Number Of Antihypertensive Agents Research Articles

Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure

Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and ‘others’ ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.

Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria.

Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown. To compare anatomical and functional remodeling of left ventricle (LV) in PA patients with or without albuminuria. Prospective cohort study. The cohort was separated into two arms according to the presence or absence of albuminuria (>30 mg/g of morning spot urine). Propensity score matching with age, sex, systolic blood pressure, and diabetes mellitus was performed. Multivariate analysis was conducted with adjustments for age, sex, body mass index, systolic blood pressure, duration of hypertension, smoking, diabetes mellitus, number of antihypertensive agents, and aldosterone level. A local-linear model with bandwidth of 2.07 was used to study correlations. A total of 519 individuals with PA were enrolled in the study, of whom 152 had albuminuria. After matching, the albuminuria group had a higher creatinine level, at baseline. With regard to LV remodeling, albuminuria was independently associated with a significantly higher interventricular septum (1.22 > 1.17 cm, p = 0.030), LV posterior wall thickness (1.16 > 1.10 cm, p = 0.011), LV mass index (125 > 116 g/m2, p = 0.023), and medial E/e' ratio (13.61 > 12.30, p = 0.032), and a lower medial early diastolic peak velocity (5.70 < 6.36 cm/s, p = 0.016). Multivariate analysis further revealed that albuminuria was an independent risk factor for elevated LV mass index (p < 0.001) and medial E/e' ratio (p = 0.010). Non-parametric kernel regression also demonstrated that the level of albuminuria was positively correlated with LV mass index. The remodeling of LV mass and diastolic function under the presence of albuminuria distinctly improved after PA treatment. The presence of concomitant albuminuria in patients with PA was associated with pronounced LV hypertrophy and compromised LV diastolic function. These alterations were reversible after treatment for PA. Cardiac Impact of Primary Aldosteronism and Albuminuria Primary aldosteronism and albuminuria has been, respectively, demonstrated to bring about left ventricular remodeling, but the aggregative effect was unknown. We constructed a prospective single-center cohort study in Taiwan. We proposed the presence of concomitant albuminuria was associated with left ventricular hypertrophy and compromised diastolic function. Intriguingly, management of primary aldosteronism was able to restore these alterations. Our study delineated the cardiorenal crosstalk in the setting of secondary hypertension and the role of albuminuria for left ventricular remodeling. Future interrogations toward the underlying pathophysiology as well as therapeutics will facilitate the improvement of holistic care for such population.

An abdominal aortic aneurysm rupture risk score: a pilot study for combining precise aortic measurements and clinical factors

ObjectiveCurrent screening and management for abdominal aortic aneurysms (AAAs) are based on maximal aortic diameter criteria. This study sought to compare anatomic and clinical factors between ruptured and intact AAAs to identify predictors of rupture. MethodsPatients treated for AAAs at Thomas Jefferson University Hospital from 2010 to 2021 were reviewed from intact AAAs (iAAAs), ruptured AAAs (rAAAs), and no aortic pathology (NP) groups. Preoperative computed tomography angiography (CTA) studies were retrospectively measured with Aquarius iNtuition (TeraRecon Inc). Maximal diameter, length, mural thrombus volume (MTV), and calcification volume were measured from the lowest renal artery to the femoral artery. A rupture risk score was calculated using AAA diameter (1 point), percent ≥MTV 50% (1 point), number of antihypertensive agents <2 (1 point), not on cholesterol-lowering medication (1 point), and active smoking (1 point) for a 5-point total score. ResultsCTAs from 48 patients (age, 69.5 ± 8.1 years; 87.5% male) were measured (23 iAAAs, 15 rAAAs, and 10 controls). When compared with iAAAs, the maximal AAA diameter (rAAA, 7.71 cm; iAAA, 6.02 cm; P = .005) and %MTV (rAAA, 66.1%; iAAA, 45.3%; P = .0001) were greater in patients with rAAAs. Mean AAA rupture risk score was greater in patients with rAAAs than those with iAAAs (rAAA, 3.40 ± 1.12; iAAA, 1.78 ± 1.44; P < .001) with 100% of rAAAs and 47.8% of iAAAs having a score 2 or greater. ConclusionsThis study demonstrates that AAA diameter, percent MTV, blood pressure control, and active smoking are significant risk factors for AAA rupture. Patients with multiple risk factors (risk score ≥2) were more likely to rupture and should be considered high risk.

