Improve Blood Pressure Control Research Articles

Identifying drug-related attributes to personalise antihypertensive agents: the outcome report of patients receiving metoprolol therapy

BackgroundCurrently, numerous antihypertensive drugs from different pharmacological classes are available; however, blood pressure control is achieved in only less than a third of patients treated for hypertension. Moreover, providing optimal and personalised treatment for hypertension is challenging. Therefore, in this study, we propose a ‘drug-related attributes’ sensitive spectrum. This novel concept can assist clinicians in selecting an optimal antihypertensive drug and improve blood pressure control after examining the attributes of a patient.MethodsWe collected clinical data on attributes related to hypertension and its therapy of inpatients from West China Hospital who received metoprolol therapy and constructed the sensitive spectrum using data-visualisation tools.ResultsOur analysis revealed that haematocrit, haemoglobin, serum creatinine, serum cystatin C, serum urea, age, sex, systolic pressure, diastolic pressure, pulse pressure, and heart rate are metoprolol-related attributes.ConclusionOur study showed that all metoprolol-related attributes identified are reasonable and helpful in improving the personalisation of metoprolol therapy. The proposed drug-related attributes spectrum can help personalise antihypertensive medication. Moreover, data-visualisation tools can be effectively used to mine the drug-related attributes sensitive spectrum.

Periodontitis as an inflammatory trigger in hypertension: From basic immunology to clinical implications.

Hypertension and periodontitis are both highly prevalent co-morbidities worldwide, and their occurrence increases with age. Multiple observational epidemiological studies have shown that periodontitis is associated with an increased cardiovascular disease (CVD) occurrence. Large systematic reviews and metanalyses further show that periodontitis increases the risk of hypertension and is associated with increased systolic and diastolic blood pressure. Genetic and clinical evidence, utilizing mendelian randomization and randomized clinical trials, support the causal role of periodontitis in hypertension. The mechanisms of this link remain unclear. Critical components of immune and inflammatory pathogenesis of periodontitis considerably overlap with immune mechanisms of hypertension. Clinical studies support that both C-reactive protein (CRP) levels and white blood cell counts (WBC) mediate the relationship between periodontal disease and high blood pressure. In particular, activation of Th1, Th17, T regulatory cells, and proinflammatory monocytes has been shown to be essential in both conditions. Immunosenescent dysregulated CD28null T cells have been implicated, along with key effector cytokines such as interleukin 6 (IL-6), TNF-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin 17 (IL-17). A better understanding of the relationships between hypertension and periodontitis is essential not only for possible utilization of this knowledge for a non-pharmacological approach to improving blood pressure control. It may also provide valuable pathogenetic clues linking inflammation and hypertension, which has become particularly relevant in the light of links between hypertension and autoimmune disorders or, more recently, COVID-19.

Successful Implementation of an All-or-None Diabetes Measure in 10 US Health Systems.

Type 2 diabetes mellitus (T2DM) affects 31.5 million adults in the United States and is commonly treated in primary care settings. One promising approach to comprehensive care is to focus on an all-or-none diabetes bundle measure, which ensures each patient meets a set of guideline-recommended measures. This requires a practice-level coordinated strategy. The purpose of this initiative was to help health care organizations (HCOs) improve the care and outcomes of patients with T2DM using an all-or-none bundle measure. This observational study was carried out in the context of a national best practices learning Collaborative that implemented targeted interventions in primary care settings and measured success using an all-or-none bundle measure. Ten AMGA member-HCOs, across 8 states, treating nearly 300,000 adult patients with T2DM in primary care participated. The primary measure, the Together 2 Goal® Core Bundle, included hemoglobin A1c (A1c) control (<8%), blood pressure (BP) control (<140/90 mmHg), lipid management (prescribed a statin), and medical attention for nephropathy. All 10 HCOs improved the Core Bundle measure during the 12-month Collaborative. The rate for the Core Bundle improved from 40.2% to 42.8%, an absolute increase of 2.6% (P < 0.001). In addition, 9 HCOs improved BP control, 8 improved lipid management, 6 improved attention to nephropathy, and 4 improved A1c control. Implementing interventions in primary care settings was successful in achieving comprehensive care for an estimated additional 7700 people living with T2DM who met all 4 components of the bundle measure during the 12-month intervention period.

