Antihypertensive Medication Intake Research Articles

Exploring Lifestyle Factors and Treatment Adherence among Older Adults with Hypertension Attending a Mobile Health Unit (MHU) in a Rural Area of Central Portugal.

This cross-sectional and analytical study aimed to characterize a sample of hypertensive older adults attending a Mobile Health Unit (MHU) in a rural area of central Portugal according to their lifestyle and to analyze the impact of lifestyles on treatment adherence. The sample comprised 235 Portuguese hypertense patients, mainly females (63.8%) with a mean age of 75 years (±8.14 years) and low level of education. The data collection was carried out through a questionnaire consisting of sociodemographic questions, dietary variables, an Alcohol Dependence Questionnaire, an International Physical Activity Questionnaire (Short Version), a Nutrition Health Determination Questionnaire, a Self-Care with Hypertension Scale, and an Adherence to Treatments Measurement Scale. Only 34.5% of the hypertensive patients have controlled blood pressure values (28.2% men and 38% women). However, more than half (56.2%) of the hypertensive patients are classified as adherent to therapeutic measures. The hypertensive individuals, who present higher levels of adherence to the treatment, do not present alcohol dependence, are frequent consumers of aromatic herbs, sporadically consume salt, present good nutritional health, and practice moderate physical activity. The predictor variables for treatment adherence are the self-care dimensions general dietary (p = 0.001), specific dietary (p = 0.034), physical activity (p = 0.031), and antihypertensive medication intake (p < 0.001). Hypertensive patients with healthier lifestyles present better levels of treatment adherence. Therefore, promoting physical activity and healthy dietary practices is necessary to improve treatment adherence and increase antihypertensive treatment's effectiveness.

Arterial Hypertension-clinical trials update 2023.

Arterial hypertension is associated with increased morbidity and mortality and research in the field is highly dynamic. This summary reviews the most important clinical trials published in 2022 and early 2023. Findings on new pharmacological approaches to treat resistant hypertension are presented and new knowledge about the optimal timing of the antihypertensive medication intake is discussed. It is focused on optimal blood pressure treatment targets and the problem of treatment and guideline inertia is acknowledged. Information about pregnancy-related hypertension is presented and blood pressure control following percutaneous thrombectomy after ischemic stroke is discussed. Finally, novel clinical data on device-based approaches to treat hypertension are summarized. The hypertension trials update summarizes the most important clincal trials on hypertension research in 2022 and early 2023. CTD - chlorthalidone, CV - cardiovascular, HCT - hydrochlorothiazide, SBP - systolic blood pressure, RDN - renal denervation *depicts systolic blood pressure only.

Aortic Coarctation Stenting in Adolescents and Adults: A Single-Center Experience.

The aim of this study was to evaluate the short and midterm results of aortic coarctation (AoCo) stenting in an adolescent and adult population. All patients with a AoCo older than 14years treated by stent placement between December 2000 and November 2016 were included in this study. Twenty-eight patients with an invasive peak systolic pressure gradient >20mmHg were identified. Number of redilations, non-invasive systolic blood pressure, peak systolic pressure gradient, antihypertensive medication intake, claudication status and complications were evaluated. Twenty-two covered and 6 uncovered stents were successfully placed. Peak systolic pressure gradient decreased immediately after stenting from a mean of 32 mmHg to 0mmHg (± 7mmHg). Mean AoCo diameter increased from 8 tot 16mm (± 4mm). Peripheral arterial injury was seen in 2 patients (7.1%). The mean follow-up time was 60 ± 49months. Redilation of the stent was required in 4 patients, 2 to accommodate for growth and 2 for restenosis. Six (35%) patients could stop all antihypertensive medication. All claudicants (6/28) became and remained asymptomatic after surgery and during their follow-up. No aneurysms, stent fractures or dissections were noticed. There were 2 stent migrations during the first procedure with only 1 needing additional stent placement. Aortic coarctation stenting is a safe and effective treatment that significantly reduces the peak systolic pressure gradient. Antihypertensive medication can be reduced, and increase of walking distance in claudicants can be obtained. Younger patients may need more frequent reinterventions to accommodate for growth.

