Higher Baseline Blood Pressure Research Articles

Parental obesity exacerbates cardiovascular responses to acute stress in male, but not female, offspring

The proportion of women and men of reproductive age who are overweight and obese has been increasing considerably, and maternal obesity and excessive gestational weight gain may predispose their offspring to health‐related consequences during childhood and adulthood. Obesity may also be associated with increased cardiovascular responses to mental stress. However, there is no available evidence on the effects of intergenerational obesity on cardiovascular responses to acute stress in adult offspring. In this study, we examined whether the pressor response to acute stress is exacerbated in obese offspring from obese parents. Offspring fed normal diet (ND) born from ND parents (N‐F1‐N, n=5 per sex) used as control, offspring fed high fat diet (HFD) born from ND parents (N‐F1‐H, n=5 per sex) and offspring fed HFD born from HFD parents (H‐F1‐H, n=5 per sex) were used. Parents were fed HFD or ND after they were weaned, while the offspring were placed on HFD from weaning until the end of experiments. Mice were implanted with telemetry probes for measurement of mean arterial pressure (MAP) and heart rate (HR). After a 10 day recovery period, baseline MAP and HR were continuously measured for 30 minutes before, during 5‐minute air‐jet stress consisting of pulses of compressed air directed at the animal’s forehead, and 30 minutes after the stress test. Male and female H‐F1‐H mice were heavier than N‐F1‐H and N‐F1‐N control mice (47.3±0.8 vs. 42.5±1.9 and 33.1±0.2 g and 41.1±0.1 vs. 37.2±0.1 and 24.1±0.1 g, respectively). Male H‐F1‐H mice had higher MAP (110±4 mmHg) compared to N‐F1‐H and control mice (100±6 and 99±3 mmHg). Acute air‐jet stress significantly increased MAP by 36±2 mmHg in male H‐F1‐H mice compared to only 26±3 and 28±3 mmHg in male N‐F1‐H and control mice, respectively. MAP remained significantly higher post stress in H‐F1‐H mice (133±2 vs. 114±6 and 110±3 mmHg). Baseline HR and HR responses to air‐jet were similar among the male groups. In females, however, baseline MAP and HR as well as MAP and HR responses to air‐jet stress test were similar among groups. These results indicate that male, but not female, offspring fed a HFD from obese parents have higher baseline blood pressure (BP) and greater BP responses during acute stress, and their BP remains elevated for a longer period post stress. These observations also suggest that parental obesity may have greater effect on male offspring cardiovascular system compared to female offspring.Support or Funding InformationNIDDK 1RO1121411, NHLBI‐PO1HL51971, NIGMS P20GM104357 and U54GM115428

The effect of psyllium supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials.

Background/AimsGlobal incidence of hypertension is estimated to be, in excess of, one billion people, and given the efficacy of soluble dietary fibers, in particular, Psyllium, to positively impact blood pressure in patients with hypertension, it is of clinical importance that consensus on its supplementation be established. Therefore, the aim of the study was systematically review and meta-analyze the effect of psyllium supplementation on blood pressure of hypertensive patients in randomized controlled trials.MethodsWe searched six universal databases including; Pubmed/Medline, Ovid, Cochrane Library, Google Scholar, Embase, and Scopus until November 2018. Both combined and stratified analyzes were conducted. A fixed-effects or random- effects model was used to assess the mean effect sizes.ResultsAn eventual 11 trials with 592 participants were considered as eligible for inclusion in the present meta-analysis. The meta-analysis revealed a significant reduction of 2.04 mmHg in systolic blood pressure (weighted mean difference, –2.04; 95% confidence interval, –2.82 to –1.63; p < 0.001). Whilst meta-regression highlighted that the hypotensive effect of psyllium was stronger in subjects with higher baseline blood pressure.ConclusionsGiven the overarching benefits and lack of reported side effects, particularly for hypertensive patients, health care providers and clinicians should consider the use of psyllium supplementation for the treatment or abatement of hypertension, or hypertensive symptoms.

Muscle strength is a major determinant of the blood pressure response to isometric stress testing: the Asklepios population study.

