Long-term Blood Pressure Control Research Articles

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial

(Abstracted from JAMA 2023;330:1991–1999 Worldwide, about 10% of pregnancies are affected by an abnormal rise in maternal blood pressure (BP). Individuals whose BP remains high 6 weeks after birth are more likely to have higher BP 5 to 10 years later.

The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis

BackgroundPrevious systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions.MethodsWe conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality.ResultsWe included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible.ConclusionsNurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.

Mechanisms of inflammation modulation by different immune cells in hypertensive nephropathy.

Hypertensive nephropathy (HTN) is the second leading cause of end-stage renal disease (ESRD) and a chronic inflammatory disease. Persistent hypertension leads to lesions of intrarenal arterioles and arterioles, luminal stenosis, secondary ischemic renal parenchymal damage, and glomerulosclerosis, tubular atrophy, and interstitial fibrosis. Studying the pathogenesis of hypertensive nephropathy is a prerequisite for diagnosis and treatment. The main cause of HTN is poor long-term blood pressure control, but kidney damage is often accompanied by the occurrence of immune inflammation. Some studies have found that the activation of innate immunity, inflammation and acquired immunity is closely related to the pathogenesis of HTN, which can cause damage and dysfunction of target organs. There are more articles on the mechanism of diabetic nephropathy, while there are fewer studies related to immunity in hypertensive nephropathy. This article reviews the mechanisms by which several different immune cells and inflammatory cytokines regulate blood pressure and renal damage in HTN. It mainly focuses on immune cells, cytokines, and chemokines and inhibitors. However, further comprehensive and large-scale studies are needed to determine the role of these markers and provide effective protocols for clinical intervention and treatment.

Place of imidazoline receptor agonists in the treatment of arterial hypertension

The review is devoted to one of the most controversial issues of modern antihypertensive therapy — the role of new generation sympatholytics — selective I1-imidazoline receptor agonists (AIRs). In modern European recommendations, AIR (moxonidine rilmenidine), along with other centrally acting drugs (reserpine, alpha-methyldopa, clonidine), are mainly intended for additional therapy in rare cases of resistant hypertension, when other treatment options have been ineffective. Nevertheless, AIR invariably finds its place in Russian recommendations for the treatment of arterial hypertension (AH). This class of drugs is recommended for patients with AH in combination with metabolic syndrome and obesity. It is noted that an important property of AIR is its positive effect on carbohydrate and lipid metabolism. This information is based on an analysis of Russian and foreign studies, which convincingly indicate that this class of drugs not only provides adequate and long-term blood pressure control, but also has the above-mentioned positive metabolic effects. At the same time, AIRs are much less likely to cause side effects characteristic of older generation centrally acting drugs. Thus, AIRs have become firmly established in clinical practice in Russia for the treatment of patients with AH in certain clinical situations.

Multivariable risk model for postpartum re-presentation with hypertension: development phase

ObjectivesPostpartum hypertension is one of the leading causes of re-presentation to hospital postpartum and is associated with adverse long-term cardiovascular risk. Postpartum blood pressure monitoring and management interventions have been...

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management

Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum. Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months. Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care. The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure. Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was -5.80 mm Hg (95% CI, -7.40 to -4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was -6.51 mm Hg (95% CI, -8.80 to -4.22; P < .001). In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK. ClinicalTrials.gov Identifier: NCT04273854.

RENAL DENERVATION REDUCES RETINAL ARTERIAL REMODELING IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: Renal denervation has been shown to be a safe and effective method to lower blood pressure (BP) in patients with uncontrolled treatment resistant hypertension (TRH). Patients with TRH and T2DM typically show hypertrophic arteriolar remodeling, which is associated with the development of early target end-organ damage. By using the retinal vasculature as a mirror of vascular remodeling in the systemic circulation, arteriolar remodeling can be non-invasively assessed with Scanning Laser Doppler Flowmetry (SLDF). In this analysis we assessed the impact of RDN on retinal arteriolar remodeling in patients with TRH and T2DM. Design and method: Retinal arteriolar remodeling was assessed using SLDF together with office and 24-hour ambulatory BP before and 6 as well as 12 months after renal denervation in 22 patients with TRH and T2DM. All patients participated in the investigator initiated study program “Renal Denervation in Treatment Resistant Hypertension” (NCT01687725). SLDF allows confocal measurement of the retinal arteriolar parameters, such as outer (OD) and inner (ID) diameter. Based on ID and OD the following parameters of arteriolar remodeling are derived: retinal arteriolar wall thickness (WT), wall-to-lumen ratio (WLR), and retinal arteriolar crosssectional area (CA). Results: Retinal arteriolar parameters were analysed in 18 male and 4 female patients with 6.5 antihypertensive medications on average. There was a significant reduction of systolic and diastolic 24-hour ambulatory as well office BP 6 as well as 12 months after RDN (table 1). In 77.3% of the patients number of antihypertensive medications was reduced. We found a reduction of hypertrophic retinal arteriolar remodeling and also a reduction of WLR 12 months after RDN (table 1). Of note, no significant changes of retinal arteriolar remodeling were found 6 months after RDN. Conclusions: In very high-risk patients with TRH and T2DM endovascular RDN reduced retinal arteriolar remodeling and retinal wall-to-lumen ratio, a prognostic marker of further end-organ damage. Whereas BP-changes already occurred 6 months after RDN, changes in retinal arteriolar remodelling were observed 12 months after RDN. We conclude that after RDN reversal of arteriolar remodeling happens slowly and requires long-term effective BP control.