Correlation of renal cortical blood perfusion and BP response after renal artery stenting.

BackgroundThis study aimed to observe the correlation between renal cortical blood perfusion (CBP) parameters and BP response in patients with severe renal artery stenosis (RAS) who underwent stenting.MethodsThis was a single-center retrospective cohort study. A total of 164 patients with unilateral severe RAS after successful percutaneous transluminal renal artery stenting in Beijing Hospital from October 2017 to December 2020 were included. According to the results of BP evaluated at 12 months, all patients were divided into the BP response group (n = 98) and BP nonresponse group (n = 66). The baseline clinical and imaging characteristics and follow-up data about 24 h ABPM and CBP were recorded and analyzed. Pearson correlation analysis was used to evaluate the relationship between CBP parameters and 24 h average SBP. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for BP response.ResultsAmong 164 patients with severe RAS, there were 100 males (61.0%), aged 37–75 years, with an average of 56.8 ± 18.4 years, and average artery stenosis of 84.0 ± 12.5%. The BP nonresponse patients had a longer duration of hypertension, more current smoking subjects and diabetic patients, lower eGFR, increased number of hypertensive agents, and rate of insulin compared with the BP response group (P < 0.05). After PTRAS, patients in the BP response group were associated with significantly lower BP and improved CPB, characterized by increased levels of maximum intensity (IMAX), area under ascending curve (AUC1), area under the descending curve (AUC2), shortened rising time (RT), mean transit time (mTT), and prolonged time to peak intensity (TTP; P < 0.05). However, the BP nonresponse group was only associated with significantly reduced RT (P < 0.05) compared with baseline data. During an average follow-up of 11.5 ± 1.7 months, the BP response group was associated with significantly lower levels of SBP, DBP, 24 h average SBP, and 24 h average DBP compared with the nonresponse group (P < 0.05). Pearson correlation analysis showed that the the pre-operative CBP parameters, including IMAX (r = 0.317), RT (r = 0.249), AUC1 (r = 0.614), AUC2 (r = 0.558), and postoperative CBP parameters, including RT (r = 0.283), AUC1 (r = 0.659), and AUC2 (r = 0.674) were significantly positively correlated with the 24 h average SBP, while the postoperative TTP (r = −0.413) and mTT (r = −0.472) were negatively correlated with 24 h average SBP (P < 0.05). Multivariate Logistic regression analysis found that diabetes (OR = 1.294), NT-proBNP (OR = 1.395), number of antihypertensive agents (OR = 2.135), pre-operation IMAX (OR = 1.534), post-operation AUC2 (OR = 2.417), and baseline dDBP (OR = 2.038) were related factors for BP response (all P < 0.05).ConclusionPatients in the BP nonresponse group often have diabetes, a longer duration of hypertension, significantly reduced glomerular filtration rate, and heavier renal artery stenosis. CBP parameters are closely related to 24 h average SBP, and pre-operation IMAX and post-operation AUC2 are markers for a positive BP response.

Аналіз клінічних, генетичних і гендерних детермінант неефективного лікування в пацієнтів з артеріальною гіпертензією

Актуальність. Поліморфізм промоторної ділянки гену альдостеронової синтази CYP11B2 -344C/T (rs1799998) вiдiграє одну з ключових ролей в модуляції об’єм- і натрій-залежних механізмів артерiальноï гiпертензiï (АГ). Пошук маркерів ефективності антигіпертензивної терапії (АГТ) обумовлений частим недосягненням цільових рівнів АТ незалежно від характеру, дози антигіпертензивних препаратів (АГП), прихильності пацієнта до лікування.Мета. Метою роботи було визначити роль поліморфізму -344С/Т гену CYP11B2 в поєднанні з традиційними факторами ризику (ФР) в контролі артеріального тиску у пацієнтів з АГ ІІ-ІІІ ст.Матеріали та методи. Обстежено 93 пацієнта з АГ ІІ-ІІІ ст. Пацієнти були розділені на 2 групи: 1 гр . (n=38) – пацієнти з цільовим рівнем АТ на тлі АГТ, 2 гр. (n = 55) – пацієнти з АТ≥135/85 мм рт. ст. Всім пацієнтам виконували стандартні клініко-лабораторні дослідження, оцінювали ФР, виконували генотипування методом полімеразної ланцюгової реакції з визначенням довжини рестрикційних фрагментів та визначенням гаплотипу -344С/Т CYP11B2.Результати. Групи пацієнтів з різними рівнями АТ були порiвнюванi за частотою модифікованих ФР, кількісним та якісним складом АГТ. У групі осіб з неконтрольованою АГ частка курців, а також пацієнтів з супутнім цукровим діабетом 2 типу була достовірно вище в порівнянні з пацієнтами 1 гр. Аналіз частот алель них варіантів гену -344С/Т CYP11B2 показав, що частка пацієнтів, що мають Т- монозиготний генотип, була достовірно вище серед пацієнтів 2 гр.Висновок. Наявність Т-алеліі TТ-генотипу -344С/Т CYP11B2 в поєднанні з множинними ФР асоціювалася з недостатнім контролем АТ , незалежно від АГТ.

