Hypertension In Older Patients Research Articles

Amelioration of gait and balance disorders by rosuvastatin is associated with changes in cerebrovascular reactivity in older patients with hypertensive treatment.

To investigate the effect of rosuvastatin on gait and balance disorder progression and elucidate the role of cerebrovascular reactivity (CVR) on this effect. From April 2008 to November 2010, 943 hypertensive patients aged ≥60 years were enrolled from the Shandong area of China. Patients were randomized into rosuvastatin and placebo groups. Gait, balance, CVR, fall and stroke were assessed. During an average 72 months of follow-up, the decreasing trends for step length, step speed, and Berg balance scale scores and the increasing trends for step width and chair rising test were slower in the rosuvastatin group when compared to the placebo group. The hazard ratio of incident balance impairment and falls was 0.542 [95% confidence interval (CI) 0.442-0.663] and 0.532 (95% CI 0.408-0.694), respectively, in the rosuvastatin group compared with placebo group. For CVR progression, the cerebrovascular reserve capacity and breath-holding index were increased and the pulsatility index decreased in the rosuvastatin group, while the cerebrovascular reserve capacity and breath-holding index were decreased, and pulsatility index increased in the placebo group. The changes in gait stability and balance function were independently associated with the changes in the CVR. The odds risks of balance impairment and falls were 2.178 (95% CI: 1.491-3.181) and 3.227 (95% CI: 1.634-6.373), respectively, in the patients with CVR impairment and patients without CVR impairment. Rosuvastatin ameliorated gait and balance disorder progression in older patients with hypertension. This effect might result from the improvement in the CVR. This double-blind clinical trial recruited 943 hypertensive patients aged ≥60 years who were randomly administered rosuvastatin and placebo interventions. The data indicates that rosuvastatin significantly ameliorated the progressions of gait and balance disorders in older hypertensive patients. The cerebrovascular reactivity might play an important mediating role in this amelioration.

Association Between Orthostatic Hypertension and Frailty Among Older Patients With Hypertension.

Frailty frequently coexists with hypertension in older patients. We aimed to evaluate the association between frailty and positional change in blood pressure, especially orthostatic hypertension. Participants were recruited from 12 University hospitals in South Korea. Using a digital device, trained research nurses measured blood pressure in the supine and standing positions. Physical frailty was evaluated using the Korean version of the FRAIL questionnaire, gait speed, and handgrip strength. Orthostatic hypertension was defined as a ≥20-mm Hg increase in systolic blood pressure within 3 minutes of standing and upright systolic blood pressure of ≥140 mm Hg. We analyzed the data of 2065 participants who had been enrolled until December 31, 2022. The mean age was 73.2±5.6 years, and 52.0% were female. The mean blood pressure was 137.1±14.9/75.1±9.7 mm Hg. Among the participants, 1886 (91.3%) showed normal response after standing, but 94 (4.6%) had orthostatic hypertension, and 85 (4.1%) had orthostatic hypotension. Orthostatic hypertension was associated with female sex, obesity, cognitive function, physical frailty, and lower quality of life. In the multivariable analysis, body mass index and frailty status were independently associated with orthostatic hypertension. Orthostatic hypertension is associated with physical frailty, cognitive impairment, and low quality of life in older patients with hypertension. Therefore, evaluation of orthostatic blood pressure changes to confirm orthostatic hypertension or hypotension in frail older adults will serve as an important diagnostic procedure in vulnerable patients. Further studies are required to identify the underlying mechanisms of this association.

Covid-19 vaccination coverage and associated factors among older hypertensive patients in Hangzhou, China.

Vaccination could provide effective protection against coronavirus disease 2019 (COVID-19). This study aims to describe the COVID-19 vaccination coverage and influential factors in Chinese older hypertensive patients. Using a cross-sectional design, participants were randomly selected from the electronic health records system during the pandemic era in Hangzhou, China. Logistic regression models were employed to compute the OR and 95% CI in order to assess the relationships between variables and the extent of COVID-19 vaccination coverage. As of 3 August 2022, among a sample of 77 970 individuals, 75.11% had completed the full COVID-19 vaccination, while 57.66% had received a booster dose. Disparities in coverage were observed across genders, regions and age groups. Unhealthy lifestyles, cardiovascular disease, cancer, uncontrolled blood pressure, abnormal fasting plasma glucose, dyslipidemia and renal dysfunction were risk factors for COVID-19 vaccination coverage. The coverage rates continuously declined along with the number of risk factors. The ORs for full and booster vaccination in subjects with ≥4 risk factors were 2.55 (2.12∼3.07) and 2.60 (2.16∼3.13), compared to individuals without risk factors. The COVID-19 vaccination program for older hypertensive patients must be strengthened further. Emphasis should be placed on patients who reside in urban areas, have comorbidities or multiple risk factors.

