Strategies For Management Of Hypertension Research Articles

Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension.

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.

Observing the uncertainty of the Amlodipine-Candesartan Incremental Cost-Effectiveness ratio using Deterministic Sensitivity Analysis (DSA)

Background: Hypertension treatment is carried out for a long time and can cause quite large costs. This study delves into the economic evaluation of Amlodipine-Candesartan combination therapy, a prominent treatment for hypertension. While the clinical benefits of this regimen are well-documented, its cost-effectiveness remains a critical consideration for healthcare systems. Employing Deterministic Sensitivity Analysis (DSA). This study aimed to discern the uncertainty surrounding the Incremental Cost-Effectiveness Ratio (ICER) associated with Amlodipine-Candesartan through comprehensive examination, next to refine economic assessments and offer insights for healthcare policymakers and practitioners. Method: This retrospective descriptive study at Andalas University Hospital in 2021 analyzed hypertension outpatient data. Of 284 patients, 73 were included. Among them, 28.77% received Amlodipine monotherapy, while 71.23% received Amlodipine-Candesartan combination therapy. Results: The ICER for systolic blood pressure was Rp. 74,738.10 per mmHg decrease, and for diastolic blood pressure, it was Rp. 205,918.24 per mmHg decrease. Both of them are in the northeast quadrant. Next, DSA will be carried out by creating a tornado diagram by providing a change range of 20% (min-max) for the input variables in ICER. Conclusion: The use of amlodipine-candesartan requires a higher cost, but the resulting effect is also better. Our findings contribute to the broader discourse on combination therapies and inform resource allocation strategies for hypertension management. This research attempts to enhance the precision of economic evaluations, ultimately facilitating more informed and efficient healthcare decision-making processes. Keywords: Amlodipine, Candesartan, Cost-effectiveness, ICER, DSA.

The Effect of Giving “Semundu” Juice with a Combination of Probiotics on Blood Pressure in Pre-Hypertension Patients

Hypertension is a medical condition characterized by elevated blood pressure beyond normal limits. Management strategies for hypertension can be pharmacological or non-pharmacological. This study aims to evaluate the effect of administering "semundu" juice combined with yogurt on reducing blood pressure in individuals with hypertension in the Jembatan Kecil Health Center area, Bengkulu City, in 2024. A total of 28 participants with high blood pressure were randomly assigned to one of four groups: P0 (control group receiving educational leaflets), P1 (200g watermelon juice, 100g cucumber, and 20ml honey), P2 (100g Ambon banana, yogurt), and P3 (200g watermelon juice, 100g cucumber, 20ml honey, and yogurt). The Kruskal-Wallis test results indicated that the administration of "semundu" juice combined with probiotics significantly affected both systolic and diastolic blood pressure, as evidenced by a p-value of less than 0.05. All treatment groups demonstrated a reduction in blood pressure, with significant differences observed between the groups: P0 vs. P3 (p-value < 0.02), P1 vs. P3 (p-value < 0.034), and P2 vs. P3 (p-value < 0.01). These findings suggest that "semundu" juice combined with probiotics has a notable impact on lowering blood pressure in individuals with hypertension.

Social support and physical literacy in young and middle-aged patients with hypertension: the mediating effects of sense of coherence and self-efficacy

BackgroundDespite the growing recognition of the importance of social support and physical literacy in managing hypertension among young and middle-aged patients, there is a lack of research exploring the mediating effects of sense of coherence and self-efficacy in this relationship. This study aims to bridge this gap by investigating the interplay between social support, physical literacy, sense of coherence, and self-efficacy, thus contributing to a deeper understanding of effective interventions for hypertension management.MethodsA cross-sectional study was conducted using convenience sampling to survey 280 young and middle-aged patients diagnosed with hypertension from five community settings in Zhejiang and Anhui provinces between January and February 2024. Measurement instruments included the General Information Questionnaire, Physical Literacy Scale for Young and Middle-aged Patients with Hypertension, Sense of Coherence Scale 13, General self-efficacy Scale, and Perception Social Support Scale. Data analysis was performed using SPSS 27.0 and AMOS 28.0, with reporting following the STROBE checklist.ResultsA total of 270 valid questionnaires were collected. The total score of physical literacy for young and middle-aged patients with hypertension ranged from 18 to 90, with a mean score of 62.30 ± 13.92, indicating a moderate level. There was a positive correlation between the physical literacy score and the scores of social support (r = 0.557, P<0.01), sense of coherence (r = 0.392, P<0.01), and self-efficacy (r = 0.466, P<0.01) among young and middle-aged patients with hypertension. Furthermore, social support was found to have multiple mediating effects through sense of coherence and self-efficacy on physical literacy.ConclusionThis study sheds light on the interconnectedness of social support, physical literacy, sense of coherence, and self-efficacy among young and middle-aged patients with hypertension. The findings underscore the importance of considering these factors holistically in hypertension management strategies.

Comparative Efficacy of Hypertension Management Strategies

Comparative Efficacy of Hypertension Management Strategies

The Impact of Hypertension on Cognitive Decline and Alzheimer's Disease and Its Management: A Systematic Review.

Hypertension, a major risk factor for cardiovascular diseases, has also been linked to cognitive decline and Alzheimer's disease (AD). This systematic review synthesizes the current evidence on how managing hypertension may influence cognitive health, particularly among elderly populations and those with cognitive impairments. By analyzing data from randomized controlled trials (RCTs), clinical trials, and cross-sectional studies, we evaluated the efficacy of various interventions, including pharmacological treatments, lifestyle modifications, and multidomain approaches that address blood pressure (BP) variability and intensive versus standard blood pressure control. Our findings reveal that effective blood pressure management can mitigate cognitive decline and potentially alter the course of Alzheimer's disease. However, the results also highlight complexities, such as the risk of adverse effects from intensive blood pressure control on cognitive processing and hippocampal volume. This review underscores the need for tailored hypertension management strategies that balance cardiovascular health with cognitive outcomes, suggesting that stabilizing blood pressure variability could play a crucial role. Future research should focus on longitudinal studies to refine these management strategies and enhance treatment guidelines, improving overall outcomes for patients at risk of cognitive decline.

The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension.

The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.

Temporal trend of first-line drug choice and treatment continuity for hypertension among citizens 75 years or over - a register-based, cohort study

BackgroundLimited knowledge of antihypertensive treatment of the elderly potentially impedes effective strategies for hypertension management in this growing patient group. We aimed to investigate temporal trends for first-line drug choice for antihypertensive treatment and treatment continuity among patients ≥75 years from 2000 to 2021. MethodsUsing nationwide Danish registers, patients ≥75 years initiated for the first time on antihypertensive drugs: Angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB), thiazides, or combinations, were identified. Patients with other indications than hypertension were excluded. Treatment continuity was described using claimed prescriptions the first 180 days following study entry. ResultsFrom 2000 to 2021, 170,769 patients (median age 80 years [interquartile range:77–84], 60.3% female) were included. From 2000 to 2003 to 2015–2021 the proportion of first-line drug choice increased for ACEi (8.7% to 14.9%), ARB (4.1% to 23.9%), and CCB (10.7% to 27.6%), decreased for thiazides (60.6% to 15.9%) and remained stable for BB (12.9% to 14.1%) and combinations (2.9% to 3.6%). For 157,457 patients alive after 180 days, discontinuation was highest among patients initiated on thiazides (28.3%) whereas most patients continued the same single drug regimen if they started on ACEi (55.2%), ARB (65.0%), BB (57.2%) or CCB (59.3%). ConclusionsFrom 2000 to 2021 thiazides have been replaced by ACEi, ARB and CCB. Thiazides had the lowest treatment continuity while ARB appeared preferred slightly over ACEi. Differences in adherence in relation to first-line drug choice may warrant scrutiny regarding recommendations for the elderly.

Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities.

Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus. To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.

Impact of educational intervention on hypertension management by primary care physician: A randomized control trial

ObjectiveThe current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. MethodsThis randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. ResultsA total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. ConclusionAfter the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. InnovationThe study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

A Randomized Controlled Trial to Assess the Effectiveness of Warm Foot Soak Therapy on Reduction of Blood Pressure among Hypertensive Patients

Introduction : Hypertension is known as the “silent killer” because of its uncertain symptom. Therefore, early detection efforts are needed such as regular blood pressure check and effective management. Both Pharmacological and Non-pharmacological management strategies for hypertension. This study aimed to determine the effectiveness of one of the non-pharmacological management : “warm water foot soak therapy” in reduction of blood pressure among hypertensive patients. Method : Experimental study design - Randomized Controlled Trial was conducted among 60 hypertensive patients using convenient sampling technique. Participants were randomly and equally allocated into Experimental and Control group with the help of computer generated randomization list. Sequentially Numbered Opaque Sealed Envelope (SNOSE) were used for allocation concealment. Experimental group received “Warm foot soak therapy” of both feet for 10-15 cm above ankle in warm water of temperature 37-40 degree Celsius for 15 minutes, once a day for 3 consecutive days. Before and after intervention blood pressure assessment were taken in both groups. Data were analyzed using SPSS ver. 27 Result : Homogenity of socio-demographic, clinical and pre-intervention blood pressure among both groups were statistically established using chi-square test (p&gt; 0.05). Paired t test concluded that, warm foot soak therapy were having statistically significant effect on blood pressure ( p &lt; 0.05) and there was a significant reduction in blood pressure among hypertensive patients (p=0.01). The study also discovered that there is no significant association between selected sociodemographic &amp; clinical variables with pre-interventional change in blood pressure except for the dietary pattern (Veg) in both groups &amp; presence of comorbidity (DM) in experimental group among hypertensive patients at level of significance 0.05. Conclusion : The study demonstrated that warm foot soak therapy have an effect on reduction of blood pressure among hypertensive patients.

Current insights and future perspectives of flavonoids: A promising antihypertensive approach.

Hypertension, or high blood pressure (BP), is a complex disease influenced by various risk factors. It is characterized by persistent elevation of BP levels, typically exceeding 140/90 mmHg. Endothelial dysfunction and reduced nitric oxide (NO) bioavailability play crucial roles in hypertension development. L-NG-nitro arginine methyl ester (L-NAME), an analog of L-arginine, inhibits endothelial NO synthase (eNOS) enzymes, leading to decreased NO production and increased BP. Animal models exposed to L-NAME manifest hypertension, making it a useful design for studying the hypertension condition. Natural products have gained interest as alternative approaches for managing hypertension. Flavonoids, abundant in fruits, vegetables, and other plant sources, have potential cardiovascular benefits, including antihypertensive effects. Flavonoids have been extensively studied in cell cultures, animal models, and, to lesser extent, in human trials to evaluate their effectiveness against L-NAME-induced hypertension. This comprehensive review summarizes the antihypertensive activity of specific flavonoids, including quercetin, luteolin, rutin, troxerutin, apigenin, and chrysin, in L-NAME-induced hypertension models. Flavonoids possess antioxidant properties that mitigate oxidative stress, a major contributor to endothelial dysfunction and hypertension. They enhance endothelial function by promoting NO bioavailability, vasodilation, and the preservation of vascular homeostasis. Flavonoids also modulate vasoactive factors involved in BP regulation, such as angiotensin-converting enzyme (ACE) and endothelin-1. Moreover, they exhibit anti-inflammatory effects, attenuating inflammation-mediated hypertension. This review provides compelling evidence for the antihypertensive potential of flavonoids against L-NAME-induced hypertension. Their multifaceted mechanisms of action suggest their ability to target multiple pathways involved in hypertension development. Nonetheless, the reviewed studies contribute to the evidence supporting the useful of flavonoids for hypertension prevention and treatment. In conclusion, flavonoids represent a promising class of natural compounds for combating hypertension. This comprehensive review serves as a valuable resource summarizing the current knowledge on the antihypertensive effects of specific flavonoids, facilitating further investigation and guiding the development of novel therapeutic strategies for hypertension management.

Association between sleep quality and blood pressure control among hypertensive patients at a rural tertiary hospital in Southern Nigeria: a cross-sectional study

ObjectivesRestorative sleep is critical in preventing hypertension and other chronic diseases. Limited research has explored the relationship between sleep quality and hypertension in Africa. This study investigated the association between...

Effectiveness of Hypertension Management Strategies in SPRINT-Eligible US Adults: ASimulation Study.

Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long-term impact of 4 hypertension management strategies in SPRINT-eligible US adults. The validated Blood Pressure Control-Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT-eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline-recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team-based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT-eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team-based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment-related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team-based care by 27 200. As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team-based care to usual care may be a pragmatic way to manage risk in this high-CVD-risk population.

Sex differences in cardiovascular risk factors and quality of life among individuals with hypertension in Korea from 2013 to 2018: A cross-sectional cohort study.

As its prevalence increases and its association with cardiovascular disease and mortality is established, there is a need to improve prevention and management strategies for hypertension. Therefore, we aimed to compare differences in cardiovascular health status between men and women with hypertension defined by systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg, and/or treatment with antihypertensive drugs. The association between cardiovascular health status and health-related quality of life was also evaluated. Additionally, a secondary analysis was performed on the cross-sectional data from 7306 adults with hypertension, ≥40 years of age between 2013 and 2018. Of this sample, 51.2% of patients were women from the Korean National Health and Nutrition Examination Survey. The seven Cardiovascular Health Metrics were used to quantify cardiovascular health status and the 5-dimensional European Quality of Life Questionnaire (EQ-5D) was used to evaluate health-related quality of life. A higher proportion of men than that of women was observed in the poor cardiovascular health score group [total score 0-7], with a higher proportion of women in the intermediate group [total score 8-10] and ideal group [total 11-14] (p<0.0001). The proportion of women in the EQ-5D index was higher than that of men in the poor and intermediate groups (p<0.0001), with no difference in the proportion of men and women in the ideal group (p = 0.1452). Furthermore, specific cardiovascular risk factors were different between men and women: women had lower physical activity level and higher prevalence of high cholesterol (≥200 mg/dl), and men had higher body mass indices and worse diet management. These findings indicate that prevention and management strategies for hypertension and cardiovascular health might need to differ for men and women to improve outcomes.

Determinants of blood pressure control in hypertensive individuals using histogram-based gradient boosting: findings from 1114 male workers in South Korea

Hypertension is a significant public health concern, particularly among workers, due to its association with increased risk of cardiovascular and cerebrovascular diseases. This study aimed to identify key factors influencing blood pressure control in hypertensive male workers aged 40 and above using the Histogram-based Gradient Boosting (HGB) algorithm. Data were drawn from the 2017–2020 Korean National Health and Nutrition Examination Survey (KNHANES), including 1114 male participants who reported being diagnosed with hypertension by a physician. The HGB model was compared with five other machine learning models: Random Forest, XGBoost, LightGBM, CatBoost and AdaBoost. The HGB model demonstrated superior performance with an accuracy of 82.3%, precision of 80.5%, recall of 78.9% and F1-score of 79.7%. Feature importance analysis revealed that age, Body Mass Index (BMI) and physical activity were the most significant factors influencing blood pressure control. Other notable factors included sodium intake, stress levels and medication adherence. The study’s findings underscore the importance of targeted interventions focusing on these key factors to improve hypertension management strategies. By employing advanced machine learning techniques, this research provides valuable insights into the determinants of blood pressure control, offering a foundation for developing effective strategies to reduce hypertension-related complications and mortality among Korean male workers.

Study on the effectiveness of a community hypertension management model based on home smart blood pressure monitoring using IoT technology.

Hypertension is rapidly increasing in China, but control rates are significantly low. There is a pressing need for effective management models in primary community health settings. In April 2023, 459 patients from six communities in Jinan City were enrolled using a multi-stage random sampling method and assigned to either a control group comprising 243 participants or an intervention group comprising 216 participants. The control group received standard hypertension care, whereas the intervention group participated in a novel IoT-based remote blood pressure monitoring program for 6 months. Data collection was conducted through detailed questionnaire surveys, cloud platform records, and community management records, both before and after the intervention period. The study employed difference-in-differences (DID) and mediation effect models to assess the effects of the IoT-based management model. The DID model demonstrated that the intervention significantly reduced systolic blood pressure by 9.883 mm Hg and diastolic blood pressure by 6.553 mm Hg. The mediation effect model showed that the frequency of blood pressure measurement and attitudes and beliefs toward hypertension treatment had mediating effects, accounting for 5.82 and 8.07% of the total effect, respectively. The heterogeneity analysis revealed significant regional differences: rural residents experienced a greater decrease in systolic and diastolic blood pressures by 14.85 mm Hg and 6.591 mm Hg, respectively, compared to urban residents, whose diastolic pressure decreased by 6.046 mm Hg. It is advisable to develop differentiated hypertension management strategies tailored to specific regional needs to promote the deep integration and widespread application of smart blood pressure monitoring technology. Enhancing patient awareness and capabilities in managing their health condition is crucial for improving the blood pressure control level among community hypertension patients.

An Exploration of Dietary Strategies for Hypertension Management: A Narrative Review.

This review aims to clarify the influence of various nutritional approaches in the management of hypertension.An extensive search of databases, namely, PubMed, Cochrane Library, Scopus, and Web of Science, was performed, covering the period from January 2012 to October 2023. We used keywords, such as "hypertension,""nutrition,""nutritional management,""nutrient intake,""dietary strategies,""DASH diet,""Mediterranean diet,"and related terms.Hypertension, a grave global health concern, affects more than one billion people worldwide. Lifestyle modifications, including nutritional strategies, are important in non-pharmacological interventions. Dietary patterns, such as the DASH (DietaryApproaches to Stop Hypertension) and Mediterranean diets, which emphasize fruit and vegetable consumption, have demonstrated efficacy in reducing blood pressure. Certain nutrients, such as potassium, calcium, and magnesium, have significant effects on blood pressure. The mechanisms underlying these dietary strategies include vasodilation, improvement in endothelial function, regulation of sodium balance, and mitigation of oxidative stress. However, successful implementation of these strategies can be hindered by various factors, such as adherence challenges, socioeconomic disparities, and cultural preferences. In conclusion, robust evidence supports the effectiveness of nutritional strategies in the management of hypertension. DASH and Mediterranean diets, along with an increased intake of specific nutrients, contribute to blood pressure reduction. Hence, comprehensive lifestyle modifications, with a focus on nutritional changes, are recommended as primary or complementary treatments for hypertension. Addressing the identified barriers could enhance the efficacy and use of these dietary approaches in clinical practice.