DIETARY SODIUM RESTRICTION REDUCES NOCTURNAL BLOOD PRESSURE IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION

Objective: Patients with treatment resistant hypertension (TRH) are characterised by lack of blood pressure (BP) control despite antihypertensive treatment. They are at particular risk of cardiovascular disease and more likely to experience BP increase as a response to sodium loading than other individuals. In this study, we aimed to analyse if self-performed dietary sodium restriction could be implemented in patients with TRH. Moreover, we aimed to analyse the effect of this on nocturnal and 24h BP, and how BP changes were correlated to changes in plasma levels of BNP, nitric oxide and body water content. Design and method: The study was conducted as an interventional cross-over study including patients with TRH from 20-70 years. Patients were screened with 24h ambulatory BP monitoring initiated after observed intake of usual antihypertensive medication. They were included if 24h systolic BP&gt;130/80 mmHg. Study participation included two periods of 14 days; a standard period with usual diet and an interventional period with instructed dietary sodium restriction and handed-out sodium-free bread. At the end of each period, patients were examined with 24h BP monitoring, 24h urine collection (sodium excretion), blood samples (nitric oxide, BNP), and bioimpedance measurement (body water content). Results: Participation was completed by 15 patients with mean age 59 years and mean 24h BP 144/82 mmHg. Mean baseline urinary sodium excretion was 192(86) mmol/24h (11.2 grams of salt). As seen in Table 1, sodium excretion was reduced to 91 mmol/24h equalling 5.3 grams of salt. BP levels were reduced significantly. Plasma levels of nitric oxide increased significantly, and this was correlated to the change in 24h BP. Total body water content and plasma levels of BNP was reduced significantly. The changes in BP were not correlated to changes in sodium excretion, body water or BNP. Conclusions: Self-performed dietary sodium restriction could be implemented resulting in a significant reduction in BP levels. BP change was not related to changes in body water or sodium excretion. Increased levels of nitric oxide may be evidence of improved endothelial function and may be one of the involved mechanisms in BP decrease following sodium restriction

Nonadherence by Serum Drug Analyses in Resistant Hypertension: 7-Year Follow-Up of Patients Considered Adherent by Directly Observed Therapy.

Background Measurement of serum concentrations of drugs is a novelty found useful in detecting poor drug adherence in patients taking ≥2 antihypertensive agents. Regarding patients with treatment-resistant hypertension, we previously based our assessment on directly observed therapy. The present study aimed to investigate whether serum drug measurements in patients with resistant hypertension offer additional information regarding drug adherence, beyond that of initial assessment with directly observed therapy. Methods and Results Nineteen patients assumed to have true treatment-resistant hypertension and adherence to antihypertensive drugs based on directly observed therapy were investigated repeatedly through 7 years. Serum concentrations of antihypertensive drugs were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry from blood samples taken at baseline, 6-month, 3-year, and 7-year visits. Cytochrome P450 polymorphisms, self-reported adherence and beliefs about medicine were performed as supplement investigations. Seven patients (37%) were redefined as nonadherent based on their serum concentrations during follow-up. All patients reported high adherence to medications. Nonadherent patients expressed lower necessity and higher concerns regarding intake of antihypertensive medication (P=0.003). Cytochrome P450 polymorphisms affecting metabolism of antihypertensive drugs were found in 16 patients (84%), 21% were poor metabolizers, and none were ultra-rapid metabolizers. Six of 7 patients redefined as nonadherent had cytochrome P450 polymorphisms, however, not explaining the low serum drug concentrations measured in these patients. Conclusions Our data suggest that repeated measurements of serum concentrations of antihypertensive drugs revealed nonadherence in one-third of patients previously evaluated as adherent and treatment resistant by directly observed therapy, thereby improving the accuracy of adherence evaluation. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01673516.

MO093: Dietary Sodium Restriction Reduces Nocturnal Blood Pressure in Treatment Resistant Hypertensive Patients

