsMajor uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment.ConclusionsThis formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients.

Trends in associations between socioeconomic development and urban-rural disparity with high blood pressure in Chinese children and adolescents over two decades.

This study aimed to assess the association between the trend of urban-rural disparity in high blood pressure (HBP) in Chinese children and adolescents and socioeconomic development. Data on 1,054,602 students aged 7-18 years were obtained from five successive national surveys administered in 29 Chinese provinces in 1995, 2000, 2005, 2010, and 2014. HBP was defined as average measured systolic BP and/or diastolic BP equal to or more than 95th percentile. The socioeconomic indicators at the provincial-level included gross domestic product (GDP) per capita, the Engel coefficient, and urbanization rates. From 1995 to 2014, HBP prevalence in Chinese children and adolescents fluctuated between 6.9% and 9.2%. Rural areas had a higher prevalence of HBP than urban areas, with a diminishing trend in urban-rural disparity from 1995 to 2010 with a reduced OR from 1.45 (95% CI: 1.40-150) in 1995 to 1.09 (1.05-1.12) in 2010, whereas a widening gap in 2014 with OR of 1.23 (1.19-1.26)). A positive association existed between the improvement of socioeconomic indicators and the increase in HBP, which was demonstrated obviously by the Engel coefficient strata. The increases in the urbanization rates were accompanied by a greater increase of HBP in urban than in rural areas. The large urban-rural disparity suggests a priority of HBP control in rural children due to their current and future HBP and cardiovascular disease risks. Socioeconomic development could affect the urban-rural disparity in HBP risk, reflecting the importance of effective policy responses for preventing HBP by avoiding unhealthy lifestyles brought about by rapid economic development.

A machine learning approach for high blood pressure prediction and music control

High blood pressure (HBP) has been one of the major threats to human health. Lack of early detection and control of high blood pressure can cause severe damages to the heart which may lead to death. Most adults suffering from high blood pressure are unaware of the disease because it may have no warning signs or symptoms. This research focuses on the real time prediction of high blood pressure using a machine learning approach and control of high blood pressure using music. The study synchronizes a machine learning technique with a simulator to predict blood pressure and play low beat music if the blood pressure is high. The research was carried out using a large dataset with the following attributes (education, age, body mass index, current smoker and heart rate). Random forest algorithm was the machine learning technique used to construct and validate the prediction model. The prediction accuracy of the model exceeds 97% and the model was able to accurately predict blood pressure and play low beat music when the blood pressure is high.

High-Risk People Identification and Key Risk Factor Comparison of Cardiovascular Diseases in Northern China Rural and Urban Areas

Data mining techniques were utilized to improve the regional cardiovascular diseases (CVDs) prevention and in addition to find why rural residents are in worse statues of CVDs. Decision tree (DT) was chosen to build a high-risk CVDs people identification model, and the steps of identifying are reduced, with 99.4% precision in the classification. In comparison with the top 18 key features assessed by Random Forest, rural people were at higher risk due to the factors such as higher total cholesterol, blood glucose, blood pressure, body mass index(BMI) and waistline. Urban people had higher hypertensive historical prevalence but lower hypertensive comorbidity prevalence than rural people because of better control of high blood pressure. Smoking, drinking and medicine taking affected current blood pressure and lipid. More tobacco use of rural female and more alcohol intake of rural male can take part of responsibilities for worse CVDs prevalence and control in rural area. In the intervention and prevention of CVDs in a region, high-risk people should be more focused on. And rural and urban residents should be separately implemented with intervenable methods because of different disease history statues, control effect and current statue. Gender also should be considered when lifestyles are significantly different.

Association between longitudinal blood pressure and prognosis after treatment of cerebral aneurysm: A nationwide population-based cohort study.

