Treatment Of Hypertension In Adults Research Articles

Влияние генетического полиморфизма генов, кодирующих мишень действия, на эффективность антигипертензивной терапии

Arterial hypertension is one of the main modifiable factors of cardiovascular events, which affects an increasing number of people around the world. In addition to the low adherence of patients to treatment, the wrong choice of medications, the presence of concomitant diseases and an unhealthy lifestyle, the effectiveness of antihypertensive therapy may be associated with genetic polymorphism. Genetic polymorphisms can influence through genes involved in the pathogenesis of hypertension, which are able to modify the effects of drugs; modifications in the mechanisms of interaction of drugs with genes; polymorphisms in metabolic enzymes; genes associated with drug carriers, and genes involved in complex cascades and metabolic reactions. The article reviews the results of studies of the relationship of polymorphic alleles of genes responsible for the pharmacodynamic response to therapy with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers as the main drugs for the treatment of hypertension according to clinical guidelines for the treatment of hypertension in adults.

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.

WHO Guideline for the Pharmacological Treatment of Hypertension in Adults

Every year, more people die from cardiovascular diseases than from any other cause. Hypertension significantly increases the risk of heart, brain, kidney, and other diseases. The last World Health Organization (WHO) guideline on hypertension was published in 1999 and is now outdated. The new WHO guideline of 2021 provides the most up-to-date recommendations for the pharmacological treatment of adult patients with hypertension. The aim of this study was to provide an overview of the WHO guideline translated into German and to summarize the main recommendations. The guideline was developed by WHO in accordance with WHO standards. The executive summary was translated into German by the WHO Collaborating Centre for Evidence-based Medicine at the University of Continuing Education Krems (Austria). WHO provides recommendations on blood pressure thresholds for initiating pharmacological treatment, the performance of examinations before initiating treatment, the choice of medication, target blood pressure, the frequency of assessments, and treatment by nonphysician professionals. This evidence-based global public health guideline from WHO captures the most up-to-date key recommendations for the pharmacological treatment of hypertension in adults.

JS-WHO: ACHIEVING SDG 3.4: WHO GLOBAL UPDATES ON HYPERTENSION

WHO and ISH have a recent MOU under which both organizations will work to reduce cardiovascular disease mortality and morbidity by focussing on treatment of hypertension through implementation of the HEARTS technical package. This session serves to highlight the work WHO is doing at the global level on hypertension and highlight the recently launched WHO guideline on pharmacological treatment of hypertension in adults. The second part of the sessions focuses on real examples of HEARTS (public health approach to managing hypertension at PHC) implementation highlighting progress of countries, as well as challenges and solutions.

Optimizing Hypertension Control Globally: WHF Roadmap.

Hypertension represents the most important cardiovascular risk factor, affecting over 4.06 billion adults worldwide. In this review, we will discuss potential barriers and their solutions to improve prevention, detection, and management of hypertension. The prevalence of hypertension has been increasing in low- and middle-income countries, requiring new strategies to improve its recognition and proper management. The World Heart Federation (WHF) developed a roadmap for hypertension, advising health system policies and clinical practices as part of its commitment to improving global cardiovascular health. The World Health Organization (WHO) has published in 2021 practical guidelines for the pharmacological treatment of hypertension in adults. Identifying potential roadblocks and solutions deserves high priority to improve the detection, management, and control of hypertension.

HEARTS in the Americas appraisal checklist and clinical pathway for comprehensive hypertension management in primary care.

ABSTRACTCardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension represents its main risk factor. However, population hypertension control rates in the Region are poor. Global Hearts is the World Health Organization's flagship initiative to reduce the burden of cardiovascular diseases. HEARTS in the Americas Initiative is its regional adaptation that seeks to be the cardiovascular disease risk management model, including hypertension and diabetes, in primary health care throughout the Americas by 2025.HEARTS in the Americas is being implemented in 22 countries and over 2 095 primary care centers. All implementing countries have defined their treatment protocols, and HEARTS in the Americas has supported continuous improvement. Because WHO recently released the 2021 Guideline for the Pharmacological Treatment of Hypertension in Adults and HEARTS in the Americas introduced the key drivers for hypertension control, the initiative generated a methodology to help countries update and strengthen their treatment protocols.This article describes the process of developing the treatment protocol appraisal checklist and defines the resulting clinical pathway. This tool can help countries and primary care centers to improve their protocols by identifying the improvement points and upgrading clinical pathways.