Maximal handgrip strength is a strong predictor of cardiovascular mortality in economically and socioculturally diverse countries, yet the main determinants of cardiovascular response to change in afterload during handgrip are not well known. We examined the blood pressure (BP) responses during submaximal handgrip (at 25% of grip strength) and the determinants of grip strength. We studied 2215 participants from a population-based random sample without overt clinical disease (Asklepios Study; mean age 56.2 years). Handgrip testing was performed using a modified Jamar dynamometer with direct visual feedback. Simultaneously, a validated finger plethysmographic device measured continuous BP and heart rate. During handgrip, SBP and DBP rose by, respectively, 20 ± 13 and 10 ± 6 mmHg. These changes were normally distributed and consistently higher in men. The main independent determinants of mean arterial pressure response during handgrip were: grip strength (F = 191.4; P < 0.001), baseline pulse pressure (F = 32.0; P < 0.001), height (F = 16.4; P < 0.001) and age (F = 12.8; P < 0.001). Grip strength was associated with muscle mass, better metabolic health, but also with higher baseline DBP. There was a significant graded increase in maximum pressure achieved and in the magnitude of pressure change during handgrip with increasing BP categories (P for trend <0.001). The population BP response to handgrip is variable and its predominant determinant turned out to be grip strength itself, which should be accounted for in future analyses. Higher baseline BP, even within the normotensive range, acted as an independent and graded predictor of BP increase during handgrip.

Feature of trajectory of blood pressure among pregnant women with gestational hypertension.

We aimed to describe the feature and the trajectory of blood pressure (BP) among pregnant women with onset of gestational hypertension. This epidemiology cohort study of pregnant women enrolled in Zhoushan, Zhejiang, included 4050 participants from the Zhoushan Pregnant Women Cohort. Each participant contributed up to eight serial perinatal visits of BP measurements from 2001 to 2018. Segmented mixed models were utilized to identify the dramatic change points in the relationship of BP elevation and gestational week among pregnant women with onset of gestational hypertension. Despite of in which gestational week gestational hypertension developed, the SBP and DBP levels of pregnant women in each gestational hypertension category maintained the stable and normal levels (SBP <119∼130 and DBP <76∼83 mmHg) before the accelerated point. However, after the accelerated point, BP dramatically developed to gestational hypertension in a very short time period. Meanwhile, the earlier gestational hypertension onset was, the higher the baseline BP were; meanwhile, the earlier the gestational hypertension onset was, the higher the difference in BP at the gestational week of gestational hypertension onset between women with and without gestational hypertension was. BP trajectories of gestational hypertension onset in different gestational week presented similar patterns. Meanwhile, the earlier gestational hypertension onset was, the higher the baseline BPs were. These findings show that BP monitoring during pregnancy is necessary, especially for women with high normal baseline BP.

Flow Diverters for Intracranial Aneurysms: The DIVERSION National Prospective Cohort Study.

Background and Purpose- Flow diverters are used for endovascular therapy of intracranial aneurysms. We did a nationwide prospective study to investigate the safety and effectiveness of flow diversion at 12 months. Methods- DIVERSION was a national prospective cohort study including all flow diverters placement between October 2012 and February 2014 in France. The primary end point was the event-free survival rate at 12 months, defined as the occurrence of morbidity (intracranial hemorrhage, ischemic stroke, noncerebral hemorrhage, or neurological deficit due to mass effect), retreatment, or death within 12 months post-treatment. A quality control was carried out on 100% of the collected data and of at least 10% of the included patients in each center, chosen at random. All reported serious events were adjudicated by an independent Data Safety and Monitoring Board. Satisfactory occlusion was defined as 3 or 4 on Kamran scale by an independent imaging core laboratory at 12 months. Results- We enrolled 398 patients harboring 477 intracranial aneurysms. At least 1 morbidity-mortality event was noted in 95 of 408 interventions representing an event-free survival rate of 75.7% (95% CI, 71.1-79.7). The rate of permanent-related serious events and mortality was 5.9% and 1.2% at 12 months, respectively. Multivariate analysis showed that high baseline blood pressure (hazard ratio, 2.54; 95% CI, 1.35-4.79; P=0.039), diabetes mellitus (hazard ratio, 3.70; 95% CI, 1.60-8.6; P=0.0022), and larger aneurysms (hazard ratio, 1.07; 95% CI, 1.04-1.11; P<0.0001) were associated with the occurrence of a neurological deficit. The satisfactory occlusion rate at 12 months was 79.9%, and the absence of high baseline blood pressure (odds ratio, 2.01; 95% CI, 1.12-3.71; P=0.0193) and postprocedural satisfactory occlusion (odds ratio, 2.75; 95% CI, 1.49-5.09; P=0.0012) were associated with a 12-month satisfactory occlusion. Conclusions- A satisfactory occlusion was achieved in almost 80% of cases after flow diverter treatment with a permanent-related serious event and mortality rates of 5.9% and 1.2% at 12 months, respectively.

