Management Of High Blood Pressure Research Articles

Editors' Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines.

Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.

The Effect of Classical Music Therapy on Blood Pressure Reduction in Hypertension in the Elderly at Tresna Werdha Budi in South Kalimantan Province

Hypertension is an increase in blood pressure. Management of high blood pressure can be carried out with pharmacological and non-pharmacological therapies. Pharmacological therapy is reducing stress by listening to classical music. The purpose of this study was to determine the effect of classical music therapy on reducing blood pressure in the elderly with hypertension. The research design was pre-test experimental with a one-group pre-test and post-test design approach. The population was all elderly people with hypertension at the Tresna Werdha Budi Sejahtera Social Institution, South Kalimantan Province, amounting to 52 people. The sample was 15 people with a purposive sampling technique. Data analysis through Wilcoxon test using 95% confidence level. The results of the study before being given classical music therapy had an average systolic blood pressure of 142 mmHg and after being given classical music therapy the average systolic blood pressure was 124 mmHg. There was an influence between classical music therapy on reducing blood pressure in the elderly with hypertension at the Tresna Werdha Budi Sejahtera Social Institution Banjarbaru, South Kalimantan Province (p value = 0.001). Nurses can provide nursing care interventions to the elderly with hypertension to reduce blood pressure through the provision of classical music.&#x0D; Keywords: Classical Music, Blood Pressure, Hypertension

1249-P: Lack of Concordance of Blood Pressure Control among Heterosexual Couples with Diabetes—An Analysis of Aging Cohorts from USA, China, and India

Background: Previous studies observed high concordance of diabetes and hypertension among married or partnered couples globally due to assortative mating and cohabitation. However, whether there is concordance in controlled blood pressure (BP) among couples with diabetes, an important risk factor for micro/macrovascular complications, is unknown. Methods: Using cross-sectional data from Health and Retirement Study (HRS 2016-17, n = 1749) and its international partner studies from China (CHARLS 2015-16, n = 923) and India (LASI 2017-19, n = 4582), we identified couples (aged 21-97 years) among whom at least one partner had diabetes and both partners had standardized BP measurements. We defined controlled BP as systolic BP &amp;lt; 140 mmHg and diastolic BP &amp;lt; 90 mmHg. We used multiple imputation and survey-weighted modified Poisson regression to study the association of controlled BP between couples for wives and husbands respectively. We adjusted for current medication use, individual and household characteristics. We additionally examined between-country differences in the association. Results: Our analytic sample consisted of 3802 wives and 4504 husbands with diabetes. The proportion of wives with controlled blood pressure were 76.6% [73.2, 80.1] in the USA, 67.5% [63.3, 71.8] in China and 65.1% [62.6, 67.6] in India. The proportion of husbands with controlled blood pressure were 70.8% [67.4, 74.1] in the USA, 63.6% [58.5, 68.6] in China and 60.0% [57.8, 62.3] in India. Partner’s control of BP was not associated with own controlled BP for wives (prevalence ratio, PR: 1.05 [0.97, 1.14]) and husbands (PR: 1.07 [0.94, 1.21]) with diabetes. Estimates of association were null across all countries. Estimates were similar when restricted to couples (n = 1076) when both partners had diabetes. Conclusions: Lack of concordance in BP control among couples with diabetes suggest continuation of strategies for individualized management of high blood pressure. Disclosure J.Varghese: None. C.Li: None. P.Lu: None.

Relationship Between High Sodium Chloride Intake and Obesity in Hypertensive Population A Cross-Sectional Study

