mmHg In Individuals Research Articles

What is New in the ESC Hypertension Guideline?

Blood pressure guidelines serve as a beacon of best practice for the diagnosis and management of hypertension. The many cultural and societal differences in hypertension risk factors and management patterns across geographic regions support the need for geographically distinct international guidelines. In 2018, the European Society of Cardiology (ESC) and European Society of Hypertension (ESH) released a joint guideline for the management of hypertension.1 This guideline represented a unified front across European hypertension-oriented societies. Similar to preceding hypertension guidelines, the 2018 guideline highlighted the myriad risks associated with inadequate blood pressure management and the importance of improving blood pressure control. The 2018 ESC/ESH guideline also offered a litany of nuanced recommendations on blood pressure measurement and management, including tiered blood pressure diagnosis and management thresholds across various ages and risk factors. For example, the guidelines recommended initiating antihypertensive therapy at a systolic blood pressure threshold of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg in individuals aged 18-79 years, and at a systolic blood pressure threshold of ≥160 mm Hg in individuals aged ≥80 years; treatment initiation could be considered at a blood pressure of ≥130/85 among individuals with established cardiovascular disease. Among individuals being treated for hypertension, the guideline recommended aiming for an initial blood pressure goal of <140/90 mm Hg in all individuals, and if tolerated, further aiming for a systolic blood pressure of 120-129 mm Hg in most individuals aged <65 years and considering a diastolic blood pressure of <80 mm Hg in all individuals. In contrast, contemporary to these guidelines, the 2017 American College of Cardiology/American Heart Association guidelines more broadly recommended stringent blood pressure diagnostic thresholds (≥140/90 mm Hg in lower risk individuals; ≥130/80 mm Hg in higher risk individuals including those with ≥10% 10-year risk of atherosclerotic cardiovascular disease) and management goals (<130/80 mm Hg in all individuals with hypertension). Thus, the 2018 ESC/ESH guideline focused much more on individualized goals. [See the full article for more].

May Measurement Month 2021: an analysis of blood pressure screening results from Poland.

May Measurement Month 2021 (MMM21) is the fourth edition of the global initiative in Poland initiated by the International Society of Hypertension (ISH) and aimed at raising awareness of hypertension and the need for blood pressure (BP) screening. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 132 sites - between May and September 2021. Blood pressure was measured in 1699 subjects (mean age: 40.8 ± 17.0 years; 68.8% females). After multiple imputation, the age and sex standardized systolic and diastolic BP was 126.6/78.7 mmHg for the entire group, 133.8/81.9 mmHg in individuals on antihypertensive medication, and 125.4/78.6 mmHg in those not taking antihypertensive drugs. The proportion of subjects with high BP (≥140/90 mmHg) were: 30.9% for the entire group, 40.4% in subjects taking antihypertensive drugs, and 17.9% in those not taking antihypertensive drugs. Of all participants, 33.9% were in the age range of 18-29 years and we observed higher BP levels and more frequent BP elevation in males in this age group. These data provide unique insights into the hypertension rates during the COVID-19 pandemic. Due to the associated restrictions, only limited data could be obtained for older adults. Interestingly, among young Polish participants, the rate of hypertension and the level of BP were higher in males compared to females, suggestive perhaps of a higher susceptibility of males to experience a rise in BP during specific circumstances associated with a pandemic.

#347 Long-term effectiveness of a village doctor-led multifaceted strategy on blood pressure control: a cluster randomized trial

