Management Of High Blood Pressure Research Articles

Motivation can improve medication adherence in hypertension patients

Introduction: Motivation is essential in improving medication adherence in hypertensive patients. Non-adherence to medication is often a significant obstacle in the management of high blood pressure, leading to an increased risk of serious complications such as heart disease and stroke. This study analyzes the relationship between patients' motivation levels and adherence to hypertension treatment regimens. Methods: The research design used is descriptive-analytical with a cross-sectional approach to hypertensive patients in a health clinic. Data were collected through questionnaires that measured motivation and adherence to medication. Results: The results of the analysis showed that patients with high motivation had better compliance levels than those with low motivation (p < 0.05). Contributing motivational factors include family support, understanding of the benefits of treatment, and confidence in managing the hypertension condition. Conclusions: Strong motivation plays a significant role in improving medication adherence in hypertensive patients, so health workers need to strengthen the motivational aspect of patient education and counseling programs. This is expected to help reduce the risk of complications and improve the quality of life of hypertensive patients.

Load-dependent mechanisms contribute to increased aortic stiffness among women with a history of preeclampsia: relation with cardiovagal baroreflex sensitivity.

Preeclampsia, a hypertensive disorder of pregnancy, results in increased lifetime cardiovascular disease (CVD) risk. Total aortic stiffness, a robust risk factor for CVD, is composed of load-dependent (blood pressure load on arterial wall) and structural (intrinsic changes in arterial wall) mechanisms. Total aortic stiffness is also associated with reduced cardiovagal baroreflex sensitivity (BRS). We sought to determine 1) whether elevated total aortic stiffness among women with a history of preeclampsia (hxPE) is attributed to load-dependent or structural stiffness, and 2) whether either mechanism is associated with lower BRS. Total aortic stiffness (carotid-femoral pulse wave velocity) and spontaneous cardiovagal BRS (sequence technique) were measured among women 1-5 yr postpartum (n = 115; age 34 ± 4 yr; hxPE n = 51; controls n = 64). Structural aortic stiffness was calculated from participant-specific exponential models by standardizing aortic stiffness to a "reference" blood pressure. Load-dependent stiffness was calculated as total minus structural stiffness. Total [+0.8 m/s, 95% confidence interval (CI) (-0.99, -0.23), P = 0.002] and load-dependent [+0.4 m/s, 95% CI (-0.56, -0.22), P < 0.001], but not structural [95% CI (-0.52, 0.08), P = 0.16] aortic stiffness were higher among women with a hxPE compared with controls. Women with a hxPE had lower BRS (P = 0.042) that was negatively associated with total [B = -3.24 ms/mmHg, 95% CI (-6.35, -0.13), P = 0.042] and load-dependent [B = -5.91 ms/mmHg, 95% CI (-11.31, -0.51), P = 0.033] aortic stiffness. Load-dependent, not structural, aortic stiffness mechanisms contribute to higher total aortic stiffness among women with a hxPE and are associated with lower cardiovagal BRS. Postpartum monitoring for high BP is critical to reduce increased CVD risk after preeclampsia.NEW & NOTEWORTHY The novel finding is that load-dependent stiffness, not structural stiffness, is the primary mechanism of aortic stiffness, and is associated with reduced baroreflex sensitivity in women with a history of preeclampsia. These findings may help tailor high blood pressure prevention and management strategies in this population to prevent structural aortic stiffening, altered baroreflex control, and increased lifetime cardiovascular disease (CVD) risk.

Diagnostic and Therapeutic Approach to the Major Secondary Causes of Arterial Hypertension in Young Adults: A Narrative Review

Arterial hypertension in young adults, which includes patients between 19 and 40 years of age, has been increasing in recent years and is associated with a significantly higher risk of target organ damage and short-term mortality. It has been reported that up to 10% of these cases are due to a potentially reversible secondary cause, mainly of endocrine (primary aldosteronism, Cushing’s syndrome, and pheochromocytoma/paraganglioma), renal (renovascular hypertension due to fibromuscular dysplasia and renal parenchymal disease), or cardiac (coarctation of the aorta) origin. It is recommended to rule out a secondary cause of high blood pressure (BP) in those patients with early onset of grade 2 or 3 hypertension, acute worsening of previously controlled hypertension, resistant hypertension, hypertensive emergency, severe target organ damage disproportionate to the grade of hypertension, or in the face of clinical or biochemical characteristics suggestive of a secondary cause of hypertension. The 2023 Guideline of the European Society of Hypertension recommends starting pharmacological therapy from grade 1 hypertension (BP ≥140/90 mm Hg), with the aim of achieving BP control of less than 130/80 mm Hg. It is important to highlight that the prevalence of secondary hypertension in these patients could be underestimated, given that there is little evidence available on the management of high BP in young adults, which is why we developed this narrative review on the diagnostic and therapeutic approach to the major secondary causes of arterial hypertension in young adults.