Abstract 11734: 'Whispering Stroke' May Be Very Common in Southeastern African Americans With Uncontrolled High Blood Pressure

Introduction: High blood pressure (BP) increases risk for stroke, but individuals experiencing stroke symptoms don’t always seek medical attention. Such ‘whispering stroke’ symptoms are reportedly common but have not been examined in African Americans with persistently uncontrolled hypertension. Hypothesis: Stroke symptoms without a stroke diagnosis are more common in African Americans with uncontrolled hypertension and are associated with stroke risk factors. Methods: We used data from the Southeastern Collaboration to Improve Blood Pressure Control, a randomized controlled trial that enrolled 1596 African Americans from rural AL and NC with persistently uncontrolled hypertension (mean clinic systolic BP &gt;140 mm Hg in the year prior to enrollment, and research-grade BP &gt; 140/90 mm Hg at enrollment). Stroke symptoms were detected using the Questionnaire to Verify Stroke-Free Status (QVSS) that detects 6 symptoms that could represent stroke. Stroke risk factors included age, blood pressure, diabetes, and cigarette smoking. Multivariable Poisson regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between stroke risk factors and report of any stroke symptom without stroke diagnosis. Results: The 1239 individuals who reported never having had a stroke or transient ischemic attack (TIA) diagnosis had mean age 57.0 + 12.0 years, 37.4% were men, and 36.1% reported having experienced a stroke symptom. In adjusted models, report of stroke symptoms without a stroke diagnosis were associated with age (PR 0.99, 95% CI 0.99-1.00), systolic blood pressure (PR 1.03, 95% CI 1.00-1.05), diabetes (PR 1.33, 95% CI 1.15-1.55), and current smoking (PR 1.29, 95% CI 1.08-1.55). Conclusions: Over one third of this relatively young sample reported stroke symptoms without a stroke diagnosis. Stroke risk factors were associated with stroke symptoms without a stroke diagnosis. Screening for stroke symptoms in individuals with persistently uncontrolled hypertension may be warranted.

Impact of a Pharmacist-Led Hypertension Management Program for Oral Chemotherapy in a Specialty Pharmacy Setting.

Oral chemotherapy agents are a growing area of oncology treatment, but some are associated with a high incidence of hypertension. Management of hypertension in oncology patients may be insufficient due to a variety of reasons. A pharmacist-led hypertension management service within the specialty pharmacy setting has the potential to help patients on oral chemotherapy achieve and maintain adequate blood pressure control. The objective of this study was to assess the impact of a pharmacist-led hypertension management program on the blood pressure control of patients on oral chemotherapy. This retrospective, single-center study compared data from two groups of patients receiving oral chemotherapy agents from a health systems specialty pharmacy within an academic medical center, before and after the establishment of a pharmacist-led hypertension management program. Twenty-one of 50 (0.42) patients in the control group had blood pressure overall at goal, compared to 19 of 29 (0.66) patients in the intervention group who had blood pressures at goal at the end of the specified 3-month time period (p = 0.04). In cases where a pharmacist intervention was necessary per the hypertension management program's protocol, the rate of provider acceptance of recommendations regarding modifying or initiating antihypertensive therapy was high. When followed with a pharmacist-led hypertension management program, patients on oral chemotherapy showed improved blood pressure control and reduced mean blood pressure readings over time.

Effect of yoga practice on Cognition in Hypertensive Patients

Background: Yoga is one such alternative healthcare practice thought to improve blood pressure control. There is no single definition of the practice of yoga, that is universally accepted although it is generally described as an ancient tradition (originating 5,000 to 8,000 years ago) that incorporates postures, breath control, and meditation, as well as specific ethical practices. Materials and Methods: This is a prospective, descriptive and observational study. Department of Physiology, Index Medical College, Hospital and Research center Indore. Period of study is from January 2020 to December 2021. Seventy hypertensive subjects on yoga therapy and Seventy hypertensive subjects on without yoga therapy was enrolled in this study. Both groups were advised to continue their regular medicines. Result: A total of 70 patients who fulfilled the selection criteria during the study were enrolled. Pre-test Yoga Group Mean LNS increased from 8.04±0.74 (Mean±SD) to Post-test 10.14±0.66. In control group Mean LNS in pre-test 8.54±0.58 and post-test 8.67±0.36. However, the difference in Mean LNS in Yoga Group is statistically significant. (P value &lt; 0.05). Conclusion: A Short Yoga program for patient to practice at home seems to have a positive effect on self-rated quality of life and reduction of stress. It also lowered the patient perception on stress and it enhanced the patient perception on health.