Abstract Background and Aims We tested the effectiveness of a village doctor-led multifaceted strategy on blood pressure (BP) control over 36 months among patients with hypertension in rural China. Village doctors are community health workers who provide basic primary health care in rural China. Method 326 villages were randomly assigned to the village doctor-led intervention or usual care. Individuals aged ≥40 years with an untreated mean BP ≥140/90 mmHg (≥130/80 mmHg in individuals with clinical cardiovascular disease) or treated BP ≥130/80 mmHg were recruited. The trained village doctors initiated and titrated antihypertensive medications according to a simple stepped-care protocol with supervision from primary care physicians. They also delivered discounted and free medications to patients and conducted health coaching on lifestyle change, medication adherence, and home BP monitoring. Intention to treat analysis was conducted. Results At baseline, mean age (62.8 vs. 63.2 years), percentage of women (60.9% vs. 61.6%), mean systolic BP (157.0 vs. 155.5 mmHg), and diastolic BP (88.1 vs. 87.3 mmHg) were comparable between intervention and control groups. At 36 months, 72.5% patients in the intervention group and 11.7% patients in the control group had a BP of less than 130/80 mmHg, with a group difference of 60.8% (95% CI 59.4 to 62.2%; p&amp;lt;0.0001). Mean systolic BP decreased by –30.8 mmHg (95% CI –31.7 to –29.9) from baseline to 36 months in the intervention group and by –7.6 mmHg (–8.5 to –6.8) in the control group, with a group difference of –23.1 mmHg (95% CI –24.4 to –21.9 mmHg; p&amp;lt;0.0001). Mean diastolic BP decreased by –14.8 mmHg (–15.3 to –14.3) from baseline to 36 months in the intervention group and by –4.9 mmHg (–5.3 to –4.4) in the control group, with a group difference of –9.9 mmHg (–10.6 to –9.3 mmHg; p&amp;lt;0.0001). No treatment-related serious adverse events were reported in either group. Conclusion In rural China, the village doctor-led multifaceted strategy significantly reduced BP over 36 months in patients with hypertension. This proven-effective and sustainable implementation strategy could be scaled up throughout rural China and in other low- and middle-income countries for hypertension control.

Community Pharmacy-Based Blood Pressure Screening in Newfoundland and Labrador, Canada for World Hypertension Day 2022: A Cross-Sectional Study

BackgroundHigh blood pressure (BP) is a leading cause of cardiovascular and stroke-related events. Office-based BP measurement has declined in recent years due to the COVID-19 pandemic, which may have resulted in higher rates of undetected and uncontrolled hypertension. To gain a better idea of adult BP levels in Newfoundland and Labrador, we engaged community pharmacists in BP screening on World Hypertension Day. MethodsData collection and BP screening occurred on May 17, 2022. Pharmacists and pharmacy students collected 3 seated BP readings from participants, using an automated device. The average of readings 2 and 3 was used to estimate BP, with elevated BP defined as ≥ 140/90 mm Hg, or ≥ 130/80 mm Hg for individuals with diabetes. Data on participant demographics, access to primary care, medical history, and antihypertensive use were also collected. Data analysis included descriptive statistics and logistic regression techniques. ResultsA total of 460 participants were included in the analysis. The mean age was 56.3 years (standard deviation: 16.95); 63.3% (n = 291) were female; and 43.7% (n = 201) reported having hypertension. Elevated BP was identified in 27% (n = 123). Of those with elevated BP, 41.5% (n = 51) had no history of diagnosed hypertension. Age, sex, and diabetes were statistically significant predictors of elevated BP in the multivariable model. ConclusionsA large proportion of participants in our study had elevated BP. Targeted measures are needed to improve the detection, treatment, and control of high BP in Newfoundland and Labrador. Community pharmacists can support BP care.

Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring.

This study compared the ability of guideline-proposed office blood pressure (OBP) screening thresholds [European Society of Hypertension (ESH) guidelines: 130/85 mmHg for individuals with an OBP < 140/90 mmHg; American College of Cardiology/American Heart Association (ACC/AHA) guidelines: 120/75 mmHg for individuals with an OBP < 130/80 mmHg] and novel screening scores to identify normotensive individuals at high risk of having masked hypertension (MH) in an office setting. We cross-sectionally evaluated untreated participants with an OBP < 140/90 mmHg (n = 22,266) and an OBP < 130/80 mmHg (n = 10,005) who underwent home blood pressure monitoring (HBPM) (derivation cohort) from 686 Brazilian sites. MH was defined according to criteria suggested by the ESH (OBP < 140/90 mmHg; HBPM ≥ 135/85 mmHg), Brazilian Society of Cardiology (BSC) (OBP < 140/90 mmHg; HBPM ≥ 130/80 mmHg) and ACC/AHA (OBP < 130/80 mmHg; HBPM ≥ 130/80 mmHg). Scores were generated from multivariable logistic regression coefficients between MH and clinical variables (OBP, age, sex, and BMI). Considering the ESH, BSC, and ACC/AHA criteria, 17.2%, 38.5%, and 21.2% of the participants had MH, respectively. Guideline-proposed OBP screening thresholds yielded area under curve (AUC) values of 0.640 (for ESH criteria), 0.641 (for BSC criteria), and 0.619 (for ACC/AHA criteria) for predicting MH, while scores presented as continuous variables or quartiles yielded AUC values of 0.700 and 0.688 (for ESH criteria), 0.720 and 0.709 (for BSC criteria), and 0.671 and 0.661 (for ACC/AHA criteria), respectively. Further analyses performed with alternative untreated participants (validation cohort; n = 2807 with an OBP < 140/90 mmHg; n = 1269 with an OBP < 130/80 mmHg) yielded similar AUC values. In conclusion, the accuracy of guideline-proposed OBP screening thresholds in identifying individuals at high risk of having MH in an office setting is limited and is inferior to that yielded by scores derived from simple clinical variables.