Background: High Sodium chloride intake and obesity are significant, regarding hypertension in the population which may develop several medical complications. Objective: The aims and objectives of the current study were to introduce lifestyle medicine awareness in people for managing high blood pressure caused by high sodium chloride intake and obesity. Study Design: It was a cross-sectional clinical Study of the management of high blood pressure in a population with the help of nutrition &amp; physical exercise. Place and Duration: The present study was conducted from January to May 2023 and Patients were selected from the community health center and Ghurky Hospital Lahore. Methodology: ToA total of 10 of 0 hypertensive individuals were selected and divided into different groups regarding hypertension, obesity, sodium chloride intake in daily life, and other demographics. People were separated into different groups based on their sodium intake levels and BMI people were separated into different groups. In group- A there was 50 male and female while in group B other 50 male and female were included respectively. Results: Significant (P≤0.05) changes in systolic and diastolic blood pressure were seen in the individuals of both groups regarding NaCl intake. The mean standard deviation levels, BMI, Systolic and Diastolic blood pressure of men in Group-A and Group-B in the beginning (27.03±0.02, 130.01±0.01, 90.01±0.02), (30.01±0.02, 135.01±0.01, 90.01±0.02) after 15 days (27.03±0.02, 125.01±0.01, 83.01±0.01), (30.01±0.02, 140.01±0.01, 90.01±0.02) and after30 days (27.03±0.02, 124.01±0.01, 80.01±0.01), (30.01±0.02, 145.01±0.01, 100.01±0.01) were measured respectively. Similarly the mean standard deviation levels, BMI, Systolic and Diastolic blood pressure of women in Group-A and Group B in the beginning (28.03±0.02, 131.01±0.01, 88.01±0.02), (31.02±0.02, 131.01±0.01, 88.01±0.02) after 15 days (28.03±0.02, 125.01±0.01, 83.01±0.01), (31.02±0.02, 140.01±0.01, 90.01±0.02) and after30 days (28.03±0.02, 120.01±0.01, 84.01±0.01), (31.02±0.02, 150.01±0.01, 92.01±0.01) were calculated. Conclusion: All recommendations suggest limiting dietary salt as one of the tried-and-true ways to lower high blood pressure because there is a well-established link between excessive salt consumption and hypertension. A current study proved that high sodium chloride intake may increase blood pressure in humans. Keywords: Hypertensive, Sodium Chloride, BMI, Systolic and Diastolic blood pressure.

The impact of updated clinical blood pressure guidelines on hypertension prevalence among children and adolescents.

To date, population estimates of hypertension prevalence among children and adolescents in Canada have been based on clinical guidelines in the National High Blood Pressure Education Program's 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP 2004). In 2017, the American Academy of Pediatrics published updated guidelines in Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP 2017), followed by Hypertension Canada in 2020 with its publication of Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children (HC 2020). This study compares national child and adolescent hypertension prevalence estimates based on NHBPEP 2004, AAP 2017 and HC 2020. Six cycles of data spanning 2007 to 2019 from the Canadian Health Measures Survey were used to compare blood pressure (BP) categories and the prevalence of hypertension by sex and age group under all sets of guidelines for children and adolescents aged 6 to 17. The impact of applying AAP 2017 across time and selected characteristics, the resulting reclassification into a higher BP category under AAP 2017, and differences in hypertension prevalence resulting from applying HC 2020 versus AAP 2017 were examined. Prevalence of Stage 1 hypertension was higher among children and adolescents aged 6 to 17 under AAP 2017 and HC 2020 than under NHBPEP 2004. Overall hypertension prevalence was also higher, and obesity was a major factor associated with being reclassified into a higher BP category under AAP 2017. Implementation of AAP 2017 and HC 2020 is associated with significant changes in the epidemiology of hypertension. Understanding the impact of applying updated clinical guidelines may help inform population surveillance efforts to track hypertension prevalence among Canada's children and adolescents.

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 1. How to correctly measure blood pressure in children and adolescents.

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.

Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study.