Assessing the Risk of Hypertension in Chronic, Elderly Patients during the COVID-19 Pandemic: A Prospective Study.

This study considers care management for older chronic patients during and after the COVID-19 pandemic. To identify groups of variables at previous time points as a basis for deriving efficient classification models during and after a pandemic situation and to quantify the effect of each variable within the model to predict levels of worsening risk in diastolic and systolic arterial hypertension (AHT). In this prospective longitudinal study, data were collected at three time points: before, during, and after the COVID-19 pandemic period. The study included 148 patients with an average age of 81.6 years. During the study period, mean systolic blood pressure among this population rose by 5 mmHg to 128.8 mmHg; the number of patients with systolic blood pressure > 140 mmHg rose by 45.3%; among those with diastolic blood pressure > 90, the number rose by 41.2%; mean triglycerides levels rose to 152.6 mg/dL; cholesterol levels rose to 147 mg/dL; and LDL cholesterol rose to 112.2 mg/dL. Meanwhile, mean levels of HDL cholesterol decreased to 46.5 mg/dL. Binary-response logistic regression models were constructed to identify the most relevant variables for predicting AHT risk during and after the pandemic. The heart rate (OR = 1.79; 95% CI: 1.22-2.72) and body mass index (OR = 1.75; 95% CI: 1.08-2.94) variables were significant at the population level (p < 0.05) for diastolic and systolic AHT in the pandemic period risk models. The body mass index variable was also significant for diastolic AHT in the post-pandemic period risk model (OR = 1.97; 95% CI: 1.32-2.94), whilst the triglycerides variable was significant in the systolic AHT post-pandemic period risk model (OR = 1.49; 95% CI: 1.01-1.86). Bad control of arterial hypertension in older patients with chronic disease is associated with elevated levels of LDL cholesterol, total cholesterol, systolic blood pressure, heart rate and triglycerides, and lower levels of HDL cholesterol.

Treatment of hypertension in older patients in 2024: What’s new?

Older individuals represent the greatest proportion of patients with arterial hypertension. For several decades, the management of old (&gt;60-65 years) and very old (&gt;80 years) patients with hypertension has been relatively conservative because of the paucity of scientific evidence of clinical benefits and the fear of doing more harm than good. Yet, in recent years, major changes in the therapeutic approach of older hypertensive patients have occurred leading to lower thresholds and treatment targets in most recent guidelines such as those of the European Society of Hypertension. These latter now emphasize the need to assess frailty properly in all older patients to propose the most accurate drug treatments, to start antihypertensive therapy prudently with a monotherapy in very old hypertensive patients (&gt;80 years) and to reassess periodically the overall medications to avoid overtreatments. In this review, the recent changes in the management of older patients are discussed comparing several recent recommendations from national and international guidelines.

EFFECTS OF THE COVID-19 ON MEDICAL USE OF ELDERLY PATIENTS WITH HYPERTENSION: A NATIONWIDE COHORT STUDY IN KOREA.

Abstract COVID-19 pandemic disrupted healthcare services, including chronic disease management for vulnerable groups like older individuals with hypertension. This study aims to evaluate hypertension management in South Korea’s elderly population during the pandemic using treatment consistency indices like Continuity of Care (COC), Modified, Modified Continuity Index (MMCI), Most Frequent Provider Continuity (MFPC). This study used the the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service (NHIS) between 2017 and 2021 The research included a total of 4,097,299 hypertensive patients aged 65 or older. We defined 2018 and 2019 as baseline period before COVID 19 pandemic, and 2020 and 2021 as COVID 19 period, and calculated the indices of medical continuity (Number of visits, COC, MMCI and MFPC) on a yearly basis were measured. The number of visits were decreased during COVID 19 period compared to baseline period ( 59.64 ±52.75 to 50.49 ± 50.33, p&amp;lt; 0.001) respectively. However COC, MMCI and MFPC were not decreased in baseline period compared to COVID-19 period ( 0.71 ± 0.21 vs. 0.71 ± 0.22, p&amp;lt; 0.001), (0.97 ± 0.05 vs. 0.96 ± 0.05, p&amp;lt; 0.001), and (0.8 ± 0.17 vs. 0.8 ± 0.17, p&amp;lt; 0.001) respectively. In conclusion, COVID-19 had no significant impact on continuity of care, but it did affect the frequency of outpatient visits of older hypertensive patients. However, this study highlights the importance of addressing healthcare inequalities, especially for older hypertensive patients, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Medical behaviours and medication adherence of older hypertensive patients in different medical insurance programs in Beijing, China: a cross-sectional study