Abstract BACKGROUND AND AIMS High blood pressure (BP) is an essential contributor to the risk of cardiovascular disease (CVD) and death. Hence, diagnosing and treating patients with high BP is paramount if the number of cardiovascular related death should be reduced. High nocturnal BP and blunting of normal nocturnal BP decrease have stronger correlation to the risk of CVD than high day time BP. Lowering nocturnal BP is assumed to reduce the risk of CVD. Patients with treatment resistant hypertension (TRH) represent a subgroup of hypertensive patients characterized by lack of BP control despite antihypertensive treatment. These patients are at particular risk of CVD and target organ damage. Patients with TRH are more likely to experience BP increase as a response to sodium loading than other individuals. Lifestyle modification is an important treatment angle in hypertensive patients. It is, in particular, central to reduce sodium intake, as high sodium intake increases the risk of TRH. Thus, in this study we aimed to analyse if self-performed dietary sodium restriction could be implemented in patients with TRH. Moreover, we aimed to analyse the effect of this attempted restriction on nocturnal BP and 24 h BP, on plasma levels of BNP and nitric oxide, and on body water content. METHOD Patients with TRH from 20 to 70 years with normal renal function were invited for participation in this cross-over interventional study. Patients were screened with 24 h ambulatory BP monitoring initiated after observed intake of usual antihypertensive medication, and they were included if 24 h systolic BP/diastolic BP ≥ 130/80 mmHg. Study participation included two periods of 14 days; a standard period with usual diet and an interventional period with instructed dietary sodium restriction and handed-out sodium-reduced bread. For both periods, all antihypertensive medication was dosed and handed out and ingested in the morning. At the end of each period, patients were examined with 24 h BP monitoring, 24 h urine collection (sodium excretion), blood samples (nitric oxide and BNP) and bioimpedance measurement (body water content). RESULTS Baseline characteristics of the fifteen included patients are shown in Table 1. Eleven of the patients were male. Patients had been treated for hypertension for a mean of 12.5 (7) years and excreted a mean of 11.2 grams of salt at baseline [192 (86) mmol sodium]. All patients but one reduced sodium excretion at follow up. Table 2 shows the effect of sodium restriction on BP, nitric oxide, BNP and body water content. Sodium excretion was reduced to 91 mmol/24 h, which equals 5.3 g of salt. BP (24 h, day and nocturnal) decreased significantly as well as body water content and plasma levels of BNP. These changes were, however, not correlated. Plasma levels of nitric oxide increased, but it was not related to the changes in BP. Nocturnal fraction of 24 h sodium excretion increased after sodium restriction; however, this was not correlated to changes in nocturnal BP. Renal function and urinary potassium excretion both remained unchanged. Four patients experienced side effects; three reported newly onset dizziness at follow-up; two of them had 24 h BP reduction &amp;gt; 10 mmHg systolic. One patient had increased creatinine and potassium at follow-up. CONCLUSION In a population of 15 treatment resistant hypertensive patients, we demonstrated that self-performed dietary sodium restriction could be implemented. Urinary sodium excretion was reduced significantly to 5.3 g/24 h. Nocturnal BP was reduced significantly; dipping status was, however, unchanged. Increased plasma levels of nitric oxide may be evidence of improved endothelial function. Hence, by the local vasodilating effect, NO may be one of the involved mechanisms in BP decrease following a sodium restriction. Reduced extracellular water content and BNP may be other explainable effects of BP reduction after inducing sodium restriction.

Prevalence and incidence of arterial hypertension and its risk factors in the 7,525 person-years Congolese adult population between 2012 and 2019 : results of the Bukavu observational study

BackgroundIn the Sub-Saharan African region, data on Arterial Hypertension (AHT) from longitudinal studies are scattered.This work analyzes the prevalence and incidence of AHT and its associated factors in an open cohort of Congolese adults in South Kivu. MethodsBetween 2012 and 2019, 2,633 subjects aged ≥ 15 years were monitored for at least 3 years. Baseline and follow-up included blood pressure (BP) measurements. AHT was defined as BP of at least 140/90 mmHg or intake of antihypertensive medication in patients with known AHT. Cox regression was used to analyze the association between risk factors and risk of AHT. ResultsThe prevalence of AHT increased from 24.8% to 29.0% and the proportion of controlled hypertensive participants rose from 46.9% to 56.6% (p=0.03). During the 7,525 person-years observation period, the incidence of AHT among 1,981 participants without AHT at baseline was 19.4/1000 person-years. The annual incidence of AHT (2.4% per year) was higher in urban (5.0% per year) than in rural areas (2.0% per year). The strongest determinants for incident AHT (p<0.05) were male gender [adjusted HR (aHR)=1.67 (1.08-2.59)], age between 40-59 years [aHR=2.26 (1.48-3.45)], age ≥ 60 years [aHR=3.53 (2.11-5.93)], urban residence [aHR=3.37 (2.07-5.50)], pre-hypertension [aHR=1.77 (1.16-2.70)], abdominal obesity [aHR=1.99 (1.29-3.07)] and smoking [aHR=2.01 (1.12-3.60)]. ConclusionThe present study shows that the prevalence and incidence of AHT are increasing in the Congolese general population. Consequently, improved strategies for the prevention and management of non-communicable diseases are very important in Sub-Saharan Africa.

Effectiveness of a School-Based Educational Intervention to Improve Hypertension Control Among Schoolteachers: A Cluster-Randomized Controlled Trial.