Performance Evaluation of Deep Learning Architectures for Blood Pressure Estimation Using Photoplethysmography

High blood pressure (BP) monitoring Blood pressure (BP) is one of the common cardiovascular diseases and therefore the early high blood pressure (hypertension) detection, management, and prevention are mandatory. One promising method of continuous, non-invasive blood pressure estimation is photoplethysmography (PPG). In this study, a novel method was proposed to introduce the AlexNet framework into the time-frequency domain for classification of BP levels based on PPG signals. The study was conducted using the publicly available Figshare dataset which offers PPG signals, and the blood pressure labels against them. Data balancing techniques were used to alleviate class imbalances. Preprocessing and Feature Extraction of PPG Signals. The PPG signals were preprocessed with noise filtering and signals were then transformed from 1D-time to image to facilitate robust feature extraction. The proposed classification model, based on AlexNet showed the best result, with 98.89% accuracy, recall, and precision, and 99.44% specificity. This model outperformed alternative models (VGG16, DenseNet, ResNet50, GoogleNet) for classifying BP levels into the JNC 7 report standard categories normotension, prehypertension and hypertension. This study has two primary contributions. Initially, it demonstrates the efficacy of AlexNet model to extract meaningful features from PPG signals by its hierarchical convolutional and max-pooling layers thereby enabling accurate classification of BP levels. This study underscores the potential of deep learning and PPG signals for developing a highly accurate and truly non-invasive BP monitoring system. In the second aspect, the study offers a systematic assessment and comparison of the proposed over other well-known deep-learning networks, presenting the effectiveness of the AlexNet-based one. These results are of critical importance in the development of novel non-invasive BP monitoring modalities and optimization of cardiovascular health managements and personalized health cares.

8137 Prevalence Of Overweight And Obesity In Dominican Children With Congenital Heart Disease

Abstract Disclosure: L.D. Rojas Rodríguez: None. M.J. Mateo Pérez: None. L.C. López Sención: None. V.T. San Martin: None. A. Grullón: None. Background: Overweight and obesity can be detrimental to the health of children with congenital heart disease, potentially leading to or contributing to other chronic medical conditions such as hypertension. This, in turn, may increase the cardiovascular demands of these patients whose lives are already affected by a defective heart anatomy. Objective: To determine the prevalence of overweight and obesity in Dominican children with congenital heart disease. Methods: An observational cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with congenital heart disease attending the Pediatric Cardiology Department at Children's Hospital (Santo Domingo, Dominican Republic), from July to December 2022. The study population was classified into categories of underweight, normal weight, overweight or obesity using the CDC Body Mass Index-for-age growth chart (2022), based on their age, weight, height, and sex. The parents of the patients were interviewed to gather information about their children’s medical history, as well as their diet type and level of physical activity. Diet type was assessed through a questionnaire about daily meals; diets in which processed foods and simple carbohydrates were predominant were categorized as unhealthy, while those with a predominance of proteins and complex carbohydrates were categorized as healthy. Physical activity levels were measured using the Assessment of Physical Activity Level Questionnaire (APALQ). Additionally, blood pressure values were categorized as normal or elevated/high based on the American Academy of Pediatrics Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents (2017). Results: A total of 84 patients with congenital heart disease were analyzed, with 11.9% (10/84) categorized as having overweight and 23.8% (20/84) categorized as having obesity. Among patients with overweight or obesity, unhealthy eating habits predominated in 66.7% (20/30), while a sedentary level of physical activity was reported in 56.7% (17/30). Additionally, among patients with overweight or obesity, 36.7% (11/30) had elevated/high blood pressure. Conclusion: About one-third of Dominican patients with congenital heart disease were found to have overweight or obesity. Additionally, about one-third of those with excess weight were found to have elevated/high blood pressure. These findings stress the need for urgent implementation of personalized interventions and educational programs focused on fostering healthier lifestyles. The ultimate goal is to reduce cardiovascular risks and improve the overall well-being of children living with congenital heart disease. Presentation: 6/1/2024