BackgroundGrassroots medical institutions are the primary “battlefield” of hypertension management based on hierarchical diagnosis and treatment policies in China. There is a considerable difference in the insured population and reimbursement ratio between different medical insurance programs. The management of hypertension directly affects the development trend of cardiovascular and cerebrovascular diseases.MethodsTo understand the difference between different medical insurance programs regarding the management of older hypertensive patients, all outpatients aged 60 and above with hypertension in the basic medical insurance database of Beijing, China, from April 1, 2019, to January 31, 2020, were included. Medical behaviours included patients’ choice of hospital level, type of hospital, number of hospitals visited, grassroots medical institutions and cross-district visits. Medication adherence was evaluated by calculating the medication possession ratio of antihypertensive medications. First, we adopted a statistical description for medical behaviours and medication adherence. Then, multivariate logistic regression was used to analyse the influencing factors of medication adherence.ResultsThis study included 1.29 million patients with Urban Employee Basic Medical Insurance (UEBMI) and 0.31 million patients with Urban‒Rural Resident Basic Medical Insurance (URRBMI). The proportions of patients with UEBMI who chose tertiary hospitals, comprehensive hospitals, grassroots medical institutions and cross-district visits were 25.84%, 56.09%, 57.34% and 39.32%, respectively, while those of patients with URRBMI were 11.14%, 60.59%, 81.28% and 6.07%, respectively. The medication adherence rates of men and women taking one medication were 61.04% and 55.86%, respectively. UEBMI patients who took their medication accounted for 62.36%, while only 40.27% of URRBMI patients adhered to their medication. The percentages of young-old, old-old and oldest-old patients who took their antihypertensive medications were 58.05%, 59.09% and 56.78%, respectively. The adherence to taking ≥ 2 medications (35.47%) was lower than that to taking one medication (58.33%). The medication adherence rates of patients with UEBMI and URRBMI for taking ≥ 2 medications were 37.21% and 27.45%, respectively.ConclusionsPatients with UEBMI were more inclined to choose tertiary hospitals and cross-district visits than patients with URRBMI. The adherence of patients with UEBMI was better than that of patients with URRBMI in China.

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model.

Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

Factors influencing xerostomia and oral health-related quality of life in polymedicated patients.

To evaluate whether the severity of xerostomia in older polymedicated patients impacts oral health-related quality of life (OHRQoL). Medication-associated xerostomia is common in older people. Xerostomia may impair OHRQoL. This cross-sectional study included older hypertensive patients from two health centres. We assessed the severity of xerostomia and OHRQoL using the Xerostomia Inventory (XI) tool, and the Oral Health Impact Profile-14 (OHIP-14) instrument, respectively. We measured unstimulated (UWS) and stimulated (SWS) salivary flows. Univariate and multiple linear regression analyses evaluated the associations of XI and OHIP-14 and different explanatory variables. Of the 218 patients enrolled, 51.8% had xerostomia, and 38.1% and 27.5% suffered from UWS and SWS hyposalivation, respectively. Patients with xerostomia, UWS, and SWS hyposalivation scored significantly higher on the XI. However, only those with xerostomia or UWS hyposalivation had significantly higher OHIP-14 scores. A moderate correlation was observed between XI and OHIP-14 scores. The multiple regression model showed that factors with the greatest impact on XI were the patient's complaint of xerostomia, UWS flow rate, age and sex. However, only the XI score was significantly associated with the OHIP-14 score. Xerostomia has a negative impact on OHRQoL in older polymedicated patients, but this impact is less than in other types of xerostomia. Longitudinal studies are needed to determine whether changes in the detected explanatory variables influence XI and OHIP scores in these patients.

