Initiation Of Antihypertensive Treatment Research Articles

Potentially inappropriate prescription of medications to older adults who access a community pharmacy in Peru

Polypharmacy in older adults is associated with a higher incidence of medication-related problems, such as pharmacological interactions, adverse reactions, and medication errors. This study aimed to identify and evaluate potentially inappropriate prescription of medications (PIP) using the screening tool of older persons’ prescriptions/screening tool to alert doctors to right treatment (STOPP/START) criteria in a representative community pharmacy in Trujillo, Peru. The population sample consisted of 158 subjects, with 66.5% between 65 and 69 years old, 53.8% male, and 77.9% receiving between 3 and 4 medications. Medical prescriptions were analyzed using the explicit STOPP/START version 2 criteria, revealing that 93.7% of patients presented STOPP criteria (to stop medication) and 53.8% presented START criteria (to start medication). The most frequently identified STOPP criterion was the gradual withdrawal of benzodiazepines, while the most frequently identified START criterion was the initiation of antihypertensive treatment in patients with systolic blood pressure > 160 mmHg and diastolic blood pressure > 90 mmHg. Principal component analysis showed that the high prevalence of PIP was significantly associated (p < 0.05) with the number of prescribed medications and as age decreases, the number of medical diagnoses also decreases. It is concluded that there is a high prevalence of PIP in the studied population, posing a greater challenge in older adults, highlighting the importance of addressing prescribing practices with greater involvement of community pharmacists.

Postpartum Management of Hypertensive Disorders of Pregnancy in Six Large U.S. Hospital Systems: Descriptive Review and Identification of Clinical and Research Gaps.

Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin-Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management. KEY POINTS: · Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.. · There is a variation in the BP threshold for antihypertensive treatment initiation.. · Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring..

A rapid review of telehealth in women with recent de novo hypertensive disease of pregnancy.

Hypertensive disorders of pregnancy pose significant risks to both maternal and fetal health. Postpartum hypertension, a common complication, often leads to emergency room (ER) visits or hospital readmissions. Despite the prevalence of these complications, there is a paucity of studies that focus on blood pressure monitoring in postpartum patients with de novo hypertensive disorders of pregnancy. This review aimed to address the gap by evaluating available evidence to compare telehealth monitoring with in-person visits in preventing ER visits and hospital readmissions among postpartum patients with de novo hypertensive disorders of pregnancy. The study identified relevant studies by conducting a rigorous search strategy (Medline/OVID, the Cochrane Library, Scopus, and research registries such as the International Clinical Trials Registry Platform [ICTRP] and clinical trials) directed by the clinical information specialist. Two reviewers independently screened titles and abstracts, resolving discrepancies with the assistance of a third reviewer. Data extraction followed standardized protocols, and risk of bias assessments were conducted using appropriate tools. This rapid review synthesized evidence from 11 studies on telehealth for women with recent de novo hypertensive disorders of pregnancy. Findings highlighted that telemonitoring led to earlier blood pressure documentation and intervention, reduced disparities in blood pressure measurement, decreased hypertension-related readmissions, higher rates of postpartum antihypertensive treatment initiation, and increased patient satisfaction. Telehealth emerges as a promising tool for managing postpartum hypertension among women with recent de novo hypertensive disorders of pregnancy.

Effect of antihypertensive treatment on the quality of life of patients with chronic rhinosinusitis with nasal polyps

AimNasal polyposis (CRSwNP) shares type 2 inflammation biomarkers with asthma, allergy or arterial hypertension (AH), including periostin, a predictive marker of severity and post-surgical recurrence of polyposis. Antihypertensives have been shown to decrease periostin expression. We set out to evaluate the effect of antihypertensives on the quality of life of patients with CRSwNP. Materials and methodsRetrospective study of 43 patients with CRSwNP and ah with at least 1year of follow-up and antihypertensive treatment prescribed after the diagnosis of CRSwNP. Phenotypes were analyzed (F1: isolated CRSwNP; F2: CRSwNP with asthma and/or NERD) and aspects related to quality of life (SNOT-22), clinical severity (VAS), polypoid size (NPS), exacerbations and surgical needs after the initiation of antihypertensive treatment. ResultsThe predominant phenotype was F1 (62.8%). The number of exacerbations was 19.2% for F1, compared to 31.3% for F2. 34.8% underwent surgery after the start of antihypertensive treatment (F1=27.9% and F2=6.97%). A significant reduction in polypoid size, SNOT22 (16.4±19.6 points), and VAS scales (p<.05) was obtained. Conclusionspolypoid size, and reduce the risk of postoperative recurrence.