American Heart Association's 2024 Impact Goal: Every Person Deserves the Opportunity for a Full, Healthy Life.

American Heart Association's 2024 Impact Goal: Every Person Deserves the Opportunity for a Full, Healthy Life.

Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices.

We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point Quality Improvement Capacity Assessment (QICA). Clinics reported performance on 3 cardiovascular CQMs-appropriate aspirin use, blood pressure (BP) control (<140/90 mm Hg), and smoking screening/cessation counseling-at baseline (2015) and follow-up (2017). Regression analyses with change in CQM as the dependent variable allowed for clustering by practice facilitator and adjusted for baseline CQM performance. Practices improved QICA scores by 1.44 points (95% CI, 1.20-1.68; P <.001) from an average baseline of 6.45. All 3 CQMs also improved: aspirin use by 3.98% (average baseline = 66.8%; 95% CI for change, 1.17%-6.79%; P = .006); BP control by 3.36% (average baseline = 61.5%; 95% CI for change, 1.44%-5.27%; P = .001); and tobacco screening/cessation counseling by 7.49% (average baseline = 73.8%; 95% CI for change, 4.21%-10.77%; P <.001). Each 1-point increase in QICA score was associated with a 1.25% (95% CI, 0.41%-2.09%, P = .003) improvement in BP control; the estimated likelihood of reaching a 70% BP control performance goal was 1.24 times higher (95% CI, 1.09-1.40; P <.001) for each 1-point increase in QICA. Improvements in clinic-level performance on BP control may be attributed to implementation of 7 evidence-based strategies to build quality improvement capacity. These strategies were feasible to implement in small practices over 15 months.

The Effect of Behavioral Changes on the Treatment of Hypertension.

Hypertension is one of the leading causes of preventable premature death. Strongly advocating for lifestyle changes to improve blood pressure control is of paramount importance in the successful management of hypertension. In this review, we will discuss the effect of various behavioral and lifestyle changes and review the evidence to support these changes to improve blood pressure control. These include dietary modifications, alcohol consumption, weight loss, various types of exercise, device-guided breathing, relaxation, and biofeedback techniques.

Impact of educational intervention on hypertension management by primary care physician (PUMP trial).

Background: To date, no optimal way of organizing and delivering care to hypertensive patients at the primary carer level has been identified, due to which a significant number of patients fail to meet the treatment goals. The current study aims to observe hypertension educational intervention's effect on general physicians (GPs) to indirectly improve blood pressure control and patient outcomes.&#x0D; Methodology: In this randomized control trial, GPs will be divided into 2 groups and both groups will be asked to fill hypertension awareness questionnaire at baseline and, after randomization. GPs of the group I will receive (1 day) face-to-face education with structured educational material on hypertension management strategies. GPs of group II will receive the print version of educational material (structured educational material) on strategies of structured hypertension management. Both groups of GPs will recruit 10 (5 newly diagnosed + 5 already diagnosed patients) from the study site. The patient will be asked to fill hypertension awareness questionnaire at baseline and share a 12-hour blood pressure measurement. GPs and patients will be reassessed after 3 months of intervention.&#x0D; Discussion: The purpose of designing this study is to observe the effect of hypertension educational intervention for general physicians to improve blood pressure control and patient outcomes indirectly. Results of this study may provide a basis for developing a hypertension educational program targeted at general physicians.&#x0D; Trial registration: The trial was registered with ClinicalTrials.gov NCT05038774.&#x0D;