Effect of multimorbidity on hypertension management

Multimorbidity, the coexistence of multiple health conditions, is associated with functional decline, disability, and mortality. We aimed to investigate the effects of multimorbidity on hypertension treatment and control rates by analyzing data from the Korean National Health and Nutrition Examination Survey database, which is a cross-sectional, nationally representative survey conducted by the Korean government. Multimorbidity, defined as having two or more chronic diseases, was evaluated by blood pressure measurements, blood chemistry examinations, and questionnaires. We classified the participants according to the number of multimorbidities from 0 to ≥ 6. Association analysis was performed to identify the patterns of multimorbidity related to hypertension control. From 2016 to 2020, 30,271 adults (≥ 20 years) were included in the analysis (age: 52.1 ± 16.8 years, male: 44.0%), and 14,278 (47.2%) had multimorbidity. The number of chronic conditions was significantly higher in older adults, women, and hypertensive patients. Multimorbidity was associated with hypertension treatment. The number of chronic conditions was significantly higher in controlled compared to uncontrolled patients (3.6 ± 1.7 vs 2.9 ± 1.6, p < 0.001). But the control rate of hypertension among treated patients was lower in patients with multimorbidity (75.6% in hypertension only group vs 71.8% in multimorbidity group, p = 0.009). Multimorbidity patterns showed distinct features in treated and controlled hypertensive patients. In conclusion, multimorbidity has a beneficial effect on the treatment of hypertension, but the control rate of systolic blood pressure was lower among the patients with multimorbidity. More attention should be paid to the hypertensive patients with multimorbidity to improve the control rate of hypertension.

A nomogram for predicting mild cognitive impairment in older adults with hypertension

BackgroundHyper- and hypotension increase the risk of cognitive dysfunction. As effective control of blood pressure can reduce the risk of mild cognitive impairment (MCI), early risk assessment is necessary to identify MCI in senile hypertension as soon as possible and reduce the risk of developing dementia. No perfect risk-prediction model or nomogram has been developed to evaluate the risk of MCI in older adults with hypertension. We aimed to develop a nomogram model for predicting MCI in older patients with hypertension.MethodsWe selected 345 older patients with hypertension in Xixiangtang District, Nanning City, as the modeling group and divided into the MCI (n = 197) and non-MCI groups (n = 148). Comparing the general conditions, lifestyle, disease factors, psychosocial and other indicators. Logistic regression was used to analyze risk factors for MCI in older hypertensive patients, and R Programming Language was used to draw the nomogram. We selected 146 older patients with hypertension in Qingxiu District, Nanning City, as the verification group. The effectiveness and discrimination ability of the nomogram was evaluated through internal and external verification.ResultsMultivariate logistic regression analysis identified 11 factors, including hypertension grade, education level, complicated diabetes, hypertension years, stress history, smoking, physical exercise, reading, social support, sleep disorders, and medication compliance, as risk factors for MCI in older patients with hypertension. To develop a nomogram model, the validity of the prediction model was evaluated by fitting the curve, which revealed a good fit for both the modeling (P = 0.98) and verification groups (P = 0.96). The discrimination of the nomogram model was evaluated in the modeling group using a receiver operating characteristic curve. The area under the curve was 0.795, and the Hosmer–Lemeshow test yielded P = 0.703. In the validation group, the area under the curve was 0.765, and the Hosmer–Lemeshow test yielded P = 0.234.ConclusionsWe developed a nomogram to help clinicians identify high-risk groups for MCI among older patients with hypertension. This model demonstrated good discrimination and validity, providing a scientific basis for community medical staff to evaluate and identify the risk of MCI in these patients at an early stage.

Clinical and pharmacological management of hypertension in older patients

The article is presented the review of published sources devoted the strategy of treatment the older patients with hypertension according to the geriatric symptoms and syndromes. The definition of orthostatic and postprandial hypotension, hypotension-hypertension syndrome is shown. Based on the analyses of publication are taken the data related to prevalence, prognostic meaning, clinical outcomes of frailty in older people. The influence of geriatric signs on cardiovascular risk is pointed out. The discussion questions of the association between administration of medications and orthostatic hypertension in older patients are considered. The recommendations of optimal pharmacological management of hypertension in older patients into account of personification principles with assessment of aging changes and their dynamics during treatment are given.

