Number Of Antihypertensive Drugs Research Articles

Discontinuation of Antihypertensive Medication, Cognitive Complaints, and Incident Dementia

ObjectivesTo evaluate whether discontinuation of antihypertensive medication in community-dwelling older people is associated with a reduction in memory complaints and/or incident dementia. DesignProspective observational cohort study within the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial. Setting and ParticipantsCommunity-dwelling participants (aged 70-78 years at baseline) who underwent 2-yearly assessments during 6-8 years of follow-up. MeasuresCox regression analyses of the relation between discontinuation of antihypertensive medication during the study and change in subjective memory complaints, incident dementia, and mortality. ResultsDementia occurred more often in participants discontinuing antihypertensive treatment (13.4% vs 6.2%, P = .02); mortality was similar (16.5% vs 13.9%, P = .52). Discontinuation of antihypertensive medication was associated with a double dementia hazard [hazard ratio (HR) (95% confidence interval) = 2.15 (1.15-4.03)], which somewhat attenuated after adjustment for sex, blood pressure, number of antihypertensives and other medications [HR = 1.92 (1.01-3.65)], and additionally for stroke, cardiovascular disease, diabetes, smoking, memory complaints, and MMSE score [HR = 1.79 (0.93-3.44)]. Antihypertensive discontinuation was associated with an approximately 50% higher hazard of dementia and/or mortality combined [HR = 1.58 (1.04-2.40); model 2: HR = 1.64 (1.07-2.51); model 3: HR = 1.49 (0.96-2.30)]. Antihypertensive discontinuation was not associated with change in memory complaints [odds ratio (95% confidence interval) = 0.96 (0.55-1.67)]. Subgroup and sensitivity analyses addressing possible sources of bias and confounding gave similar results. Conclusions/ImplicationsOur results suggest that antihypertensive withdrawal in community-dwelling older people does not preserve cognition and may in fact increase dementia risk. This is not due to reduced mortality as competing risk. Additional analyses suggest results are unlikely to be explainable by confounding, reverse causality, or observational biases. Studies with person-specific reasons for antihypertensive discontinuation may be able to exclude reverse causality completely. Given the beneficial effects of antihypertensive medication on cardiovascular risk, observational data may be the best currently obtainable on the pressing issue of when withdrawal of antihypertensives in older people is acceptable and what consequences need to be weighed.

A14955 Investigation of blood pressure, number of anti-hypertensives and accomplishment rate of target blood pressure in hypertensive patients with diabetes mellitus or chronic kidney disease

A14955 Investigation of blood pressure, number of anti-hypertensives and accomplishment rate of target blood pressure in hypertensive patients with diabetes mellitus or chronic kidney disease

Abstract P375: Association Between Use of Alpha-Blockers and Hypotension and Hypotension-Related Clinical Events in Patients With Hypertension

Importance: Alpha- blockers (AB) are commonly prescribed agents in the treatment of hypertension. Little is known regarding the risk of hypotension and hypotension-related clinical outcomes in patients with advanced age with ongoing treatment for hypertension. Objective: To assess the risk of hypotension and hypotension-related adverse events (syncope, falls, fractures), major adverse cardiac events and all-cause mortality with AB use compared to other anti-hypertensives. Methods: Population-based, retrospective cohort study of 933,033 eligible adults of advanced age (> 66 years) prescribed an anti-hypertensive medication between 1995 and 2015 in Ontario, Canada. A high dimensional propensity score was used to match AB prescription to other anti-hypertensives. AB exposure was modeled as a time-varying and cumulative covariate using extended, conditional Cox proportional hazards to examine the association with outcomes. Primary outcome was hospitalization or emergency room usage for hypotension and related complications (syncope, fractures, falls). Secondary outcomes included major adverse cardiovascular events and all-cause mortality. Results: Among 69,092 matched patients prescribed AB, the incident rate of hypotension related complications were higher compared to other anti-hypertensives (hypotension 1.15 vs. 0.39, syncope 1.47 vs. 0.46, falls 4.37 vs. 1.37, fractures 2.23 vs. 0.69 per 100 person-years of follow-up). In time-varying exposure models with additional adjustment for the total number of anti-hypertensives, the higher risk persisted (hypotension HR 1.34 95%CI 1.26-1.43, syncope HR 1.49 95%CI 1.41-1.57, falls HR 1.27 95%CI 1.23-1.32, HR fractures 1.41 95%CI 1.34-1.48). Secondary outcomes of MACE and all-cause mortality were higher or similar among AB users (MACE IR 7.03 vs. 2.31, mortality 6.54 vs 6.37 per 100 person-years follow-up). The risk was highest among those > 85 and differed by the number of total anti-hypertensives prescribed. Conclusions: The use of AB is associated with a higher risk of hypotension-related events and other complications. Our findings suggest other anti-hypertensive agents be considered especially among those of advanced age or based on the number of total anti-hypertensive agents.