Interventions for reducing blood pressure in prehypertension: A meta-analysis.

We aimed to address which interventions best control blood pressure (BP) and delay disease progression in prehypertension and to give recommendations for the best option following a quality rating. A Bayesian network meta-analysis was used to assess the effect of the intervention on BP reduction, delaying hypertension progression and final outcome, with subgroup analyses for time and ethnicity. Recommendations for interventions were finally based on cumulative ranking probabilities and CINeMA. From 22,559 relevant articles, 101 eligible randomized controlled trial articles (20,176 prehypertensive subjects) were included and 30 pharmacological and non-pharmacological interventions were evaluated. Moderate-quality evidence demonstrated that angiotensin II receptor blockers, aerobic exercise (AE), and dietary approaches to stop hypertension (DASH) lowered systolic blood pressure (SBP). For lowering diastolic blood pressure (DBP), AE combined with resistance exercise (RE) or AE alone provided high quality evidence, with calcium channel blockers, lifestyle modification (LSM) combined with drug providing moderate quality evidence. LSM produced the best BP lowering effect at 12 months and beyond of intervention. In Asians, TCD bubble was moderate quality evidence for lowering SBP and RE may have had a BP lowering effect in Caucasians. No recommendation can be given for delaying the progression of hypertension and reducing mortality outcomes because of low to very low quality of evidence. AE combined RE are preferentially recommended for BP control in prehypertension, followed by DASH. Long-term BP control is preferred to LSM. Asians and Caucasians add TCD bubble and RE to this list as potentially effective interventions. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022356302, identifier: CRD42022356302.

Predictive value of gut microbiota in long-term blood pressure control: a cross-sectional study

ObjectivesTo investigate the prediction of long-term blood pressure control using the intestinal flora of patients with hypertension.MethodsA total of 125 patients with primary grade-2 hypertension who attended the cardiovascular department of Hebei Province Hospital of Chinese Medicine between April 2021 and April 2022 were enrolled; these included 65 patients with substandard long-term blood pressure control (the uncontrolled group) and 60 patients with standard long-term blood pressure control (the controlled group). General clinical data and data on morning stools and diet were recorded for all the enrolled patients. The 16 s rDNA sequencing of faecal intestinal flora was also performed to analyse the differences in intestinal flora between the two groups of patients and to investigate the relationship between blood pressure compliance and the presence of flora.ResultsThe intestinal flora of the two groups of patients differed in terms of the Firmicutes–Bacteroidetes ratio (F/B), α-diversity analysis (Chao1, ACE and Shannon) results and β-diversity analysis results. At the genus level, the number of Streptococcus and Paraprevotella in patients in the uncontrolled group was greater than that of the controlled group, and the level of Akkermansia and Bifidobacterium was lower than that in the controlled group. A logistic regression analysis of the difference factors found differences in ACE, F/B, Streptococcus, Paraprevotella and Akkermansia in the two groups; these differences remained after correcting for age, gender and body mass index. The receiver operating characteristic curves revealed the following: ACE (area under the curve [AUC] = 85.282), Streptococcus (AUC = 82.705), Akkermansia (AUC = 77.333), Paraprevotella (AUC = 66.154) and F/B (AUC = 60.436).ConclusionsThere were significant differences in the intestinal flora of the patients in the controlled blood group compared with that of the uncontrolled group. Therefore, the ACE, genus levels of Streptococcus and Akkermansia could provide some prediction of late blood pressure compliance or non-compliance in patients with hypertension.