Abstract 114: Effect Of Dose Of Chlorthalidone And Hydrochlorothiazide Dosing On Cardiovascular Outcomes In The Diuretic Comparison Project (DCP)

Background: The Diuretic Comparison Project (DCP) showed chlorthalidone (CTD) to be comparable with hydrochlorothiazide (HCTZ) in cardiovascular prevention among older hypertensive patients. Previous hypertension outcome trials showing benefit for either, higher doses of each were predominant. DCP randomized 13,523 participants to stay on existing HCTZ (25/50mg) or switch to a dose equivalent CTD (12.5/25mg). Such trial data was used to test if CTD was superior to HCTZ when prescribed at a higher dose. Methods: This analysis examined treatment effects with respect to low (25mg HCTZ/12.5mg CTD) and high (50mg HCTZ/25mg CTD) dose regimens. Outcomes including non-fatal MI, stroke, acute heart failure, revascularization for unstable angina and non-cancer death were tested individually and as a composite measure. Results: There were no differences for the composite and all individual outcomes in both low dose (12,781/13,523; 94.5%) and high dose (742/13,523; 5.5%) groups. Mean age (72 y), baseline blood pressure (139 mm Hg), and follow-up time (2.4 y) were similar across doses. High dose participants had a greater prevalence of diabetes and received more antihypertensive drugs. Consistent with DCP results, there was a significant interaction between treatment group and history of MI/stroke in the low dose group (p=0.002); this was not found in the high dose group (p=0.8). Conclusion: As in the main DCP trial results, there were no differences in outcomes between CTD and HCTZ within higher or lower dose subgroups. Treatment interaction with prior mi/stroke was found with lower doses. However, the high dose group was small and might not reflect a true treatment effect at higher doses.

Differences in Cardiovascular Regulation to Head-up Tilt between Healthy and Hypertensive Subjects.

To date there have only been limited studies exploring abnormal hemodynamic responses to head-up tilt tests (HUTs) in elderly, treated patients with hypertension. Cardiovascular regulation in response to HUT as well as upright hemodynamics may be altered when older hypertensive patients with antihypertensive treatments are studied. Hypertensive patients with and without receiving antihypertensive medication and above the age of 45 were recruited in this study. This study compared the cardiovascular responses to HUT and at rest between healthy and hypertensives using non-invasive hemodynamic measurements. Parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke index (SI) and total peripheral resistance index (TPRI) were measured in 40 subjects (20 healthy and 20 hypertensives) for 10-min supine baseline, 10-min HUT at 70◦ and 6-min supine recovery. At rest and during HUT, SBP and TPRI were significantly higher in hypertensives together with a significantly smaller baseline SI. In response to HUT, both groups showed changes in hemodynamic parameters at differing degrees. During recovery, all parameters returned to the baseline range. Our findings indicated that hypertensive patients of older age being treated by antihypertensive drugs may have different cardiovascular changes in response to orthostatic stress.Clinical Relevance- This pilot study describes how cardiovascular regulation in response to postural change may behave differently in hypertensive elder patients taking antihypertensive drugs.

First-line diuretics versus other classes of antihypertensive drugs for hypertension.

First-line diuretics versus other classes of antihypertensive drugs for hypertension.

COVID-19 and the Use of Angiotensin II Receptor Blockers in Older Chronic Hypertensive Patients: Systematic Review and Meta-Analysis.

Angiotensin II-converting enzyme inhibitors (ACEIs) and selective angiotensin II receptor antagonists (ARAIIs) are widely used antihypertensive agents. Their use has generated controversy due to their possible influence on the health status of chronic patients infected with COVID-19. The objective of this work is to analyze the influence of COVID-19 on chronic hypertensive patients treated with ACEI and ARAII inhibitors. A systematic review and meta-analysis in the databases Pubmed, Pro-Quest and Scopus were carried out. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search equation descriptors were obtained from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "Older AND hypertension AND (COVID-19 OR coronavirus) AND primary care" and its equivalent in Spanish. Nineteen articles were obtained, with n = 10,806,159 subjects. Several studies describe the COVID-19 association with ACEI or ARAII treatment in hypertension patients as a protective factor, some as a risk factor, and others without a risk association. In the case of ACEI vs. ARAII, the risk described for the former has an odds ratio (OR) of 0.55, and for ARAII, an OR of 0.59. Some authors talk about mortality associated with COVID-19 and ACEI with a half ratio (HR) of 0.97, and also associated ARAIIs with an HR of 0.98. It is recommended to maintain the use of the renin-angiotensin-aldosterone axis in the context of the COVID-19 disease.