P796Intensive blood pressure treatment significantly increases visit-to-visit systolic blood pressure variability. A randomized clinical trial

Abstract Background Intensive blood pressure lowering is increasingly gaining attention. Besides higher baseline blood pressure, visit-to-visit variability has showed association with target organ damage and major adverse cardiovascular outcomes in multiple medical reports. Purpose Our aim was to assess the effect of intensive treatment on systolic blood pressure (SBP) visit-to-visit variability in the SPRINT trial population during follow-up. Methods We included 9068 SPRINT participants with 128139 repeated SBP measurements. Participants were randomly assigned to intensive (SBP &lt;120 mmHg) vs standard treatment (SBP between 135–139 mmHg). The primary outcome was a composite outcome of myocardial infarction, other acute coronary syndromes, acute decompensated heart failure, stroke, and cardiovascular mortality. We calculated the coefficient of variation (CV) and standard deviation (SD), taking into account all SBP measurements prior to the SPRINT primary outcome. Comparison of CV between intensive and standard treatment in the total SPRINT population and among different subgroups was made. Results CVs in intensive treatment groups were higher in total population and in all groups under study (See table). While second and third CV quartile showed a larger tendency to increase the risk for the primary SPRINT outcome in the intensive treatment compared to the standard treatment group, fourth CV quartiles were significantly associated with increase in primary SPRINT outcome in both intensive and standard treatment groups. Coefficient of variation in SPRINT trial Group Intensive treatment Standard treatment Total population 9.80 (3.22)* 8.52 (2.96) Females 10.46 (3.29)* 9.18 (3.15) Black person 9.99 (3.38)* 8.82 (3.15) Prevalence CKD 10.14 (3.22)* 9.12 (3.06) Prevalence CVD 10.28 (3.32)* 8.93 (3.23) ≥75 year 10.40 (3.18)* 9.01 (3.07) SAEs 10.30 (3.39)* 9.08 (3.13) (CKD: chronic kidney disease; CVD: cardiovascular disease; SAEs: serious adverse events. *P&lt;0.05). Conclusions Intensive blood pressure treatment significantly increases SBP visit-to-visit variability in total SPRINT population and in all subgroups under study. Additional longitudinal studies with long-term follow-up are warranted to evaluate the impact of increases in SBP visit-to-visit variability due to intensive treatment on risk of major cardiovascular events.

P1691Impact of dose and duration of dietary salt reduction on blood pressure levels: systematic review and meta-analysis of randomised trials

Abstract Background Authoritative medical and public health agencies in most countries advise to reduce population dietary salt intake to under 5–6 g/day as a strategy for preventing high blood pressure and cardiovascular disease. However, there is still dispute about whether salt reduction should be adopted by all populations. In addition, the effect of duration of dietary salt reduction has not been sufficiently investigated. Purpose To understand the effect of dietary salt reduction on blood pressure and the impact of intervention duration. Methods A systematic review and meta-analysis was conducted. Randomized controlled trials that allocated participants to low and high salt intake, without confounding from unequal concomitant interventions, were included. We excluded studies done in individuals younger than 18 years, pregnant women, individuals with renal disease or heart failure, and studies with sodium excretion estimated from spot urine. Random effect meta-analysis was used to generate pooled estimates of the effect on 24-hour urinary sodium excretion, systolic and diastolic blood pressure. Multivariate meta-regression was used to quantify the dose response effect of dietary salt on blood pressure change and to understand the impact of the intervention duration. Results 125 studies were included with 162 data points extracted. Ninety-nine data points (61%) had interventions under 4 weeks. Overall, 24-hour urinary sodium excretion changed by −141 mmol (95% CI: −156; −126), systolic blood pressure changed by −4.4 mm Hg (95% CI: −5.2; −3.7) and diastolic blood pressure changed by −2.4 mm Hg (95% CI: −2.9; −1.9). Sodium reduction resulted in a significant decrease of systolic blood pressure in all subgroups except in participants with low baseline sodium intake (&lt;109 mmol) (Figure 1). Each 100 mmol reduction of sodium was associated with 2.7 mm Hg (95% CI: 1.0; 4.4; p=0.002) reduction of systolic blood pressure and 1.2 mm Hg (95% CI: 0.0; 2.4; p=0.046) reduction of diastolic blood pressure after adjusting for intervention duration, age, sex, race, baseline blood pressure, baseline sodium intake and interaction between age and baseline blood pressure. For the same amount of salt reduction, a 10 mm Hg higher baseline systolic blood pressure would result in 2.5 mm Hg greater reduction of systolic blood pressure. There is not enough evidence to show the impact of intervention duration. Figure 1 Conclusions Our meta-analysis showed that sodium reduction could reduce blood pressure in all adult populations regardless of age, sex and race. The effect of salt reduction on systolic blood pressure increases with higher baseline blood pressure. Further studies, designed to investigate the impact of intervention duration, are needed to understand the significance of the duration. Acknowledgement/Funding None