Efecto del tratamiento antihipertensivo en la calidad de vida de los pacientes con rinosinusitis crónica con pólipos nasales

AimNasal polyposis (CRSwNP) shares type2 inflammation biomarkers with asthma, allergy or arterial hypertension (AH), including periostin, a predictive marker of severity and post-surgical recurrence of polyposis. Antihypertensives have been shown to decrease periostin expression. We set out to evaluate the effect of antihypertensives on the quality of life of patients with CRSwNP. Materials and methodsRetrospective study of 43 patients with CRSwNP and AH with at least 1year of follow-up and antihypertensive treatment prescribed after the diagnosis of CRSwNP. Phenotypes were analyzed (F1: isolated CRSwNP; F2: CRSwNP with asthma and/or NERD) and aspects related to quality of life (SNOT-22), clinical severity (VAS), polypoid size (NPS), exacerbations and surgical needs after the initiation of antihypertensive treatment. ResultsThe predominant phenotype was F1 (62.8%). The number of exacerbations was 19.2% for F1, compared to 31.3% for F2. 34.8% underwent surgery after the start of antihypertensive treatment (F1=27.9% and F2=6.97%). A significant reduction in polypoid size, SNOT22 (16.4±19.6 points), and VAS scales (P<.05) was obtained. ConclusionsAntihypertensives administered in patients with CRSwNP and comorbid AH improve quality of life, reduce polypoid size, and reduce the risk of postoperative recurrence.

Estimated impact of timely guidelines-based initiation of dual-combination anti-hypertensive therapy on long-term cardiovascular outcomes in a population of 1.4 million individuals

Abstract Background In most patients qualifying for anti-hypertensive treatment initiation, guidelines recommend dual-combination therapy. Purpose To estimate cardiovascular (CV) events rate with optimal and suboptimal adoption of guideline-based treatment in comparison with observed risk in a large population representing usual clinical practice. Methods A study population representing real-world clinical practice was developed from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics databases in England. Adults qualifying for dual BP-lowering therapy as per the 2018 ESC/ESH guidelines were identified during 15-year period (2005-2019). Primary endpoint was composite of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and CV death. A Cox model relating patient characteristics to the risk of primary endpoint was estimated for overall population and subgroups (Atherosclerotic cardiovascular disease [ASCVD] and diabetes). Patients in the real-world cohort entered a Monte-Carlo simulation model which simulated CV events over time consistent with an individual-specific predicted risk from the Cox model based on their characteristics. Following scenarios were investigated: (1) untreated (reference); (2) optimal treatment (full adherence and persistence); (3) suboptimal adherence (50% adherence); (4) suboptimal persistence (50% discontinuation at 1-year). Scenario 5 represented observed clinical practice in databases. Ten-year event rates, ARRs and NNTs were estimated for each scenario with scenario 1. Results The observed 10-year event rate for the primary endpoint representing clinical practice (scenario 5) in the database was 17.8% (Tables 1 and 2). In scenario 2, the simulated 10-year event rates for the primary endpoint were 15.8% (absolute risk reduction [ARR] 6.6%, number needed to treat [NNT] 15) and 15.2% (ARR 7.1%, NNT 14) for Ramipril plus Amlodipine (R+A) and Irbesartan plus Amlodipine (I+A), respectively. In scenario 3, the simulated 10-year event rates for the primary endpoint were 18.8% (ARR 3.6%, NNT 28) and 18.5% (ARR 3.9%, NNT 26), respectively, for R+A and I+A. The most notable risk reductions were seen in ASCVD subgroup for scenario 2; ARR 11.2% and 12.3% for R+A and I+A, respectively. Similarly, in diabetes subgroup scenario 2, resulted in highest ARR (8.2% and 8.7%) and lowest NNT (12 for both), indicating good clinical benefit of treatment. Conclusions These findings indicate substantial opportunity for population-level risk reduction by optimal guidelines-based treatment initiation with dual-combination anti-hypertensive therapy as compared to observed clinical practice. Results suggest substantial population attributable risk for behaviors of suboptimal adherence and persistence. The opportunity for risk reduction by optimal treatment, and attributable risk due to suboptimal treatment, were especially high for individuals with ASCVD or diabetes.Table 1Table 2