May Measurement Month 2019: an analysis of blood pressure screening results from Poland.

May Measurement Month 2019 is the third edition of a global initiative organized by the International Society of Hypertension aimed at raising awareness of hypertension and the need for blood pressure (BP) screening. We present data analysis from Poland. To evaluate the potential of opportunistic BP measurements as a tool for cardiovascular disease prevention programmes. To collect new country data for further annual comparisons. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 201 sites in May 2019. BP was measured in 7072 subjects (mean age: 54 ± 15 years; 62.3% females). After multiple imputation, the age- and sex-standardized systolic BP (SBP) and diastolic BP (DBP) was 125.4/78.5 mmHg in the whole group, 133.3/82.8 mmHg in individuals on antihypertensive medication and 123.3/77.7 mmHg in those not taking antihypertensive drugs. The proportion of subjects with high BP (≥140/90 mmHg) were 41.8% in subjects taking antihypertensive drugs, and 19.6% in those not taking any antihypertensive drugs. Overall, hypertension was present in 55.4% of participants (3917 out of 7072), of whom 83.0% were aware of their diagnosis. 80.4% of hypertensives were taking antihypertensive medication. 46.7% of all hypertensives had BP controlled to target (<140/90 mmHg). Higher BP correlated with body mass index and age but not tobacco smoking. SBP but not DBP was higher in diabetic participants. These data provide evidence on the current epidemiology of hypertension and may serve as a source of information to introduce primary and secondary prevention programmes to reduce cardiovascular risk in Poland.

Blood Pressure Target Achievement Under Monotheraphy: A Real-Life Appraisal

IntroductionDespite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension.AimTo investigate BP control under monotherapy in the setting of real-life.MethodsWe extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant’Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18–65 years; (b) < 140/80 mmHg in those aged > 65 years.ResultsFrom an overall sample of 7797 records we selected 1578 (20.2%) hypertensive outpatients (47.3% female, age 59.5 ± 13.6 years, BMI 26.6 ± 4.4 kg/m2) treated with monotherapies, among whom 30.5% received ACE inhibitors, 37.7% ARBs, 15.8% beta-blockers, 10.6% CCBs, 3.0% diuretics, and 2.0% alpha-blockers. 36.6% of these patients reached the conventional clinic BP goal of < 140/90 mmHg, whilst the 2018 European guidelines BP treatment targets were fulfilled only in 14.0%. In particular, 10.2% patients aged 18–65 years and 20.4% of those aged > 65 years achieved the recommended BP goals. All these proportions results significantly lower than those achieved with dual (18.2%) or triple (22.2%) combination therapy, though higher than those obtained with life-style changes (10.8%). Proportions of patients on monotherapies with normal home and 24-h BP levels were 22.0% and 30.2%, respectively, though only 5.2% and 7.3% of these patients achieved sustained BP control, respectively. Ageing and dyslipidaemia showed significant and independent positive predictive value for the achievement of the recommended BP treatment targets, whereas European SCORE resulted a negative and independent predictor in outpatients treated with monotherapies.ConclusionsOur data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines.Electronic supplementary materialThe online version of this article (10.1007/s40292-020-00420-y) contains supplementary material, which is available to authorized users.