Sodium-glucose cotransporter 2 inhibition does not improve the acute pressure natriuresis response in rats with type 1 diabetes.

What is the central question of this study? Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular risk in patients with both diabetic and non-diabetic kidney disease: can SGLT2 inhibition improve renal pressure natriuresis (PN), an important mechanism for long-term blood pressure control, which is impaired in type 1 diabetes mellitus (T1DM)? What is the main finding and its importance? The SGLT2 inhibitor dapagliflozin did not enhance the acute in vivo PN response in either healthy or T1DM Sprague-Dawley rats. The data suggest that the mechanism underpinning the clinical benefits of SGLT2 inhibitors on health is unlikely to be due to an enhanced natriuretic response to increased blood pressure. Type 1 diabetes mellitus (T1DM) leads to serious complications including premature cardiovascular and kidney disease. Hypertension contributes importantly to these adverse outcomes. The renal pressure natriuresis (PN) response, a key regulator of blood pressure (BP), is impaired in rats with T1DM as tubular sodium reabsorption fails to down-regulate with increasing BP. We hypothesised that sodium-glucose cotransporter 2 (SGLT2) inhibitors, which reduce cardiovascular risk in kidney disease, would augment the PN response in T1DM rats. Non-diabetic or T1DM (35-50mg/kg streptozotocin i.p.) adult male Sprague-Dawley rats were anaesthetised (thiopental 50mg/kg i.p.) and randomised to receive either dapagliflozin (1mg/kg i.v.) or vehicle. Baseline sodium excretion was measured and then BP was increased by sequential arterial ligations to induce the PN response. In non-diabetic animals, the natriuretic and diuretic responses to increasing BP were not augmented by dapagliflozin. Dapagliflozin induced glycosuria, but this was not influenced by BP. In T1DM rats the PN response was impaired. Dapagliflozin again increased urinary glucose excretion but did not enhance PN. Inhibition of SGLT2 does not enhance the PN response in rats, either with or without T1DM. SGLT2 makes only a minor contribution to tubular sodium reabsorption and does not contribute to the impaired PN response in T1DM.

S-58-3: HOW COULD CONTINUOUS CUFFLESS AUTOMATED BLOOD PRESSURE MEASUREMENT DEVICES CONTRIBUTE TO HYPERTENSION MANAGEMENT?

Evidence that hypertension is the most importat global risk factor for cardiovascular morbidity and mortality, and demonstration of the cardiovascular protection offered by antihypertensive treatment, have been based on upper-arm cuff blood pressure (BP) measurements. This approach is recommended by current hypertension guidelines for BP measurement in clinical practice, as well as for validation of novel BP measuring devices. However, the spot or intermittent BP measurements in static conditions allowed by arm-cuff devices are unable to identify and track the continuous and rapid BP changes characterizing daily life. Moreover, cuff-based BP measurements are exposed to errors related to cuff size, shape and positioning, and cuff inflation may itself induce an alerting response and produce discomfort in the users during daily activities and in particular during sleep, which may modify the measured BP levels. To face these issues, use of continuous recordings techniques, not based on arm-cuff inflation, would be required. This is possible through intra-arterial recordings, which however are not feasible in daily practice because of their invasiveness. An alternative solution is represented by photoplethysmographic volume-clamp method for finger BP monitoring which, however, is difficult to implement in clinical practice because of its cost and complexity. Technological progress is now offering an increasingly large and heterogeneous series of cuffless BP monitors, which estimate BP based on sensors, signal processing and algorithms embedded in wearable devices, smartphones or pocket devices. These cuffless devices might allow for comfortable and continuous BP recordings, detecting rapid BP changes during day and night sleep, thus offering information on both short, mid and long term BP variability. Cuffless devices might also be useful for continuous non invasive BP monitoring in different clinical settings, including ICUs, during anaesthesia, in patients with arrhythmias, hypotension/syncope, and other transient conditions affecting BP levels and variability. Moreover, cuffless BP measurement devices connected to telemonitoring facilities or smartphones apps may improve patients empowerment, adherence to treatment and long-term BP control. In spite of all these potential advantages, however, cuffless BP devices have to face specific accuracy issues, which would need refinement of specific validation protocols aimed at testing the need of individual calibration, the stability of measurements after calibration and the device actual ability to track BP changes before they might be recommended for clinical use.

AW-APSH-1: TARGETING WINDOWS OF PLASTICITY TO PREVENT HYPERTENSION.

Failing lifestyle interventions, there are many classes of anti-hypertensive drugs that are highly effective in most patients if taken appropriately. But multiple agents taken daily may be required to achieve target blood pressure (BP). The problem is that the majority of patients are non-compliant: they do not take their drugs continuously, choose to only take some, or stop taking them completely. It is time to focus on interventions that do not require lifelong daily medications, and this requires understanding and treating the causative factors. For decades, it has been understood that the kidney, under the influence of both the renin-angiotensin-aldosterone system and sympathetic nerves, has a dominant role in the long-term control of extracellular fluid volume and BP. The kidney is an important target for the treatment of hypertension. Early postnatal life is a period of remarkable plasticity and is a neglected window of opportunity to prevent disease onset. Our aim is to preserve and protect function of existing nephrons. If born with reduced renal mass (less nephrons), the compensatory response is to increase the filtration rate of each individual nephron so that GFR is maintained. Clinically, the degree of nephron overload is linked to faster age and disease related reduction in renal functional reserve, glomerular damage, albuminuria and hypertension. By targeting the postnatal period of maturation, our aim is to prevent maladaptive compensatory hypertrophy and hyperfiltration to preserve kidney health-span without the need for lifelong drug therapy. Our studies in a large animal model of congenital renal mass reduction demonstrate the long-term therapeutic potential of a brief period of angiotensin converting enzyme inhibition early in life to alter the trajectory of renal and cardiovascular disease.

The Safety and Efficacy of Clonidine in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Background: Clonidine is a frequently prescribed long-term antihypertensive medication in hemodialysis (HD) patients in the USA, but its safety and efficacy has not been clearly established in the HD population. Objective: To evaluate, we conducted a systematic review and meta-analysis on the safety and efficacy of clonidine in HD patients. Methods: Keyword search of “clonidine” and “dialysis” was conducted through April 2021 in PubMed, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov databases. Inclusion criteria were as follows – study design: randomized controlled trials, cohort studies, prospective studies, retrospective studies, or case series; subjects: adult HD patients; main outcome: blood pressure (BP) and safety; language: English; and article type: peer-reviewed publications. Studies that examined the effects of clonidine in populations other than adult HD patients were excluded. Meta-analysis was performed on BP reduction outcomes. Results: Eight studies met the inclusion criteria for the systematic review, including prospective pre-post studies (2), double-blind controlled trial (1), single-blinded placebo-controlled trial (1), crossover open-label clinical trial (1), retrospective analysis (1), and case report series (2). Three studies included in the meta-analysis ranged from 2 to 12 weeks duration, with a collective sample size of 24 (ages 12–77 years). Risk of bias, assessed using the ROBINS-1 tool, was high for all included studies. Significant adverse effects reported included hypotension, light-headedness, drowsiness, dry mouth, rebound hypertension, and contact dermatitis from patch application. Short-term clonidine use was associated with significant improvement in systolic BP (pooled effect: −12.985 mm Hg, 95% CI [−7.878, −18.092], p < 0.001), while changes in diastolic BP were not statistically significant (−11.119 mm Hg, 95% CI [−22.725, 0.487], p = 0.060). No data currently support the long-term efficacy of clonidine in HD patients. This study was unfunded and was developed using PRISMA guidelines and registered on PROSPERO (CRD42018112042). Conclusions: There is no evidence supporting the long-term use of clonidine in the HD population and a significant side-effect profile. There is low-quality evidence demonstrating the efficacy of clonidine in lowering BP in HD patients in short-term use, but significant safety concerns remain. Fluid removal strategies and other antihypertensives should be used over clonidine for long-term BP control in the HD population.