Abstract P117: Blood Pressure Outcomes in Patients With Primary Aldosteronism after Adrenalectomy versus Medical Management in Relation to the New 2017 ACC/AHA Blood Pressure Guidelines

Objective: Investigate blood pressure (BP) outcomes in primary aldosteronism (PA) patients following adrenalectomy or medical therapy in the context of the lower BP target goal and threshold proposed by the 2017 ACC/AHA blood pressure guidelines. Methods: A retrospective study was conducted in patients with confirmed diagnosis of PA who were referred to Hypertension clinic at the University of Texas Southwestern between January 2009 and August 2017. Presence of PA was confirmed using previously recommended cutoff values of urinary aldosterone greater than 12 mcg/2h for the oral salt loading test and serum aldosterone greater than 10 ng/dL after intravenous saline suppression test. Patients were categorized into adrenalectomy or medical therapy groups. The average BP and number of anti-hypertensives were compared between the two groups at each clinic visit. Hypertension cure rate of PA patients undergoing adrenalectomy was compared using the JNC8 threshold BP of 140/90 mmHg versus the 2017 ACC/AHA threshold BP of 130/80 mmHg. Results: Forty-nine patients were found to have PA. Twenty-two patients had an adrenalectomy, twenty-seven patients were started on a mineralocorticoid antagonist. The adrenalectomy subgroup required a fewer number of anti-hypertensives at the last follow-up visit (p=0.0004) compared to the medically treated group. Systolic BP reduced similarly from the baseline visit to the last visit in the adrenalectomy group compared to the medical therapy group (from 151.3 +/- 5.7 to 134.3 +/- 4.5 mmHg vs. 149 +/- 4.1 to 134.7 +/- 4.1 mmHg, p < 0.01 for visit and p=0.5 for group). Thirteen percent (3 of 23) of adrenalectomy patients achieved cure based on the previous JNC8 guidelines, whereas only 8.7% (2 of 23) achieved cure based on the current guidelines. Conclusion: Adrenalectomy is more efficacious than medical management in reducing the number of anti-hypertensives needed for BP control. The percentage of patients who achieved cure following adrenalectomy decreased when defined by the 2017 ACC/AHA guidelines.

Long-Term Consequences of Complex Living Renal Donation: Is It Safe?

IntroductionAs there is a paucity of literature regarding the long-term outcomes of complex living donors, we conducted this study to assess the effect of kidney donation on the complex living kidney donor. Materials and MethodsThis retrospective study was conducted in Narayan Health Hospital, Kolkata, Eastern India. The cohort consisted of complex living kidney donors who donated kidneys between the years 2007 and 2012. All donors were 60 years old or older, or were younger than 60 years and had comorbidities like hypertension and obesity. After a minimum follow-up of 5 years, all donors underwent evaluation. Data pertaining to hypertension, new-onset diabetes, body mass index (BMI), estimated glomerular filtration rate (eGFR) and albuminuria, and cardiac events were compared from the time of donation till 5 years post-transplant. Results and DiscussionWe found a statistically significant increase in blood pressure, number of antihypertensives used, and mean BMI at follow-up. Diabetes mellitus was developed in 22.3% of donors. The mean GFR also decreased significantly at follow-up. There were 42 elderly donors (≥60 years) and 23 ≤ 59 years of age. There was a significant fall of eGFR in both groups, but the percentage fall was similar in both groups. A significant percentage of donors developed proteinuria, the majority being hypertensives. ConclusionProcurement of kidneys from marginal donors should be done cautiously, and donors should be assessed for morbidity and mortality in the future, as we found a statistically significant deterioration in renal function, blood pressure, and BMI over long-term follow-up.