Real-life appraisal on blood pressure targets achievement in adult outpatients at high cardiovascular risk

Background and aimAlthough hypertension guidelines highlight the benefits of achieving the recommended blood pressure (BP) targets, hypertension control rate is still insufficient, mostly in high or very high cardiovascular (CV) risk patients. Thus, we aimed to estimate BP control in a cohort of patients at high CV risk in both primary and secondary prevention. Methods and resultsA single-center, cross-sectional study was conducted by extracting data from a medical database of adult outpatients aged 40–75 years, who were referred to our Hypertension Unit, Rome (IT), for hypertension assessment. Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: a)<130/80 mmHg in individuals aged 40–65 years; b)<140/80 mmHg in subjects aged >65 years. Primary prevention patients with SCORE <5% were considered to be at low-intermediate risk, whilst individuals with SCORE ≥5% or patients with comorbidities were defined to be at very high risk. Among 6354 patients (47.2% female, age 58.4 ± 9.6 years), 4164 (65.5%) were in primary prevention with low-intermediate CV risk, 1831 (28.8%) in primary prevention with high-very high CV risk and 359 (5.6%) in secondary prevention. In treated hypertensive outpatients, uncontrolled hypertension rate was significantly higher in high risk primary prevention than in low risk primary prevention and secondary prevention patients (18.4% vs 24.4% vs. 12.5%, respectively; P < 0.001). In high risk primary prevention diabetic patients only 10% achieved the recommended BP targets. ConclusionsOur data confirmed unsatisfactory BP control among high-risk patients, both in primary and secondary prevention, and suggest the need for a more stringent BP control policies in these patients.

MON-627 Number of Antihypertensives Required for Achieving BP Goals in Individuals with Diabetes and Hypertension-A Cross-Sectional Observational Study

BACKGROUND: The 2019 ADA Standards of Medical Care in Diabetes, recommends blood pressure (BP) target of <130/80 mmHg for individuals with diabetes and hypertension at higher cardiovascular (CV) risk and a BP target of <140/90 mmHg for individuals at lower risk for CV disease.1 Monotherapy can attain goal BP in some patients with diabetes and hypertension. This is most likely to occur in those with BP that are only modestly above goal. However, combination therapy is eventually required in most patients.2 AIM: To assess the number of antihypertensives that are required for optimal control of BP in Indian patients with type 2 diabetes mellitus (T2DM) and hypertension. METHODS: Data was retrieved from the electronic database of a tertiary super-speciality hospital in Kolkata over a period of four weeks in July to August 2018. The inclusion criteria- T2DM patients with hypertension between 35 to 55 years of age. Patients with recent weight gain, recent use of SGLT 2 inhibitors and those with prior cardiac events were excluded from the study.The study included 2000 adult patients with T2DM with normal renal function. Of these, 58% were male patients. The mean age was 48 years. The mean HbA1c was 7.4% during the period of observation. Patients were being treated with oral hypoglycaemic agents (OHA) (except SGLT 2 inhibitors which might affect BP) or insulin. All patients were receiving statins. The antihypertensives that were considered were analysis were telmisartan, amlodipine, and hydrochlorothiazide. RESULTS: The number of T2DM Hypertensive patients requiring 3 or more drugs were 640 (32 %). Out of the 640 patients, 300 patients (15 %) required higher dose of telmisartan 80 mg.A total 980 patients (49%) required a combination of two drugs (telmisartan and amlodipine) for optimal BP control. Out of these 980 patients, 360 patients (18%) required higher dose of telmisartan i.e. 80 mg. One hundred and eighty patients (9%) required a combination of telmisartan and hydrochlorothiazide. Out of these 180 patients, 80 patients (4%) required higher dose of Telmisartan i.e. 80mg. Two hundred patients (10 %) required only one drug i.e. telmisartan for achieving optimal BP. Out of these 200 patients, 110 patients (5.5 %) required the higher dose of telmisartan i.e. 80 mg CONCLUSION: The optimal control of BP is mandatory in T2DM patients in order to reduce cardiovascular events as well as microvascular complications. As evident from our study majority of patients required more than one antihypertensive, 32% required triple drug therapy and 49 % required dual therapy for optimal BP control. Regular monitoring of BP and timely up-titration of antihypertensives are of utmost importance to prevent future micro- and macro- vascular complications in young diabetic hypertensives.

Influence of arterial hypertension, smoking, and their combination on mortality (according to the results of a 27-year cohort prospective study of the unorganized population of Tomsk)