Difference in Antihypertensive Medication Pattern in the First Year Compared to More than a Year of Maintenance Hemodialysis: A Northern India Tertiary Care Experience

Introduction There is a high prevalence of hypertension in maintenance hemodialysis patients. Information regarding prevalent pattern of antihypertensive medications will help modify it to prevent future cardiovascular morbidity and mortality. Materials and Methods In this cross-sectional study, patients on maintenance hemodialysis, aged ≥18 years visiting Nephrology outpatient department (OPD) from April 2019 to May 2020 were included. The patients were divided into two groups based on their dialysis vintage, ≤12 months and &gt;12 months. Their antihypertensive medication patterns and two-dimensional (2D) echocardiography (ECHO) findings were compared. Independent t-test was used to compare continuous variables. One-way analysis of variance was used to study the antihypertensive drug-dosing pattern in both the groups. Results Out of 250 patients, 131 had a dialysis vintage of ≤12 months, whereas 119 had a vintage of &gt;12 months. There was no significant difference in the number of antihypertensive agents used in either of the vintage groups. Calcium channel blockers (87.02 and 89.07%, respectively, in ≤12 and &gt;12 months' vintage groups) and β blockers (64.12 and 65.54%, respectively, in ≤12 and &gt;12 months' vintage groups) were the commonly used antihypertensive agents. Metoprolol use was higher in ≤12 months' group, whereas carvedilol usage was higher in &gt;12 months' group (p = 0.028). Mean pill burden was more than five in both the groups. Concentric left ventricular hypertrophy was significantly more common in &gt;12 months' group. Renin–angiotensin system (RAS) blocking agent use was limited to 3% of patients. Conclusion This study shows a high antihypertensive pill burden in dialysis patients likely due to underlying chronic volume overload in addition to the perceived efficacy of certain class of drug in a frequent dosing pattern. Low use of RAS blocking agent was also underlined. This study highlights the need to bring about changes in the antihypertensive prescription pattern in line with the existing evidence.

Coffee Consumption and Blood Pressure: Results of the Second Wave of the Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS).

This study examined the relationship between the frequency of coffee consumption and blood pressure over a two year follow up of a cohort of elderly people. Healthy, older people (N = 205) were examined at baseline and at two years. Participants completed physical and behavioural assessments, which included body composition, current pharmacological treatment, and frequency of coffee consumption grouped into three categories: “never to a few times per month”, “once a week to a few times per week”, and “every day”. Blood pressure (systolic (sBP), diastolic (dBP), mean (mBP), and pulse pressure (PP)) was measured at baseline and after two years. After adjusting for body composition, smoking status, age, sex, heart rate, and number of antihypertensive agents taken, participants who drank coffee everyday had a significant increase in sBP, with a mean of 8.63 (1.27; 15.77) and an mBP, with a mean of 5.55 mmHg (0.52; 10.37) after two years (t = 2.37, p = 0.02 and t = 2.17, p = 0.03, respectively) compared to participants who never or very rarely (up to a few times per month) drank coffee. DBP and PP were not affected by coffee consumption frequency in a statistically significant manner.

Well Controlled Blood Pressure in Turkish Patients: How Many Drugs Are Required to Attain and Maintain the Blood Pressure Goal?