Hypertension Control Cascade and Regional Performance in India: A Repeated Cross-Sectional Analysis (2015-2021).

Background The weak control cascade of hypertension from the time of screening till the attainment of optimal blood pressure (BP) control is a public health challenge, particularly in resource-limited settings. The study objectives were to(1) estimate the change in the rate of prevalence of hypertension, the yield of newly diagnosed cases, initiation of treatment, and attainment of BP control in the age group15 to 49 years; (2)ascertain the magnitude and predictors of undiagnosed hypertension, lack of initiation of treatment, and poor control of those on antihypertensive therapy; and(3)estimate the regional variation and state-level performance of the hypertension control cascade in India. Methodology We analyzed demographic and health surveillance (DHS) data from India's National Family Health Survey Fifth Series (NFHS-5), 2019-2021, and NFHS-4 (2015-2016). The NFHS-5 sample comprised 695,707 women and 93,267 men in the age group of 15 to 49 years. Multiple logistic regressions were performed to find the associated predictors, and respective adjusted odds ratios (aORs) were reported. Results The prevalence of hypertension (cumulative previously diagnosed and new cases) amongindividuals aged 15 to 49 years was 22.8% (22.6%, 23.1%; n = 172,532), out of which 52.06% were newly diagnosed cases. In contrast, in NFHS-4, the prevalence of hypertension amongindividuals aged 15 to 49 years was 20.4% (20.2%, 20.6%; n = 153,384), of which 41.65% were newly diagnosed cases. In NFHS-5, 40.7% (39.8% and 41.6%) of the previously diagnosed cases were on BP-lowering medications compared to 32.6% (31.8%, 33.6%) in NFHS-4. Furthermore, in NFHS-5, controlled BP was observed in 73.7% (72.7% and 74.7%) of the patients on BP-lowering medication compared to 80.8% (80.0%, 81.6%) in NFHS-4.Females compared to males (aOR =0·72 and 0·007), residents of rural areas (aOR = 0·82 and 0·004), and those belonging to the socially disadvantaged groups were not initiated on treatment despite awareness of their hypertension status indicative of poor treatment-seeking behavior.Furthermore, increasing age (aOR = 0·49, P< 0·001), higher body mass index (aOR = 0·51, P< 0·001), and greater waist-to-hip ratio (aOR = 0·78, P= 0·047) were associated with uncontrolled hypertension in patients on antihypertensive drug therapy. Conclusions Hypertension control cascade in India is largely ineffectual although screening yieldand initiation of antihypertensive treatment have improved in NFHS-5 compared to NFHS-4. Identification of high-risk groups for opportunistic screening, implementing community-based screening, strengthening primary care, and sensitizing associated practitioners are urgently warranted.