A Study on the Evaluation of Serum Uric Acid in Patients with Essential Hypertension

ABSTRACT Background: Hyperuricemia can lead to nephrolithiasis and gout. It is an essential indicator of diseases like metabolic syndrome, cardiovascular disease, diabetes mellitus, and chronic renal disease. It indicates that hyperuricemia is associated with the risk of cardiorenal disease and new-onset hypertension. In older hypertensive patients, hyperuricemia is an essential indicator of cardiovascular risk for the development of hypertension. Methodology: A facility-based case-control study to identify the relationship between serum uric acid levels and hypertension, the relation between severity and duration of hypertension and the serum uric acid levels, and the relation between duration of hypertension and serum uric acid levels at tertiary care hospital. Sample size: 400; 200 cases and 200 controls. Adult male and female patients &gt;18 years of age diagnosed as hypertensive according to JNC VII classification for hypertension were included. Patients with comorbidities are excluded. The method of uric acid estimation was done by the VITROS URIC Slide method. Results: The mean total cholesterol of cases was 159.18 ± 20.16, and controls were 125.21 ± 21.12. The mean high density lipoproteins (HDL) among cases was 36.33 ± 5.08, and controls were 45.64 ± 5.90. The mean low density lipoproteins (LDL) among cases was 124.99 ± 20.03, and controls were 104.48 ± 12.48. The mean triglycerides among cases was 172.58 ± 31.40, and controls were 131.21 ± 21.50. The mean serum uric acid level among males in the cases group was 6.1 ± 1.79, and among males in the control group, it was 5.2 ± 1.3. The mean serum uric acid level among females in the case group was 6.2 ± 1.92, and among the control group, it was 5.3 ± 1.1. The unpaired t-test was used and was statistically significant with a P value &lt; 0.0001 among the above parameters. Conclusion: The study had a direct relationship between hyperuricemia and hypertension. Also, there is a positive correlation between the severity of hypertension and serum uric acid levels and higher hypertension of longer duration when compared to lesser duration.

AVERAGE ACHIEVED BP &lt;130/80 MMHG IN HIGH-RISK MIDDLE-AGED AND OLDER HYPERTENSIVE PATIENTS PROVIDES STRONG CARDIOVASCULAR PROTECTION EXCEPT IN LEFT VENTRICULAR HYPERTROPHY

Objective: Evidence that reducing blood pressure (BP) to &lt;130/80 mmHg rather than to &lt;140/90 mmHg by antihypertensive treatment in hypertensive patients is conflicting. Left ventricular hypertrophy (LVH) is common in hypertension, and low perfusion pressure may result in ischemia in patients with LVH. We investigated whether average achieved BP &lt;130/80 mmHg implied cardiovascular benefits in high-risk middle-aged and older hypertensive patients who participated in the VALUE Trial. Considering a previous report of excess mortality in LVH patients with in-treatment systolic BP (SBP) &lt;130 mmHg, we paid special attention to whether the average achieved SBP &lt;130 mmHg may cause harm in similar patients with LVH. Design and method: Of the 15,245 participants, we identified 13,803 patients without cardiovascular events during the first six months after randomization during which previous medications were discontinued and study drugs up-titrated. Of these, 2,458 patients had LVH on an electrocardiogram (ECG). Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other pre-specified endpoints for patients who achieved average SBP 130 - 139 mmHg (No LVH group n = 4,863, ECG LVH group n = 929) and &lt;130 mmHg (No LVH group n = 2,107, ECG LVH group n = 305). Reference groups were patients who achieved an average SBP &gt; = 140 mmHg following the first excluded six months (No LVH group n = 4,375, ECG LVH group n = 1,224). Results: The No LVH group with average achieved BP &lt;130/80 mmHg had a significantly lower incidence of all endpoints except for myocardial infarction. The ECG LVH group with average achieved SBP &lt;130 mmHg had increased cardiac mortality (HR = 1.98, p = 0.032) and all-cause mortality (HR = 1.74, p = 0.007), and SBP &lt;130 mmHg was not associated with a reduction in any endpoint. However, as in those without LVH, the ECG-LVH group had fewer strokes and heart failure with an average achieved diastolic BP &lt;80 mmHg. Conclusions: Our data suggest that target SBP &lt;130 mmHg may cause harm and needs further investigation in middle-aged and older patients with LVH detected by ECG. Otherwise, the average achieved BP &lt;130/80 mmHg prevents most cardiovascular endpoints in middle-aged and older hypertensive patients with high cardiovascular risk but without LVH.