Reducing excess body weight is important for control and management of high blood pressure (BP) in adults. Previous studies showed high prevalence of hypertension in River Nile State-north of Sudan, hence this study to establish whether obesity can be among the main risk factors and to study the prevalence of obesity related hypertension among Sudanese adults in River Nile State. This was a cross sectional community-based study conducted in River Nile State, Northern Sudan from January to June 2021. Obese and overweight, aged 18 years and above and accepted to participate in the study were included in the study. Convenience sampling method was used to select the participants. Data was collected through structured questionnaire filled by the patients after taking informed consent. Anthropometric measurements were taken. Two measurements of BP were obtained. Data was analyzed using SPSS version 23.0 (IBM, Chicago, USA). Chi-square test was used to determine the associations between categorical variables while logistic regression test was used to predict the presence of hypertension among studied population. A total of 1,295 participants were enrolled in this study. Obesity was reported in 1,118 (86.3%) of the participants. The prevalence of hypertension among the participants was 1,027 (79.3%). Central obesity was reported in 951 (92.6%) among hypertensive patients (P<0.001). Moreover, among hypertensive patients 470 (45.8%) were obese class I, 334 (32.5%) overweight, 139 (13.5%) obese class II and 84 (8.2%) obese class III (P<0.001). Obesity, BMI are risk factor of hypertension (P<0.001). Other risk factors were age above 40 years (P<0.001), unemployment (P<0.001), low education level (P<0.001) and being married (P<0.001). Logistic regression analysis showed that increasing age [P<0.001; odds ratio (OR) =1.055; 95% confidence interval (CI): 1.041-1.068], central obesity (P<0.001; OR =5.16; 95% CI: 3.4-7.8) and high body mass index (BMI) (P<0.001; OR =3.7; 95% CI: 1.7-7.9) were associated with uncontrolled hypertension. The study showed that the prevalence of obesity related hypertension was high. Common risk factors were age above 40 years, unemployment, and marriage. Importantly, central obesity, gross obesity and increasing age can be associated with uncontrolled BP management.

Antihypertensive Medications Use among Chronic Hemodialysis Patients Visiting the Outpatient Department of Nephrology of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Anti-hypertensive medications are prescribed for the management of high blood pressure which is the leading cause of mortality in chronic hemodialysis patients. The objective of our study was to find out the prevalence of anti-hypertensive medication use among chronic hemodialysis patients visiting the outpatient Department of Nephrology of a tertiary care centre. This was a descriptive cross-sectional study conducted among chronic hemodialysis patients visiting the Department of Nephrology of a tertiary care centre from 2 April 2022 to 30 September 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 062-078/079). A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. The prevalence of anti-hypertensive medications use was present in 102 (97.14%) (93.95-100, 95% Confidence Interval) patient undergoing hemodialysis. The three common drugs prescribed for hypertensive patients were amlodipine 79 (77.45%), torsemide 59 (57.84%), and prazosin 48 (47.05%). The prevalence of antihypertensive medication use among patients undergoing hemodialysis was higher than other similar studies done in similar settings. anti-hypertensive drugs; hemodialysis; prevalence.

Improving cardiovascular health in rural China and beyond

In 2021, high blood pressure claimed 11·3 million lives globally. 1 Vaduganathan M Mensah GA Turco JV Fuster V Roth GA The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol. 2022; 80: 2361-2371 Crossref PubMed Scopus (4) Google Scholar High blood pressure has ranked consistently as the top modifiable risk factor globally for over 20 years. Although its prevalence is universally high, awareness, management, and control of high blood pressure are particularly poor in low-income and middle-income countries. 2 Geldsetzer P Manne-Goehler J Marcus ME et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet. 2019; 394: 652-662 Summary Full Text Full Text PDF PubMed Scopus (199) Google Scholar Several cluster randomised controlled trials have shown that community health worker-led interventions were effective in significantly reducing blood pressure in Argentina (the HCPIA trial), 3 He J Irazola V Mills KT et al. Effect of a community health worker-led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA. 2017; 318: 1016-1025 Crossref PubMed Scopus (98) Google Scholar Malaysia and Colombia (the HOPE 4 trial), 4 Schwalm JD McCready T Lopez-Jaramillo P et al. A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster randomised controlled trial. Lancet. 2019; 394: 1231-1242 Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar and Bangladesh, Pakistan, and Sri Lanka (the COBRA-BPS trial). 5 Jafar TH Gandhi M de Silva HA et al. A community-based intervention for managing hypertension in rural South Asia. N Engl J Med. 2020; 382: 717-726 Crossref PubMed Scopus (68) Google Scholar More recently, in 2022, Sun and colleagues 6 Sun Y Mu J Wang DW et al. A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial. Lancet. 2022; 399: 1964-1975 Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar showed that in the China Rural Hypertension Control Project (the CRHCP trial), a village doctor-led intensive hypertension intervention increased hypertension control by 37% compared with usual care. The 18-month net reduction in systolic blood pressure was as large as 14·5 mm Hg. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trialThe non-physician community health-care provider-led intensive blood pressure intervention is effective in reducing cardiovascular disease and death. Full-Text PDF