AW-AD-2: ASSOCIATION BETWEEN AMBULATORY BLOOD PRESSURE AND RISK OF HOME HYPERTENSION IN A NORMOTENSIVE POPULATION

Objective: Most of the hypertension management guidelines recommend out-of-office blood pressure (BP) measurement such as self-measured BP at home (home BP) and ambulatory BP monitoring for the accurate diagnosis and management of hypertension. Both out-of-office BP measurements are more useful than office BP as prognostic indicators of cardiovascular risk. However, no prospective study has assessed the longitudinal association between the two types of out-of-office BP measurements. Therefore, we investigated the association between ambulatory BP and the risk of home BP-based hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous study. Desigh and method: We followed up 410 participants (83.2% women; age, 53.6 years) without home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios for home hypertension (home BP ≧135/≧85 mmHg or initiation of antihypertensive treatment). In addition, the predictive ability for home hypertension incidence between the models adjusted for the covariates with 24-h, daytime, or nighttime SBP was examined using Harrell's C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). The NRI considers changes in the estimated prediction probabilities that imply a change from one category to another between different models. IDI is defined as the difference between the discrimination slopes of a basic model and an extended model. Results: During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The hazard ratio (95% confidence interval) for home hypertension incidence per 1-standard deviation increase in 24-h systolic BP (SBP) was 1.59 (1.33–1.90) after adjustments for possible confounding factors, including baseline home SBP. Harrell's C-statistic was 0.72 (0.69–0.75) for the basic 10-year risk prediction model, which includes sex, age, BMI, current or ex-smoker status, office SBP, and baseline home SBP. By adding 24-h, daytime, or nighttime SBP to the basic model, continuous NRI and IDI significantly improved although no significant improvement in Harrell's C-statistics was observed. Conclusions: Independent of the baseline home SBP, 24-h SBP was associated with the risk of home hypertension in a normotensive population. The prediction model for home hypertension risk was improved by the addition of 24-h SBP to the basic model. It could be useful to measure ambulatory BP for the early detection of home hypertension.

Association Between Ambulatory Blood Pressure and Risk of Home Hypertension in a Normotensive Population: The Ohasama Study.

We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study. In this prospective study, we followed up with 410 participants (83.2% women; age, 53.6 years) without a home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios (HRs) for home hypertension (home BP ≥ 135/≥85 mmHg or the initiation of antihypertensive treatment) and model improvement. During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The HR (95% confidence interval) for home hypertension incidence per 1-SD higher (=6.76 mmHg) 24-hour systolic BP (SBP) was 1.59 (1.33 to 1.90), after adjustments for possible confounding factors, including baseline home SBP. Harrell's C-statistics increased from 0.72 to 0.73 (P = 0.11) when 24-hour SBP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office SBP, and baseline home SBP. Continuous net reclassification improvement (0.53, P < 0.0001) and integrated discrimination improvement (0.028, P = 0.0014) revealed improvement in the model. A total of 24-hour SBP could be an independent predictor of future home hypertension. Home BP and 24-hour BP can longitudinally influence each other in the long term.

Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis.

Background:In older age, the benefits of antihypertensive treatment (AHT) become less evident, with greater associated risk. Of particular concern is compromising cerebral blood flow (CBF), especially in those with cognitive impairment.Methods:We created a synthesis of the published evidence by searching multiple electronic databases from 1970 to May 2021. Included studies had participants with mean age ≥50 years, hypertension or cognitive impairment, and assessed CBF before and after initiating AHT. Two authors independently determined eligibility and extracted data. Study quality was assessed using The Risk of Bias in Nonrandomized Studies of Interventions tool. We summarized study characteristics (qualitative synthesis) and performed random-effects meta-analyses (quantitative synthesis).Results:Thirty-two studies (total n=1306) were included, of which 23 were eligible for meta-analysis. In line with the qualitative synthesis, the meta-analysis indicated no effect of AHT initiation on CBF (standardized mean difference, 0.08 [95% CI, −0.07 to 0.22]; P=0.31, I2=42%). This was consistent across subgroups of acute versus chronic AHT, drug class, study design, and CBF measurement. Subgroups by age demonstrated an increase in CBF after AHT in those aged >70 years (standardized mean difference, 4.15 [95% CI, 0.16–8.15]; P=0.04, I2=42%), but not in those aged 50 to 65 and 65 to 70 years (standardized mean difference, 0.18 [95% CI,−2.02 to 2.38]; P=0.87, I2=49%; standardized mean difference, 1.22 [95% CI, −0.45 to 2.88]; P=0.15, I2=68%). Overall, risk of bias was moderate-to-high and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation) was very low, reflecting the observational nature of the data.Conclusions:Accepting the observed limitations, current evidence does not suggest a harmful effect of AHT on CBF. Concerns over CBF should not preclude treatment of hypertension.