Evaluation of a Pharmacists’ Patient Care Process Approach for Hypertension

An estimated 116 million American adults (47.3%) have hypertension. Most adults with hypertension do not have it controlled-3 in 4 (92.1 million) U.S. adults with hypertension have a blood pressure ≥130/80 mmHg. The Pharmacists' Patient Care Process is a standardized patient-centered approach to the provision of pharmacist care that is done in collaboration with other healthcare providers. Through the Michigan Medicine Hypertension Pharmacists' Program, pharmacists use the Pharmacists' Patient Care Process to provide hypertension management services in collaboration with physicians in primary care and community pharmacy settings. In 2019, the impact of Michigan Medicine Hypertension Pharmacists' Program patient participation on blood pressure control was evaluated. Propensity scoring was used to match patients in the intervention group with patients in the comparison group and regression analyses were then conducted to compare the 2 groups on key patient outcomes. Negative binomial regression was used to examine the number of days with blood pressure under control. The findings presented in this brief are part of a larger multimethod evaluation. More patients in the intervention group than in the comparison group achieved blood pressure control at 3 months (66.3% vs 42.4%) and 6 months (69.1% vs 56.5%). The intervention group experienced more days with blood pressure under control within a 3-month (18.6 vs 9.5 days) and 6-month period (57.0 vs 37.4 days) than the comparison group did. Findings support the effectiveness of the Michigan Medicine Hypertension Pharmacists' Program approach to implementing the Pharmacists' Patient Care Process to improve blood pressure control.

Practical efficacy and safety of Konsilar D24 in patients with hypertension: data from the KONSONANS program

Aim. In practice, to evaluate the efficacy, safety and long-term adherence to therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24) in patients with grade 1-2 hypertension (HTN) who have not achieved blood pressure (BP) control with prior therapy or have not taken antihypertensive therapy.Material and methods. This multicenter open-label observational program included 524 patients with grade 1-2 HTN who did not take antihypertensive therapy or did not reach the target BP level with mono or dual antihypertensive therapy, as well as patients shifted to Konsilar-D24 therapy no later than two weeks before the start of the program. All patients signed a written informed consent to participate in the program. The safety analysis set includes all patients who have taken at least one dose of a fixed-dose combination of ramipril/indapamide and have visited physician at least once during the program. The effectiveness analysis set included all patients in the safety population who completed the study in accordance with protocol (n=511). Clinical systolic blood pressure (SBP), diastolic BP (DBP) and heart rate were assessed at baseline, as well as at 0,5, 1, 3 and 6 months of treatment. A post hoc subgroup analysis of changes in BP and heart rate was performed depending on age, sex and baseline body mass index.Results. The fixed-dose combination of ramipril with indapamide significantly reduced SBP and DBP after 2-week treatment (-20,9±10,1 mm Hg; pConclusion. Despite the limitations inherent in observational studies, the KONSONANS program has demonstrated high efficacy and safety of fixed-dose combination of ramipril/indapamide taken once a day in hypertensive patients. Ramipril/indapamide fixed-dose combination therapy significantly improved BP control and achieved even lower individual target BP levels in the majority of hypertensive patients.

Effects of Intermittent Compared With Continuous Energy Restriction on Blood Pressure Control in Overweight and Obese Patients With Hypertension.

Background and Aims: Weight-loss diets reduce body weight and improve blood pressure control in hypertensive patients. Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight reduction. We aimed to compare the effects of IER with those of CER on blood pressure control and weight loss in overweight and obese patients with hypertension during a 6-month period.Methods: Two hundred and five overweight or obese participants (BMI 28.7 kg/m2) with hypertension were randomized to IER (5:2 diet, a very-low-calorie diet for 2 days per week, 500 kcal/day for women and 600 kcal/day for men, along with 5 days of a habitual diet) compared to a moderate CER diet (1,000 kcal/day for women and 1,200 kcal/day for men) for 6 months. The primary outcomes of this study were changes in blood pressure and weight, and the secondary outcomes were changes in body composition, glycosylated hemoglobin A1c (HbA1c), and blood lipids.Results: Of the 205 randomized participants (118 women and 87 men; mean [SD] age, 50.2 [8.9] years; mean [SD] body mass index, 28.7 [2.6]; mean [SD] systolic blood pressure, 143 [10] mmHg; and mean [SD] diastolic blood pressure, 91 [9] mmHg), 173 completed the study. The intention-to-treat analysis demonstrated that IER and CER are equally effective for weight loss and blood pressure control: the mean (SEM) weight change with IER was −7.0 [0.6] kg vs. −6.8 [0.6] kg with CER, the mean (SEM) systolic blood pressure with IER was −7 [0.7] mmHg vs. −7 [0.6] mmHg with CER, and the mean (SEM) diastolic blood pressure with IER was −6 [0.5] mmHg vs. −5 [0.5] mmHg with CER, (diet by time P = 0.62, 0.39, and 0.41, respectively). There were favorable improvements in body composition, HbA1c, and blood lipid levels, with no differences between groups. Effects did not differ according to completer analysis. No severe hypoglycemia occurred in either group during the trial.Conclusions: Intermittent energy restriction is an effective alternative diet strategy for weight loss and blood pressure control and is comparable to CER in overweight and obese patients with hypertension.Clinical Trial Registration: http://www.chictr.org.cn, identifier: ChiCTR2000040468.