Background: This study aimed to determine the number of antihypertensive agents required to achieve optimal blood pressure (BP) in Turkish hypertensive patients. Material and Methods: Totally 400 hypertensive patients (114 males and 286 females) were enrolled. BP was measured by patients at home twice a day. The patients were called for controlling in every four weeks, and those who had BP 140/90 drug, doses were increased or another antihypertensive drug added and the patients were continued to be followed-up. Results: In the first follow-up (on the 4th week), 152 (38%) patients, including 35 (31%) men and 117 (41%) women, attained the goal BP. The mean duration of hypertension in single, double, triple, and quadruple treatment groups was 6.2 ± 5.0, 6.8 ± 5.9, 8.8 ± 5.4, and 10.4 ± 6.6 years, respectively. In the beginning, the median number of agents used for each patient was 2.17. When the follow-up was concluded, the median of agents used for each patient was 2.72. Conclusion: Thirty-eight percent of participants had controlled hypertension in the first follow-up. Women had better BP control. The median number of agents required for attaining and maintaining BP goal was 2.72. More drugs are needed when hypertension gets longer.

Antihypertensive Treatment in Kidney Transplant Recipients-A Current Single Center Experience.

Arterial hypertension affects the survival of the kidney graft and the cardiovascular morbidity and mortality of the recipient after kidney transplantation (KTx). Thus, antihypertensive treatment is necessary for a vast majority of these patients. Long-term data on antihypertensive drugs and their effects on allograft function after KTx is still limited, and further investigation is required. We retrospectively analyzed a cohort of 854 recipients who received a kidney transplant at our transplant center between 2007 and 2015 with regard to antihypertensive treatment and its influence on graft function and survival. 1-y after KTx, 95.3% patients were treated with antihypertensive therapy. Of these, 38.6% received mono- or dual-drug therapy, 38.0% received three to four drugs and 8.1% were on a regimen of ≥5 drugs. Beta-blockers were the most frequently used antihypertensive agents (68.1%). Neither the use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (51.9%) and calcium channel blockers (51.5%), nor the use the use of loop diuretics (38.7%) affected allograft survival. Arterial hypertension and the number of antihypertensive agents were associated with unfavorable allograft outcomes (each p < 0.001). In addition to the well-known risk factors of cold ischemic time and acute rejection episodes, the number of antihypertensive drugs after one year, which reflects the severity of hypertension, is a strong predictor of unfavorable allograft survival.

Impact of self-monitoring of salt intake by salt meter in hypertensive patients: a randomised controlled trial (SMAL-SALT)

Abstract Background Hypertension is one of the most common chronic medical conditions. The concerned sequelae are the cardiovascular complications. In Thailand, the incidence of hypertension is increasing each year. Many clinical studies found that salt intake over the reference level (&amp;gt;5 g/day) would result in elevated blood pressure (BP) and morbidity. Dietary salt reduction campaigns were unsuccessful, in part, due to time limitation in the clinic, lacking of awareness, and the higher threshold to detect salt taste in chronic high salt ingestion. Salt meter is a device used to detect sodium content in daily food. It will facilitate monitoring and control of salt intake. This study aimed to compare the efficacy of salt meter plus dietary education compared with education alone in terms of salt intake reduction, blood pressure, salt taste sensitivity, and vascular consequence. Method A randomized-controlled trial was conducted in hypertensive patients whose BP was uncontrolled (SBP ≥140 mmHg or DBP ≥90 mmHg) despite therapy or antihypertensive-naïve. Patients were randomized to receive salt meter to use in conjunction with dietary education (group A) or receive education only (group B), and were followed up for 8 weeks. Dietary education was provided by certified dietician without awareness of patients' allocation. The primary endpoint was change in 24-hour urinary sodium excretion. Changes in BP, salt taste sensitivity threshold, cardio-ankle vascular index (CAVI), as well as motivation to maintain low salt diet were also analyzed. Results A total of 100 patients were enrolled, with 90 patients who met the eligible criteria and had completed to follow-up, 45 in group A and 45 in group B. Mean age was 62.9 years and 53% were females. 11.1% were treatment-naïve, and median number of antihypertensive agents was 2. Mean baseline 24-hour urine sodium was 151.6 mmol/24h and mean baseline SBP and DBP were 152.8 and 83.4 mmHg, respectively. Baseline characteristics including age, sex, number of drugs, BP, body weight, 24-hour urine sodium, creatinine, salt sensitivity, and CAVI were similar between two groups. At 8 weeks, mean decrease in 24-hour urine sodium were 29.1 mmol/24h and −0.9 mmol/24h in group A and group B, respectively (p=0.017). Mean decrease in BP (group A vs group B) were SBP, 14.3 vs 8.4 mmHg (p=0.043), and DBP 5.7 vs 1.8 mmHg (p=0.021). The salt sensitivity was improved in both groups, more in group A (detection threshold decrement = 1.547 in group A and 0.265 in group B). There was no different between change in CAVI. All patients have more motivation to maintain low salt diet after finish the study. No adverse event was observed throughout the study. Conclusions Salt meter in conjunction with dietary education, for self-monitoring of salt intake is superior to education alone in hypertensive patients, and provided better blood pressure control. Salt meter should be considered in patients with uncontrolled hypertension. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Faculty of Medicine, Ramathibodi Hospital of Mahidol University