Abstract P428: Evaluating a Personalized Low Sodium Diet Intervention for Blood Pressure Control in Hypertensive Patients: A Pilot Study

Introduction: Although many clinical trials tested the effects of a low sodium diet (LSD) on high blood pressure (HBP) management, adherence to an LSD remains challenging. Considerable barriers to adherence to diet modification have been examined, and heterogenous responses to an LSD evolved. We tested the intra-individual response to an LSD to develop an individualized dietary intervention to optimize HBP management. The purpose of this pilot study was to determine the effectiveness of a personalized low-sodium diet (P-LSD), enhanced by mobile health technology for real-time dietary assessment and at-home BP monitoring in hypertensive adults. Methods: A total of 24 hypertensive patients (60.4±10.7 years) were randomly assigned to either PLSD (n=16) or usual care control groups (n=8). Participants in P-LSD went through individual sessions via video conferencing to discuss LSD regimens, patients’ food choices, and BP tracks on mobile apps. The Control group followed their usual care for HBP management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, SBP, and DBP were measured at the baseline and at 8 weeks. The preliminary effects of P-LSD were tested by paired t-test and analysis of covariance (ANCOVA). Results: Dietary sodium intake ( t = 3.82), SBP ( t = 3.95), and DBP ( t = 3.54) were significantly declined overtime in the P-LSD group (Ps&lt;0.01) but not in control group (Ps&gt;0.05). There were significant differences between the control and intervention groups in changes of dietary sodium intake (F=18.6, p&lt;0.001) and SBP over time (F=4.84, p&lt;0.05) before and after the intervention. No statistically significant difference was revealed in DBP between the two groups before the intervention (p=0.20). Conclusion: The PLSD appears to be effective on the adherence to an LSD and BP control in hypertensive patients. Future studies with larger sample sizes are warranted to examine the long-term effects of PLSD on outcomes.

Systematic review on combination pharmacotherapy: methodological rigor but no pharmacology.

Systematic review on combination pharmacotherapy: methodological rigor but no pharmacology.

Perceptions, insights, and attitudes (P.I.A.) of selected filipino female physicians on cardiovascular risks and diseases

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In 2012, coronary heart disease and stroke are the leading causes of death worldwide, accounting for more than 31% of deaths from all causes. In 2020, PH statistics showed that ischemic heart diseases were the leading causes of death in the Philippines (PH), responsible for 17.3% of the total deaths. Objective To determine the knowledge, perceptions, insights and attitudes on cardiovascular disease (CVD) prevention, personal health-related lifestyle practices, and lifestyle counseling practices of selected female physicians who are practicing or training in the PH through an online survey. Methods A descriptive ambispective cross-sectional study where the survey questionnaire of Ameh, et al. (2019) was modified with the authors' permission, was conducted online and answered by consenting female physicians. 484 participants’ data were collated and analyzed. Results Majority had accurate responses for the CVD prevention knowledge items (Figures 1 and 2). Among the participants, 36.98% had hypertension, 32% were obese, 28.5% had dyslipidemia, and 17.2% had diabetes mellitus. Sleep of 6-8 hours is practiced by 60.33%, 53.51% eat vegetables and fruits daily, 55.79% prefer fish and seafood, 89.05% do not smoke, 61.2% take coffee or black tea daily, 84.51% have no regular exercise, and 30.79% of those who do only exercise for 10-20 minutes. Moreover, 67.98% add salt, soy or fish sauce to their meals, and 72.73% do not drink enough water daily. In addition, 44.42% do not undergo annual general check-up and 58.06% do not have a personal physician. Limitations due to COVID-19 pandemic, lack of education, and expensive screening tests are perceived to be major barriers to CVD screening. More than 90% of our participants practice health teachings on diabetes mellitus prevention, high blood pressure screening, cholesterol screening and management, nutrition, and weight management. Counseling on regular exercise, smoking, and alcohol abuse are being practiced by 88.02%, 85.74%, and 83.88% of our respondents, respectively. Conclusion There are female physicians who are not aware of the World Health Organization’s recommendations on the prevention of CVD, who do not do health teaching and counseling, and who practice unhealthy lifestyle. Changing physicians’ knowledge and behavior towards CVD prevention is a great challenge to improve standards of CVD prevention. Improvement and enhancement in education of both physicians and patients, together with more consultation time, financing for CVD prevention, and comprehensive, multidisciplinary preventive cardiology programs supported by government and societies in favor of prevention are some of the best ways to improve management of CVD risk factors and prevention.