Similarities in Hypertension Status but Differences in Mortality Risk: A Comparison of 2017 ACC/AHA and 2018 Chinese Hypertension Guidelines

BackgroundFew studies investigated the concordance in hypertension status and antihypertensive treatment recommendations between the 2018 Chinese Hypertension League (CHL) guidelines and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines and assessed the change of premature mortality risk with hypertension defined by the ACC/AHA guidelines.MethodsWe used the baseline data of the China Health and Retirement Longitudinal Study (CHARLS) to estimate the population impact on hypertension management between CHL and ACC/AHA guidelines. Mortality risk from hypertension was estimated using the data from China Health and Nutrition Survey (CHNS). Cox proportional hazards model was used to estimate the hazard ratios (HRs) and their 95% confidence intervals(CIs).ResultsAmong 13,704 participants analyzed from the nationally representative data of CHARLS, 42.64% (95% CI: 40.35, 44.96) of Chinese adults were diagnosed by both CHL and ACC/AHA guidelines. 41.25% (39.17, 43.36) did not have hypertension according to either guideline. Overall, the concordance in hypertension status was 83.89% (81.69, 85.57). A high percentage of agreement was also found for recommendation to initiate treatment among untreated subjects (87.62% [86.67, 88.51]) and blood pressure (BP) above the goal among treated subjects (71.68% [68.16, 74.95]). Among 23,063 adults from CHNS, subjects with hypertension by CHL had a higher risk of premature mortality (1.75 [1.50, 2.04]) compared with those without hypertension. The association diminished for hypertension by ACC/AHA (1.46 [1.07, 1.30]). Moreover, the excess risk was not significant for the newly defined Grade 1 hypertension by ACC/AHA (1.15 [0.95, 1.38]) when compared with BP <120/80 mmHg. This contrasted with the estimate from CHL (1.54 [1.25, 1.89]). The same pattern was observed for total mortality.ConclusionsIf ACC/AHA guidelines were adopted, a high degree of concordance in hypertension status and initiation of antihypertensive treatment was found with CHL guidelines. However, the mortality risk with hypertension was reduced with a non-significant risk for Grade 1 hypertension defined by the ACC/AHA.

Abstract TP136: Disparities In Care Of Patients With Intracerebral Hemorrhage According To Baseline Functional Status

Introduction: Disparities exist in acute ischemic stroke care according to patients’ pre-stroke functional status. However, the effects of baseline disability on the presentation and care of patients with intracerebral hemorrhage (ICH) are unknown. We aimed to understand this using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study. Methods: We ascertained all hospitalized ICH patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 GCNK) population; all cases were physician-reviewed. Per-stroke functional status was ascertained by medical record review. Baseline NIHSS, Glasgow coma scale (GCS), imaging modalities (CT/MRI), in-hospital rehabilitative therapies (rate and frequency), initiation of antihypertensive treatment, and discharge disposition between patients with pre-ICH mRS 0-1 vs ≥2 were compared using Wilcoxon rank-sum or chi-square tests. Logistic regression was used to evaluate the association between pre-stroke mRS and in-hospital therapy, post-discharge therapy, and ICH workup adjusting for age, Glasgow score, insurance status, and ICH location. Results: Of 350 patients with ICH, 187 (53%) had a pre-ICH mRS ≥2. Compared to those with pre-stroke mRS 0-1, these patients had more severe clinical presentation as measured by NIHSS and GCS (table). Among patients who were not made comfort care, no association between pre-ICH mRS and performance of inpatient MRI or in-hospital and post-discharge rehabilitative therapies was found in adjusted analyses. Conclusions: Patients with pre-ICH mRS &gt;2 were made comfort care at a higher rate, but for those not made comfort care there were no post-ICH disparities of care seen in the 2015 GCNK population-based cohort of 350 patients.