Immediate Results and Long-Term Outcomes Following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma.

The aim of this study was to evaluate early and long-term clinical and laboratory findings in patients with resistant hypertension secondary to aldosterone-producing adenoma (APA) treated with radiofrequency ablation (RFA). From July 2009 to September 2017, eight adult patients underwent percutaneous computed tomography (CT)-guided RFA for APA. The safety, efficacy and complications of the procedure were determined. Blood pressure (BP), number of antihypertensive agents, serum potassium, plasma aldosterone and aldosterone-to-renin ratio (ARR) were analyzed before RFA and immediately, short-term and long-term after RFA. The technical success rate was 100%. Two patients developed minor complications but there were no major complications. Clinical improvement was achieved immediately and short-term after RFA. In the long-term (mean follow-up duration of 6.7 ± 2.1 years) there were significant improvements in systolic (from 162.3 mmHg ± 18.6 to 125 mmHg ± 16.1, p = 0.02) and diastolic (from 96.3 mmHg ± 12.7 to 68.5 mmHg ± 6.3, p = 0.02) BP, with a significant reduction in the number of antihypertensive agents (from 3.33 ± 0.82 to 1.33 ± 1.21, p = 0.02). Hypokalemia improved significantly (serum potassium from 2.16 meq/L ± 0.22 to 4.34 meq/L ± 0.54, p = 0.04). Although the plasma aldosterone level decreased significantly, ARR did not (from 100.7 ± 124.4 to 28.7 ± 30.7 ng/dL-per-ng/mL/h, p = 0.13). Hypertension was cured in 33.3% of the patients, and the BP of all patients was more easily controlled regardless of the plasma aldosterone and renin status. CT-guided percutaneous RFA appears to be effective and safe to treat patients with APA, with clinical improvements in BP, reduced number of antihypertensive agents, and normalization of serum potassium level. These favorable outcomes persisted in short-term and long-term follow-up.

Intradialytic Hypertension and Associated Factors in Chronic Hemodialysis at the National Hemodidiadiasis Center in Donka, Guinea

Introduction: Dialytic high blood pressure (DHBP), although often ignored, is now recognized as a recurring and persistent phenomenon in a subgroup of hemodialysized patients. Its occurrence is associated with an increased risk of hospitalization and death. The objective of the study was to determine the prevalence of intradialytic hypertension and the factors associated with it. Methods: Study was cross-sectional, monocentric, descriptive and analytical over a three-month period from April 22 to July 22, 2019. Included were all patients 18 years of age or older, chronic hemodialysis for at least three months, with intra-dialytic high blood pressure. The blood pressure machine used for the majority of patients was an electronic “OMRON” blood pressure monitor. Epidemiological, clinical, para clinical and dialysis parameters were studied. The data were collected, captured and analyzed using IBM SPSS Statistics Version 20 software. The factors associated with intradialytic high blood pressure were searched using a univariate logistic regression model. The significance threshold for all statistical tests has been set at 5%. Results: Of our 131 patients, 53 had intradialytic hypertension, a frequency of 40.5%. The time of (DHBP) occurrence was more frequent at the 3rd and 2nd hour, 94.34% and 86.79%, respectively. The average age of patients was 45.51 years with extremes ranging from 19 to 70 years. The average Systolic Blood Pressure (SBP) before dialysis was 148 mm Hg ?16.62 and the average Diastolic Blood Pressure (DBP) before dialysis was 88 mm Hg ?12.50. Pre-dialysis Blood Pressure—140/90 mm Hg was noted in 18 cases, or 34.0%. The intradialytic average SBP was 164 mm Hg ?17.25 with extremes of 121 to 202 mm Hg. The intradialytic average DBP was 92 mm Hg ?12.52 with extremes 67 to 124 mm Hg. The main risk factors associated with intra-dialytic hyperation were: Age range (40 - 50 years), Duration on dialysis (<6 months). Vascular nephropathy, hypoalbuminemia, Pre-dialytic Blood Pressure ≥ 140/90 mmHg. BP post dialysis ≥ 165, Dry weight ≥ 70 Kg, Number of antihypertensive agents ≥ Ultrafiltration rate ≥ 550 ml/h. Conclusion: This study, the first of its kind in Guinea, was able to determine the frequency of intradialytic hypertension and the factors associated with it.