High blood pressure is a major risk factor for the development and rupture of cerebral aneurysm. Endovascular coil embolization and surgical clipping are established procedures to treat cerebral aneurysm. However, longitudinal data of blood pressure after the treatment of cerebral aneurysm and its impact on long-term prognosis are not well known. This retrospective cohort study included 1275 patients who underwent endovascular coil embolization (n = 558) or surgical clipping (n = 717) of cerebral aneurysm in 2002-2015 using the nationwide health screening database of Korea. Systolic and diastolic blood pressure of patients were repeatedly obtained from the nationwide health screening program. We performed a multivariate time-dependent Cox regression analysis of the primary composite outcome of stroke, myocardial infarction, and all-cause death. During the mean follow-up period of 6.13 ± 3.41 years, 89 patients suffered the primary outcome. Among the total 3546 times of blood pressure measurement, uncontrolled high blood pressure (systolic ≥140 mmHg or diastolic ≥90 mmHg) was 22.9%. There was a significantly increased risk of primary outcome with high systolic (adjusted HR [95% CI] per 10 mmHg, 1.16 [1.01-1.35]) and diastolic (adjusted HR [95% CI] per 10 mmHg, 1.32 [1.06-1.64]) blood pressure. High blood pressure is prevalent even in patients who received treatment for cerebral aneurysm, which is significantly associated with poor outcome. Strict control of high blood pressure may further improve the prognosis of patients with cerebral aneurysm.

Comparison between invasive and non-invasive assessment of blood pressure in hypertensive disorders of pregnancy

BackgroundThe management of hypertensive disorders of pregnancy (HDP) during hospitalization requires an accurate blood pressure (BP) measurement, mainly by invasive intra-arterial reading. Nevertheless, little is known about the precision of non-invasive (NI) central BP measurements in HDP. We aimed to assess the accuracy of NI central BP assessment in comparison to invasive BP measurement in HDP.This cross-sectional study included all patients with HDP that were admitted to university hospitals for high BP control, from December 2018 till December 2019, and 10 healthy matched non-hypertensive controls. Patients were compared for demographic, anthropometric, and echocardiographic data. In all subjects, invasive BP assessment was done by radial arterial cannulation and NI assessment of BP was performed by an oscillometric automated device (Mobil-O-Graph); the comparison was done after initial control of BP.ResultsOne hundred patients were included and divided into 3 groups (pre-existing hypertension (HTN), gestational HTN, and pre-eclampsia). There was no statistically significant difference between NI central and invasive methods in measuring both systolic BP (SBP) (126.39 ± 14.5 vs 127.43 ± 15.3, p = 0.5) and diastolic BP (82.41 ± 9.0 vs 83.78 ± 8.9, p = 0.14) among the total studied population. A strong positive correlation was found between NI central and invasive SBP (r = 0.96, p < 0.001). HDP was associated with an increase in arterial stiffness, left ventricular diastolic dysfunction, and complications.ConclusionNon-invasive measurement of BP using oscillometric automated devices is as accurate as the invasive method, and it is a practical safe method in pregnant women with hypertensive disorders (CTR no. = NCT04303871).

May Measurement Month 2019: an analysis of blood pressure screening results in the Philippines.

The Philippine Society of Hypertension (PSH) took part again in the annual May Measurement Month 2019 (MMM19) blood pressure (BP) measurement campaign to raise awareness of hypertension especially in those who are not aware of their condition. The MMM19 standard protocol designed by the International Society of Hypertension was used during screening. These included the collection of basic data on demography, lifestyle, and environmental factors. Standardized sitting BP measurements were taken two to three times, using an automated BP apparatus and were inputted either in the MMM19 app or data were recorded in paper form and manually transferred to Excel spreadsheets by encoders supervised by the PSH. A total of 89 941 participated through opportunistic convenience sampling. After multiple imputation, a total of 47 925 (53.3%) participants had hypertension (≥140/90 mmHg or on antihypertensive medication). Of this number, 31 151 (65%) were aware that they had high BP and 30 120 (62.8%) were on antihypertensive medications. Of the 30 120 participants on antihypertensive medications, only 18 373 (61.1%) had controlled BP (<140/90 mmHg). Being overweight or obese were significant predictors of high BP. Other predictors of high systolic BP and diastolic BP were alcohol intake, smoking, and a previous history of hypertension in pregnancy, while pregnant participants had significantly lower BP. The MMM19 campaign succeeded in raising awareness of high BP in our country, and the opportunistic sampling enhanced a sense of people empowerment by their knowing how easy it is to detect high BP and thereby enabling the prevention of long-term health complications. The higher BP control in the MMM19 hypertensive individuals possibly attests to the success of the previous MMM17 and MMM18 campaigns.

