Newly-diagnosed Hypertensive Patients Research Articles

EFFECT OF SODIUM GLUCOSE CO-TRANSPORTER 2 INHIBITORS ON LIPID LEVELS IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS

Aim: This study aimed to examine the effects of sodium glucose cotransporter 2 inhibitors (SGLT-2i) on lipid levels at 12 weeks of follow-up in newly diagnosed hypertensive (NDHT) patients with type 2 diabetes mellitus (T2DM). Methodsː This retrospective study, 236 NDHT patients with T2DM were included. The SGLT-2i group consisted of patients who received SGLT-2i (empagliflozin or dapagliflozin) in addition to stable triple combination treatment. The control group was selected over NDHT patients with T2DM who did not receive SGLT-2i and matched with the SGLT-2i group in terms of baseline risk factors by propensity score. The laboratory findings of the patients were compared retrospectively at the time of diagnosis of NDHT (baseline) and at 12-month followup. Resultsː The decrease in fasting blood glucose and hemoglobin A1C levels was higher in the SGLT-2i group than control group. Although both groups received similar antihypertensive therapy, the improvement in lipid profile was higher in the SGLT-2i group. Glycemic control and side effects were similar in empagliflozin and dapagliflozin groups. However, greater improvement in lipid profiles was detected in dapagliflozin users. Conclusionsː In NDHT patients with T2DM, the addition of SGLT2i to treatment management in cases where glycemic control is not achieved is associated with more improvement of the lipid profile without significant side effects. However, the effects of various SGLT2i agents on this improvement may be different.

Personalized prediction of incident hospitalization for cardiovascular disease in patients with hypertension using machine learning

BackgroundPrognostic information for patients with hypertension is largely based on population averages. The purpose of this study was to compare the performance of four machine learning approaches for personalized prediction of incident hospitalization for cardiovascular disease among newly diagnosed hypertensive patients.MethodsUsing province-wide linked administrative health data in Alberta, we analyzed a cohort of 259,873 newly-diagnosed hypertensive patients from 2009 to 2015 who collectively had 11,863 incident hospitalizations for heart failure, myocardial infarction, and stroke. Linear multi-task logistic regression, neural multi-task logistic regression, random survival forest and Cox proportional hazard models were used to determine the number of event-free survivors at each time-point and to construct individual event-free survival probability curves. The predictive performance was evaluated by root mean squared error, mean absolute error, concordance index, and the Brier score.ResultsThe random survival forest model has the lowest root mean squared error value at 33.94 and lowest mean absolute error value at 28.37. Machine learning methods provide similar discrimination and calibration in the personalized survival prediction of hospitalizations for cardiovascular events in patients with hypertension. Neural multi-task logistic regression model has the highest concordance index at 0.8149 and lowest Brier score at 0.0242 for the personalized survival prediction.ConclusionsThis is the first personalized survival prediction for cardiovascular diseases among hypertensive patients using administrative data. The four models tested in this analysis exhibited a similar discrimination and calibration ability in predicting personalized survival prediction of hypertension patients.

Effectiveness of a Transtheoretical Model-Based Intervention to Improve Blood Pressure Control of Hypertensive Patients in China: A Clustered Randomized Controlled Trial.

BackgroundHypertension can result in great cardiovascular risk, while medication adherence and blood pressure control of patients were suboptimal. Therefore, we conducted a 12-month clustered randomized controlled trial to evaluate the effectiveness of transtheoretical model (TTM)-based health intervention mode on blood pressure of Chinese newly-diagnosed hypertensive patients.MethodsThis trial was conducted in six primary healthcare centers, Shunyi District, Beijing, China from September 2016 to September 2017. A total of 400 patients were included and randomized, 194 patients in the control group and 206 patients in the intervention group. Patients in the intervention group received TTM-based health intervention and those in the control group received usual care. Multilevel modeling was used to adjust for clustering effect and repeated measurements.ResultsSystolic blood pressure of patient was reduced by 4.534 mm Hg at 3-month follow-up [95% CI (−3.054, −1.403), p = 0.005], 3.982 mm Hg at 6-month follow-up [95% CI (−7.387, −0.577), p = 0.022], and 5.803 mm Hg at 12-month follow-up [95% (−9.716, −1.891), p = 0.004]. Diastolic blood pressure of patient was reduced by 3.383 mm Hg at 3-month follow-up [95% CI (−5.724, −1.042), p = 0.005], 0.330 mm Hg at 6-month follow-up [95% CI (−2.870, 2.210), p = 0.799], and 3.129 mm Hg at 12-month follow-up [95% CI (−6.048, −0.21), p = 0.036]. Medication adherence of patients was improved at all the three time points. For stages of change for taking medication, patients in the intervention group were 8.401-fold more likely to be in a higher stage at 3-month follow-up [95% CI (4.186, 16.862), p < 0.001]. The odds ratio of being in a higher stage was 8.454 at 6-month follow-up [95% CI (3.943, 18.123), p < 0.001] and 19.263 at 12-month follow-up [95% CI (7.979, 46.505), p < 0.001].ConclusionTranstheoretical model-based health intervention might be a promising strategy to improve medication adherence of newly-diagnosed hypertensive patients in community.