The blood pressure paradox in acute ischemic stroke.

To explore the association of poststroke baseline blood pressure with cerebral collateral flow and functional outcome in acute ischemic patients with large vessel occlusion/stenosis. Patients identified with large vessel occlusion/stenosis with baseline multimodal computed tomography, follow-up imaging, and complete clinical profiles were included. A 90-day modified Rankin Scale of 0-1 was defined as an excellent functional outcome. Cerebral collateral flow was quantified by the volume ratio of tissue within the delay time >3 seconds perfusion lesion with severely delayed contrast transit (delay time >3 seconds/delay time >6 seconds). There were 306 patients included in this study. With every increase of 10 mmHg in baseline systolic blood pressure, the odds of achieving an excellent functional outcome decreased by 12% in multivariate analysis (odds ratio = 0.88, p = 0.048). Conversely, increased baseline blood pressure was associated with better collateral flow. In subgroup analysis of patients with major reperfusion, higher blood pressure was associated with decreased infarct growth and a better clinical outcome, and vice versa in patients without reperfusion. Higher baseline blood pressure in acute ischemic stroke patients with large vessel occlusion/stenosis was associated with better collateral flow. However, for patients without reperfusion, higher baseline blood pressure was associated with increased infarct growth, leading to an unfavorable clinical outcome. The relationship between blood pressure and outcomes is highly dependent on reperfusion, and active blood pressure-lowering treatment may be inappropriate in acute ischemic stroke patients prior to reperfusion treatment. ANN NEUROL 2019;85:331-339.

Abstract WMP22: High Baseline Blood Pressure is Associated With Better Collaterals but Not Better Clinical Outcome in Acute Ischemic Stroke

Background and Purposes: The relationship between post-stroke blood pressure (BP), collaterals and functional outcome in acute ischemic stroke patients is still controversial. The purpose of this study is to explore the influence of post-stroke baseline BP on collateral flow and functional outcome in acute ischemic patients with large vessel occlusion/stenosis. Methods: Patients identified with large vessel occlusion/stenosis with baseline multimodal computed tomography, clinical data, follow-up imaging, and clinical outcomes recruited from 2011 to 2017 in the International Stroke Perfusion Imaging Registry (INSPIRE) were included in this study. A modified Rankin Score of 0-1 at 90 days after stroke was defined as an excellent functional outcome. Collateral flow was quantified by the volume of tissue with severely delayed contrast transit (delay time&gt;6 seconds) within the delay time&gt;3 seconds perfusion lesion. The association between baseline BP, collateral flow and 3-month outcome were retrospectively investigated using multivariate models. Results: There were 306 patients included in this study. With every increase of 10mmHg in baseline systolic BP, the odds of achieving an excellent functional outcome decreased by 12% in multivariate analysis (OR 0.88, 95% CI 0.76-0.995, P=0.048). Conversely, every increment of 10mmHg in baseline BP (regardless of systolic, diastolic and mean BP) was associated with better collateral flow, and was also associated with reduced final infarct volumes (FIV). In subgroup analysis of patients with major reperfusion, higher BP was associated with decreased FIV. For patients without reperfusion, higher BP was associated with increased FIV and decreased odds of a favorable clinical outcome. Conclusions: Higher baseline BP in acute ischemic stroke patients with large vessel occlusion/stenosis was associated with better collateral flow. However, for patients without reperfusion, higher baseline BP was associated with increased infarct growth, and led to an unfavorable clinical outcome. To our knowledge, this is the first time that the association between BP and collaterals has been quantified by perfusion imaging, and this is also the first study to demonstrate that higher BP is correlated with infarct growth.