Depletion of Esterase‐Harboring Bacteria Increases Antihypertensive Efficacy of ACE Inhibitor Quinapril

Introduction Resistant hypertension (rHTN) is a critical impediment to successful control of high blood pressure (BP) and hypertension-linked pathophysiology in 15-20% of all hypertensive patients. rHTN is of importance in African American patients because they experience early onset, increased prevalence and severe outcomes. The mechanisms for drug resistance in rHTN remain unknown. Eggerthellaceae family harbors biotransformative enzymes including esterase, which influences drug catabolism in the gut prior to absorption. Thus, we hypothesized that an increased abundance of bacteria with catabolic capacity for an antihypertensive drug will decrease its efficacy (Fig. A) and may thereby serve as a novel treatment target for rHTN. Methods Ten human feces (4 controlled HTN (cHTN), 6 rHTN) were analyzed by metatranscriptomics. 16-week old male Spontaneously Hypertensive Rats (SHR) were gavaged with (N=12) or without (N=6) Vancomycin, Meropenem, and Omeprazole (VMO), at 50 mg/kg/day for five days to deplete the gut microbiota. To test the quinapril efficacy, a single 8mg/kg dose was gavaged to both SHR and SHR+VMO before BP recording via telemetry. Quinapril catabolism was quantified by liquid chromatography-mass spectrometry. Bacterial esterase activity was monitored by the hydrolysis of p-nitro-phenylbutyrate. Cecal microbiota was analyzed by 16S rDNA. Pearson r correlation was plotted using GraphPad. Results Patients with rHTN showed ~3-fold more Eggerthellaceae compared to cHTN (p=0.0027, Fig. B). With 50% reduction in bacterial 16S copy numbers (P<0.0001, Fig. C), the SHR+VMO group showed (1) reduced Eggerthellaceae (P<0.0001, Fig. D); (2) lower esterase activity per gram of cecal microbiota to hydrolyze quinapril (p=0.0065, Fig. E); (3) a 50% lower reduction in quinapril quantity (Δquinapril, nmol) after incubation with 1mg of cecal lysate (P<0.0001, Fig. F); (4) decreased bacterial genes in KEGG drug metabolism pathway (P<0.0001, Fig. G). The abundance of Eggerthellaceae positively correlated with Δquinapril (P=0.029, Fig. H) and genes in drug metabolism (P<0.0001, Fig. I). Importantly, administration of quinapril to the SHR+VMO led to lowering of BP, compared to SHR (Fig. J). Conclusion Eggerthellaceae was enriched ~3-fold in rHTN. Using SHR, we showed that depletion of Eggerthellaceae and esterase activity of the gut microbiota by VMO increased the antihypertensive efficacy of quinapril, due to protection of quinapril from catabolism in the gut. Therefore, our study, for the first time, provides evidence for a previously unrecognized role of gut microbiota in rHTN. Innovative approaches can now be considered for rHTN based on strategies to protect antihypertensive drugs from catabolism by gut bacteria before reaching the systemic circulation for improved efficacy.

Epidemiology and control of hypertension in Japan: a comparison with Western countries.

Based on data from national surveys, the prevalence of hypertension rests at 40-60% in Japan, the USA, and in European countries. This suggests there has been little progress in the prevention of hypertension in even high-income countries despite their well-functioning health systems. In particular, compared with the USA and European countries, the improvement in awareness, treatment, and control of hypertension has been relatively low in Japan. For example, the rates of hypertension awareness, treatment, and control were observed, respectively, in 60-70%, 50-60%, and 20-30% of Japanese compared with 80-90%, 70-80%, and 50-60% of US citizens in the years around 2015. The lower proportions in Japan might be explained by the slower progress in lowering the accepted thresholds for diagnosis of hypertension and initiation of treatment compared with Western countries; however, the underlying reasons for the differences warrant further study. The high prevalence (>40%) of uncontrolled hypertension in even high-income countries has major implications for the prevention of cardiovascular disease. Health policy and research on early control of high blood pressure at the individual and public health levels will contribute to decreases in the prevalence of hypertension. Furthermore, proactive treatment and strict adherence to intensified antihypertensive treatment guidelines will more effectively achieve targeted blood pressure levels. In this context, it is important to continue to carefully monitor and compare trends in hypertension across countries.