BackgroundThe control of hypertension is low in low‐ and middle‐income countries like India. We evaluated the effects of a nurse‐facilitated educational intervention in improving the control rate of hypertension among school teachers in India.Methods and ResultsThis was a cluster‐randomized controlled trial involving 92 schools in Kerala, which were randomly assigned equally into a usual care group and an intervention group. Participants were 402 school teachers (mean age, 47 years; men, 29%) identified with hypertension. Participants in both study groups received a leaflet containing details of a healthy lifestyle and the importance of regular intake of antihypertensive medication. In addition, the intervention participants received a nurse‐facilitated educational intervention on hypertension control for 3 months. The primary outcome was hypertension control. Key secondary outcomes included systolic blood pressure, diastolic blood pressure, and the proportion of participants taking antihypertensive medications. For the primary outcome, we used mixed‐effects logistic regression models. Two months after a 3‐month educational intervention, a greater proportion of intervention participants (49.0%) achieved hypertension control than the usual care participants (38.2%), with an odds ratio of 1.89 (95% CI, 1.06–3.35), after adjusting for baseline hypertension control. The odds of taking antihypertensive medications were 1.6 times higher in the intervention group compared with the usual care group (odds ratio, 1.62; 95% CI, 1.08–2.45). The reduction in mean systolic blood pressure was significantly greater in the intervention group by 4.2 mm Hg (95% CI, −7.2 to −1.1) than in the usual care group.ConclusionsA nurse‐facilitated educational intervention was effective in improving the control and treatment rates of hypertension as well as reducing systolic blood pressure among schoolteachers with hypertension.RegistrationURL: https://www.ctri.nic.in; Unique Identifier: CTRI/2018/01/011402.

Out-of-hospital cardiac arrest in elderly individuals

Abstract Background Out-of-hospital cardiac arrest (OHCA) is associated with poor outcome, particularly in elderly people. Due to the shift in global demographics towards an ageing population, understanding risk factors for OHCA is essential for the development of primary prevention strategies. Thus, we aimed to identify predictors for OHCA in a large, community-dwelling cohort of elderly individuals. Methods We analyzed data from 11,156 participants enrolled in a randomized, placebo-controlled primary prevention trial, investigating the effect of low-dose aspirin in individuals aged 70 years or above. At baseline all participants had no prior cardiovascular disease events, dementia or major physical disability. OHCA events occurring within 5 years were identified by probabilistic data-linkage with a state-wide out-of-hospital cardiac arrest registry. Possible predictors included age, sex, anthropometric measures, conventional cardiovascular risk factors, renal function and frailty. To evaluate the association with OHCA, we performed univariable and multivariable Cox regression analyses. In exploratory analyses we also evaluated the effect of low-dose aspirin on OHCA events. Results In the cohort 54.7% were female and median age was 74.1 years (Interquartile Range [IQR] 71.8–77.7). During a median follow up time of 4.7 years (IQR 3.4–6.0) we recorded 67 OHCA events with presumed cardiac cause. The incidence rate was 1.07 per 1,000 person-years (95% Confidence-Interval [CI] 0.80–1.40). The mortality rate following OHCA was 91.2% (n=62). Univariable Cox regression analyses identified age, sex, weight, abdominal circumference, serum creatinine, diabetes, arterial hypertension, intake of antihypertensive medication and pre-frailty as predictors for the outcome. In multivariable Cox regression analyses we identified age (Hazard Ratio [HR] 1.06, CI 1.00–1.13), female sex (HR 0.49, CI 0.26–0.94) and pre-frailty (HR 1.92, CI 1.03–3.58) to be independent predictors (Table). In exploratory analyses there was no effect of low-dose aspirin on OHCA (HR 1.52, CI 0.87–2.70). Conclusion In a large, contemporary cohort of healthy, elderly individuals we describe a significant incidence of OHCA events associated with a very high mortality. We identified age, sex and pre-frailty, but interestingly not conventional cardiovascular risk factors as independent predictors of OHCA. We could not show a benefit of low-dose aspirin treatment, although the number of events was small. Our findings emphasize the importance of preventive strategies for pre-frailty in elderly individuals. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The ASPREE study was primarily funded by the National Institute of Aging and National Cancer Institute at the National Institutes of Health (grant number U01AG029824), the Australian National Health &amp; Medical Research Council (grants 334047 &amp; 1127060), Monash University (Australia) and the Victorian Cancer Agency (Australia). Multivariable Cox regression analyses