Abstract P353: SOME ATYPICAL PRESENTATIONS OF HYPERALDOSTERONISM

Primary hyperaldosteronism (PA) has an incidence between 5% to 13% as a cause of secondary hypertension. Independent of hypertension, PA itself has demonstrated cardiovascular side effects. Therefore, it may be worthwhile to be aware of any unusual presentations of PA. Our case series shows 2 unique presentations of PA. Cases: A 68-year-old woman with a past medical history of hypertension and hypokalemia had a negative workup for secondary hypertension including PA 10 years ago. She was managed on amiloride however developed a breakthrough with elevated blood pressure (BP), hypokalemia, high serum aldosterone level of 36.6 ng/dl, and low renin of 0.8 ng/ml/hr. CT of the abdomen showed bilateral adrenal hyperplasia (BAH), more prominent on the left side along with a 1.6cm nodule. Adrenal vein sampling (AVS) showed an aldosterone level 3.5 times higher on the left side, but the right adrenal gland aldosterone production was not suppressed. Repeat AVS is now planned. A 63-year-old male with a past medical history of PA in the setting of BAH was treated with an eplerenone-based regimen. During one of his routine nephrology office visits, the patient had potassium of 2.2mmol/L and elevated BP. MRI of the abdomen showed an adenoma of 2 cm on the left adrenal gland. Proper lateralization was documented and underwent left adrenalectomy which proved to be beneficial. Discussion: BAH and unilateral adrenal adenomas account for 90% of PA cases. BAH is medically managed, however, if disease lateralization is noted, surgery may be an option for better long-term BP control. Our first patient had BAH with no documented PA, however, she developed a breakthrough event after several years, and a repeat workup documented a dominant nodule. AVS is still unclear in this patient, and we plan to repeat it. Our second case shows the maturation of one of the adrenal nodules in the setting of well-controlled BAH to produce breakthrough symptoms of PA. Lateralization was documented leading to a successful surgical intervention. A significant improvement in BP and return to normokalaemia was noted clearly exemplifying the role of surgery in BAH.

Hubungan Karakteristik Penderita Hipertensi dengan Tingkat Kepatuhan Minum Obat di RSUD Embung Fatimah Kota Batam

Hypertension is one of the non-communicable diseases which is a problem in the health sector and is often found in primary health services. A person is said to suffer from hypertension when systolic blood pressure ≥ 140 mmHg and diastolic pressure ≥ 90 mmHg. The use of antihypertensive drugs alone is proven to be insufficient to produce long-term blood pressure control effects if it is not supported by adherence to the use of antihypertension. The high incidence of hypertension in the world, is influenced by two types of factors, namely factors that cannot be changed such as age, sex, and race. Furthermore, factors that can be changed include obesity, alcohol consumption, lack of exercise, excessive salt consumption, and smoking habits. The purpose of this study was to determine the relationship between the characteristics of hypertension sufferers with the level of adherence to take medication at Embung Fatimah District Hospital in Batam. This study used a cross-sectional descriptive study method using the MMAS-8 (Morisky Medication Adherence Scale) questionnaire. Respondents who were the subject of this study were suffering from hypertension at Embung Fatimah Regional Hospital in Batam. The sampling technique used is a simple random sampling technique with a total sample of 96 people. The results of this study generally showed that 36.5% of patients had high adherence to take hypertension medication while the remaining 13.5% of patients had moderate adherence and as many as 50% had high adherence. To support the success rate of hypertension treatment can be done with the presence of hypertension counseling so that adherence to taking medication for hypertension sufferers can increase.

Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities.

Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.

PATHOGENICITY AND LONG-TERM OUTCOMES OF LIDDLE SYNDROME CAUSED BY A NONSENSE MUTATION OF SCNN1G IN A CHINESE FAMILY

Objective: Liddle syndrome (LS) is a common monogenic hypertension with continuous activation of epithelial sodium channels (ENaCs) encoded by SCNN1A, SCNN1B, and SCNN1G. This study aimed to identify the pathogenicity of a nonsense mutation in SCNN1G in a Chinese family with LS and the outcomes of tailored treatment with amiloride. Design and method: Clinical data were collected from six family members and this mutation site was reported by our team at 2015. To explore the pathogenicity of candidate variants, we constructed mutant and wild-type models in vitro and measured amiloride-sensitive current in Chinese Hamster Ovary cells using patch clamp technique. Participants were followed up for 6 years to monitor their target organ damage after tailored treatment with amiloride. Results: Four family members presented with severe hypertension and hypokalemia, and two had stroke. This nonsense variant resulted in a termination codon at codon 572, truncating the Pro-Pro-Pro-X-Tyr motif. The mutant epithelial sodium channels displayed higher amiloride-sensitive currents than the wild-type channels (P &lt; 0.05). Tailored treatment with amiloride achieved ideal blood pressure control in the patients, and no adverse events occurred during follow-up. Conclusions: We found the pathogenicity of a nonsense SCNN1G mutation (p.Glu571*) with enhanced amiloride-sensitive currents in a LS family. Tailored treatment with amiloride may be an effective strategy for the long-term control of blood pressure and the prevention of cardiovascular events in these patients.