Cost-Effectiveness of Recommendations From the Surgeon General's Call-to-Action to Control Hypertension.

In response to high prevalence of hypertension and suboptimal rates of blood pressure (BP) control in the United States, the Surgeon General released a Call-to-Action to Control Hypertension (Call-to-Action) in the fall of 2020 to address the negative consequences of uncontrolled BP. In addition to morbidity and mortality associated with hypertension, hypertension has an annual cost to the US healthcare system of $71 billion. The Call-to-Action makes recommendations for improving BP control, and the purpose of this review was to summarize the literature on the cost-effectiveness of these strategies. We identified a number of studies that demonstrate the cost saving or cost-effectiveness of recommendations in the Call-to-Action including strategies to promote access to and availability of physical activity opportunities and healthy food options within communities, advance the use of standardized treatment approaches and guideline-recommended care, to promote the use of healthcare teams to manage hypertension, and to empower and equip patients to use self-measured BP monitoring and medication adherence strategies. While the current review identified numerous cost-effective methods to achieve the Surgeon General's recommendations for improving BP control, future work should determine the cost-effectiveness of the 2017 American College of Cardiology and American Heart Association Hypertension guidelines, interventions to lower therapeutic inertia, and optimal team-based care strategies, among other areas of research. Economic evaluation studies should also be prioritized to generate more comprehensive data on how to provide efficient and high value care to improve BP control.

Protocol design and preliminary evaluation of the REAL-Health Triple Aim, an open-cohort CVD-care optimisation initiative

IntroductionEffective treatment of cardiovascular disease (CVD) in primary care could be improved. We aim to assess the efficacy of a scalable treatment optimisation programme in unselected community populations in South East England, with the triple aim of improved blood pressure control in people with hypertension, increased high-intensity statin use in people with CVD and reduced gastrointestinal bleeding in patients on antithrombotic medication.MethodThis observational study comprises an open cohort of approximately 200,000 adults at high cardiovascular risk registered with general practitioners in five South East England Clinical Commissioning Groups (CCGs). An intervention programme is planned in four of these CCGs with a further non-intervention CCG acting as a control group. The intervention will consist of: clinical guidelines and educational outreach; virtual patient-reviews software; peer-performance “dashboards” and, where available, financial incentives.The study will examine 3 primary outcomes: 1. Diagnosed hypertension with a blood pressure <140/90mmHg; 2. Diagnosed CVD on a high-intensity statin; 3. A cardiovascular indication for antithrombotic therapy with one or more factors for increased risk of gastrointestinal bleeding (e.g. age ≥65) on gastroprotection. A further 17 secondary outcomes related to these three aims will be assessed.AnalysisWe will use an interrupted time series analysis over 18 months, representing the pre-implementation, implementation and the post-implementation phases with comparison to the control CCG and applicable national Quality and Outcomes Framework and national prescribing statistics (e.g. OpenPrescribing). Secondary outcomes include an equity impact analysis with results stratified by age, gender, ethnic group and index of deprivation.Preliminary dataWe present preliminary data on Key Performance Indicators (KPIs) collected from 191 GP practices including [percentage achievement on 01/09/2019, on 01/09/2020]: 1. Patients with hypertension and most recent blood pressure ≤140/90mmHg [68.7%, 60.6%]. 2. Patients eligible for treatment with a high-intensity statin on such treatment [53.8%, 55.8%]. 3. Patients on antithrombotics with ≥1 risk factors for gastrointestinal bleeding on gastroprotection [59.0%, 60.1%]. We also present our virtual patient-review software tool and outcome visualisation dashboard.ConclusionThe REAL-Health Triple Aim initiative is a large-scale primary care cardiovascular risk reduction initiative which was launched almost contemporaneously with the United Kingdom's first SARS-CoV-2 related lockdown. Preliminary data justify the need for the Triple Aim initiative and give us an insight on the impact of the pandemic on its implementation.FUNDunding AcknowledgementType of funding sources: Other. Main funding source(s): Barts CharityBritish Heart Foundation