One-Year Impact of Kidney Transplantation on Cardiac Abnormalities and Blood Pressure in Hemodialysis Patients.

Cardiac abnormalities, including left ventricular hypertrophy and systolic dysfunction, are frequently observed among patients with CKD, including kidney transplant recipients; they are closely linked to cardiovascular disease and mortality. Although several studies have been performed for elucidating changes and mechanisms of cardiac abnormalities after kidney transplantation, details remain unclear. This study included 43 consecutive patients who underwent HD and received kidney transplantation between 2008 and 2012 at our institution. All subjects underwent echocardiography before and 1 year after kidney transplantation. One year after kidney transplantation, left ventricular mass index, cardiac chamber sizes, BP, and the number of antihypertensive agents were reduced. Although the percentage of patients with concentric hypertrophy did not change, the percentage of those with eccentric hypertrophy significantly decreased after kidney transplantation. Volume reduction due to the recovery of kidney function may be primarily attributed to the improvement of cardiac abnormalities, including left ventricular hypertrophy.

Комбинированный метод лазерного лечения первичной узкоугольной (смешанной) глаукомы

Purpose. To study the efficiency of a combined method for laser treatment – the laser iridectomy in combination with the selective laser trabeculoplasty (LIE+SLTP) – in patients with primary narrow-angle (mixed) glaucoma. Material and methods . The study included 72 patients (72 eyes) with initial stage of primary narrow-angle (mixed) glaucoma. The average age of the patients was 65.1±6.56 years: 27 males, 43 females. The followup period was up to 4 years after laser treatment. The level of intraocular pressure (Р 0 ) before the treatment was on average 24.47±1.85mmHg. The mean quantity of antihypertensive drugs used by the patients before the laser operation was 2.2±0.4. Stages of the combined treatment: laser iridectomy and selective laser trabeculoplasty were performed immediately one after the other in all patients. Results. All laser interventions were carried out without complications.An extension of the anterior chamber angle (ACA) was achieved in all patients, which was confirmed by data of gonioscopy and anterior optical coherence tomography (OCT). On the 1st day after the combined laser treatment, the reactive elevation of IOP was observed in 9.7% of cases and was stopped by an additional antihypertensive therapy within 1-2 days. Other complications such as inflammatory, hemorrhagic were not detected. A week after laser treatment there was a significant decrease (p<0.05) of intraocular pressure (IOP) by 6.9mmHg on average (28.2%) of the original. In the long-term postoperative follow-up period, the average decrease of IOP was 23.4%. Ophthalmotonus normalization occurred with increasing the coefficient of aqueous humor outflow facility (C) from 0.09±0.01 to 0.18±0.01 (p<0.05). In the long-term postoperative follow-up the IOP normalization was achieved in 87.5% of cases (63 eyes of 72). The IOP decrease to normal occurred in 9 eyes after the repeated SLT. The average number of antihypertensive agents that were used by the examined patients after the treatment decreased and averaged 1.02±0.1. The visual acuity remained unchanged in 80.5% of cases. The decrease of the vision was due to the progression of complicated cataract. Limits of peripheral visual field remained stable by the end of the follow-up period in 96% of cases. Within the observation period, according to computer perimetry data, negative dynamics was recorded in 6 patients (6 eyes out of 72 – 8.3%). According to HRT, negative dynamics in the form of a decrease in the volume of the neural rim, an increase in the area of the optic disc excavation was noted in 7% of cases (5 eyes of 72). Conclusion. The proposed method of combined laser treatment allows to achieve the IOP normalization due to an expansion of ACA after LIE with a subsequent activation of trabecula by SLT in 87.5% of patients. Ophthalmotonus normalization, stabilization of visual functions and indicators of the optic nerve conditions in the vast majority of patients in the long-term postoperative period proves the efficiency of the proposed technique in the treatment of patients with the initial stage of primary narrow-angle (mixed) glaucoma. The simultaneous operation of two stages – laser iridectomy and SLT is safely and enables significantly to reduce the duration of treatment and rehabilitation of patients.