The Importance of the De Ritis Ratio and Glasgow Prognostic Score in prehypertensive patients

Aim: To evaluate Glasgow prognostic score (GPS) and De Ritis ratio in optimal blood pressure and prehypertensive patients, and investigate whether these parameters can predict antihypertensive treatment in the follow-up period.Methods: A total of 402 patients who were followed up with a 24-hour ambulatory blood pressure with a pre-diagnosis of hypertension between January 2018 and December 2018 were included in the study. Routine laboratory parameters of the patients were recorded in the hospital digital system. The common health system data of the patients was analyzed until June 2020, and those who were started on antihypertensive treatment were recorded.Results: 402 patients (mean age 40.16 ± 13.01 years, 49% male) were included in the study. 226 of these were in prehypertension group. The mean GPS and the De Ritis ratio, aspartate transferase levels, mean systolic and diastolic blood pressures were different between the groups (p=0.035, p=0.023, p=0.039, p&amp;lt;0.001 and p=0.012, respectively). When patients whose antihypertensive treatment was started and those who did not receive antihypertensive treatment were compared, age, De Ritis ratio and mean diastolic blood pressure differed between the two subgroups (p&amp;lt;0.001, p=0.015 and p=0.040, respectively). Multivariate logistic regression analysis showed that De Ritis ratio and age were, independently, predictors for antihypertensive treatment (OR:3.064, p=0.015 and OR:1.050, p= 0.001 respectively). In ROC curve analysis, both age and De Ritis ratio were successful at predicting the initiation of antihypertensive treatment with an AUC:0.697 and p&amp;lt;0.001 and AUC:0.630 and p=0.018 respectively.Conclusion: Both GPS and the De Ritis ratio were found to be significantly higher in prehypertensive patients than those with optimal blood pressure. Moreover, the De Ritis ratio, an easily calculated laboratory parameter, can be used as a predictive value for antihypertensive treatment.

Prediction Models for the 5- and 10-Year Incidence of Home Morning Hypertension: The Ohasama Study.

We aimed to develop risk prediction models for new-onset home morning hypertension. We followed up 978 participants without home hypertension in the general population of Ohasama, Japan (men: 30.1%, age: 53.3 years). The participants were divided into derivation (n = 489) and validation (n = 489) cohorts by their residential area. The C-statistics and calibration plots were assessed after the 5- or 10-year follow-up. In the derivation cohort, sex, age, body mass index, smoking, office systolic blood pressure (SBP), and home SBP at baseline were selected as significant risk factors for new-onset home hypertension (≥135/85 mm Hg or the initiation of antihypertensive treatment) using the Cox model. In the validation cohort, Harrell's C-statistic for the 5-/10-year home hypertension was 0.7637 (0.7195-0.8100)/0.7308 (0.6932-0.7677), when we used the full model, which included the significant risk factors in the derivation cohort. The calibration test revealed good concordance between the observed and predicted 5-/10-year home hypertension probabilities (P ≥ 0.19); the regression slope of the observed probability on the predicted probability was 1.10/1.02, and the intercept was -0.04/0.06, respectively. A model without home SBP was also developed; for the 10-year home hypertension risk, the calibration test revealed a good concordance (P = 0.19) but Harrell's C-statistic was 0.6689 (0.6266-0.7067). The full model revealed good ability to predict the 5- and 10-year home morning hypertension risk. Although the model without home SBP is acceptable, the low C-statistic implies that home BP should be measured to predict home morning hypertension precisely.

The impact of anti-hypertensive treatment on foetal growth and haemodynamics in pregnant women with pre-existing diabetes - An explorative study.