High blood pressure pattern amongst adolescents in Lagos, South West Nigeria.

high blood pressure (HBP), once considered rare in adolescents is now a growing health problem. Usually asymptomatic in adolescents, if uncontrolled, can track into adulthood leading to various end-organ complications. In 2017, the American Academy of Pediatrics (AAP) published a new Clinical Practice Guideline (CPG) for screening and management of high blood pressure in children and adolescents to update the 2004 Fourth report. The objective of this study was to determine the prevalence of high blood pressure among adolescents in Mushin Local Government Area (LGA) using the 2017 AAP guidelines. a descriptive cross-sectional study, conducted from August 2020 to December 2020. A two-stage sampling technique was used to select 1490 students aged 10 to 19 years, from 14 secondary schools. Socio-demographic information and relevant clinical data were obtained using a structured questionnaire. The anthropometry and blood pressure measurements were taken according to standard protocol (elevated blood pressure is systolic and/or diastolic blood pressure ≥ 90th percentile but ≤ 95th percentile for age, gender and height). Socio-demographic and anthropometric characteristics were described with descriptive statistics. Categorical variables were summarized using frequency and percentages, while numerical variables were summarized using mean and standard deviation. The predictors of hypertension were determined using logistic regression analysis. study participants were 1490, 49.9% (744) were male and 50.1% (746) females (male: female ratio was 1: 1). Subjects mean age was 14.39 ± 2.79 years. There were 8.9% overweight and 1.7% obese participants. Prevalence of high blood pressure, elevated blood pressure and hypertension were 26.7% (n = 398), 13.8% (n = 205), and 12.9% (n = 193). Middle and late adolescence, when compared to early adolescence, significantly predicted the likelihood of high blood pressure; aOR 1.78, 95%CI: 1.20 - 2.63, p=0.004 and 3.90 (2.69 - 5.67, p=0.001 respectively). Similarly, male sex had increased odds for raised blood pressure when compared to female sex aOR 1.49,95% CI: 1.1 - 2.0, p= 0.009. the prevalence of high blood pressure, elevated blood pressure and hypertension amongst adolescents was high. Early detection and treatment will forestall development of complications.

A Review on Impact of Training Program on Knowledge and Practice Regarding Hypertension among Accredited Social Health Activist

Hypertension (HTN) is the term used to describe high blood pressure (BP). One of the major causes of morbidity and mortality and a public health issue that affects all nations in the world is HTN. The low diagnosis of HTN in rural India is caused by a number of obstacles. Accredited Social Health Activist (ASHA) workers who work for mother and child health programs across the nation could be used to improve HTN control because rural India has low access to healthcare services. ASHAs can receive training to facilitate community-based group discussions focused on education and to assist people in controlling high BP. ASHAs may obtain training to support people and lead community-based group discussions on high BP management. Following the intervention, the ASHAs had a greater understanding of and use for HTN. According to the ASHAs, the training materials were easy to understand and effective at educating local populations. This study proved that health education provided by community health practitioners improved the adherence of HTN patients to low-sodium diets and medications. More health issues than any other condition are caused by HTN globally. Rural communities have lower levels of awareness of available HTN control options. We came to the conclusion after examining the available literature that training programs could improve the understanding and attitude of ASHA employees about HTN.