Remote Blood Pressure Monitoring With a Wearable Photoplethysmographic Device (Senbiosys): Protocol for a Single-Center Prospective Clinical Trial.

BackgroundWearable devices can provide user-friendly, accurate, and continuous blood pressure (BP) monitoring to assess patients’ vital signs and achieve remote patient management. Remote BP monitoring can substantially improve BP control. The newest cuffless BP monitoring devices have emerged in patient care using photoplethysmography.ObjectiveThe Senbiosys trial aims to compare BP measurements of a new device capturing a photoplethysmography signal on the finger versus invasive measurements performed in patients with an arterial catheter in the intensive care unit (ICU) or referred for a coronarography at the Hospital of Fribourg.MethodsThe Senbiosys study is a single-center, single-arm, prospective trial. The study population consists of adult patients undergoing coronarography or patients in the ICU with an arterial catheter in place. This study will enroll 35 adult patients, including 25 patients addressed for a coronarography and 10 patients in the ICU. The primary outcome is the assessment of mean bias (95% CI) for systolic BP, diastolic BP, and mean BP between noninvasive and invasive BP measurements. Secondary outcomes include a reliability index (Qualification Index) for BP epochs and count of qualified epochs.ResultsPatient recruitment started in June 2021. Results are expected to be published by December 2021.ConclusionsThe findings of the Senbiosys trial are expected to improve remote BP monitoring. The diagnosis and treatment of hypertension should benefit from these advancements.Trial RegistrationClinicalTrials.gov NCT04379986; https://clinicaltrials.gov/ct2/show/NCT04379986International Registered Report Identifier (IRRID)PRR1-10.2196/30051

Tracking Blood Pressure Control Performance and Process Metrics in 25 US Health Systems: The PCORnet Blood Pressure Control Laboratory.

BackgroundThe National Patient‐Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally.Methods and ResultsWe conducted a serial cross‐sectional study with queries against standardized electronic health record data in the National Patient‐Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well‐documented hypertension and a recent encounter at the health system for a series of 1‐year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient‐years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control (<140/90 mm Hg) was observed in 62% (range, 44%–74%) but varied by race and ethnicity, with the lowest BP control among Black patients at 57% (odds ratio, 0.79; 95% CI, 0.66–0.94). A new class of antihypertensive medication (medication intensification) was prescribed in just 12% (range, 0.6%–25%) of patient visits where BP was uncontrolled. However, when medication intensification occurred, there was a large decrease in systolic BP (≈15 mm Hg; range, 5–18 mm Hg).ConclusionsMajor opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.

Standalone sauna vs exercise followed by sauna on cardiovascular function in non-naïve sauna users: A comparison of acute effects.