CAN HYPERTENSION EXPLAIN THE DIFFERENT SEASONAL EVOLUTION OF STEMI PATIENTS?

Abstract Objective: To determine the impact of hypertension on evolution of a STEMI population studied during winter and summer months. Design and method: We reviewed the local STEMI registry data. Data were recorded from the in-hospital medical charts and from a phone follow-up with patients/family. Hospitalization inform consent stipulates the possibility of follow-up for research purposes. Results: We reviewed the 2018 data from a local STEMI registry We analyzed 470 patients admitted with STEMI in a primary PCI hospital from a temperate region. We reviewed 247 (52.6%) patients admitted during 3 winter months and 223 (47.4%) during 3 summer months and we interviewed 32.6% (153) patients for follow-up. In-hospital death-rate was 7.9% (37 patients), with death-rate at follow-up to 13.2% (62 patients). A higher in-hospital mortality was noted for winter (10,5% vs. 4,9%, X2 = 5,05, p = 0,025), while at follow-up a similar evolution was noted (16,7% vs. 9.5%, x2 = 5,35, p = 0,021). A higher median blood pressure was recorded for the alive STEMI patients at discharge (132,09 ± 23,64 mmHg vs. 107,15 ± 38,84 mmHg; t (463) = 5,524; p = 0,000) and at follow-up (131,94 ± 23,56 mmHg vs. 118,60 ± 36,3 mmHg; t (460) = 3,73; p = 0,000). During wintertime, the maximum in-hospital Killip class was higher (x2 = 9,28, p = 0,026); Killip class was higher in dead persons, initialy and after discharge. At follow-up, patients were asked to self-report their exercise capacity. A lower BP level was noted for higher exercise tolerance - NYHA I, 140,92 ± 20,66 mmHg, p = 0.04), NYHA II (141,25 ± 17,24 mmHg, p = 0.06), both compared with lower exercise tolerance - NYHA III-IV (162.33 ± 29,45 mmHg, p = 0.04); differences were significant (ANOVA test (F (3) = 4.53, P = 0.005). Limitations. The phone interview was performed at different time interval after discharge, 17,11 ± 5,48 months for winter group, and 16,23 ± 0.89 months for summer (T (468) = 2,37, p = 0.018) with a low rate of answers. Evaluation of larger cohorts is needed for further validation of the results. Conclusions: The course of a STEMI patient is critical. It's valuable to predict evolution upon the level of cardiovascular risk factors. A good high blood pressure control migth further improve outcome.

Gender Disparities in the Prevalence, Awareness, Treatment, and Control of High Blood Pressure.

The gender effects in arterial hypertension (HT) epidemiology remain poorly clarified to date. We present an up-to-date review of the data regarding gender disparities in HT's prevalence, awareness, treatment, and control. Based on the data from three consecutive national-representative SEPHAR (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania) surveys conducted between 2005 and 2016, we provide insights into gender differences in HT's epidemiology and their 11- years the evolutionary trend in a high-CV risk European country. Our data displays gender effects in different age-dependent epidemiological patterns in terms of hypertension prevalence, awareness, treatment, and control, mainly due to hormonal status. Hypertension's prevalence is higher in younger men and older women. Although women are more often aware of their hypertensive condition and receive more often antihypertensive treatment, BP control is lower in older women compared to men of the same age, mainly due to a higher treatment side-effect rate. There is no solid evidence that different antihypertensive drugs exhibit different effects in lowering BP values between genders. In high CV risk European countries like Romania, if all the influencing conditions remain similar to those in the past 11 years, gender discrepancies in terms of HT's prevalence will diminish over time, awareness and treatment of hypertension will continue to be higher in females than in men, with an upward trend of BP control predicted only for women, while in men HT treatment control rate is expected to stagnate.

CORONARY ARTERY DISEASE

Healthy coronary arteries have smooth walls through which blood can easily flow. When there’s damage to an artery wall, plaque gets trapped in those crevices inside the artery lumen.Plaque deposits are made of fats, cholesterols, inflammatory cells, and calcium. A healthy lifestyle can help keep the arteries strong and clear of plaque. To improve heart health, Quit smoking, Control high blood pressure, high cholesterol and diabetes, Exercise often, Maintain a healthy weight, Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole