Mean Decrease In Diastolic Blood Pressure Research Articles

Improving Access to Home Blood Pressure Monitors at a Federally Qualified Health Center.

Background: Self-monitoring of blood pressure (BP) clinically decreases BP. However, cost can limit access, especially in underserved populations. Objective: This mixed-methods pilot study aims to determine the impact of providing home BP monitors free of charge to patients at a federally qualified health center (FQHC) by quantifying the effect on BP and surveying patients to measure satisfaction and engagement. Methods: One hundred eighty patients with clinically diagnosed hypertension received BP monitors. Patient charts were reviewed to collect demographics and office BP readings 3 months before and after receiving a monitor. A 13-question phone survey was conducted to a sample of patients addressing satisfaction and engagement. Answers were based on a Likert scale and dichotomous yes/no. Results were analyzed with descriptive statistics and paired t tests. Results: The chart review demonstrated a significant mean decrease in systolic BP by 5.44 mm Hg (P < 0.001, -8.03 to -2.84) and a mean decrease in diastolic BP by 2.70 mm Hg (P < 0.001, -4.08 to -1.32) after the intervention. For those included who responded to the survey (13%), there was a significant mean increase in the frequency of checking BP per week by 1.5 Likert points (P < 0.00001, -1.0 to -1.9), and a majority (57.8%) felt slightly or much more active in their health care in addition to other benefits. Conclusion: Providing BP monitors to FQHC patients free of charge may have contributed to a significantly decreased office BP, improved engagement, and satisfaction. This program removed cost barriers and allowed patients to be more active in their health care.

Remote Automated Peritoneal Dialysis Management in Colombia

Remote Automated Peritoneal Dialysis Management in Colombia

Pharmacological stress myocardial perfusion scintigraphy: use of a modified adenosine protocol in patients with asthma

Stress radionuclide myocardial perfusion scintigraphy (MPS) using adenosine pharmacological vasodilatation is the preferred method in many centres because of its convenience, safety and speed. It can, however, cause bronchospasm and hence its use is avoided in patients with known or suspected bronchospasm. Owing to service pressures, we use technologist-led adenosine stressing for patients referred for MPS studies. We use a modified adenosine infusion protocol under medical supervision for patients with asthma to prevent and minimize adenosine-induced bronchospasm. In this study, we audited our use of this modified protocol in asthmatic patients and compared the side-effect profile with the standard adenosine protocol used in nonasthmatic patients. We audited 50 consecutive patients with asthma attending our department for stress MPS. All patients were taking regular inhalers+/-oral steroids. Patients who had exacerbation of asthma requiring hospital admission during the preceding 6 months were excluded. Before commencing the infusion, two inhaled puffs of salbutamol were administered. A modified adenosine infusion protocol was used, starting initially at a rate of 70 microg/kg/min and increasing to the standard 140 microg/kg/min within 1 min and then maintained for a further 5 min. Technetium-99m tetrofosmin was injected at 3 min. Blood pressure (BP), pulse rate (PR), oxygen saturation and ECG were monitored before, during and at the end of the infusion. All side effects were recorded. Fifty-eight consecutive patients without asthma were included as controls and received the standard 140 microg/kg/min infusion over 6 min. One hundred and eight patients, 50 with asthma and 58 without asthma, were entered into the study. The test was stopped early in two patients (4%) with asthma and 11 patients (19%) without asthma (chi=5.679; P=0.017). Proportionally, more nonasthmatics developed shortness of breath (SOB) (47 of 58, 81% without asthma vs. 35 of 50, 70% with asthma); however, this did not reach statistical significance (chi=1.788, P=NS). Three out of 50 (6%) patients in the asthma group experienced severe SOB but only one of those 50 patients (2%) developed bronchospasm, manifesting as wheeze. In the nonasthma group, five of 58 patients (8.6%) experienced severe SOB but none developed a wheeze. Less flushing (16 of 50, 32% vs. 36 of 58, 62%; P=0.002), dizziness (12 of 50, 24% vs. 26 of 58, 45%; P=0.023) and neck/throat pain (5 of 50, 10% vs. 16 of 58, 28%; P=0.021) was observed in the modified infusion group with asthma compared with the standard infusion group without asthma. Statistical significance was observed in these three side effects. No significant difference in other side effects was noted. A similar decrease in mean diastolic BP, and an increase in mean PR were observed during the infusion in both asthmatic and nonasthmatic groups. The mean systolic BP decreased significantly in nonasthmatic patients (P<0.001) but not in the asthmatic group. No significant change in oxygen saturation was seen during infusion in the asthmatic group. The modified adenosine infusion protocol with salbutamol premedication can be used in patients with asthma. This protocol resulted in fewer side effects and changes in BP and PR in asthmatic patients compared with nonasthmatic patients who received the standard adenosine infusion.

Blood pressure response, but not adverse event incidence, correlates with dose of angiotensin II antagonist.

To assess the efficacy and safety of the novel angiotensin II antagonist olmesartan medoxomil in patients with mild to moderate essential hypertension, using a meta-analysis of the combined database from seven US and European clinical trials. Studies were randomized, double-blind, placebo-controlled and dose-finding (2.5-80 mg), with treatment duration of 6-52 weeks. Hospital outpatient clinics. A total of 3,095 patients in the safety population and 3,055 patients in the intent-to-treat (efficacy) population. All studies used conventional sphygmomanometry for blood pressure measurements at trough (end of the dosing interval). Three studies also used 24-h ambulatory blood pressure monitoring for the principal efficacy evaluations. Percentage of patients achieving diastolic blood pressure (DBP) < or = 90 mmHg or decrease > or = 10 mmHg (responder rate), percentage of patients achieving a target DBP < or = 90 mmHg or target systolic blood pressure (SBP) < or = 140 mmHg (normalization rate), and mean decrease in DBP from baseline to last visit. Efficacy variables tended to be dose related up to the 40 mg dose level. All olmesartan medoxomil doses were statistically significantly more effective than placebo for responder rate, DBP and SBP normalization rates, and mean decrease in DBP. A clinically relevant decrease of > or = 5 mmHg from baseline in sitting DBP was also observed at doses of 20 mg and above after correction for placebo effect The safety profile of olmesartan medoxomil was similar to that of placebo and was not dose related. Olmesartan medoxomil was safe and highly effective in lowering blood pressure in patients with mild to moderate essential hypertension in these studies.

Cardiovascular Effects of a Novel Enkephalin Analogue, 443C81, in Humans

The cardiovascular effects of a novel enkephalin analogue, 443C81 (Tyr-D-Arg-Gly-Phe(4NO2)-Pro.NH2), were studied in healthy volunteers. According to a double-blind, cross-over, randomised, balanced design, six men received two different doses of 443C81 or saline as intravenous (i.v.) infusions on three occasions. Mean +/- SD plasma concentrations achieved at steady state were 0.46 +/- 0.11 microgram/ml after low-dose 443C81 and 1.0 +/- 0.2 microgram/ml after high-dose 443C81. In the supine position, low and high doses produced mean transient increases in diastolic blood pressure (DBP) of 5 and 4 mm Hg and heart rate (HR) of 5 and 12 beats/min, respectively. With the higher dose, these changes were followed by a mean decrease in DBP of 8 mm Hg while HR returned to control values. When the subjects were tilted, the pressor effect was not observed, and hypotension occurred earlier and was more pronounced. Both doses reduced forearm and systemic vascular resistance, and there was a dose-related increase in supine forearm venous capacitance; venoconstriction associated with tilting was unaffected by 443C81. Plasma renin activity and elevation of epinephrine concentrations on tilting were increased by the enkephalin, which also caused a diuresis through an increase in free water clearance.

Antihypertensive effects of β-blockers administered once daily: 24-hour measurements

Whole-day automated ambulatory blood pressure (BP) monitoring was used to assess the duration of the antihypertensive actions of the β-bockers atenolol (50 to 100 mg; n = 20) and acebutolol (400 to 800 mg; n = 19) each given once daily at 9 am. When compared with its pretreatment 24-hour average, atenolol decreased diastolic BP by 10 ± 2 mm Hg ( p < 0.01) and systolic BP by 12 ± 2 mm Hg ( p < 0.01). Acebutolol decreased the 24-hour diastolic BP by 11 ± 1 mm Hg ( p < 0.01) and systolic BP by 13 ± 2 mm Hg ( p < 0.01). More specifically, a comparison of the two drugs during the final 6 hours (3 am to 9 am) of the dosing interval showed that the mean decrease in diastolic BP of 10.2 ± 1.5 mm Hg with acebutolol was greater ( p < 0.05) than the decrease of 6.2 ± 1.3 mm Hg with atenolol. Moreover, this final 6-hour effect of atenolol was less ( p < 0.01) than that observed during the first 18 hours of the day. The late effects of acebutolol did not change significantly from its early effects. The two agents also differed in their though (final 2-hour decrease in diastolic BP) and peak (maximum 2-hour decrease in diastolic BP) effects: for atenolol the peak-to-trough difference was 7.8 ± 3.1 mm Hg ( p < 0.05), whereas for acebutolol it was 3.8 ± 4.2 mm Hg (N.S.). This study confirms the efficacy of atenolol and acebutolol. Moreover, acebutolol given once daily maintains its antihypertensive effects throughout the entire 24-hour period, including the important early to midmorning hours.