IN PATIENTS'S PREFERENCES TO ASPIRIN COMPARING WITH ANTIHYPERTENSIVE MEDICATION AND STATINS FOR PRIMARY PREVENTION

Objective: According to recent data of Russian epidemiological studies and screening campaigns hypertension control and statins use in primary prevention is still poor. The aim of our study was assess of aspirin and statin use comparing with antihypertensive medication in Russian residents in terms of MMM19. Design and method: An opportunistic cross-sectional survey of volunteers aged 18 years from 21 Russian Regions (n = 5274) was performed in terms of international campaign MMM19. 1,834 of the residents were men (34.8%). 49.2% of the respondents were younger than 25 years, therefore, considering significant differences in age, further analysis of the data was performed among participants over 25 years (n = 2681). The questionnaire was being completed on presence of diabetes mellitus, history of cardiovascular complications, smoking and alcohol intake. Information regarding intake and omission of antihypertensive medication, aspirin, statins were clarified. Blood pressure (BP) was measured three times with automated and manual sphygmomanometers and mean value was calculated. Results: Only 73.6% hypertensive patients take antihypertensive therapy and 44.8% of them achieved target BP of less than 140/90 mm Hg. Data regarding statins and aspirin intake in participants with hypertension and diabetes is presented in table. Conclusions: Despite insufficient hypertension control and current guideline positions against aspirin prescribing for primary prevention – 42,7% of hypertensives take aspirin. Only half of the patients having diabetes with automatically indicated high or very high risk are taking statins. Independently of diabetes presence patients are more likely to take aspirin comparing with statins. It is remarkably that 18,3% of hypertensives prefer aspirin than antihypertensive medication.

HYPERTENSION CONTROL IN RUSSIAN RESIDENTS WITH MULTICOMPONENT ANTIHYPERTENSIVE THERAPY

Objective: To assess the hypertension control depending on the number of antihypertensive drugs in Russian sampling in terms of MMM19 screening. Design and method: An opportunistic cross-sectional survey of volunteers the age of 18 from 21 Russian Regions (n = 5274) was performed in terms of international campaign MMM19. 1,834 of the residents were men (34.8%). 49.2% of the respondents were younger than 25 years, therefore, considering significant differences in age, further analysis of the data was performed among participants over 25 years (n = 2681). The questionnaire was being completed on presence of diabetes mellitus, history of cardiovascular complications, smoking and drinking. Information regarding intake and omission of antihypertensive medication were clarified. Blood pressure (BP) was measured three times with automated and manual sphygmomanometers. Results: Average age of the participants was 49.3 ± 16.2 years (17–96 years old). 51.5% of the participants had history of hypertension (n = 1343), while 73.6% (n = 989) received antihypertensive therapy. 44.8% of patients (n = 444) achieved target BP of less than 140/90 mm Hg, and only 20.5% (n = 203) - less than 130/80 mm Hg. The percentage of achieving the target BP depending on medication number is illustrated in Figure 1. Conclusions: In Russian screening sample older 25 years the level of hypertension control remains low, especially when the criteria of target blood pressure is tightened. Half of patients achieved blood pressure level of less than 140/90 mm Hg and only one fifth of the participants achieved blood pressure level of less than 130/80 mm Hg. Despite multicomponent therapy, only 20–30% of patients in this category achieved target blood pressure level even they were less likely to miss medication.

SERUM CONC. OF ANTIHYPERTENSIVE DRUGS MAY REVEAL NON-ADHERENCE IN PATIENTS CONSIDERED TO HAVE TRUE TREATMENT RESISTANT HYPERTENSION ASSESSED BY DIRECTLY OBSERVED THERAPY

Objective: Detecting non-adherence is challenging. Both directly observed intake of antihypertensive medication (DOT) followed by 24 hour-ambulatory blood pressure monitoring and serum conc. measurements of antihypertensive drugs are objective methods considered reliable in revealing drug non-adherence. We aimed to investigate whether serum conc. offers additional information regarding drug adherence compared to DOT in patients with assumed true treatment resistant hypertension. Design and method: Patients referred for renal denervation (RDN) were thoroughly investigated and tested for adherence. 19 patients were defined as true treatment resistant when their daytime systolic BP remained high (&gt; 135 mmHg) after DOT. Blood samples were collected at baseline, 6 months and 3 years after RDN and analyzed using ultra high pressure liquid chromatography-tandem mass spectrometry. Partial non-adherence was defined as at least one undetectable drug (but not all)and non-adherence as no detectable drugs in serum. Results: Ten out of 56 blood samples (17.9%) showed too low levels of one or more drug to be compatible with drug adherence. Six patients were redefined as either non-adherent or partially non-adherent based on their serum conc. results. Their systolic BPs are shown in the Figure. Three of these six patients went through a renal denervation procedure, while the remaining three were randomized to control. One of two patients considered to be RDN responders, became adherent to medication after six months which may have contributed to the fall in BP. At the 3 years visit none of the five antihypertensive agents prescribed were detected, and the patient́s BP was again elevated. Conclusions: Non-adherence was revealed in more patients when serum conc. measurements of antihypertensive drugs were added to directly observed therapy. Serum conc. measurement is objective and quantitative, and since some antihypertensive drugs require regular intake over a certain period of time to have maximal effect, they may offer important additional information.

Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures.

We examine how combinations of systolic and diastolic blood pressure levels and pulse pressure levels predicted mortality risk. Respondents are those aged over 50 from the Health and Retirement Study (N=10,366) who provided blood pressure measures in 2006/2008. Systolic and diastolic blood pressures were measured three times; and we averaged the three readings. Pulse pressure was calculated as systolic minus diastolic blood pressure. Seven combinations of systolic and diastolic blood pressure (low/normal/high of each) and three levels of pulse pressure (low/normal/high) were used to categorize blood pressure. Over 1 to 10 years of follow-up (average follow-up time of 7.8 years), 2,820 respondents died after blood pressure measurement in 2006/2008. Potential covariates including age, gender, education, BMI, total cholesterol, HbA1c, antihypertensive medication intake and lifetime-smoking pack years were adjusted in Cox proportional hazard models and survival curves. The blood pressure subgroup with low systolic blood pressure (<90 mmHg) and low diastolic blood pressure (< 60 mmHg) had the highest relative risk of mortality (HR=2.34, 95% CI: 1.45-3.80), followed by those with normal systolic blood pressure but low diastolic blood pressure (HR=1.45, 95% CI: 1.17-1.81) among those with cardiovascular conditions at baseline. For those without cardiovascular conditions at baseline, low blood pressure, either systolic or diastolic, was not related to mortality. Those with high levels of both systolic and diastolic blood pressure had a higher risk of mortality than those with both blood pressures normal but no other subgroups with low blood pressure differed from normal/normal in predicting mortality. Pulse pressure did not predict mortality. How high and low blood pressures are related to mortality needs to be examined by jointly looking at systolic and diastolic blood pressure.

Acquired brachial cutaneous dyschromatosis

Acquired brachial cutaneous dyschromatosis (ABCD) is a relatively newly described, acquired disorder of pigmentation characterized by geographic-shaped, gray-brown, hyperpigmented patches and interspersed with hypopigmented macules, involving the dorsal aspects of the forearms in postmenopausal women. There is a suggested relationship with hypertension and antihypertensive medication intake, specifically angiotensin-converting enzyme inhibitors, or a cumulative effect of sun damage, as possible triggers. ABCD is benign, asymptomatic, and more of an esthetic concern. Topical depigmenting agents, chemical peels, and laser therapy may be helpful.

Comorbidity of hypertension and chronic venous disease in men

Aim. To study the clinical manifestations and characteristics of lower extremity chronic venous disorders (CVD) in working-age men with hypertension (HTN).Material and methods. The study included 74 men with HTN at the age of 30-50 years and 41 men without HTN. HTN duration and regularity of antihypertensive medication intake were studied. We analyzed complaints and objective signs associated with CVD, their severity, structural and functional parameters of superficial, deep and perforator veins of the lower extremities using the triplex ultrasound. The prevalence and severity of cardiovascular risk factors among patients with HTN and CVD and patients with HTN and without CVD were analyzed.Results. Men aged 30-50 with HTN showed a high prevalence of complaints (68%) associated with CVD: evening heaviness and fullness in the legs; pain decrease at rest; a combination of pain, spasm and swelling in long-time standing. Objective signs of CVD were recorded in 83,8% of men with HTN (most often — telangiectasia (38%) and swelling (24%)). Men with HTN were diagnosed with more severe manifestations of CVD than men without HTN. In patients with HTN, episodic pain and evening perimalleolar swelling were 1,8 and 4 times more likely, respectively, than in men without HTN. The presence of CVD and HTN was not associated with cardiovascular risk factors. HTN in men was characterized by a large-diameter veins, pathological reflux, vein tortuosity, the presence of thrombotic masses and postthrombotic lesions. In patients with HTN, along with an increased blood flow velocity in the deep and perforator veins of the lower leg, a low velocity in the deep femoral veins was observed. This is the evidence of venous insufficiency even at rest. Orthostasis in men with HTN increased the frequency of reflux in superficial veins by 2-4 times, which proves latent venous insufficiency.Conclusion. HTN is characterized by an increase in the frequency and severity of symptoms and signs of CVD, which indicates their comorbidity.