Fibrosis-4 index: A new marker to predict non-dipper blood pressure pattern in patients with newly diagnosed hypertension

Introduction: Epicardial fat tissue (EFT) is a significant risk factor for cardiovascular diseases. This study aimed to investigate whether there is a relationship between the fibrosis-4 index (FIB-4 index) and EFT in newly-diagnosed hypertensive patients and explore the usability of the FIB-4 index in predicting non-dipper blood pressure (BP) pattern. Materials and methods: Our case–control study consisted of 210 patients in 3 groups according to BP values, namely normotensive, dipper, and non-dipper groups. Transthoracic echocardiography and 24-h ambulatory BP monitoring were performed in all patients. Results: The median FIB-4 index was higher in the non-dipper group [1.56 (1.10-2)] than in the dipper [1 (0.71-1.32)] and normotensive groups [0.96 (0.69-1.32)] (p &lt; 0.001, for both). A positive correlation was observed between EFT and the FIB-4 index (r=0.389, p&lt;0.001). In multivariate logistic regression analysis, EFT (odds ratio (OR): 0.506, 95% confidence interval (CI): 1.288-2.135; p&lt;0.001) and FIB-4 index (OR: 1.099, 95% CI: 1.621–5.556; p&lt;0.001) were found to be independent predictors of non-dipper BP. In the receiver operating characteristic curve analysis, the FIB-4 index had 68% sensitivity and 72% specificity at a value &gt;1.25 (area under the curve: 0.751, 95%CI: 0.679-0.823, p&lt;0.001). Conclusions: In newly-diagnosed hypertensive people, the FIB-4 index is related to non-dipper BP patterns. FIB-4 index appears to be a helpful tool in assessing risk associated with cardiovascular disease.

Impact of continuity of care on cardiovascular disease risk among newly-diagnosed hypertension patients

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. However, the association of COC in hypertension patients with subsequent cardiovascular disease (CVD) risk is yet unclear. Therefore, we aimed to investigate the impact of COC on CVD risk among newly-diagnosed hypertension patients. We conducted a cohort with a study population consisted of 244,187 newly-diagnosed hypertension patients in 2004 from the Korean National Health Insurance Service database. The participants were then divided into approximate quartiles of COC index, and followed from 1 January 2007 until 31 December 2017. Cox proportional hazards models were used to evaluate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quartiles. Compared to patients within the lowest quartile of COC index, those within the highest quartile of COC index had reduced risk for CVD (aHR 0.76, 95% confidence interval; CI 0.73–0.79), CHD (aHR 0.66, 95% CI 0.62–0.69) and stroke (aHR 0.84, 95% CI 0.80–0.88). COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. The importance of maintaining COC should be emphasized to reduce the risk of CVD among hypertension patients.

Traditional Chinese medicine insights of newly-diagnosed and young hypertension and clinical practice of Tianma Gouteng Decoction for hypertension treatment

Hypertension is a global major public health problem. Early intervention and timely blocking are necessary for newly-diagnosed hypertensive and young hypertensive patients. Tianma Gouteng Decoction recorded in Zabing Zhengzhi Xinyi written by HU Guangci has the major functions in treating excess syndrome and wind-Yang disturbance syndrome with effects in calming liver-wind, clearing heat and activating blood, and nourishing liver and kidney. As we known, Tianma Gouteng Decoction is a classical formula for treating hypertension. However, due to the limitation of historical conditions, some problems impede Tianma Gouteng Decoction from being handed down successfully, such as uncertain diagnosis, uncertain antihypertensive efficacy and treatment-course. In this case, we ask whether Tianma Gouteng Decoction can be used as antihypertensive therapy and the exactly decrease of systolic and diastolic blood pressure, and wonder the half-life of Tianma Gouteng Decoction and the relationship with Western medicine. Therefore, defined prescription and syndrome, efficacy, treatment-course are important in clinical practice. According to the findings, ① previously, we thought that hypertension was a liver-Yang hyperactivity and liver-wind stirring syndrome, and the liver-based therapy theory was effective. However, based on our study, long-term treatment with Western medicine could block disease progression, control the increased blood pressure and change the pathogenesis and syndrome of traditional Chinese medicine. Therefore, the frequency of liver-Yang hyperactivity syndrome &quot;fire syndrome&quot; decreased sharply, and the main syndrome was fluid-retention syndrome and deficiency syndrome. The etiology and pathogenesis of hypertension was prone to deficiency syndrome accompanied with excess syndrome. Therefore, it was necessary to intervene hypertension in &quot;liver-wind&quot; and &quot;liver-Yang&quot; excess syndrome stage, and the early intervention and treatment are important. ② The newly-diagnosed hypertensive and young hypertensive patients usually had no Western medicine intervention. Thus, the etiology and pathogenesis of hypertension were free from Western medicine, which maintained the initial stage of hypertension in line with the liver-Yang hyperactivity syndrome. ③ The pathological mechanisms of newly-diagnosed and young hypertension were mainly increase in sympathetic activity, active renin-angiotensin-aldosterone system, change in morphology of vascular smooth muscle cells and endothelial cell dysfunction. ④ According to the syndrome of Tianma Gouteng Decoction, in modern medicine, Tianma Gouteng Decoction was widely used to treat the early-stage hypertension and the early-intervention of hypertension without Western medicine, particularly newly-diagnosed, young hypertension, Ⅲ hypertension, hypertensive crisis and hypertensive emergency. Tianma Gouteng Decoction can treat such symptoms as headache, dizziness, fullness of head, slurring of speech; facial flushing, conjunctival congestion and blurred vision; dysphoria, anxiety, palpitation, insomnia, mental disorder and hot flushes; dry-mouth with bitter taste and sweeting; myasthenia of limbs and lassitude in loin and legs; brown urine with burning sensation during urination; a solid or liquid stool consistency; red tongue, slippery and rapid pulse, wiry and rapid pulse over to Cunkou. ⑤ After treatment with Tianma Gouteng Decoction for three to six months, the blood pressure was decreased, and the symptoms were improved with reduction or even discontinuance of Western medicine. ⑥ According to recent studies, Caul is Polygoni Multiflori of Tianma Gouteng Decoction induced certain hepatotoxicity and increased the risk of long-term treatment. However, with the regular monitoring of biomedical index, long-term treatment with Caulis Polygoni Multiflori(3-10 g·d~(-1) for 3 to 6 months) didn't show hepatic dysfunction. ⑦ The pharmacological activity of Tianma Gouteng Decoction coincided with the pathology and disease mechanism of newly-diagnosed and young hypertension. Therefore, Tianma Gouteng Decoction was the specific recipe for newly-diagnosed and young hypertension. Therefore, further studies of efficacy, safety and molecular mechanism of Tianma Gouteng Decoction may make a medical breakthrough for hypertension treatment.

OP-031 The Relationship Between Monocyte/HDL Cholesterol Ratio and Aortic Elasticity in Newly-Diagnosed Hypertensive Patients