Percentage of free fat mass is associated with elevated blood pressure in healthy Chinese children.

Previous studies have reported that a high free fat mass (FFM) was associated with elevated blood pressure in children. However, the observed relationship could be confounded by body weight. Thus, we performed cross-sectional analyses to understand the differences between the percentage of free fat mass (FFM%) and FFM in relation to blood pressure in healthy Chinese children. A total number of 2671 (1264 girls; aged 6-14 years) healthy Chinese children was recruited in 2014 (baseline). We further prospectively examined whether these indices predicted hypertension risk during the 2 years of follow-up (2014-2016) among 2094 participants who were free of hypertension at the baseline. Blood pressure was repeatedly measured in 2014, 2015 and 2016. Hypertension was defined as either high systolic blood pressure and/or high diastolic blood pressure (≥age- and sex-specific 95th percentile for Chinese children). The baseline FFM was assessed by bio-impedance analysis, and FFM% was calculated as FFM divided by the body weight. A high FFM was associated with a high baseline blood pressure and high hypertension risk after adjustment for potential confounders (all p < 0.001). By contrast, a high FFM% was associated with a low baseline blood pressure and low hypertension risk in the fully adjusted model (all p < 0.001). Each one-percent increment of FFM% was associated with a 9% lower risk of developing hypertension (adjusted hazard ratio = 0.91; 95% confidence interval: 0.89, 0.94). A high FFM% was associated with a low blood pressure and low hypertension risk in healthy Chinese children.

Prediction of long-term renal denervation efficacy

Diversity of blood pressure response and great variability within studies emphasise the need to identify predictors of renal denervation efficacy. Previous studies identified various predictors within periods of 3–6 months. The goal of the current study is to examine the possible predictors of sustained decline of blood pressure (BP) after renal denervation in a long-term period of 2 years.Evaluated patients were either randomised in the original Prague-15 study or were pilot patients, meeting the same inclusion criteria of true-resistant hypertension. Patients were considered as responsive when the decline of 24h systolic BP≥10mmHg was present 6, 12 and 24 months after the procedure. In addition, analysis for separate visits was performed. Denervation was performed using the unipolar Symplicity® Renal Denervation System. Extensive assessment of computed tomography angiography by numerous measurements including morphology of the renal arteries was performed.A total of 48 patients were analysed, with 27 patients suitable for long-term prediction. Five of the 27 patients were identified as long-term responders with average 24h BP decline of 20/9mmHg. Strongest predictors of BP decline were higher baseline 24h systolic blood pressure (p=0.01) and higher diameter of the left renal artery (p=0.04).Only a minority of denervated patients exhibited sustained BP decline. Higher baseline BP and higher renal artery diameter might be the strongest predictors. Our findings might theoretically support the actual hypothesis of the necessity to ablate the distal parts of the renal artery (these conditions might allow such ablation to be performed).

A5862 Does diabetes mellitus modify the effect of antihypertensive treatment across blood pressure levels? Systematic review and metaregression analysis

Objectives: Previous meta-analyses have found different treatment effects in people with diabetes compared to non-diabetics at low blood pressure levels. These analyses are susceptible to ecological bias, however, because studies in people with diabetes differ from those in non-diabetics. The aim of this systematic review was to assess within-trial differences in treatment effect between diabetics and non-diabetics, to minimize the risk of ecological bias. Methods: We performed a systematic review according to the recommendations from the Cochrane Collaboration. We included randomized controlled trials of antihypertensive treatment versus placebo or different treatment goals, including both people with and without diabetes. Relative risks in treated versus controls were calculated for each patient group in each study. Relative treatment effects in people with diabetes compared to non-diabetics were calculated for each study. Relative treatment effects were analyzed in relation to baseline systolic blood pressure using metaregression. Results: 19 trials, including 123 211 participants, were analyzed. Diabetes modified treatment effect across blood pressure levels for myocardial infarction (p = 0.04) and heart failure (p = 0.01). For high baseline blood pressure values, treatment was more beneficial in people with diabetes compared to non-diabetics, whereas at levels below 152 mm Hg for myocardial infarction and 141 mm Hg for heart failure, treatment was less beneficial in people with diabetes. Interactions were non-significant for mortality outcomes and stroke. Conclusion: The effect of antihypertensive treatment depends on an interaction between systolic blood pressure and diabetes. These results further support that intensive blood pressure lowering may be harmful in the diabetic population.