Long-term clinical parameters after switching to nocturnal haemodialysis: a Dutch propensity-score-matched cohort study comparing patients on nocturnal haemodialysis with patients on three-times-a-week haemodialysis/haemodiafiltration

ObjectivesNocturnal haemodialysis (NHD), characterised by 8-hour sessions ≥3 times a week, is known to improve clinical parameters in the short term compared with conventional-schedule haemodialysis (HD), generally 3×3.5–4 hours a...

Twenty-four hour urinary cortisol excretion and the metabolic syndrome in prednisolone-treated renal transplant recipients

Chronic prednisolone treatment in renal transplant recipients (RTR) causes metabolic abnormalities, which cluster in the metabolic syndrome (MS). It also suppresses the hypothalamic–pituitaryadrenal (HPA)-axis. We investigated whether HPA-axis suppression, as measured by 24h urinary cortisol excretion, is associated with presence of the MS and its individual components, in outpatient RTR with a functioning graft for >1year. Urinary cortisol was measured in 24h urine, using LC–MS/MS (LOQ 0.30nmol/L). We included 563 RTR (age 51±12years; 54% male) at median 6.0 [IQR, 2.6–11.5] years post-transplantation. MS was present in 439/563 RTR (78%). Median 24h urinary cortisol excretion was 2.0 [IQR, 0.9–5.1]nmol/24h. Twenty-four hour urinary cortisol excretion was independently associated with MS presence (OR=0.80 [95% CI, 0.66–0.98], P=0.02). It was also independently associated with bodyweight (st.β=−0.11, P=0.007), waist circumference (st.β=−0.10, P=0.01), BMI (st.β=−0.14, P=0.001), fasting triglycerides (st.β=−0.15, P=0.001), diabetes (st.β=−0.12, P=0.005), and number of antihypertensives used (st.β=−0.13, P=0.003). Suppressed HPA-axis activity, as reflected by decreased 24h urinary cortisol excretion, is associated with higher prevalence of MS and its individual components (i.e. central obesity, dyslipidemia, diabetes, hypertension) in prednisolone-treated RTR. Assessment of 24h urinary cortisol excretion by LC–MS/MS may be a tool to monitor metabolic side-effects of prednisolone in RTR.

A study of the prescribing pattern of antihypertensive drugs in a Tertiary Care Teaching Hospital of Andaman & Nicobar Island

Introduction: Hypertension is the increased systolic blood pressure of ?140 mm Hg or diastolic blood pressure of ?90 mm Hg. The antihypertensive drugs currently available are chosen on the basis of their efficacy, side-effects, and cost. Accordingly, a need to survey the pattern of usage of antihypertensive drugs is must, to see if the current usage is rational and in concordance with current guidelines for treatment of hypertension. Therefore this study was carried out with the aim of analyzing the pattern of antihypertensive drugs being prescribed and its adherence with JNC-8 guidelines, in a tertiary care Teaching hospital of Andaman & Nicobar Islands, India.Material & methods: A cross-sectional, observational study was done in ANIIMS, Port Blair, India over a period of 6 months from October 2016 to March 2017, in which analysis of the prescriptions of patients of essential Hypertension was done. A total of 870 prescriptions were analyzed based on age group, gender, number of antihypertensives, combination/ or monotherapy. The results obtained were expressed as percentages & proportion and were compared with JNC-8 Guidelines.Observations: In this study, a total of, 870 prescriptions were analyzed and it was observed that male patients with hypertension were 586(67.3%), and female patients were 284(32.7%), with male: female ratio of 2.05:1. Also most common therapy was the combination therapy in 630(72.4%) patients, out of which a CCB+ Diuretic combination was the commonest in 318(50.4%), followed by ACE-I + Beta Blocker combination in 180(28.6%) patients. Most common Drug used as monotherapy was Diuretics in 110(45.8%) patients, followed by Calcium channel blockers in 82(34.2%) patients, followed by ARBs in 48(20.0%) patients.Conclusion: The trend of hypertension is on the rise, if treated rationally this disease can be overcome. This study suggests the trend of prescribing of antihypertensive drugs in ANIIMS Port Blair, India and will provide a baseline data for similar studies in future.

Foot insensitivity is associated with renal function decline in patients with type 2 diabetes: a cohort study.

BackgroundIdentifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to prevent/slow the progression to end-stage renal disease (ESRD). CKD and diabetic peripheral neuropathy (DPN) share common mechanisms. Hence, we aimed to examine the relationship between foot insensitivity and CKD in patients with Type 2 diabetes.MethodsA prospective observational cohort study in adults with Type 2 diabetes. Patients with ESRD were excluded. Foot insensitivity was assessed using the 10-g monofilament test. Renal function was assessed using estimated glomerular filtration rate (eGFR) based on the MDRD equation. Albuminuria was defined as the presence of urinary albumin/creatinine ratio (ACR) >3.4 mg/mmol.ResultsTwo hundred and twenty eight patients were recruited and followed-up for 2.5 years. One hundred and ninety patients (83.4%) had eGFR ≥ 60 ml/min/1.73 m2. Seventy six (33.3%) patients had foot insensitivity (i.e. abnormal monofilament test). Patients with foot insensitivity had lower eGFR and higher prevalence of albuminuria compared to patients with normal monofilament test. After adjustment for age, gender, ethnicity, diabetes duration, HbA1c, body mass index, insulin treatment, number of anti-hypertensives, history of peripheral vascular disease, and baseline eGFR (R2 0.87), baseline foot insensitivity was associated with study-end eGFR (B = −3.551, p = 0.036).ConclusionsPatients with Type 2 diabetes and foot insensitivity are at increased risk of eGFR decline. Identifying these patients offers an opportunity to intensify metabolic and blood pressure control to prevent/retard the development of CKD. Future studies of larger sample size and longer follow up from multiple centres are needed to assess the diagnostic performance of our findings in predicting CKD development, and to compare the performance of the monofilament test with albuminuria.

Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score).

BackgroundAdverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in older patients living in the community. This study aimed to develop and validate a score to predict ADR-related hospitalization in people aged ≥65 years.MethodsADR-related hospitalization and its risk factors were determined using a prospective, cross-sectional study in patients aged ≥65 years admitted to two hospitals. A predictive model was developed in the derivation cohort (n = 768) and the model was applied in the validation cohort (n = 240). ADR-related hospital admission was determined through expert consensus from comprehensive reviews of medical records and patient interviews. The causality and preventability of the ADR were assessed based on the Naranjo algorithm and modified Schumock and Thornton criteria, respectively.ResultsIn the derivation sample (mean [±SD] age, 80.1±7.7 years), 115 (15%) patients were admitted due to a definite or probable ADR; 92.2% of these admissions were deemed preventable. The number of antihypertensives was the strongest predictor of an ADR followed by presence of dementia, renal failure, drug changes in the preceding 3 months and use of anticholinergic medications; these variables were used to derive the ADR prediction score. The predictive ability of the score, assessed from calculation of the area under the receiver operator characteristic (ROC) curve, was 0.70 (95% confidence interval (CI) 0.65–0.75). In the validation sample (mean [±SD] age, 79.6±7.6 years), 30 (12.5%) patients’ admissions were related to definite or probable ADRs; 80% of these admissions were deemed preventable. The area under the ROC curve in this sample was 0.67 (95% CI 0.56–0.78).ConclusionsThis study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission. Further refinement and testing of this tool is necessary to implement the score in clinical practice.

Primary Inadequate Weight Loss After Roux-en-Y Gastric Bypass Is not Associated with Poor Cardiovascular or Metabolic Outcomes: Experience from a Single Institution.

It is well accepted that bariatric surgery has cardiovascular and metabolic effects independent of weight loss. Weight loss outcomes of patients undergoing Roux-en-Y gastric bypass (RYGB) at a high volume referral center were collected at 1year postoperatively. Patients with failed primary weight loss were identified. Primary inadequate weight loss was defined as total body weight loss less than 15%. Changes in hypertension (HTN), dyslipidemia, type 2 diabetes mellitus (T2DM), and metabolic syndrome profiles were investigated using Student's t test. A total of 2500 patients underwent RYGB from the years 2001-2013 at our institution. One hundred five (4.2%) patients had primary inadequate weight loss. Within this cohort, 81 (77.1%) patients had hypertension, 67 (63.8%) had dyslipidemia, 53 (50.5%) had type 2 diabetes mellitus, and 66 (62.9%) patients had metabolic syndrome. At 1year postoperatively, all metabolic parameters were significantly improved. Measures of metabolic disease included high-density lipoprotein (HDL) (46.3±11.6 versus 54.1±12.7mg/dL, p<0.01), low-density lipoprotein (LDL) (103.6±35.8 versus 89.2±30.0mg/dL, p<0.01), triglycerides (177.3±139.1 versus 117.6±59.3mg/dL, p<0.01), mean plasma glucose (128.9±55.3 versus 102.7±27.3mg/dL, p<0.01), and hemoglobin A1C (7.3±1.9 versus 6.1±1.0%, p<0.01). HTN was noted to improve in 27 (33.3%) patients based on a decrease in the number of anti-hypertensives used (1.7±1.0 versus 1.3±1.3, p<0.01), and 21 (31.8%) patients had resolution of their metabolic syndrome. Improvement in cardiometabolic comorbidities still occurs despite suboptimal weight loss following RYGB.

Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy

PurposeTo compare adrenal radiofrequency (RF) ablation with adrenalectomy in treating unilateral aldosterone-producing adenoma (APA). Materials and MethodsBetween April 2008 and September 2013, 44 patients with adrenal venous sampling–confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RF ablation (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of adrenal RF ablation (patient age, 51 y ± 11; 4/12 men) were compared with adrenalectomy (patient age, 50 y ± 11; 19/32 men). Blood pressure (145/94 mm Hg ± 19/13 vs 144/89 mm Hg ± 10/8, P = .92), number of antihypertensives (3.0 ± 1.3 vs 2.7 ± 0.89, P = .38), and serum potassium (3.2 mEq/L ± 0.6 vs 3.5 mEq/L ± 0.6, P = .65) of patients were similar before treatment. ResultsRF ablation and adrenalectomy resulted in normokalemia (RF ablation, 4.2 mEq/L ± 0.1, P = .0004; adrenalectomy, 4.3 mEq/L ± 0.6, P < .0001) and normotension (RF ablation, 129/81 mm Hg ± 11/11, P = .02/P = .001; adrenalectomy, 128/85 mm Hg ± 13/12, P < .0001/P = .07) in all patients. Proportions of RF ablation and adrenalectomy patients cured of hypertension (2/12 [17%] vs 12/32 [38%], P = .28) or requiring fewer antihypertensives (7/12 [58%] vs 13/32 [40%], P = .29) were similar. RF ablation patients had a shorter length of stay (0.6 d ± 0.8 [range, 0–2 d] vs 1.7 d ± 1.4 [range, 0–7 d]; P = .01) and less intraoperative blood loss (1.2 mL ± 3 vs 40 mL ±85; P = .01). Procedural complications occurred in 5/32 (15%) adrenalectomy patients (2 major, 3 minor) and in 0/12 RF ablation patients. ConclusionsRF ablation to treat APA can achieve similar clinical outcomes as adrenalectomy and results in shorter hospital stays. Larger, prospective trials are needed to validate these results.

Prescription patterns of antihypertensives in a community health centre in Mexico City: a drug utilization study.

Hypertension is highly prevalent; in Mexico, the 2012 National Health and Nutrition Survey reported a prevalence of hypertension of 31.5% in the adult population. Pharmacological treatment is the commonest intervention and has been shown to reduce cardiovascular mortality and morbidity, and total mortality. Accordingly, the type and number of antihypertensives used and the outcome - in terms of blood pressure (BP) control - are important. Therefore, our purpose is to learn the pattern of antihypertensive drug prescription and explore the determinants of BP control in an urban population in Mexico. A retrospective cross-sectional drug utilization study was conducted. Medical records from a community health centre were searched to identify those corresponding to patients diagnosed with hypertension; information upon antihypertensives used and control of the disease was carefully retrieved. A logistic regression model was built to know the main determinants of BP control. A sample of 345 clinical records of interest was identified. Most patients received antihypertensives (86.4%); the leading medications used were angiotensin-converting enzyme inhibitors, 63.8%; beta-blockers (26.5%), diuretics (19.8%), angiotensin-receptor blockers (15.8%) and calcium-channel blockers (6.4%). Only the age (≥55 years) and BMI (>30) of the patients, and the age of the doctors (≥55 years), had an important influence on BP control. Obesity is a particular and important determinant of uncontrolled hypertension; it is worth to act on body weight, on an individual basis. As lack of control has been also tied to elderly doctors, an education programme could be envisaged.

Assessment of blood pressure in patients with hypertension aged 60-79 years before and after the publication of the 2014 Eighth Joint National Committee report.