Is there still a role for renal artery stenting in the management of renovascular hypertension - A single-center experience and where do we stand?

Renal artery (RA) stenosis has been implicated in the pathophysiological mechanism for resistant hypertension. Despite the increasingly diagnosed frequency of hemodynamically significant lesions, the value of RA revascularization remains controversial. Our group had previously demonstrated significant blood pressure (BP) reduction in a retrospective cohort of appropriately selected patients undergoing RA stenting up to 18-months of follow-up. We herein present long-term clinical outcomes data 5-years post revascularization on 26 subjects who continued follow-up at our institution. Retrospective analysis was performed on subjects who underwent RA stenting at our institution for hemodynamically significant (≥70%) RA stenosis and systolic hypertension on ≥3 antihypertensive agents. Clinical outcome data for systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine level and number of antihypertensive drugs was assessed prior to and then later at 6-12 months and 3-5 years post RA stenting. Mean age was 69 ± 9 years; 27% (7/26) were male. Median follow-up was 5.1 years. Blood pressure reduction was sustained at long-term follow-up (135/70 ± 18/11 mmHg) compared to initial reduction noted at 6-months (136/69 ± 16/8 mmHg; p ≤0.01 for both) and from baseline (162/80 ± 24/18 mmHg; p ≤0.001 for both). The number of antihypertensive agents also decreased from 4.1 ± 1.0 to 2.7 ± 2.1 (p = 0.002) at 6-months and was sustained at long-term follow-up, 3.4 ± 1.2 (p = 0.03) with no difference in renal function between short- and long-term follow-up compared to baseline. This study shows sustained benefit of RA stenting in BP reduction in an appropriately selected cohort with significant stenosis ≥70% and uncontrolled hypertension on multiple medications on long-term follow-up.

Individualizing treatment choices in the systolic blood pressure intervention trial.

Any treatment decision should be tailored to the individual patients' characteristics. A personalized approach aims to help better selecting the patients who are likely to benefit most from a treatment decision. In the systolic blood pressure intervention trial, intensive treatment reduced the rate of major cardiovascular events, but increased the rate of serious adverse events (SAEs). To assess the trade-off between efficacy and safety to simultaneously quantify an individual patient's absolute benefit and absolute harm, helping clinicians making better therapeutic choices in daily practice. Multivariable Poisson regression models were used to identify independent risk factors for: primary composite cardiovascular outcome and major SAEs = safety. Estimates from the models were used to quantify each individual risk. Subclinical cardiovascular disease, number of antihypertensive agents, current smoking, age, urine albumin-to-creatinine ratio, and serum creatinine were associated with increased risk of both primary outcome events and SAEs. Triglycerides were associated with increased primary outcome events only, and chronic kidney disease and female sex with SAEs only. The models were well calibrated and showed good performance (c-index for safety = 0.69 and c-index for efficacy = 0.72). For the primary outcome, there is a steep gradient in risk by fifths of the predicted model and a similar gradient exists for the safety outcome predicted model. Mortality within 1 year of an efficacy outcome (as assessed by the Kaplan-Meier method) was nearly three-fold higher than following a safety outcome (21.9 vs. 7.5%). If one judges the clinical importance of efficacy and safety outcomes based on their 1-year mortality, then there is a net benefit of intensive therapy for almost all patients. Antihypertensive treatment intensification is associated with lower cardiovascular event rates; however, it increases the risk of adverse events. However, having adverse events has less weight when it comes to therapeutic decisions and antihypertensive therapy intensification is beneficial for the great majority of patients included in the systolic blood pressure intervention trial.