Intensive Blood Pressure Lowering Improves Left Ventricular Hypertrophy in Older Patients with Hypertension: The STEP Trial.

Intensive systolic blood pressure (SBP) lowering has been increasingly used; however, its effect on cardiac remodeling remains not fully understood. This secondary analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients trial aims to determine the changes in left ventricular hypertrophy (LVH) that occur in the context of intensive SBP lowering. A total of 7141 older patients with hypertension were randomly assigned to intensive treatment (SBP target, 110-130 mm Hg) or standard treatment (130 to 150 mm Hg). LVH was defined according to the Peguero-Lo Presti criteria on a standard 12-lead ECG. At baseline, the prevalence of LVH (16.6% versus 16.5%) and the mean Peguero-Lo Presti value (1811 versus 1808 μV) were comparable between the treatment groups. During a median follow-up of 3.24 years, intensive SBP lowering was associated with a significantly lower risk of new LVH occurrence (hazard ratio, 0.76 [95% CI, 0.66-0.89]; P=0.001) and slower progression of the mean Peguero-Lo Presti index value by -23.47 μV/y (95% CI, -34.93 to -12.01; P=0.000). However, the rates of regression of baseline LVH did not differ significantly. Of note, the beneficial effect of intensive SBP lowering in terms of cardiovascular events (hazard ratio, 0.75 [95% CI, 0.59-0.97]) was not markedly attenuated after adjusting for LVH as a time-varying covariate (hazard ratio, 0.76 [95% CI, 0.59-0.97]). Intensive SBP lowering protects against LVH development in older hypertensive patients, however, this favorable effect could not explain most of the reduction in cardiovascular events associated with intensive SBP lowering.

Left Ventricular Hypertrophy and Clinical Outcomes in Heart Failure Patients Based on Hypertension Subtypes: Insights from a Tertiary Hospital Heart Failure Registry in Malang, Indonesia

Background Left ventricular hypertrophy (LVH) is a maladaptive response to chronic pressure overload and an important risk factor sudden death in patients with heart failure. Previous studies show that LVH is a risk factor for systolic heart failure. It’s interesting to examine whether Isolated Systolic Hypertension (ISH) in the presence of LVH contribute to clinical outcome. Objective: The aims of this study to examined association of ISH with cardiovascular outcomes and to examined associations of ISH and LVH in Heart failure registry patient Methods: A total of 120 subject’s were collected from Saiful Anwar Heart Failure Registry from January 2019 to December 2019. All participants were individually interviewed with a structured questionnaire for collecting baseline characteristic. Subject were classified into 2 group of hypertension (ISH and Systolic Diastolic Hypertension (SDH)). ISH based on the criteria of SBP ≥ 140 and DBP &lt; 90 mmHg and SDH based on SBP ≥ 140 and DBP ≥ 90 mmHg. The EF and volumes were measured with 2D-biplane Simpson's method by measured as a standart manner Result’s: ISH commonly found among older hypertensive patients than SDH (Mean age 61,23±11,2 yo vs 53,52±11,1 yo, respectively, p&lt;0,04)). LVH was more prevalence among ISH than SDH. No difference in clinical outcome such as in hospital mortality, Rehospitalization, and Lengt of stay were observed in both groups. Complication of hypertension was similar in both groups such as stroke, Myocardial Infarct, and Chronic Kidney Disease. Intrestingly, no difference also observe in compliance to the drug between ISH and SDH. We also examined subgroup analysis of subject’s with ISH. There was no statistically significant difference in clinical outcome between ISH with LVH and ISH without LVH. Conclusion: In this study, we suggest that ISH more common in older patient with HF than SDH but had similar associations with cardiovascular mortality and rehospitalization. ISH was associated with a higher prevalence of left ventricular hypertrophy than SDH.