The Benefits of Lifestyle Changes in the Management of Hypertension: A Review of the Literature

Introduction: Hypertension has been identified as an important health problem worldwide. It is a major factor in cardiovascular diseases with a resultant high mortality rate. Understanding the role of lifestyle modification in the management of hypertension is important in improving the health of the population, especially in middle-aged adults. Aim: The aim of this research is to identify and evaluate the positive effects of lifestyle changes, specifically dietary modifications and physical activities in the management of hypertension. Methods: This study employed a systematically structured literature review, with emphasis on important studies that focused on lifestyle changes and their effect on hypertension. The review focused on peer-reviewed articles that addressed dietary interventions and physical activity levels among middle-aged adults with hypertension. Results: The research revealed that changes in the lifestyle if properly implemented would have a positive impact on the management of high blood pressure. A more personalized dietary regimen and regular exercise are the strategies that were singled out as efficient for reducing blood pressure Conclusion: The findings of this study underscore the importance of lifestyle modifications in the management of hypertension. When applied correctly, these changes can significantly contribute to better health outcomes and reduced risks associated with high blood pressure.

Predicting high blood pressure using machine learning models in low- and middle-income countries

Responding to the rising global prevalence of noncommunicable diseases (NCDs) requires improvements in the management of high blood pressure. Therefore, this study aims to develop an explainable machine learning model for predicting high blood pressure, a key NCD risk factor, using data from the STEPwise approach to NCD risk factor surveillance (STEPS) surveys. Nationally representative samples of adults aged 18-69 years were acquired from 57 countries spanning six World Health Organization (WHO) regions. Data harmonization and processing were performed to standardize the selected predictors and synchronize features across countries, yielding 41 variables, including demographic, behavioural, physical, and biochemical factors. Five machine learning models - logistic regression, k-nearest neighbours, random forest, XGBoost, and a fully connected neural network - were trained and evaluated at global, regional, and country-specific levels using an 80/20 train-test split. The models’ performance was assessed using accuracy, precision, recall, and F1 score. Feature importance analysis identified age, weight, heart rate, waist circumference, and height as key predictors of blood pressure. Across the 57 countries studied, model performances varied considerably, with accuracy ranging from as low as 58.96% in some models for specific countries to as high as 81.41% in others, underscoring the need for region and country-specific adaptations in modelling approaches. The explainable model offers an opportunity for population-level screening and continuous risk assessment in resource-limited settings.

Exploring the role of blood pressure in the black-white disparity in cardiovascular disease mortality: a causal mediation analysis

BackgroundCardiovascular diseases (CVDs) are the leading cause of death in the USA, and high blood pressure is a major risk factor for CVD. Despite the overall declining rates of CVD...

Strengthening Linkages Between Health Care and Public Health: A Novel Framework for Public Health Action in Health Care Settings to Improve Cardiovascular Disease Risk.

The Chronic Disease Prevention and Control Program (CDPCP) at the Nebraska Department of Health and Human Services developed a novel public health framework and tools to translate public health knowledge, grant work, and terminology to a health care audience in order to inform clinical practice changes in the management of hyperlipidemia and hypertension. The CDPCP piloted the tools with 2 accountable care organizations that included 19 clinics and then funded 9 independent clinics. The project sought to empower clinics to design and implement interventions for reducing high blood pressure and high blood cholesterol focused on populations disproportionately at risk for those conditions utilizing electronic health records. A team comprising the CDPCP and evaluation specialists created a framework called CAAPIE (Capture, Assess, Action Plan, Implement, Evaluate) to provide a clinic-friendly approach to the public health-focused work. For the capture phase, baseline data were collected from clinics. To guide the assess, action plan, and evaluate phases, the team created a Scan & Plan Tool for clinics to assess practices and policies and then use results to develop an action plan. The assessment was repeated upon completion of the project to evaluate change. Interviews were conducted to assess the utility of these tools and capture information related to the implementation of the project. Clinicians reported the framework and tools provided a useful approach, aiding clinics in understanding public health terminology and intended outcomes of the project. Work resulted in the creation of new or enhanced clinical policies and procedures that led to modest improvements in the management of high blood pressure and high cholesterol. The CAAPIE framework is a novel approach for state health departments to utilize in translating public health grant work to health care professionals, promoting a working relationship between the spheres to achieve positive impacts on individual and population-based health care.