To explore the impact of anti-hypertensive treatment of pregnancy-induced hypertension on foetal growth and hemodynamics in women with pre-existing diabetes. A prospective cohort study of 247 consecutive pregnant women with pre-existing diabetes (152 type 1 diabetes; 95 type 2 diabetes), where tight anti-hypertensive treatment was initiated and intensified (mainly with methyldopa) when office blood pressure (BP) ≥135/85mmHg and home BP ≥130/80mmHg. Foetal growth was assessed by ultrasound at 27, 33 and 36weeks and foetal hemodynamics were assessed by ultrasound Doppler before and 1-2weeks after initiation of anti-hypertensive treatment. In 215 initially normotensive women, anti-hypertensive treatment for pregnancy-induced hypertensive disorders was initiated in 42 (20%), whilst 173 were left untreated. Chronic hypertension was present in 32 (13%). Anti-hypertensive treatment for pregnancy-induced hypertensive disorders was not associated with foetal growth deviation (linear mixed model, p=0.681). At 27weeks, mainly before initiation of anti-hypertensive treatment, the prevalence of small foetuses with an estimated foetal weight <10th percentile was 12% in women initiating anti-hypertensive treatment compared with 4% in untreated women (p=0.054). These numbers were close to the prevalence of birth weight ≤10th percentile (small for gestational age (SGA)) (17% vs. 4%, p=0.003). Pulsatility index in the umbilical and middle cerebral artery remained stable after the onset of anti-hypertensive treatment in a representative subgroup (n=12, p=0.941 and p=0.799, respectively). There is no clear indication that antihypertensive treatment causes harm in this particular at-high-risk group of pregnant women with diabetes, such that a larger well-designed study to determine the value of tight antihypertensive control would be worthwhile.

The impact of antihypertensive treatment initiation on health-related quality of life and cardiovascular risk factor levels: a prospective, interventional study

BackgroundEffective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year.MethodsIn this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months.ResultsWe found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year.ConclusionsOur study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life.Trial registration ClinicalTrials NCT02377960 (Date of registration: 04/03/2015).

INFLUENCE OF ANTIHYPERTENSIVE TREATMENT ON RAAS PEPTIDES IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS

Objective: Recently, the influence of antihypertensive treatment on the renin-angiotensin-aldosterone system (RAAS) gained increasing attention, especially since concerns were raised regarding a potential influence of RAAS inhibitors on Corona Virus Disease 2019 (COVID-19). Our objective was to study the effect of recently initiated antihypertensive drugs on Angiotensin (Ang) II (1–8) and Ang (1–7) as markers of the pro-inflammatory ACE/Ang II/Ang Type 1 receptor (AT1R) axis and the counteractive ACE2/Ang (1–7)/Mas R axis in patients with newly diagnosed hypertension. Design and method: Randomized, open-label trial investigating RAAS peptide profiles after initiation of antihypertensive treatment with either perindopril, olmesartan, amlodipine, or hydrochlorothiazide. Ang II and Ang (1–7) concentrations were measured at 8am and 12am at day of treatment initiation and after four weeks of treatment. Results: 80 patients were randomized in a 1:1:1:1 fashion. Between the four substances, we found significant differences for the concentrations of Ang II (p &lt; 0.0005 for 8 and 12am) and Ang (1–7) (p = 0.019 for 8am and &lt;0.0005 for 12am) four weeks after treatment start. Ang II was decreased by perindopril (p = 0.002), and increased by olmesartan (p &lt; 0.0005) and amlodipine (p = 0.012), and hydrochlorothiazide (p = 0.001) (Figure panel A). Ang (1–7) was increased by perindopril and olmesartan (p = 0.008 and 0.002), but not measurably altered by amlodipine and hydrochlorothiazide (p = 0.317 and 0.109) (Figure panel B). Conclusions: Initiation of antihypertensive therapy causes early and distinct alterations of equilibrium angiotensin levels. Given the additional AT1R blocking action of olmesartan, RAAS peptide shifts upon initiation of perindopril and olmesartan appear to work in favor of the anti-inflammatory axis compared to amlodipine and hydrochlorothiazide.