Comparing cardiovascular outcomes and costs of perindopril-, enalapril- or losartan-based antihypertensive regimens in South Africa: real-world medical claims database analysis

Abstract Background Effective strategies for hypertension management are essential to reduce associated morbidity and mortality in sub-Saharan Africa, where blood pressure control rates are alarmingly low. Renin-angiotensin-aldosterone system (RAAS) inhibitors are recommended as first-line treatment; however, differences in class or molecule-specific effects have not been conclusively demonstrated. Purpose This real-world study analysed medical insurance claims data to assess clinical and cost outcomes of antihypertensive therapy based on the three most commonly prescribed RAAS inhibitors in South Africa: perindopril, losartan and enalapril. Methods Patients on standard doses of perindopril, enalapril or losartan (alone or in combination with other agents) for ≥12 months prior to January 2015 were identified from a large, South African private health insurance database. Anonymised patient-level claims over the next 5 years (January 2015 to December 2019) were analysed in patients with ≥80% adherence. The primary outcome was the risk-adjusted rate of the composite of myocardial infarction (MI), ischaemic heart disease (IHD), heart failure (HF) or stroke. The key secondary clinical outcome was the risk-adjusted all-cause mortality rate; risk-adjusted costs per life per month (PLPM) in South African Rands (ZAR) were also assessed. Results In total, 63,489 patients who received perindopril (n=32,857), losartan (n=16,693) or enalapril (n=13,939) were included. Within the 5-year study period, the risk-adjusted rate of ≥1 claim for MI, IHD, HF or stroke (primary outcome) was significantly lower with perindopril than losartan (205 vs 221 per 1000 patients; P&amp;lt;0.0001) or enalapril (205 vs 223 per 1000 patients; P&amp;lt;0.0001). The risk-adjusted all-cause mortality rate was also significantly lower with perindopril than enalapril (100 vs 139 deaths per 1000 patients; P=0.007), but similar to that with losartan (100 vs 94 deaths per 1000 patients; P=0.650). Perindopril was also associated with significantly lower overall risk-adjusted costs than the other agents, with mean (95% confidence interval) costs PLPM of ZAR 1342 (87–8973) for perindopril, ZAR 1466 (104–9365) for losartan (P=0.0044) and ZAR 1540 (77–10,546) for enalapril (P=0.0003). Conclusion In this real-world analysis of South African individuals with hypertension, perindopril-based regimens were associated with a lower rate of cardiovascular events (MI, IHD, HF and stroke) over 5 years than enalapril- or losartan-based regimens. Perindopril also provided considerably greater cost-saving benefits, both statistically and socioeconomically, compared with the other RAAS inhibitor agents. Although these observations need to be confirmed in a broader South African population, including those treated in the public health sector, they may have significant implications for the choice of antihypertensive therapy.Time to outcome event over 5 yearsRisk-adjusted cost in South African Rand

Qualitative Study on Knowledge of Non-Pharmacological Interventions as Management Strategies for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State

Recent World Health Organization records show that hypertension is more common in Africa than in other parts of the world, and remains a major common risk factor for cardiovascular diseases, stroke, renal diseases, and death. However, little is known about hypertension management strategies among people in rural areas. Therefore, this phenomenological study aimed to investigate knowledge of hypertension management strategies among middle-aged adults in rural areas of Anambra state. Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). The data were analysed thematically. Results showed that the participants were all aware of hypertension but lacked in-depth knowledge of disease management strategies. Most of the participants did not believe that engaging in regular physical exercise/activity, and other factors like reduction in salt and alcohol intake could help in controlling high blood pressure. Social workers who are also social service providers are needed to raise awareness among middle-aged people in rural areas about hypertension management strategies. This can be done through the provision of social services like education, health services, and transport services, as this will go a long way in helping rural dwellers gain more knowledge of hypertension management strategies. With the provision of health services, the rural population will not only know management strategies for hypertension but will also be able to check their blood pressure regularly, while transport services will make it possible for the rural population who do not have health centres in their community and means of transporting themselves to the neighbouring community for treatment to do so. Future research should focus on the importance of welfare/home visits as an avenue for awareness creation on hypertension management strategies, as this will be an avenue for the provision of better social services for people in rural areas and an improvement in social service research.