Aortic Root Dilatation Is Associated With Incident Cardiovascular Events in a Population of Treated Hypertensive Patients: The Campania Salute Network.

Aortic root (AR) dimension (ARD) at the Valsalva sinuses has been associated with incident cardiovascular (CV) events in population-based studies, but this effect could be due to the association with increased left ventricular (LV) mass. There is also uncertainty on how to define clear-cut AR dilatation. Thus, we analyzed the Campania Salute Network (CSN) registry to (i) establish criteria for evaluation of ARD, (ii) propose cut-points for AR dilatation, and (iii) determine whether AR dilatation has prognostic value independent of LV hypertrophy (LVH). We analyzed hypertensive patients with available follow-up, in sinus rhythm and free of prevalent valvular and CV disease (n = 8,573). AR exceeding the 75th percentile of the AR z-score (Ao-Z) obtained by comparison with the value predicted by age, sex, and height (i.e., Ao-Z > 0.80) was considered dilated. Patients with baseline-dilated ARD by Ao-Z were more likely to be younger, men, and obese and had higher baseline blood pressure (BP; all <0.02) but similar kidney function as those without ARD dilatation. In multivariable Cox regression model, dilated ARD predicted 36% increased rate of CV events, independently of older age, male sex, systolic BP, LVH, and class of antihypertensive medications used during follow-up (95% confidence interval: 1.07-1.71, P = 0.011). In the context of a population of treated hypertensive patients, ARD defined by z-score of predicted values is an independent predictor of CV events regardless of LVH and other common confounders. Trial Number NCT02211365.

Predictors for profound blood pressure response in patients undergoing renal sympathetic denervation.

Renal sympathetic denervation (RDN) as treatment for hypertension shows highly variable results. Although some patients do not show any blood pressure (BP) change and in most patients a BP reduction of at least 5 mmHg can be found, some show a reduction at least 20 mmHg. We sought to identify predictors for such a profound BP response. Profound BP response was defined as drop of at least 20 mmHg in daytime systolic ambulatory BP measurement (ABPM) 3 months after catheter-based RDN. Three different denervation devices were used for RDN, and pulse wave velocity was determined invasively in a subgroup of patients. One hundred and ninety consecutive patients were included in this analysis. Profound BP response was found in 33 patients. Patients with profound BP response were younger (P = 0.04), presented with higher baseline ABPM values (P < 0.001), were treated with ultrasound-based RDN and received more often a combined treatment with two different diuretics (P = 0.005 for both). After 3 months, a treatment target of daytime BP less than 135 mmHg could be achieved more frequently in patients with profound BP response (61 vs. 17%, P < 0.001). Age, use of ultrasound RDN, combined diuretic therapy and baseline BP independently predicted pronounced BP reduction. A second multivariate logistic regression model including pulse wave velocity if available identified baseline BP, pulse wave velocity and use of ultrasound denervation as independent predictors for profound BP response. Younger vascular age, higher baseline BP, treatment with ultrasound RDN and combined diuretic therapy were found as predictors for a pronounced BP reduction following RDN, improving BP control at follow-up.

CONTRIBUTION FACTORS ON ACHIEVEMENT RATE OF TREATMENT GOALS OF BP AND LDL-C BY 3 MONTHS’ THERAPY OF ROVELITO (FIXED DOSE COMBINATION PILL OF IRBESARTAN AND ATORVASTATIN)