DIFFERENCES IN BOLD MRI SIGNAL INTENSITY BETWEEN HYPERTENSIVE PATIENTS AND HEALTHY VOLUNTEERS

Objective: An increased sympathetic tone is associated with the initiation and maintenance of most forms of arterial hypertension. Background activity of a core network of neurons in the brain and brainstem is supposed to be important for long-term blood pressure control. Imaging techniques such as blood oxygen level dependant magnetic resonance imaging (BOLD MRI) are now capable of detecting changes in oxygenation within the brain using blood oxygen levels. So far, the BOLD fMRI signal intensity changes provoked by a cold pressor test (CPT) have not been compared between hypertensive patients (HT) and normotensive subjects (NT). The primary objective was to compare the signal intensity changes in HT and NT participants. Design and method: This was a prospective case-controlled study. A 7 tesla MRI was used for fMRI acquisition. BOLD MRI signal intensity changes during a cold pressure test and during rest were analyzed using statistical parametric mapping (SPM) for whole brain analysis. The connectivity CONN toolbox was used to analyze functional networks. Results: 30 NT subjects (age 34 ± 10 (mean ± SD), BMI 23 ± 2 kg/m2, systolic blood pressure (SBP) 117 ± 10 mm Hg and diastolic blood pressure (DBP) 71 ± 9 mm Hg) and 16 HT patients (age 46.5 ± 13, BMI 27 ± 3 kg/m2, SBP 148 ± 11 mm Hg and DBP 92 ± 6 mm Hg) were enrolled. The CPT increased the SBP by 21 ± 20 (median ± SD) and 25 ± 24 mm Hg in NT and HT, respectively, and the DBP by 20 ± 19 (NT) and 19 ± 17 (HT) mm Hg. BOLD fMRI signal intensity increased significantly in NT but not in HT. The pattern of resting state connectivity was different between NT and HT, with a decreased global connectivity in HT. Conclusions: BOLD fMRI signal intensity responses to CPT test were less pronounced in HTA patients compared to NT. The different response to stress may be secondary to different neuronal activity pattern during the resting state between the two groups as suggested by connectivity analysis.

Pathogenicity and Long-Term Outcomes of Liddle Syndrome Caused by a Nonsense Mutation of SCNN1G in a Chinese Family.

ObjectiveLiddle syndrome (LS) is a monogenic hypertension consistent with autosomal dominant inheritance, often with early onset high blood pressure in childhood or adolescence. This study aimed to identify the pathogenicity of a nonsense mutation in SCNN1G in a Chinese family with LS and the long-term outcomes of tailored treatment with amiloride.MethodsTo explore the pathogenicity of candidate variant reported in 2015 by our team, we constructed mutant and wild-type models in vitro and measured amiloride-sensitive current in Chinese Hamster Ovary (CHO) cells using patch clamp technique. Participants were followed up for 7 years after tailored treatment with amiloride.ResultsA nonsense variant was detected in six members, two of whom were pediatric patients. This mutation resulted in a termination codon at codon 572, truncating the Pro-Pro-Pro-X-Tyr motif. The mutant epithelial sodium channels displayed higher amiloride-sensitive currents than the wild-type channels (P < 0.05). Tailored treatment with amiloride achieved ideal blood pressure control in all patients with normal cardiorenal function, and no adverse events occurred during follow-up.ConclusionWe found the pathogenicity of a nonsense SCNN1G mutation (p.Glu571*) with enhanced amiloride-sensitive currents in a LS family with young patients. Tailored treatment with amiloride may be an effective strategy for the long-term control of blood pressure and protection from target organ damage or cardiovascular events, including children and youth patients with LS.

Long-Term Secondary Prevention: Management of Blood Pressure After a Transient Ischemic Attack or Stroke.

Reducing blood pressure (BP) is a highly effective strategy for long-term stroke prevention. Despite overwhelmingly clear evidence from randomized trials that antihypertensive therapy substantially reduces the risk of stroke in primary prevention, uncertainty still surrounds the issue of BP lowering after cerebrovascular events, and the risk of recurrent stroke, coronary events, and vascular death remains significant. Important questions in a secondary prevention setting include should everyone be treated regardless of their poststroke BP, how soon after a stroke should BP-lowering treatment be commenced, how intensively should BP be lowered, what drugs are best, and how should long-term BP control be optimized and monitored. We review the evidence on BP control after a transient ischemic attack or stroke to address these unanswered questions and draw attention to some recent developments that hold promise to improve management of BP in current practice.