A The Association between Plasma Thiols Levels and Left Ventricular Diastolic Dysfunction in Patient with Hypertension. Musluhittin Emre Erkus, Ibrahim Halil Altiparmak, Ali Riza Akyuz, Recep Demirbag, Yusuf Sezen, Ozgur Gunebakmaz, Salim Neselioglu, Ozcan Erel. Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey; Cardiology Clinic, Akcaabat Hackali Baba State Hospital, Trabzon, Turkey; Department of Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey. Beta-blocker,% 42 58 47 0.257 ACEI/ARB, % 43 54 60 0.334 Statin,% 22 33 42 0.141 Diuretic, % 26 16 22 0.401 HR, beats/min 81 15 74 13 73 12 75 12 0.084 Systolic BP, mm Hg 123 14 121 16* 133 14 128 14 0.001 Diastolic BP, mm Hg 74 9 75 12s 80 10 77 9 0.041 Cholesterol, mg/dL 176 30 198 47 187 44 200 49 0.207 LDL-C, mg/dL 105 26 123 36 107 37 121 60 0.103 HDL-C, mg/dL 42 10 41 9 39 9 39 8 0.620 Triglyceride, mg/dL 125 64 137 60 117 82 174 95 0.053 Fasting blood sugar, mg/dL 100 12 98 9 103 12 101 15 0.418 EF, % 63 4c 61 4 60 5 59 4 0.017 LVMI, g/m2 108.4 14.5 120.8 14.1 122.7 21.2 134.9 22a <0.001 Lateral TDE e, cm/s 12.3 3.6 14.5 3.5* 9.7 2.4 10.5 3.6 <0.001 Mitral E/A 1.20 0.33 1.25 0.29* 0.76 0.18 1.11 0.07 0.001 Lateral TDE e/a 1.12 0.40 1.27 0.73 0.73 0.15 0.80 0.30 < 0.001 IVRT, ms 91.8 20.3 91.4 13.4 94.3 13.7 89.1 16.9 0.580 DT, ms 178.4 49.1c 181.6 40.5* 210.7 48.8 201.3 35.4 0.006 E/e 6.5 1.9 6.0 1.6 7.1 4.0 7.4 4.2 0.484 Plasma thiol, mmol/L 319 47c 204 44*s 171 59 147 27{ <0.001

Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up

There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08–206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03–6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.

Relation of Anemia to Echocardiographically Estimated Left Ventricular Filling Pressure in Hypertensive Patients Over 50 Year-Old

Anemia is associated with worse long term outcomes in heart failure. However, there is little evidence on the effect of low hemoglobin level to the left ventricular (LV) structure and diastolic function in hypertensive patients. This study assessed the relationship of hemoglobin level to LV filling pressure in elderly hypertensive patients. From January 2005 to January 2009, 200 newly diagnosed hypertensive patients over 50 years old (mean age 60 ± 6 years, 116 women) were analyzed. The clinical parameters and comprehensive echocardiographic data were obtained. The patients with and without anemia were compared. There were significant differences between the anemic and non-anemic groups in the LV mass index (115.27 ± 34.95 vs. 103.75 ± 28.21 g/m(2)), left atrial (LA) volume index (29.31 ± 10.74 vs. 24.99 ± 7.43 mL/m(2)), and E/E' (11.92 ± 4.34 vs. 9.37 ± 2.51). Chronic renal failure was more prevalent in anemic group. On multivariate logistic analysis, anemia was significantly correlated with high LV filling pressure, reflected by E/E', even after controlling for LV mass index and LA volume index. Furthermore, E/E' was significantly correlated with the hemoglobin level (R(2) = 0.093, p < 0.001). In newly-diagnosed hypertensive patients over 50 years old, the presence of anemia was significantly associated with elevated LV filling pressure and LV structural changes. And the hemoglobin level was negatively correlated with noninvasively estimated LV filling pressure.

The Role of Asymmetric Dimethylarginine (ADMA) and Leptin in Hypertensive Patients

We investigated the role of leptin and asymmetric dimethylarginine (ADMA) in uncomplicated hypertension. We also investigated their relationship with insulin resistance and serum levels of several metabolic parameters, including homocysteine, lipoprotein(a) and malondialdehyde (MDA). A total of 34 untreated newly-diagnosed hypertensive patients (seven men and 27 women; mean age, 57.4 +/- 10.1 years) and 38 normotensive healthy subjects (20 men and 18 women; mean age, 55.9 +/- 8.7 years) were studied prospectively. Serum leptin, homocysteine, lipoprotein(a), MDA and insulin resistance (HOMA-IR) were significantly higher in hypertensive patients compared with normotensive subjects. There were no significant differences in ADMA, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 between the two groups. No correlation was found between serum ADMA and leptin levels. Our findings suggest that high serum leptin and homocysteine levels, oxidative stress and insulin resistance may be important risk factors for atherosclerosis among patients with uncomplicated hypertension.