Primary Aldosteronism With Type 2 Diabetes Mellitus Requires More Antihypertensive Drugs for Blood Pressure Control: A Retrospective Observational Study

BackgroundDiabetes mellitus (DM) and primary aldosteronism (PA) have been reported to induce drug-resistant hypertension and atherosclerosis. It is likely that blood pressure (BP) control becomes far more difficult in PA patients with DM. However, precise clinical characteristics of PA with type 2 DM especially in the aspect of BP control are not clear.MethodsThe study included 18 patients who were diagnosed as PA with DM and 52 PA patients without DM who matched age and sex and chosen as a control group. We have compared differences in BP control, use of antihypertensive agents and clinical characteristics between PA patients with and without DM.ResultsThere was no difference with regard to the duration of hypertension and BP control between either group. Interestingly, the PA with DM group was found to require more antihypertensive agents than the PA without DM group (number of antihypertensive agents used, 2.0 ± 1.5 vs. 1.3 ± 1.1; P < 0.05, respectively). In the 28 patients who underwent measurement of central BP (CBP) values, plasma aldosterone concentration (PAC) was high in the PA with DM group. Furthermore, a positive correlation was shown between PAC and CBP (r = 0.58; P < 0.01); the higher the PAC, the higher the CBP of patient.ConclusionsThese results might suggest that hypertension becomes more difficult to control in PA patients with DM in the future.

PS 05-13 EFFECT OF THE OPERATIVE TREATMENT ON MORNING AND EVENING BLOOD PRESSURE MEASURED BY SELF-MEASURED BLOOD PRESSURE MONITORING IN PRIMARY ALDOSTERONISM PATIENTS

Objective: Effect of the operative treatment on the blood pressure (BP) variability in patients with primary aldosteronism (PA) remains to be elucidated. We studied the determinants of the morning minus evening systolic BP difference (ME difference) in self-measured BP in PA patients. Design and Method: 29 patients (male/female, 13/16, age 56.4 ± 12.12) were diagnosed with PA and underwent subtype differentiation according to the findings of adrenal venous sampling (AVS). The all patients with APA (alsosterone producing adenoma) were underwent adrenalectomy. We analyzed BP before and after the operative treatment of 30 days using self-measured BP monitoring in the morning and evening. Results: The all patients took the ≥3 antihypertensive agents (3.59 ± 0.27), mainly MR antagonist (spironolactone or eplerenone) until operative treatment after AVS. The morning BP average was 124.11 ± 12.0 mmHg before operative treatment of 30 days. After the treatment, the plasma aldosterone concentrations (PAC:ng/ml) significantly decreased (38.0 ± 3.65 to 10.5 ± 5.0), and the number of antihypertensive agents were reduced (1.21+-0.187). 8/29 patients had not took antihypertensive agents after the treatment. The morning BP average was 125.17 ± 12.5 mmHg after operative treatment of 30 days, and was not significantly unchanged. However, the operative treatment significantly decreased the ME difference (ME average: before 11.35 ± 0.38 to after 9.64 ± 0.34 mmHg). Conclusions: Morning blood pressure (BP) surge in ambulatory BP monitoring was a risk factor for stroke in previous studies. In the PA (APA) patients, the operative treatment more strongly reduced ME difference and depressed BP variability compared to pharmacotherapy, so that may be more useful to prevent cerebrovascular disease (CVD).

Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients.

Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD. Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses. 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m(2). At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020). Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients.

Pretransplant Stable Systolic Cardiac Functions Play an Important Role in Short-term Systolic Cardiac Functions After Kidney Transplant in Children.

In this study, our aim was to evaluate the systolic cardiac parameters and related risk factors in children within 6 months after kidney transplant. We retrospectively evaluated 24 children who received kidney transplants. Clinical and laboratory parameters before and after transplant were recorded. Results were evaluated statistically, with a P value less than .05 considered significant. Before transplant, systolic cardiac functions were within normal limits. After transplant, ejection fraction (63.35% ± 5.38% vs 66.95% ± 4.62%; P = .01) was significantly increased and left ventricular mass index (32.63 ± 17.21 g/m2.7 vs 31.29 ± 15.65 g/m2.7; P = .78) was not significantly decreased, whereas fractional shortening (52.16% ± 15.32% vs 59.8% ± 12.94%; P = .54) did not change. Systolic blood pressure, systolic blood pressure index, diastolic blood pressure, and diastolic blood pressure index values were not statistically different before and after transplant (P > .05). The number of antihypertensive agents was significantly decreased (P = .001). Before and after transplant, cardiac geometry was normal in 15 patients (62.5%) and 17 patients (70.8%). Our patients, who had stable systolic cardiac function before transplant, showed further improvements in systolic cardiac function even within 6 months after transplant. Therefore, strictly monitored and controlled blood pressure, volume, anemia, and nutrition in children before transplant may play important roles in achieving better cardiac systolic function after kidney transplant.