Clinical outcomes between calcium channel blockers and angiotensin receptor blockers in hypertensive patients without established cardiovascular diseases during a 3-year follow-up

Although both angiotensin receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs) are all suitable for the initiation of antihypertensive treatment, studies investigating efficacy and safety between ARBs and CCBs are limited, and there is no previous study comparing their clinical outcomes during long-term follow-up periods in real world setting. We compared cardiovascular (CV) events between ARBs and CCBs in 464,948 hypertensive adults using the Korean National Health Insurance Service database during a 3-year follow-up. The patients with hypertension without heart failure, ischemic heart disease, cerebrovascular disease, or peripheral artery disease were enrolled. The CV events between only single prescription of CCBs and ARBs were finally compared. The primary endpoint for this study was the first occurrence of a major adverse CV events, defined as the composite of all-cause death, cardiac death, nonfatal myocardial infarction, or nonfatal stroke. ARB was significantly more administered in male and patients with higher income, diabetes mellitus, chronic kidney diseases, and higher Charlson comorbidity index. The primary endpoints occurred in 10,526 patients (5.2%) in the ARB group and in 19,363 patients (7.3%) in the CCB group (p < 0.001) during a 3-year follow-up (HR 0.96, 95% CI 0.93–0.98). All the components of CV events including all-cause death, cardiac death, nonfatal myocardial infarction, and nonfatal stroke occurred more frequently in the CCB group. With multivariable models adjusting age, sex, income, diabetes, chronic kidney disease, and Charlson comorbidity index, the primary endpoints less frequently developed in the ARB group than in the CCB group (HR 0.957, 95% CI 0.933–0.983, p < 0.001). After the propensity-score matching, baseline characteristics were similar and still showed significantly better primary endpoints in ARB group than CCB group (5.3% vs. 5.8%, p < 0.001). In this nationwide population-based simple hypertension study, administration of ARBs showed superior protection against CV events than CCBs during a 3-year follow-up. Our results suggest that ARBs could be preferred over CCBs as the initial choice of antihypertensive treatment regardless of age in real-world practice.

Novel approaches to management of hypertension.

Of the roughly 1.4 billion people with hypertension worldwide, only about one in seven has their blood pressure (BP) successfully treated and adequately controlled. This review will focus on new therapeutic approaches of hypertension. Several recent clinical studies and guidelines have favoured the assessment of target organ damage and cardiovascular risk scores for the diagnosis and treatment approach of hypertension. Paradigm shifts recommended in the guidelines are the initiation of antihypertensive treatment with combination (not mono) therapy and the recommendation of single-pill combinations (SPC), which improve adherence and result in rapid and effective BP control. In clinical trials with optimized design and renal denervation (RDN) technology, the biological proof of concept has been established. Consistent, durable ambulatory and office BP reductions without procedure associated serious adverse events have been documented. The challenges are now to identify patients who respond best to interventional treatment. Major key points in the treatment strategy for hypertension are: individualization of the therapy according to total cardiovascular risk, combination therapy as initial step, recommendation of SPC and RDN as promising interventional therapy.

Adherence to anti-hypertensive medications and its determinants: A study among hypertensive stroke patients in a tertiary care government hospital of West Bengal.

There is a paucity of antihypertensive drug adherence studies among stroke patients in West Bengal. With an aim to identify antihypertensive drug adherence and its determinants, this descriptive cross-sectional study was conducted for 2 months among a calculated sample of 133 study participants using predesigned and pretested schedule, the metric "Proportion of days covered (PDC)," and the Morisky, Green, and Levine (MGL) Scale. Data were compiled and analyzed using SPSS software (version 20.0). Adherence rates were 31.6% and 44.4% based on the MGL scale and PDC method, respectively. Higher adherence was significantly associated with increased age (P = 0.006), higher literacy (P = 0.013), increased interval between diagnosis of hypertension and present symptom (P = 0.001), a greater gap between antihypertensive treatment initiation and present symptom (P = 0.003), receiving advice on regular drug intake (P = 0.000), and registered medical practitioner prescribing the medication (P = 0.007).