In late 2013, the Joint National Committee (JNC 8) published hypertension treatment recommendations endorsing a goal blood pressure (BP) of < 150/90 mmHg starting at age 60 years. This was in contrast to other cardiovascular groups recommending age 80 years for this BP goal. This study examined mean BP in patients from age 60 years to 79 years with hypertension before and after publication of the JNC 8 recommendations. This retrospective cohort study examined mean BP and number of antihypertensives for a period of 1 year before and after the release of the JNC 8 report. Patients aged 60-79 years with hypertension receiving care at a University of Colorado Hospital primary care clinic were included. Patients with diabetes, chronic kidney disease, or kidney transplant were excluded. A total of 150 BP measurements were included in each of the before and after time frames. The primary outcomes were change in mean BP and number of antihypertensives. A total of 171 patients met the criteria and were included in the study. Most had BPs in both the before and after time frames. Mean BP values were similar in the before and after groups (130.2/75.9 mmHg versus 131.5/76.6, respectively; p = 0.27/p = 0.46). Mean number of antihypertensives were similar in the before and after groups (1.95 versus 1.93, respectively; p = 0.79). Over 1 year at an academic health system, new recommendations from the JNC 8 did not affect mean BP or number of antihypertensives in older patients with hypertension. A similar investigation after more time or in patients with newly diagnosed hypertension may help determine the full impact.

Frequency of Poor Adherence to Antihypertensive Treatment and an Analysis of Clinico-demographic Correlates.

This observational study is aimed to determine the frequency of poor compliance to antihypertensive treatment and to identify predictive demographic factors. One hundred and six hypertensive patients, on treatment for more than three months, were enrolled. Demographic characteristics (age, gender, level of education, duration of hypertension and area of residence) were recorded. Number of antihypertensive as well as total medicines, presence of any co-morbid conditions, possible side effects to treatment and financial source for obtaining medications were also enquired. Blood pressure was measured and body mass index was calculated. Compliance was assessed with 4-Item Morisky Medication Adherence Scale. Poor compliance (scores &le; 2) was present in 31 (29.25%) patients. Systolic and diastolic blood pressures were higher in poorly compliant patients. Patients with co-morbid conditions were more likely to have poor compliance (OR=4.238; 95% CI 1.161, 15.468). Other variables did not have a significant association with compliance to treatment. Poor compliance is fairly common in hypertensive patients and should be looked after for more so in patients with co-morbid conditions.

Readmissions related to antihypertensive medications used in chronic hemodialysis

Background: In hemodialysis, hypertension is treated by removing excess fluid and antihypertensive therapy. Commonly, the antihypertensives used to treat hypertension in earlier stages of kidney disease are continued as the patient progresses into end-stage renal disease and begins dialysis, without much evidence for benefit. Methods: This study is a single center, retrospective chart review that included hemodialysis patients admitted for congestive heart failure (CHF), fluid overload, or pulmonary edema as determined by ICD-9 code (428.x, 276.6, 518.4, 506.1). The primary objective was to determine if the number or class of antihypertensives used in the chronic hemodialysis population increased the number of readmissions related to CHF, fluid overload, or pulmonary edema. Patients were separated into two groups based on total number of antihypertensive medications, less than or equal to 2 medications for group 1 and greater than two medications for group 2. The primary endpoint was 30-day readmission for CHF, fluid overload, or pulmonary edema. Results: For the study period, 85 individual patient charts met inclusion criteria. Group 1 (n = 44) experienced seven readmissions (16%) and group 2 (n = 41) experienced eight readmissions (18%) (p = 0.663). The most common antihypertensives at discharge were ACE inhibitors for group 1 (45%) and dihydropyridine calcium channel blockers for group 2 (66%). No difference in systolic blood pressures before, during and after hemodialysis was found between groups. Conclusions: Antihypertensive medications continue to play an important role in the hemodialysis population. This study suggests that drug class and quantity of antihypertensives do not alter readmission rate in the setting of fluid overload.