Relation Between Hypertension and Obesity in Children Between 5-12 Years of Age

Objectives: Obesity and high blood pressure are a well-known combination. Some studies Shows that development of hypertension in kids, teenagers, adults, which eventually led to heart disorders.We measured that blood pressure of 15 school-aged kids (ages 5–12) for 06 months, beginning in February 2019 to October 2019, while also providing Regular nutrition class and activities to assess the impact of nutrient as a routine life mediation on the kids' body composition, weight, and blood pressure school-aged children prevention programmer. In children and young children, obesity is an indisputably serious clinical problem. From 2001 to 2010, public research establish that the frequency of weighty in children increased from 6% to 14%. The consequences of adolescent obesity. Methodology: It was a cross- sectional study conducted in a hospital. The Department of Peads Medicine, P.E.M.H, Rawalpindi, Pakistan, conducted this descriptive case series. The research lasted a year. Over the course of a year, from February 2019 to October 2019, the number of children aged 5–12 years who were called in for a regular health check-up from around 100 patientswas lower normal blow cohorts than in the weighty and obese group. This shows a link between obesity and hypertension. During the hour of time spent in two groups, pulse levels decreased. Thiscould be the result of the personalized mediation or the children adjusting to the new situation. A large number of children were fearful. Results: Systolic pulse values can be seen in the results. In the standard group, fifteen children (10 M kids and 05 F kids) had circulatory strain in the 90th percentile or above in at least one calculation. In this study, 15 children (10 M kids and 5 kids F) in the intercession group reported increased cardiovascular strain in at least one estimate. Conclusion: Fat loss is the main-route antihypertensive therapy in children having high blood pressure caused by obesity. In addition, in the management of obesity-related high blood pressure, establishing heart-healthy life that take in daily bodily exercise also a food rich in berries and root vegetable, fibre, that is also low in complex carbohydrate and sweet cold drink critical. This may be problematic in children with stoutness, which is often associated with comorbid illnesses and depression and anxiety decreased flexibility. For maximum adequacy, a multidisciplinary approach is frequently expected. A small number of children will require antihypertensive medication. Both are not effective to lowering blood pressure in children. In any case, the reduced CV events observed in adults treated with RAAS inhibitors are promising. Keywords: Relationship; hypertension; obesity; children

INVESTIGATION OF THE PHYTOCHEMICAL CONTENTS, MINERAL CONTENTS, FREE RADICAL SCAVENGING, AND ALPHA-AMYLASE INHIBITORY ACTIVITIES OF ARISTOLOCHIA RINGENS (VAHL.) ROOT

Introduction: Aristolochia ringens is a medicinal plant that has been used traditionally in the management of several diseases. Aim: This study is focused on investigating the phytochemical contents, mineral contents, free radical scavenging, and alpha-amylase inhibitory activities of Aristolochia ringens (Vahl.) root Materials and Methods: The plant materials were collected, dried, coarsely grounded, and extracted using methanol. The methanol extract was then partitioned into n-hexane and ethyl acetate to obtain the respective extracts. The qualitative phytochemical screening of the extracts was carried out using standard methods. Selected elements were determined from the plant material using Atomic Absorption Spectroscopy (AAS). The antioxidant assays were carried out using the reducing power and 2,2-Diphenyl-l-1-picrylhydrazyl assay methods. The alpha-amylase inhibitory activities were determined preliminarily using the starch-iodide assay. Results: The extraction gave the methanol extract (ArMe) which on partitioning gave the n-Hexane (ArnH), ethyl acetate extract (ArEa), and the residual methanol extract (ArRMe), qualitative phytochemical screening shows the presence of flavonoids, steroids, cardiac glycosides, and phlobatannin in all the extracts with tannins and alkaloids found in only ArRMe, saponins is found in ArRMe and ArEa. Elemental analysis shows a significant level of the selected elements Ca, Mg, K, Fe, Zn, Na, Cu, Co, and Se in ppm. Antioxidant results show that all extracts exhibit dose-dependent reducing properties and an increase in DPPH scavenging activity. Conclusion: These results further confirmed some of the traditional uses of A. ringens in the management of high blood pressure, diabetes, and inflammatory conditions.