Background and aimsSauna bathing and aerobic exercise have each been shown to affect cardiovascular function. However, direct comparisons between standalone sauna bathing and a combination of exercise and sauna on vascular indices remain limited. Therefore, we conducted a cross‐over study using matched durations to explore the hemodynamic changes of sauna exposure when compared to a combination of aerobic exercise and sauna exposure.MethodsParticipants (N = 72) with at least one cardiovascular risk factor underwent, on two separate occasions: (a) a 30‐minute sauna at 75°C (SAUNA) and (b) the combination of a 15‐minute cycling exercise at 75% maximum heart rate followed by 15‐minute sauna exposure (EX+SAUNA). Relative changes to arterial stiffness (PWV), augmentation index (Alx), brachial systolic and diastolic blood pressure (SBP and DBP), central SBP (cSBP), mean arterial pressure (MAP), and heart rate (HR) were compared PRE‐POST and pre‐ to 30‐minutes post‐intervention (PRE‐POST30).ResultsBaseline SBP and DBP were 143 (SD 18) mmHg and 86 (SD 10) mmHg, respectively. From PRE‐POST, SAUNA had lower DBP (mean difference [95% CI] 2.5 [1.0, 4.1], P = .002) and MAP (2.5 [0.6, 4.3], P = .01). However, EX+SAUNA had lower SBP (−2.7 [−4.8, −0.5], P = .02), DBP (−1.8 [−3.3, −0.4], P = .01), and MAP (−2.0 [−3.5, −0.5], P = .009) PRE‐POST30. There were no statistically significant differences between SAUNA and EX+SAUNA for other measured parameters.ConclusionThis study demonstrated that when matched for duration, EX+SAUNA and SAUNA elicit comparable acute hemodynamic alterations in middle‐aged participants with cardiovascular risk factors. The sauna is a suitable option for acute blood pressure reductions in those who are unable to perform aerobic exercise, and may be a viable lifestyle treatment option to improve blood pressure control.

Питательные вещества и пищевые добавки для лечения высокого нормального артериального давления: консенсусный документ на основе доказательств

Эссенциальная гипертензия по-прежнему представляет собой наиболее распространенный фактор риска сердечно-сосудистой системы, отвечающий за большую часть глобального бремени заболеваний во всем мире. Антигипертензивная терапия, направленная на снижение уровня артериального давления (АД) в рекомендованных терапевтических целях, доказала снижение риска развития сердечно-сосудистых, цереброваскулярных и почечных осложнений. Несмотря на эти доказательства, общий уровень контроля АД остается достаточно низким в большинстве европейских и западных стран, а также в развивающихся странах, что способствует увеличению расходов на лечение и инвалидность, связанных с гипертензией. По этим причинам превентивные стратегии, направленные на улучшение уровня контроля АД у больных артериальной гипертензией (АГ), которые принимают медикаментозную терапию, и снижение АД при его высоком нормальном уровне у бессимптомных здоровых лиц могут способствовать уменьшению бремени заболеваний, связанных с гипертензией. С этой точки зрения было показано, что использование определенных питательных веществ и пищевых добавок может обеспечить благоприятные эффекты в лечении и контроле АГ, вне приема фармакологических препаратов и нефармакологических вмешательств. Их применение может эффективно и безопасно снижать уровень АД до целевых показателей и предотвращать прогрессирование заболевания с высокого нормального уровня АД к гипертензии 1-й степени. В этом консенсусном документе представлены систематический обзор и критический анализ имеющихся в настоящее время доказательств в пользу использования питательных веществ и пищевых добавок у лиц с высоким нормальным уровнем АД при различных степенях сердечно-сосудистого риска.

Exploring the role of pharmacists in improving blood pressure control among hypertensive patients at the workplace

Several hours of productivity are lost due to improper management of hypertension. Poor adherence and inadequate care due to weak healthcare systems contribute to the lack of effectiveness of anti-hypertensive therapy. Pharmaceutical care plays a vital role in achieving treatment goals for patients with chronic conditions such as hypertension. This study sought to ascertain the effectiveness of pharmaceutical care services provided at the workplace on adherence and blood pressure control among staff with hypertension. This was a prospective pre-post study conducted at the Kwame Nkrumah University of Science and Technology from September 2019 to September 2020. Staff with confirmed diagnosis of hypertension were offered individualized pharmaceutical care every month for six months. Outcome measures were changes in blood pressure measurement, adherence and the number of pharmaceutical care issues identified and resolved. Forty-three university staff participated in this study. Reductions in mean systolic and diastolic blood pressure and difference in mean adherence scores were statistically significant after 6 months of follow up (p ≤ 0.00). A medical diagnosis of diabetes (p ≤ 0.044) and Body Mass Index (p ≤ 0.038) were associated with control of hypertension. Adherence to medications improved after the follow up period. Participants and pharmacists involved in the study expressed satisfaction with the program's impact. Pharmaceutical care at the workplace can improve medication adherence and blood pressure control among hypertensive patients. Blood pressure control was also better among individuals with normal Body Mass Index or a medical history of diabetes.