Progressive Muscle Relaxation Therapy to Lower High Blood Pressure in the Elderly Through Community Service Midwifery Lecturer Unand

Background: Elderly health is an increasingly urgent aspect in today's social dynamics. With the increasing number of elderly people in the population, healthcare challenges specific to them are increasingly important to discover. Purpose: This study aims to analyze Progressive Muscle Relaxation Therapy to Lower High Blood Pressure in the Elderly Through Community Service Method: A series of activities were carried out in several stages, with active participation from the elderly Results: The results are in line with previous research that has also shown the effectiveness of this therapy in lowering blood pressure and relieving stress in the elderly population. Increased understanding of progressive muscle relaxation therapy is an important first step in the management of high blood pressure. Participants who better understand these relaxation techniques can use them as aids to maintain their health in the long term. Conclusion: Community service by applying progressive muscle relaxation therapy has proven its benefits in lowering high blood pressure in the elderly. Increased understanding of this therapy, decreased blood pressure, and increased feelings of relaxation are encouraging results

Validity and reliability of the Romanian version of the Hill-Bone compliance to high blood pressure therapy scale.

Romania is considered a country with high cardiovascular risk, arterial hypertension and its complications accounting for about 60% of total deaths. The management of high blood pressure often involves a combination of both therapeutic regimens as well as lifestyle changes, to which patients have to be adherent. In order to assess patients adherence to professionals' recommendations, validated tools are needed. The aim of our study was to translate, culturally adapt and validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale into Romanian. The study included 215 participants from Iasi, North-Eastern Romania. The internal consistency of the instrument was measured with Cronbach's alpha coefficient, while the construct validity was determined using exploratory factor analysis and principal component extraction with promax rotation. Sampling adequacy and appropriateness of data for factor analysis was measured using Kaiser-Meyer-Olkin (KMO) statistics and Bartlett's test of sphericity. Our statistical analysis revealed a Cronbach's alpha coefficient of 0.733 (73.3%) and a Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy of 0.697. The chi square test demonstrated that the overall perfect adherence was not significantly associated with the number of medications taken per day variable (p = 0.721). The Romanian version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale demonstrated suitability for its use in evaluating adherence in the intended population.

Elevated blood pressure among children born to women with obstructed labour in Eastern Uganda: a cohort study

BackgroundGlobally, high systolic blood pressure accounts for 10.8 million deaths annually. The deaths are disproportionately higher among black people. The reasons for this disparity are poorly understood, but could include a high burden of perinatal insults such as birth asphyxia. Therefore, we aimed to assess the incidence of elevated blood pressure and to explore associated factors among children born to women with obstructed labour.MethodsWe followed up children born to women with obstructed labour aged 25 to 44 months at Mbale regional referral hospital that had participated in the sodium bicarbonate trial ( Trial registration number PACTR201805003364421) between October 2021 and April 2022. Our primary outcome was elevated blood pressure defined as blood pressure (either systolic or diastolic or both) ≥ the 90th percentile for age, height, and sex in the reference population based on the clinical practice guideline for screening and management of high blood pressure in children and adolescents. We used logistic regression to estimate odds ratios between selected exposures and elevated blood pressure.ResultsThe incidence of elevated blood pressure was (39/140, 27.9%: 95% (CI: 20.6–36.1)). Participants aged three years and above had twice the odds of elevated blood pressure as those aged less than three years (Adjusted odds ratio (AOR) 2.46: 95% CI (1.01–5.97). Female participants had 2.81 times the odds of elevated blood pressure as their male counterparts (AOR 2.81 95% CI (1.16–6.82). Participants with reduced estimated glomerular filtration rate had 2.85 times the odds of having elevated blood pressure as those with normal estimated glomerular filtration rate (AOR 2.85 95% CI (1.00–8.13). We found no association between arterial cord lactate, stunting, wealth index, exclusive breastfeeding, food diversity and elevated blood pressure.ConclusionOur findings show a high incidence of elevated blood pressure among children. We encourage routine checking for elevated blood pressure in the pediatric population particularly those with known risk factors.