Effect of hypertension on salivary pH, salivary flow and buffering capacity: An in-vivo study

Introduction: Hypertension is a highly prevalent cardiovascular disease, which affects over 1 billion people worldwide. Although more than 70% of hypertensive patients are aware of the disease, only 23.49% are treated, and fewer (20%) achieve control. Aim of the study is to evaluate the influence of hypertension on ph. of saliva, saliva flow rate and buffer capacity in individuals. Material and methods: The subjects were categorized into the following four groups: Group 1- normal blood pressure (SBP of . Results: The DBP and SSFR were significantly higher in men than women. USSFR was almost equal in both males and females. 57.7% of analyzed subjects comprised individuals with normal blood pressure, 12.3% of these subjects took antihypertensive medication. 17.3% of all subjects included individuals taking antihypertensive medication. Statistically significant difference was not observed for hypertension or intake of antihypertensive medication and unstimulated or stimulated salivary flow rate. However, a statistically significant difference was observed for the pH of unstimulated among the four groups. Conclusion: In conclusion, the contributory factors in maintaining the integrity of oral cavity is salivary flow rate, pH and the buffering action of the saliva. Use of anti-hypertensive medications effects pH of un-stimulated saliva which can be lead to many oral detrimental changes Keywords: Hypertension, Salivary pH, Salivary flow, Buffering capacity.

Associations between dietary patterns and blood pressure in a sample of Australian adults

BackgroundInvestigating effects of whole diets on blood pressure (BP) can contribute to development of diet-based recommendations for health. Our aim was to assess the relationship between dietary patterns and BP in a sample of free-living Australian adults.MethodsUsual dietary patterns of participants recruited to dietary intervention studies were assessed using factor analysis (two 24-h recalls). The mean of seven days of daily, seated BP measurements were used.ResultsComplete data from 251 participants (112 males; mean age 55.1(9.1) (SD) years; body mass index (BMI) 29.5(3.9) kg/m2) was included. Three dietary patterns were identified. Only Dietary Pattern 2 was positively associated with home systolic BP (β = 1.88, 95% CI 0.16, 3.60) after adjusting for age, sex, BMI, anti-hypertensive medication, smoking, education, physical activity and energy intake. This dietary pattern was characterised by high consumption of low-fibre bread, pasta, noodles and rice, meat dishes, poultry dishes and egg dishes, mixed cereal dishes, salted nuts and low consumption of milk and yoghurt (low-fat), vegetable juice, vegetables and high-fibre bread. Dietary Pattern 2 was also positively associated with intakes of energy (P = 0.002) and sodium (P = 0.005) and inversely associated with potassium intake (P = 0.002). After adjustment for energy, only the inverse association with potassium remained (P < 0.001).ConclusionsIn this sample of Australian adults, Dietary Pattern 2 was associated with higher BP and thus chronic disease risk, supporting the evidence that diets high in energy and sodium, and low in potassium from vegetables and dairy, are detrimental to cardiovascular health.

Association Between Dietary Patterns and Kidney Function in Patients With Chronic Kidney Disease: A Cross-Sectional Analysis of the German Chronic Kidney Disease Study

In the general population, "healthy" dietary patterns are associated with improved health outcomes, but data on associations between observance of specific dietary patterns and kidney function in patients with chronic kidney disease (CKD) are sparse. Dietary intake was evaluated using food frequency questionnaires in patients with moderately severe CKD under nephrology care enrolled into the observational multicenter German CKD study. The Dietary Approaches to Stop Hypertension (DASH) diet score, Mediterranean diet score, and German Food Pyramid Index (GFPI) were calculated and their association with estimated glomerular filtration rate (eGFR) and albuminuria was assessed by multivariable linear regression analysis, adjusted for gender, age, body mass index, energy intake, smoking status, alcohol intake, education, high-density lipoprotein-cholesterol (HDL- cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), hypertension, and diabetes mellitus. A total of 2,813 patients (41% women; age 60.1±11.6years) were included in the analysis. High DASH diet score and GFPI were associated with lower systolic blood pressure and lower intake of antihypertensive medication, higher HDL, and lower uric acid levels. Mediterranean-style diet was associated with lower prevalence of diabetes mellitus. Higher DASH and Mediterranean diet scores were associated with higher eGFR (β-coefficient=1.226, P < .001; β-coefficient=0.932, P=.007, respectively). In contrast, GFPI was not associated with eGFR. For the individual components of the dietary patterns, higher intake of nuts and legumes, cereals, fish, and polyunsaturated fats was associated with higher eGFR and higher intake of dairy, composed of low- and whole-fat dairy, was associated with lower eGFR. No association was found between dietary patterns and albuminuria. Higher observance of the DASH or Mediterranean diet, but not German food pyramid recommendations, was associated with higher eGFR among patients with CKD. Improving dietary habits may offer an opportunity to better control comorbidities and kidney function decline in patients with CKD.