Aim. To study the influence of arterial hypertension (AH), smoking, and their combination on the risk of all cause and cardiovascular mortality.Material and methods. We conducted a 27-year cohort prospective study of the unorganized population of Tomsk (916 women and 630 men aged 20-59 years). At the first stage, we studied the prevalence of AH and smoking (1998-1991), at the second (2015) — the effect of these risk factors (RF) and their combination on the risk of all cause and cardiovascular mortality. AH was diagnosed at a blood pressure level of &gt;140/90 mmHg and &lt;140/90 mm Hg in individuals taking antihypertensive drugs. Smokers were individuals who smoked at least 1 cigarette per day and quit smoking less than one year ago.Results. The study found a significant effect of AH and smoking on mortality: the relative risk (RR) of all-cause mortality in people with hypertension was 2,2, in smokers — 2,3, in those with a combination of RF — 5,0. The RR of cardiovascular mortality in AH individuals was 3,4, in smokers — 1,6, in smoking men and women suffering from AH — 5,2. An increase in the risk of all-cause mortality in people with AH and smoking was observed in all gender-age groups. Smoking was found to increase the risk of all-cause mortality in individuals with high levels of blood pressure by 2,1 times compared with non-smoking hypertensive patients. It reduces the chances of a 27-year survival rate to 64,4%, and more so in the youngest (20-39 years) age group (RR — 3,9). Multivariate analysis showed that AH and smoking make the most significant contribution to the formation of mortality compared to other modifiable RFs.Conclusion. We found that AH and smoking are among the most influential RFs, and their combination increases the RR of all-cause mortality by 5,0 times (cardiovascular — 5,2 times). We also determined an additional risk of smoking in individuals suffering from AH to the all-cause mortality.

PULMONARY ARTERY WEDGE PRESSURE AT REST AND DURING EXERCISE IN HEALTHY ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

The pulmonary artery wedge pressure (PAWP) response to exercise may unmask latent heart failure with preserved ejection fraction (HFpEF). Diagnostic utility is dependent on selection of a reference standard derived from an appropriate population. Age and sex are important considerations associated with the development of HFpEF; however, studies of healthy older humans are limited to small sample sized. As such, there remains a lack of consensus over threshold values for PAWP during exercise. Peer-reviewed publications evaluating PAWP by right heart catheterization at rest and during exercise in healthy individuals were identified from comprehensive literature searches of PubMed/Medline and Embase databases from database inception to June 2017. A secondary search of reference lists of key studies and reviews was also conducted. Relevant data derived from healthy volunteers were stratified by age (> or ≤ 40 years) and sex. Three exercise intensities were predefined: Light, Moderate, and Strenuous. Weighted means and weighted 95% confidence limits for the aggregate data were calculated. A total of 424 individuals from 32 unique studies were included, of which 19% (n = 82) were female. The mean PAWP at rest was 8 mmHg for both age groups. PAWP increased during exercise in both age groups, reaching weighted mean and 95% confident limit values of 19 (17-21) and 17 (16-18) mmHg in individuals > 40 years [vs. 11 (9-13) and 13 (10-15) mm Hg in ≤ 40 years] at Light and Moderate exercise, respectively (Figure 1). The PAWP response to exercise was similar between men and women > 40 years. However, exercise intensities were lower in women (Table 1). In healthy adults > 40 years, the PAWP increases during exercise, reaching up to and over 20 mmHg. Older women achieve similar PAWP values as older men, but at lower intensities. Findings support a threshold of 25 mmHg as an absolute cut-off value for ‘normal’ PAWP response to exercise in individuals > 40 years.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Intraocular pressure and its normal range adjusted for ocular and systemic parameters. The Beijing Eye Study 2011.

PurposeTo examine the distribution of intraocular pressure (IOP) in a normal population and the associations of IOP with other ocular and systemic parameters.MethodsOut of 3468 participants of the population-based cross-sectional Beijing Eye Study 2011 we selected those individuals without glaucomatous optic neuropathy. The study particpants underwent a detailed ophthalmologic and systemic examination. IOP was measured by air puff non-contact tonometry.ResultsThe study included 3135 eyes of 3135 participants with a mean age of 64.1 ± 9.6 years (mean ± standard deviation). The mean IOP was 14.7 ± 2.8 mmHg. The 95% percentile and 97.5% percentile of the IOP distribution decreased from 20 mmHg / 21 mmHg in individuals aged 40 to 54 years to 18 mmHg / 19 mmHg in individuals aged ≥80 years. In multivariable analysis, higher IOP was associated with the systemic parameters of younger age (P<0.001), higher blood concentration of glucose (P = 0.03) and triglycerides (P<0.001), higher diastolic blood pressure (P<0.001), higher pulse rate (P = 0.003) and higher quantity of alcohol consumption (P = 0.004), and with the ocular parameters of larger central corneal thickness (P<0.001), more myopic refractive error (P = 0.01) and steeper anterior corneal curvature radius (P = 0.006). IOP decreased significantly by 0.50 mmHg and 0.76 mmHg for each increase in age by 10 years and each increase in corneal curvature radius by 1.0 mm, respectively. The range of the mean ± 2 standard deviations of the IOP adjusted for the parameters of the multivariable model was 9.0 to 18.1 mmHg versus 9.2–20.2 mmHg for the unadjusted IOP. In the age group of 50 to 55 years, the age-adjusted IOP range (mean ± 2 standard deviations) was 9 to 18 mmHg, and in the age group of ≥75 years, it was 8 to 18 mmHg.ConclusionsIOP physiologically depends on a multitude of systemic and ocular factors including age and blood pressure. These physiological associations of the IOP may be taken into account in the definition of the normal range of the IOP.

Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness.

The aim of the present study was to determine whether lung volume recruitment (LVR) acutely increases respiratory system compliance (Crs) in individuals with severe respiratory muscle weakness (RMW).Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12) and healthy controls (n=12) underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume.At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O−1, p<0.001). Immediately after LVR, Crs increased by 39.5±9.8% to 50±7 mL·cmH2O−1 in individuals with RMW (p<0.05), while no significant change occurred in controls (p=0.23). At 1 h and 2 h post-treatment, there were no within-group differences in Crs compared to baseline (all p>0.05). LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05). During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05).LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique.

Validity of self-reported blood pressure control in people with hypertension attending a primary care center

The aim of this study was to estimate the validity of self-reported blood pressure control and medication use in people with hypertension, with and without diabetes. In a sample of 161 patients with hypertension in a family health team in Ontario, we applied questions from the 2009 Survey on Living with Chronic Disease in Canada Hypertension Component and compared responses against objectively measured and chart-abstracted clinical indicators. Objective blood pressure control was defined as a blood pressure of less than 130/80 mmHg and less than 140/90 mmHg for individuals with and without diabetes, respectively. Self-reported blood pressure control showed reasonable sensitivity (83±11 and 78±10%) but low specificity (30±19 and 58±21%) in people with and those without diabetes, respectively. In the subgroup with diabetes, specificity improved to 88±11% when blood pressure control was defined on the basis of a 140/90 mmHg target. Self-reported and chart-abstracted numbers of prescribed antihypertensive medications showed fair agreement (κ=0.7); 9 and 14% of patients overestimated and underestimated the number of prescribed medications, respectively. Although most individuals with controlled hypertension reported having controlled blood pressure, a large proportion of individuals with uncontrolled hypertension also reported that their blood pressure was controlled. This level of misclassification suggests that in a family medicine clinic population and in health survey contexts, a self-reported measure of blood pressure control may not be useful for assessing hypertension control.

Hypertension and orthostatic hypotension in older patients

Hypertension and orthostatic hypotension in older patients

Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure

Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure

Use of arterial transfer functions for the derivation of central aortic waveform characteristics in subjects with type 2 diabetes and cardiovascular disease.

Optimal blood pressure control in subjects with diabetes reduces cardiovascular complications. There is theoretical benefit in the assessment of central aortic waveforms including the augmentation index, which is taken as a putative index of stiffness. Transfer functions may be used to reconstruct aortic from radial pressure waveforms; however, a single generalized transfer function may not be appropriate for all patients. We aimed to evaluate the technique in subjects with diabetes. Simultaneous invasive central aortic and noninvasive radial waveforms were acquired in 19 subjects with type 2 diabetes, and a diabetes-specific transfer function was derived. Similar data were acquired from 38 age- and sex-matched subjects without diabetes. Central waveforms were reconstructed using a generalized transfer function in all patients and the diabetes-specific transfer function in individuals with diabetes. There was no difference between groups in measured central pressures. The error in generalized transfer function-derived systolic pressure was greater in individuals with diabetes (6 +/- 7 mmHg) (mean +/- SD) than without diabetes (2 +/- 8 mmHg) (P<0.05). Errors in other parameters were no different. The diabetes-specific transfer function reduced the error in derived systolic pressure to 0 +/- 7 mmHg in individuals with diabetes--no different than that with the generalized transfer function in individuals without diabetes. The central augmentation index reconstructed by either transfer function was unrelated to that directly measured. A generalized transfer function is inappropriate for the derivation of central waveforms in subjects with type 2 diabetes. Errors in subjects with diabetes might be reduced with a diabetes-specific transfer function.