Abstract 18388: Hypertension Identification and Management in the USA: Adherence of the 2017 ACC/AHA High Blood Pressure Guidelines

Background: The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults changed the criteria for a diagnosis of hypertension and provided new recommendations goals and management. We aimed to investigate the prevalence of hypertension identification, treatment, and adherence in the US population. Methods: We analyzed the 2017-2020 pre-pandemic National Health and Nutrition Examination Survey for participants between 18 and 79 years of age. Participant data was used to assess for a hypertension diagnosis and eligibility for AHA/ACC’s primary or secondary prevention hypertension strategies. Current hypertension medication usage was stratified if prescribed for hypertension management or a non-hypertension indication. Participants with a current hypertension-indicated medication were identified as “Undergoing Treatment”; all other participants were stratified into “No Indication”, “Primary Prevention”, or “Secondary Prevention”, based on the AHA/ACC guideline. Complex survey methodology with weighting was utilized for national estimates. Results: Our study included 236,621,712 participants, of which 22.4% (n=53,064,773) were undergoing treatment for hypertension, 67.0% (n=158,613,605) had no indication for management, 8.9% (n=21,158,544) qualified for primary prevention, and 1.6% (n=3,784,790) qualified for secondary prevention. A known hypertension diagnosis was reported in 26.0% of the primary prevention group, 45.0% of secondary prevention, and 94.8% of those undergoing treatment. In patients undergoing treatment, 57.9% of participants had mean blood pressure readings above goal. Conclusion: One in ten adults under 80 qualify for hypertension management but may not be undergoing treatment. Of patients qualifying without current treatment, most did not know they would qualify for a hypertension diagnosis. More than half of treated patients did not meet blood pressure goals.

FORMULATION AND EVALUATION OF NANOPARTICLE DRUG DELIVERY SYSTEM FOR TREATMENT OF HYPERTENSION

Objective: The aim of the current research is to formulate and evaluate Trandolapril loaded solid lipid nanoparticles (SLNs) for the management of high blood pressure. Methods: SLNs were formulated using Glyceryl monostearate and poloxamer 188 by hot homogenisation and ultrasonication method. Different concentrations of lipid and surfactant were used for the preparation adopting 32 full factorial design. The prepared formulations were initially evaluated for particle size, PDI, zeta potential and entrapment efficiency to obtain the optimised formulation. Results: The optimised formulation TF 6 reported the particle size of 212.6±5.39 nm and entrapment efficiency of 91.02±0.57%; this was further characterised for FT-IR, DSC and scanning electron microscopy. The in vitro release of drug for the prepared formulations was performed for 24 h and the optimised formulation showed better-controlled drug release compared to other formulations. Conclusion: The pure Trandolapril solution was collated with the optimised formulation TF 6 and the result concluded that the formulation showed controlled drug release compared to pure drug. This study proves that Trandolapril SLNs can be prepared for increasing the release of drug for prolonged period.

To Estimate the Prevalence of Obesity and High Blood Pressure among Undergraduate Students at a University Medical Institution in North India.

Background: Hypertension is a major public health issue in India. Early detection and management of high blood pressure (BP) is crucial, especially among young adults. This study aimed to estimate the prevalence of obesity and hypertension among undergraduate medical students. Materials and methods: A cross-sectional study was conducted among 450 first year undergraduate medical students aged 18-25 years in S.M.S. Medical and Hospital Jaipur, Rajasthan after clearance from institutional ethics committee and written consent from participants. Anthropometric measurements like height, weight, BMI, waist circumference, hip circumference and blood pressure were recorded. Hypertension was defined as per JNC VIII guidelines. Data was analyzed using appropriate statistical tests. Results: Overall, 15.56% students were hypertensive and 40.67% were prehypertensive. Hypertension was more prevalent in males (18.83%) compared to females (12.33%) (p = 0.002). Overweight/obesity was present in 29.33% students, more common in males (37.67%) than females (21.15%) (p < 0.001). Obese students had higher rates of prehypertension (47%) and hypertension (28.8%). Abnormal waist-hip ratio and waist-stature ratio were significantly associated with hypertension (p < 0.001). Conclusion: Overweight/obesity and hypertension are highly prevalent among undergraduate medical students, especially males. Unhealthy lifestyles and risk factors need to be addressed to prevent long term morbidity. Routine screening and health promotion activities should be conducted for this high risk group. How to cite this article: Sharda K, Saxena P, Yadav SK, et al. To Estimate the Prevalence of Obesity and High Blood Pressure among Undergraduate Students at a University Medical Institution in North India. J Assoc Physicians India 2023;71(11):30-35.