2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the Region of the AmericasDirectrices de la Organización Mundial de la Salud del 2021 sobre el tratamiento farmacológico de la hipertensión: implicaciones de política para la Región de las Américas

RESUMOA doença cardiovascular (DCV) é a principal causa de morte nas Américas, e a pressão arterial elevada é responsável por mais de 50% dos casos de DCV. Nas Américas, mais de um quarto das mulheres adultas e quatro de cada dez homens adultos têm hipertensão arterial, sendo que diagnóstico, tratamento e controle estão abaixo do ideal. Em 2021, a Organização Mundial da Saúde (OMS) divulgou uma atualização das diretrizes para o tratamento medicamentoso da hipertensão arterial em adultos. Esta publicação ressalta o papel facilitador da iniciativa Global HEARTS da OMS e da iniciativa HEARTS nas Américas para catalisar a implementação dessas diretrizes, oferece recomendações específicas de políticas para sua implementação e enfatiza a necessidade de uma abordagem estratégica abrangente para o controle da hipertensão arterial. Os autores clamam para que tanto as pessoas que advogam pela Saúde, quanto as autoridades responsáveis, priorizem a prevenção e o controle da hipertensão arterial como forma de melhorar a saúde e o bem-estar das populações e reduzir as disparidades de saúde cardiovascular dentro das populações das Américas e entre elas.

Inadequate hypertension control rates: A global concern for countries of all income levels.

Inadequate hypertension control rates: A global concern for countries of all income levels.

Time to benefit for stroke reduction after blood pressure treatment in older adults: A meta-analysis.

BackgroundHypertension treatment in older adults can decrease mortality, cardiovascular events, including heart failure, cognitive impairment, and stroke risk, but may also lead to harms such as syncope and falls. Guidelines recommend targeting preventive interventions with immediate harms and delayed benefits to patients whose life expectancy exceeds the intervention's time to benefit (TTB). Our objective was to estimate a meta‐analyzed TTB for stroke prevention after initiation of more intensive hypertension treatment in adults aged ≥65 years.MethodsStudies were identified from two Cochrane systematic reviews and a search of MEDLINE and Google Scholar for subsequent publications until August 31, 2021. We abstracted data from randomized controlled trials comparing standard (untreated, placebo, or less intensive treatment) to more intensive treatment groups in older adults (mean age ≥ 65 years). We fit Weibull survival curves and used a random‐effects model to estimate the pooled annual absolute risk reduction (ARR) between control and intervention groups. We applied Markov chain Monte Carlo methods to determine the time to ARR thresholds (0.002, 0.005, and 0.01) for a first stroke.ResultsNine trials (n = 38,779) were identified. The mean age ranged from 66 to 84 years and study follow‐up times ranged from 2.0 to 5.8 years. We determined that 1.7 (95%CI: 1.0–2.9) years were required to prevent 1 stroke for 200 persons (ARR = 0.005) receiving more intensive hypertensive treatment. Heterogeneity was found across studies, with those focusing on tighter systolic blood pressure control (SBP < 150 mmHg) showing longer TTB. For example, in the SPRINT study (baseline SBP = 140 mmHg, achieved SBP = 121 mmHg), the TTB to avoid 1 stroke for 200 patients treated was 5.9 years (95%CI: 2.2–13.0).ConclusionsMore intensive hypertension treatment in 200 older adults prevents 1 stroke after 1.7 years. Given the heterogeneity across studies, the TTB estimates from individual studies may be more relevant for clinical decision‐making than our summary estimate.

Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis.

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Strength training for arterial hypertension treatment: a systematic review protocol

Background Hypertension is one of the most prevalent chronic diseases and a leading cause of mortality worldwide. High blood pressure levels can be modified and controlled through both drug and non-drug treatments, such as physical exercise. However, the effects of strength training on hypertension is still not consensual in the literature. Objectives The current review aimed to investigate, synthesize, and discuss the effects of strength training for treatment of hypertension in adults. Method Six electronic databases; MEDLINE (through PubMed), Cochrane Library, EMBASE, Scopus, Lilacs, and the World Health Organization will be searched for randomized controlled trials which investigated a strength training intervention longer than 8 weeks to prevent or treat high blood pressure. The search will be performed in December 2020, by two independent reviewers. Studies published from database inception up to 2020, in English or Portuguese languages, will be included. The PICO question is defined as follows: Patients who have Hypertension; Intervention of strength training treatment; Comparison with patients without strength training or strength training pre- and post-treatment; and Outcome which reports clinical indices (crude number or proportion of variation). The risk of bias will be assessed using the Cochrane tool. The primary outcomes will be whether strength training interventions promote changes in blood pressure and its hypotensive effects. Secondary outcomes will analyze the intervention protocols of strength training on blood pressure, in order to synthesize, discuss, and determine the best type of protocol to be used in hypertension treatment in the adult population. PROSPERO registration number: CRD42020151269.