Objective: Coexistence of hypertension (HTN) and hypercholesterolemia is the major synergistic and modifiable risk factor for cardiovascular disease (CVD). A fixed-dose combination (FDC) of anti-HTN drug and stain may be valuable in terms of improving drug compliance especially for statin. Because renin angiotensin system activation and hypercholesterolemia are accompanied with obesity and angiotensin receptor blocker is more advantageous for Asians as it does not cause dry cough due to the angiotensin converting enzyme inhibitors, FDC of irbesartan and atorvastatin (Rovelito) may improve the treatment success rate. Design and method: Patients with comorbid HTN and hypercholesterolemia were screened for this prospective, observational, descriptive, multi-center, phase IV study. Eligible patients were administered with Rovelito for 3 months. Dose adjustment was allowed per physician's discretion. Primary purpose of this study was to evaluate the variables that affect treatment success rate for blood pressure (BP) and/or LDL-cholesterol (LDL-C). In addition, the compliance with the therapeutic lifestyle modification and the safety of the study drug were evaluated. Results: Among the total of 2,801 patients enrolled in the study, 945 patients were analyzed for clinical efficacy. BP and LDL-C goals were achieved in 813 (86.03%) and 811 (85.82%), respectively. Higher baseline BP and body mass index (BMI) were the factors for poor treatment success rate of BP goal. Baseline LDL-C level, number of concurrent medications and drinking status were the factors for poor treatment success rate for LDL-C goal. Of the total of 945 study participants, 706 (74.71%) reached the both treatment goals BP and LDL-C, diabetes and higher baseline LDL-C levels and number of concurrent medications were the factors for poor treatment success rate for both BP and LDL-C. Adherence with Rovelito was 97.87 ± 6.06% and incidence of AEs was 4.15%. Conclusions: FDC of irbesartan and atorvastatin (Rovelito) can be very helpful for managing patients with both HTN and hypercholesterolemia in Asian perspectives. Poor metabolic profile itself is as well the reason to choose Rovelito as the factor for poor treatment success rate. Therapeutic life style modification still should be underscored even with 75% treatment success rate for both conditions.

Blood pressure in acute ischemic stroke: challenges in trial interpretation and clinical management: position of the ESH Working Group on Hypertension and the Brain.

: Altered blood pressure (BP) is a common phenomenon in acute ischemic stroke (AIS), with high BP being the most frequent scenario. The pathophysiology of BP changes in AIS is complex and only partially understood. The available evidence indicates that extremely high BP during AIS is associated with a poor outcome. Importantly, the observed relationship between BP and stroke outcome may or may not be causally related. Higher baseline BPs in focal cerebral ischemia may indicate preexisting hypertension, but may also be an effect of both nonspecific and stroke-related factors. Although antihypertensive therapy effectively reduces BP in AIS, studies on early BP lowering in AIS produce conflicting results in terms of functional outcome and mortality. Systematic reviews on BP management in AIS did not result in clinically applicable conclusions in general. However, the investigation on the effect of BP and its alterations in AIS are hampered by various important methodological issues. This position statement was prepared by a group of experts from the European Society of Hypertension and invited neurologists to discuss the main reasons for the discrepancies in the current evidence on the prognosis and treatment of altered BP in AIS which should be taken into account in future studies.

Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study.

BackgroundAlthough hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations.ObjectiveThe aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix’s EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting.MethodsWe recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks.ResultsAfter 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI −14.5 to −7.2, P<.001) and DBP by 6.6 mm Hg (95% CI −9.9 to −3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg.ConclusionsEpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care.

Effects of comorbidity and medication use on the haemodynamic status during office-based laryngeal procedures: A prospective cohort study.

Office-based laryngeal procedures (OBLPs) are emerging as effective alternative modalities for vocal disorders. This study systematically investigates the haemodynamic status of patients, specifically focusing on the potential effects of underlying comorbidity and medication use. Prospective cohort study. Tertiary referral centre. We prospectively recruited 214 consecutive patients who received OBLPs during January-December 2015. All procedures were performed under local anaesthesia without sedation, in an upright (sitting) position. We measured heart rate (HR), systolic and diastolic blood pressure, and oxygen saturations at baseline (before procedure), immediately after local anaesthesia to the pharynx and larynx, immediately after completing of procedure, and 20 minutes after the procedure. Systolic, diastolic blood pressures and HR all significantly increased after local anaesthesia, and gradually decreased after the procedure (P<.01). Oxygen concentration remained unchanged. Patients with comorbidity and those receiving vasoactive medications showed significantly higher perioperative blood pressures than the other patients (P<.05), but the trend remained similar. Prominent hypertension (systolic ≥160 mm Hg or diastolic ≥100 mm Hg) was noted in 17 patients, more commonly in patients with older age, higher baseline blood pressures and receiving vasoactive medications. Only 2% of patients with normal baseline measurements developed prominent hypertension perioperatively. Tachycardia (HR≥100 bpm) developed in 22 patients, more frequently in patients with higher baseline HRs, and perceiving greater discomforts. This study revealed that routine haemodynamic monitoring may not be necessary for all the OBLPs, but should be considered for older patients, those with higher baseline blood pressure or HR, sensitive patients who might be more susceptible to perioperative discomfort, and those receiving vasoactive medications.

Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure: From the ASCEND-HF Trial

BackgroundIt is unclear how patients hospitalized for acute heart failure (HF) who are long-term chronic HF survivors differ from those with more recent HF diagnoses. ObjectivesThe goal of this study was to evaluate the influence of HF chronicity on acute HF patient profiles and outcomes. MethodsThe ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial randomized 7,141 hospitalized patients with acute HF with reduced or preserved ejection fraction (EF) to receive nesiritide or placebo in addition to standard care. The present analysis compared patients according to duration of HF diagnosis before index hospitalization by using pre-specified cutoffs (0 to 1 month [i.e., “recently diagnosed”], >1 to 12 months, >12 to 60 months, and >60 months). ResultsOverall, 5,741 (80.4%) patients had documentation of duration of HF diagnosis (recently diagnosed, n = 1,536; >1 to 12 months, n = 1,020; >12 to 60 months, n = 1,653; and >60 months, n = 1,532). Across HF duration groups, mean age ranged from 64 to 66 years, and mean ejection fraction ranged from 29% to 32%. Compared with patients with longer HF duration, recently diagnosed patients were more likely to be women with nonischemic HF etiology, higher baseline blood pressure, better baseline renal function, and fewer comorbidities. After adjustment, compared with recently diagnosed patients, patients with longer HF duration were associated with more persistent dyspnea at 24 h (>1 to 12 months, odds ratio [OR]: 1.20; 95% confidence interval [CI]: 0.97 to 1.48; >12 to 60 months, OR: 1.34; 95% CI: 1.11 to 1.62; and >60 months, OR: 1.31; 95% CI: 1.08 to 1.60) and increased 180-day mortality (>1 to 12 months, hazard ratio [HR]: 1.89; 95% CI: 1.35 to 2.65; >12 to 60 months, HR: 1.82; 95% CI: 1.33 to 2.48; and >60 months, HR: 2.02; 95% CI: 1.47 to 2.77). The influence of HF duration on mortality was potentially more pronounced among female patients (interaction p = 0.05), but did not differ according to age, race, prior ischemic heart disease, or ejection fraction (all interactions, p ≥ 0.23). ConclusionsIn this acute HF trial, patient profile differed according to duration of the HF diagnosis. A diagnosis of HF for ≤1 month before hospitalization was independently associated with greater early dyspnea relief and improved post-discharge survival compared to patients with chronic HF diagnoses. The distinction between de novo or recently diagnosed HF and worsening chronic HF should be considered in the design of future acute HF trials. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT00475852)

Association between changes in systolic blood pressure and incident diabetes in a community-based cohort study in Korea.

An association between hypertension and diabetes has been reported; however, the temporal relationship of blood pressure changes and incident diabetes has not been fully investigated in the general population. We examined whether increasing blood pressure is associated with the risk of developing diabetes among community-dwelling Korean adults. This study included 2225 participants (859 men and 1366 women) aged 27-87 years from the Korean Genome Epidemiology Study. The participants were free of diabetes and cardiovascular disease at baseline. Incident diabetes was defined as fasting blood glucose⩾126 mg dl-1 or hemoglobin a1c ⩾6.5% (48 mmol mol-1) at follow-up examination and/or a physician's diagnosis of diabetes during the follow-up period. The effects of the baseline level and change in blood pressure on the risk of incident diabetes were assessed by multivariate logistic regression analysis. During the mean follow-up of 2.6 years, new-onset diabetes was observed in 5.0% (43/859) of the men and 3.4% (47/1366) of the women. In the multivariate model, the baseline systolic blood pressure was not significantly associated with incident diabetes (adjusted odds ratio 0.93 per 10 mmHg, P=0.747). However, an increase in systolic blood pressure during the follow-up period was independently associated with incident diabetes (adjusted odds ratio 5.53 per 5 mmHg per year, P=0.002) after adjusting for the baseline blood pressure and other potential confounders. Increasing blood pressure, but not a high baseline blood pressure, was independently associated with the risk of diabetes in Korean adults.