The Self-Fulfilling Process of Clinical Race Correction: The Case of Eighth Joint National Committee Recommendations.

There is growing attention to how unfounded beliefs about biological differences between racial groups affect biomedical research and health care, in part, through race adjustment in clinical tools. We develop a case study of the Eighth Joint National Committee (JNC 8)'s 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, which recommends a distinct initial hypertension treatment for Black versus nonblack patients. We analyze the historical context, study design, and racialized findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that informed development of the guideline. We argue that ALLHAT's racialized outcomes emanated from a poor and artificial study design and analysis weakened by implicit assumptions about race as biological. We show that the acceptance and utilization of ALLHAT for race correction arises from its historical context within the "inclusion-and-difference paradigm" and its indication of the inefficacy of angiotensin-converting-enzyme inhibitors for Black patients, which follows from the enduring, yet, refuted slavery hypertension hypothesis. We demonstrate that the JNC 8 guideline displays the self-fulfilling process of racial reasoning: presuppositions about racial differences inform the design and interpretation of research, which then conceptually reinforce ideas about racial differences leading to differential medical treatment. We advocate for the abolition of race adjustment and the integration of structural competency, biocritical inquiry, and race-conscious medicine into biomedical research and clinical medicine to disrupt the use of race as a proxy for ancestry, environment, and social treatment and to address the genuine determinants of racialized disparities in hypertension.

Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia.

The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022). In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70-80] vs. 80 [75-80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.

Ubiquity of Hypertension- Systematic Review

The prevalence, knowledge, diagnosis, treatment, and control of hypertension in an adult population-representative group were alldiscussed in this review. Due to its high prevalence and link to anincreased risk of developing a number of diseases, hypertension is asignificant health concern around the globe illness of the heart.Recent dramatic decreases in the mortality rates from coronary heartdisease and stroke in industrialized nations are largely attributable toimprovements in the diagnosis and management of hypertension. Therates of high blood pressure management in many of these nationshave, however, actually slowed over the past few years. Globally, 1.2billion individuals are anticipated to have hypertension by the year2010. About 125 million people in the Eastern Mediterranean regionsuffer from hypertension, which has a frequency of 26% on average.More concerning is the rise in the frequency of heart failure, stroke,and other cardiovascular complications of high blood pressure,including end-stage renal disease.

Lifestyle Medicine as a Treatment for Resistant Hypertension.

Approximately 10% of the adults with hypertension fail to achieve the recommended blood pressure treatment targets on 3 antihypertensive medications or require ≥ 4 medications to achieve goal. These patients with 'resistant hypertension' have an increased risk of target organ damage, adverse clinical events, and all-cause mortality. Although lifestyle modification is widely recommended as a first-line approach for the management of high blood pressure, the effects of lifestyle modifications in patients with resistant hypertension has not been widely studied. This review aims to provide an overview of the emerging evidence on the benefits of lifestyle modifications in patients with resistant hypertension, reviews potential mechanisms by which lifestyles may reduce blood pressure, and discusses the clinical implications of the recent findings in this field. Evidence from single-component randomized clinical trials demonstrated that aerobic exercise, weight loss and dietary modification can reduce clinic and ambulatory blood pressure in patients with resistant hypertension. Moreover, evidence from multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce clinic and ambulatory blood pressure, and improve biomarkers of cardiovascular risk. This new evidence supports the efficacy of lifestyle modifications added to optimized medical therapy in reducing blood pressure and improving cardiovascular risk biomarkers in patients with resistant hypertension. These findings need to be confirmed in larger studies, and the persistence of benefit over extended follow-up needs further study.

Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol

Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. ACTRN12622001583730.