Contemporary view on hypertension: From diagnostics to treatment

Arterial hypertension is a persistent increase in resting systolic blood pressure and/or diastolic blood pressure than recommended thresholds. An increase in blood pressure without a known cause is the most common. Hypertension with a known cause is usually associated with obstructive sleep apnea, chronic kidney disease, primary aldosteronism, diabetes, or obesity. Usually, symptoms appear only with severe or prolonged course. Diagnosis is based on sphygmomanometry. Diagnosis allows to determine the cause, evaluate the lesion, and also identify other cardiovascular risk factors. Treatment includes lifestyle changes and medications, including diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and calcium channel blockers. In this article latest study are stated in terms of early identification, diagnosis and timely management of this disease. Knowing risk factors and predictors allows health care workers early identification and management of high blood pressure as well as reduce the burden associated with its complications.

Black Garlic and Pomegranate Standardized Extracts for Blood Pressure Improvement: A Non-Randomized Diet-Controlled Study

Recently released position papers by the European Society of Hypertension (ESH) and the Italian Society of Hypertension (SIIA) provide therapeutic recommendations for the use of nutraceuticals in the management of high blood pressure (BP) and hypertension, opening up new perspectives in the field. This not-randomized diet-controlled clinical study aimed to evaluate if daily dietary supplementation with black garlic and pomegranate (namely SelectSIEVE® SlowBeat) could advantageously affect BP in individuals with high-normal BP or stage I hypertension. Enrolled subjects were adhering to a Mediterranean DASH (Dietary Approaches to Stop Hypertension) diet for two weeks before deciding whether to continue following Mediterranean DASH diet alone or in association with SelectSIEVE® SlowBeat. At the end of the study, dietary supplementation with SelectSIEVE® SlowBeat was associated with significant improvement in systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to baseline (Pre-treatment: SBP = 134.3 ± 4.2 and DBP = 88.2 ± 3.4; 4-Week Follow-up: SBP = 130.1 ± 2.8 and DBP= 83.7 ± 2.6). SBP improved also in comparison with control. In conclusion, the study shows that dietary supplementation with extracts from black garlic and pomegranate safely exert significant improvements in BP in healthy individuals adhering to a Mediterranean DASH diet.

Considerations for Optimal Blood Pressure Target of Hypertension

Hypertension is a major risk factor for cardiovascular morbidity and mortality that has led to a huge public health burden. The optimal target of blood pressure (BP) to prevent cardiovascular complications remains unclear. Based on the results of the Systolic BP Intervention Trial (SPRINT) in 2015, the 2017 American College of Cardiology/American Heart Association guidelines for diagnosis and management of high BP in adults has changed the diagnostic threshold from 140/90 to 130/80 mmHg, and the target BP to 130/80 mmHg for nearly all hypertensive patients diagnosed using the new criteria. However, the findings from the SPRINT trial were to an extent contrasting with the results of previous large randomized controlled trials, namely Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Secondary Prevention of Small Subcortical Strokes (SPS3). Besides, the 2018 European Society of Cardiology/European Society of Hypertension guidelines and the 2018 Chinese guidelines have maintained the conventional threshold and recommended target of 140/90 mmHg for most hypertensive patients. Given the special measurement of BP in the SPRINT trial and using an automated measurement system, the intensive systolic BP target of 120 mmHg provided by the SPRINT trial was not widely adopted. Most recently, the Strategy of BP Intervention in the Elderly Hypertensive Patients (STEP) trial, with a higher systolic BP target of 110 to 130 mmHg in the intensive group, confirmed the benefit and safety of intensive BP control in patients with hypertension, in accordance with the SPRINT trial. Here, the results from randomized controlled trials, meta-analyses, and other observational research studies, have been reviewed to evaluate the optimal target of BP treatment and the threshold of diagnostic criteria for hypertension.

Management of high blood pressure in acute stroke. What is the right answer?

Management of high blood pressure in acute stroke. What is the right answer?