Patient Persistency with ocular prostaglandin therapy: A population-based, retrospective study

Background: Open-angle glaucoma affects an estimated 33 million individuals worldwide. An intraocular pressure >21 mm Hg in individuals with no evidence of optic nerve damage is termed ocular hypertension, a risk factor for glaucoma that has been estimated to affect as many as 10% of individuals 40 years of age or older.Objective: The purpose of this research was to assess persistency (time on therapy) with prostaglandin analogues in the treatment of glaucoma or ocular hypertension.Methods: This population-based, retrospective cohort study used the Protocare Sciences managed care database, which includes prescription and medical claims data from multiple managed care organizations. Patients 20 years of age or older who initiated therapy with latanoprost, bimatoprost, or travoprost (index drugs) between April 2001 and June 2002 were included. Patients were required to be continuously enrolled in the same plan for the 180 days preceding index prescription fill. Follow-up continued through June 30, 2002. Two outcome measures were analyzed: (1) discontinuation of the index prostaglandin and (2) either discontinuation or change in the index prostaglandin regimen. Changing therapy was defined as switching to or adding another ocular hypotensive agent. Cox regression models were used to compare rate ratios of discontinuation and discontinuation/change. Patient data were censored on termination of insurance coverage or at the end of the study period.Results: Overall, 7527 patients were prescribed a prostaglandin analogue; 4356 patients met the inclusion criteria (n = 2376, 993, and 987 for latanoprost, bimatoprost, and travoprost, respectively). A total of 58% of patients were women, and 74% were 65 years of age or older. Compared with latanoprost, those treated with bimatoprost were 38% more likely to discontinue and 31% more likely to discontinue/change therapy, and patients treated with travoprost were 36% more likely to discontinue and 29% more likely to discontinue/change therapy (P < 0.001 for each comparison).Conclusion: Latanoprost-treated patients demonstrated significantly (P < 0.001) greater persistency than did those treated with either bimatoprost or travoprost.

Clinical Advisory Statement. Importance of systolic blood pressure in older Americans.

This clinical advisory statement from the Coordinating Committee of the National High Blood Pressure Education Program is intended to advance and clarify the recommendations of the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI, 1997).1 The advisory addresses several interrelated issues about blood pressure (BP) that affect people approaching the later decades of life. On the basis of the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic BP become the major criterion for diagnosis, staging, and therapeutic management of hypertension, particularly in middle-aged and older Americans. Several lines of strong evidence support the initiative to emphasize systolic BP. Pathophysiologically, there are strong associations among aging, increased stiffness of large arteries, increased systolic BP, increased pulse pressure, and the prevalence of cardiac and vascular disease. Epidemiologically, isolated systolic hypertension is the most common form of hypertension and is present in approximately two thirds of hypertensive individuals >60 years of age. Diagnostically, classification and staging of hypertension are more precise when systolic rather than diastolic BP is used as the principal criterion. Risk stratification for major complications of hypertension (stroke, myocardial infarction, heart failure, and kidney failure) is actually confounded by the use of diastolic BP; in older people with systolic hypertension, diastolic BP is inversely related to cardiovascular risk. Clinical benefits of treatment of isolated systolic hypertension include reductions in stroke, myocardial infarction, heart failure, kidney failure, and overall cardiovascular disease morbidity and mortality. Currently, only 1 in 4 Americans with hypertension falls below JNC VI–recommended values of 140/90 mm Hg in uncomplicated hypertension or 130/85 mm Hg in individuals with kidney disease or diabetes. Hypertension control rates are poorest in older people, primarily as a result of inadequate …

Are the Days of the Sphygmomanometer Past?

Hypertension remains one of the most commonly encountered clinical conditions and one that health care providers can effectively treat. At least two intervention trials have demonstrated clinical benefits as a consequence of reduction of diastolic blood pressure greater than 90 mm Hg in individuals 60 years of age or older.^1-3Systolic blood pressure elevation remains more problematic, even though most would agree that systolic hypertension is at least an equal culprit in the production of cardiovascular complications, but unfortunately no intervention trial data are presently available to support aggressive treatment. Reduction of blood pressure in those at highest risk (systolic blood pressure, &gt;180mm Hg) and in those with concomitant coronary artery disease, congestive heart failure, left ventricular enlargement, or retinopathy seems appropriate, whereas intermediate systolic levels between 160 and 180 mm Hg require a more individualized approach.⁴ See also p 673. All of the therapeutic recommendations that are