Factors associated with noncompliance to hypertension treatment in adults in a district health facility in north Dayi in the Volta Region of Ghana

Factors associated with noncompliance to hypertension treatment in adults in a district health facility in north Dayi in the Volta Region of Ghana

Blood Pressure Targets for Older Patients-Do Advanced Age and Frailty Really Not Matter?

In 2017, Hypertension Canada removed advanced age and frailty as considerations for caution when deciding on intensive therapy in their guidelines for the diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Dementia is not mentioned. In this commentary, we review why advanced age and frailty were removed, and examine what is currently known about the relationship between hypertension and both incident and prevalent dementia. We make the case that the presence of frailty (especially when severe) and dementia should be considered when deciding on intensive therapy in future iterations of Hypertension Canada guidelines.

Prescribing pattern of antihypertensive medication and adherence to Joint National Commission-8 guidelines in a rural tertiary care Indian teaching hospital.

Background Antihypertensive medications are one among the most highly used drugs across the globe as well as in India, and their prescribing pattern will be erratic despite the various clinical guidelines. Few studies address the pattern and adherence to the standard treatment guidelines in India. This study aimed to review the prescribing pattern of antihypertensive medications in a rural tertiary care teaching Indian hospital and to investigate the adherence to the Joint National Commission-8 (JNC-8) guidelines on prevention, detection, evaluation, and treatment of hypertension in adults. Methods A prospective observational study was conducted among the participants from four different inpatient wards who are aged >18 years, without gender restriction. The prescription pattern was reviewed and adherence to the JNC-8 guidelines was also assessed. A purposive sampling technique was adopted and descriptive statistics were used in Statistical Package for the Social Sciences v16. Results Of the 101 participants included in the study, 62 (61.39%) were female, 23.76% were aged <30 and >60 years, and the other 52.48% belong to the range of 30-60 years. As per JNC-8 guidelines, 4.95%, 17.82%, 44.55%, and 32.67% of patients were classified as normal, pre-hypertensive, stage I, and stage II, respectively. Most of them (31.68%) were free from comorbidities. The most (23.76%) prescribed drug was calcium channel blocker (CCB), and 15.84% of the patients received combination therapy. Treatment was effective in 70.30% of the patients through analyzing their blood pressure even though the adherence to the JNC-8 guidelines was only in 54.46%. Conclusions Our study revealed that CCB was the most prescribed drug, and in spite of the only 50% adherence rate, treatment was effective in the majority of the population. The treatment outcome can be improved if the adherence rate is increased further.

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older from the American College of Physicians and the American Academy of Family Physicians

An elevation in systolic and diastolic blood pressure, known as hypertension, is characterized as a condition where blood pressure values are above the normal values, ranging around 120/80mmHg for most adults. There are two forms of hypertension, primary hypertension and secondary hypertension. Primary or essential hypertension accounts for 90–95% of patients with hypertension, with its etiology unknown, while secondary hypertension accounts for 5–10% of the population, due to chronic kidney disease, endocrine disorders, or usage of ibuprofen or venlafaxine.(1) If left untreated, hypertension can lead to heart attack, stroke, heart failure, vision problems, kidney damage, and a variety of other problems, depending on which vessels it affects. As seen in Figure 1, either having low or high systolic or diastolic blood pressure can be detrimental to one's health. Having low blood pressure can lead to hypoperfusion of vital organs, whereas elevated blood pressure can lead to end organ damage, stroke, and myriad related instances.

Correction: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets.

Correction: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets.

Single-Pill Combinations in the Treatment of Hypertension in Adults: Beyond Convenience.

Adequate blood pressure control in patients with hypertension remains the pillar of cardiovascular-event prevention. Smoking cessation, reduced dietary salt intake, physical exercise and weight loss contribute to better blood pressure control and reduced cardiovascular morbidity, but alone, they are often insufficient in doing so, and their success is highly dependent on individual patient motivation. Pharmacologic therapy, thus, remains necessary for most patients, and our conception of the optimal way of approaching this therapy has evolved over the past decade. Traditionally, monotherapy using a first-line drug was initiated and uptitrated, with the addition of other antihypertensive agents as needed. The latest Hypertension Canada guidelines, however, now recommend first-line treatment with single-pill combinations in patients without compelling indications for treatment. In this review, we discuss the evidence behind this recommendation and how single-pill combinations can improve patient care.

Abstract from: Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians

Abstract from: Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians

Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention and treatment of hypertension in adults for pharmacists: An update.

Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention and treatment of hypertension in adults for pharmacists: An update.

Correction: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.

Correction: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older.