PCV26: CARING FOR HYPERTENSION ON INITIATION: COSTS AND EFFECTIVENESS (CHOICE). DESIGN AND RATIONALE OF A NATURALISTIC STUDY

INTRODUCTION: Naturalistic studies are essential to prospectively study real-world antihypertensive treatment OBJECTIVE: to evaluate the feasibility of performing a naturalistic study in newly diagnosed hypertensives in terms of enrollment, adequacy, timeliness of data collection, and study procedures. METHODS: CHOICE prospectively collected actual practice data on the treatment of newly-diagnosed hypertensive patients. Initial therapy was randomly assigned to either Group 1 (beta blockers or diuretics) or Group 2 (ACE inhibitors or calcium channel blockers). The protocol made no demands in scheduling visits or changing treatment during follow-up. Physicians were blind to study purpose and hypotheses. Only a final visit at 5 ± 1 months, if none occurred naturally, was mandated. Direct involvement of the CHOICE study team was minimized using a Remote Study Monitoring System to collect data and communicate with study sites. RESULTS: Within 30 weeks, a total of 55 physicians enrolled 512 patients with a mean age of 51 years and blood pressure of 158/99 mmHG. In all, 46 different antihypertensive medications were prescribed and 2,554 office visits (range = 1–16 visits per patient) were attended. Other medical resource use was low during the study period. A final, clean database was ready for analysis 30 days after last patient last visit. CONCLUSIONS: It has been demonstrated that CHOICE is a feasible framework to study the real-world effectiveness of initial therapy for newly diagnosed hypertension. Protocol flexibility and a novel electronic data entry system are core elements of this naturalistic design.

A general‐practice study of the efficacy and tolerability of metoprolol in mild essential hypertension

The efficacy and tolerability of metoprolol (100 mg once a day) were assessed in general practice in 6713 newly-diagnosed or previously-treated hypertensive patients in an open study of eight weeks' duration. In 3534 mildly-hypertensive patients who were eligible for the efficacy analysis, the mean blood pressure level was reduced by 19/10 mmHg; 68% of the patients achieved diastolic blood pressures below 90 mmHg by the end of the assessment period. Of 6557 patients who were eligible for the tolerability analysis, only 5.6% of patients withdrew because of adverse events. The incidence of adverse events diminished considerably from the clinic assessment at four weeks (20%) to that at eight weeks (11%). At the completion of the study, 92% of the mildly-hypertensive patients were to continue with metoprolol, either as monotherapy (including 64% of patients who were receiving 100 mg once a day and 6% of patients who were receiving 50 mg once a day), or as combination therapy. Analysis of the large subgroup of mildly-hypertensive elderly patients (n = 1214) and of moderately-hypertensive patients, whose diastolic pressures exceeded the set upper limits (n = 2505), showed similar efficacy and tolerability results. Sixty-eight per cent of the former and 47% of the latter demonstrated satisfactory control of blood pressure. These results show that the majority of mildly-hypertensive patients can be controlled with 50-100 mg of metoprolol once a day.

Prevalence and Predictors of White Coat Hypertension among Newly-Diagnosed Hypertensive Patients in a Tertiary Health Centre in Nigeria.

Failure to diagnose and adequately classify newly-diagnosed hypertensive patients may lead to non-recognition of White Coat Hypertension (WCH) and inappropriate use of antihypertensive medications. This study determined the prevalence and predictors of white coat hypertension among newly-diagnosed hypertensive patients in a tertiary health centre in Nigeria. One hundred and twenty newly-diagnosed hypertensive patients and 120 controls were recruited for the study. All the participants had 24-hour Ambulatory Blood Pressure Monitoring (ABPM) using an oscillometric device (CONTEC®). Data were analyzed using SPSS version 20.0. Out of 120 patients, 52 were males and the mean age was 44.2 ± 9.7 years whereas of the 120 controls, 53 were males and the mean age was 44.0 ± 7.5 years. The mean body mass index of the patients, BMI (27.0 ± 4.5kg/m2) was higher than control (24.1 ± 4.5kg/m2), p-value <0.001. The prevalence of WCH was 36.7%. The mean age and BMI of those with WCH were 43.3 ± 11.4 years and 26.4 ± 4.5kg/m2 respectively. Females constituted a greater proportion (70.5%). In multivariate analysis, high level of education and being overweight or obese were significant determinants of WCH. High prevalence of WCH existed among participants studied. High level of education and being obese were predictors of white coat hypertension. Hence, ambulatory blood pressure monitoring should be included as part of routine work-up for newly-diagnosed hypertensive patients in order to limit the number of those who may be committed to lifelong antihypertensive medications with its unwanted side effects.