TRADITIONAL RISK FACTORS OR ADMA IN PATIENTS WITH RHEUMATOLOGIC DISEASES – WHAT IS MORE IMPORTANT FOR CARDIOVASCULAR RISK?

Objective: Causes and mechanisms of increased cardiovascular morbidity and mortality in patients with rheumatologic diseases now are in epicenter of research. The aim of the present study was to compare traditional risk factors and asymmetric dimethyl arginine (ADMA), as a marker of endothelial dysfunction, in patients with various rheumatologic diseases and patients with increased intima-media thickness (IMT) without cardiovascular diseases (CVD). Design and method: The study included 208 patients with rheumatologic diseases: 67 patients with systemic sclerosis (SSc), 49 patients with rheumatoid arthritis (RA), 41 patients with Sjogren disease (SD) and 51 patients with systemic lupus erythematosus (SLE). Comparison group consisted of 63 patients with 3 or more traditional cardiovascular risk factors and subclinical carotid atherosclerosis (carotid IMT more than 0.9 mm) without clinical signs of CVD. Hypercholesterolemia was determined at a total cholesterol level> 4.9 mmol/L or statins intake. Hypertension was detected in patients with systolic blood pressure > 140 mm Hg and/or diastolic blood pressure > 90 mm Hg or antihypertensive medication intake. Hyperglycemia was determined at a glucose level> 5.6 mmol/L. Obesity was detected in body mass index>30 kg/m2. Statistical analysis was performed using SPSS Statistics 20. Results: Results of comparison of groups are presented in table.Conclusions: In comparison group prevalence of obesity, metabolic disorders and increased cardiovascular risk was significantly higher than in rheumatologic patients. Despite that increased level of ADMA was more common for rheumatologic diseases group. It can be assumed that increased cardiovascular morbidity and mortality in rheumatologic patients can be associated more with disease-specific endothelial dysfunction than with the influence of traditional cardiovascular risk factors.

What factors do influence arterial hypertension control in Russia

In the work, the results presented, gathered in the multicenter study ESSE-RF, and characterizing factors associated with insufficient control of blood pressure (BP) in arterial hypertension (AH) patients. Aim. Evaluation of the factors associated with insufficient BP control in Russian males and females age 25-64 y. o., with AH, by the ESSE-RF data. Material and methods . Representative selections were assessed of 13 regions of Russia, males (n=5563) and females (n=9737) 25-64 y. o., investigated in 2012-2013 y. Systematic stratified multistage random selection was applied. Response about 80%. All participants were surveyed with a standard questionnaire (demography, anamnesis, wealth). Mean values were calculated (M±m), quintiles and ranges. Methods of analytical statistics were applied: dispersion-co variation, logistic regression, odds ratio. Results . Two groups were revealed, with raised BP, that differ basically. Group one, those with BP higher than 140/90 mm Hg, not taking antihypertensive medication, and group two — those who take medications, but do not reach target BP. Group one consists of men almost 2 times more, with risk factors, but no cardiovascular diseases in anamnesis. Only the heart rate (HR) and alcohol overconsumption significantly positively correlate with the treatment absence in men — OR=1,49 (p<0,001) and OR=1,47 (p<0,0001), respectively, as in women — OR=1,41 (p<0,003) and OR=1,62 (p<0,0001). Group two is characterized by higher level of the risk factors, and complete model of logistic regression has revealed positive associations of high HR, general obesity, high triglycerides and glucose with ineffective treatment in males; in females — high HR, general obesity. Conclusion. It is necessary to apply various approaches to increase the number of persons with controlled BP. Broad informing on healthy lifestyle, incl. target BP levels in those who do not visit physician office. Screening in AH is necessary, esp. for antihypertensive medication intake control.