Summer Syncope Syndrome Redux

BackgroundWhile antihypertensive therapy is known to reduce the risk for heart failure, myocardial infarction, and stroke, it can often cause orthostatic hypotension and syncope, especially in the setting of polypharmacy and possibly, a hot and dry climate. The objective of the present study was to investigate whether the results of our prior study involving continued use of antihypertensive drugs at the same dosage in the summer as in the winter months for patients living in the Sonoran desert resulted in an increase in syncopal episodes during the hot summer months. MethodsAll hypertensive patients who were treated with medications and admitted with International Classification of Diseases, 9th Revision code diagnosis of syncope were included. This is a 3-year retrospective chart review study. They were defined as “cases” if they presented during the summer months (May to September) and “controls” if they presented during the winter months (November to March). The primary outcome measure was the presence of clinical dehydration. The statistical significance was determined using the 2-sided Fisher's exact test. ResultsA total of 834 patients with an International Classification of Diseases, 9th Revision code diagnosis of syncope were screened: 477 in the summer months and 357 in the winter months. In patients taking antihypertensive medications, there was a significantly higher number of cases of syncope secondary to dehydration during the summer months (40.5%) compared with the winter months (29%) (P = .04). No difference was observed in the type of antihypertensive medication used and syncope rate. The number of antihypertensives used did not increase the cases of syncope in either summer or winter. ConclusionsAn increased number of syncope events was observed in the summer months among people who reside in a dry desert climate and who are taking antihypertensive medications. The data confirm our earlier observations that demonstrated a greater number of cases of syncope among people who reside in a dry desert climate who were taking antihypertensive medications during summer months. We recommend judicious reduction of antihypertensive therapy in patients residing in a hot and dry climate, particularly during the summer months.

Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients

Background: Elderly patients are particularly susceptible to polypharmacy. The present study evaluated the renal effects of optimizing potentially nephrotoxic medications in an older population. Methods: Retrospective study of patients’ ≥60 years treated between January of 2013 and February of 2015 in a Nephrology Clinic. The renal effect of avoiding polypharmacy was studied. Results: Sixty-one patients were studied. Median age was 81 years (range 60–94). Twenty-five patients (41%) were male. NSAIDs alone were stopped in seven patients (11.4%), a dose reduction in antihypertensives was done in 11 patients (18%), one or more antihypertensives were discontinued in 20 patients (32.7%) and discontinuation and dose reduction of multiple medications was carried out in 23 patients (37.7%). The number of antihypertensives was reduced from a median of 3 (range of 0–8) at baseline to a median of 2 (range 0–7), p < 0.001 after intervention. After intervention, the glomerular filtration rate (GFR) improved significantly, from a baseline of 32 ± 15.5 cc/min/1.73m2 to 39.5 ± 17 cc/min/1.73m2 at t1 (p < 0.001) and 44.5 ± 18.7 cc/min/1.73m2 at t2 (p < 0.001 vs. baseline). In a multivariate model, after adjusting for ACEIs/ARBs discontinuation/dose reduction, NSAIDs use and change in DBP, an increase in SBP at time 1 remained significantly associated with increments in GFR on follow-up (estimate = 0.20, p = 0.01). Conclusions: Avoidance of polypharmacy was associated with an improvement in renal function.

G-protein receptor kinase 4 polymorphism and response to antihypertensive therapy.

G-protein receptor kinase 4 polymorphism influences blood pressure regulation via modulation of dopamine receptor D1 in renal proximal tubular cells. We investigated the role of G-protein receptor kinase 4 polymorphism in the response to hypertensive therapy in patients with essential hypertension. In a prospective study, we assessed the G-protein receptor kinase 4 polymorphisms R65L, A142V, and A486V in 100 hypertensive patients. We analyzed the association of the 3 gene variants on blood pressure control and response to antihypertensive therapy with single-locus analysis, haplotype analysis, and regression analysis. Hypertensive individuals with a homozygous double variant of 65 L and 142 V needed significantly more antihypertensive treatment (number of antihypertensives 2.59 vs 1.95, P = 0.043) and especially diuretic therapy (0.82 vs 0.49, P = 0.029) to reach the same mean arterial blood pressure than did homozygous carriers of only 1 variant or heterozygous/wild-type carriers of R65L, A142V, and A486V alleles. G-protein receptor kinase 4 polymorphism is associated with antihypertensive treatment response in patients with essential hypertension. Determination of G-protein receptor kinase 4 polymorphism may improve individual antihypertensive blood pressure control in patients with essential hypertension.

Renal Denervation in Kidney Transplant Patients.

Objectives: This study investigates the effect of renal denervation in kidney transplant patients with hypertension refractory to treatment according to the following definition: patients with blood pressure (BP) 140/90 mm Hg with a minimum of three drugs including a diuretic (JNC VII and ESH guidelines / ESC), in adequate doses and dismissing the causes of hypertension after renal transplantation and confirmed through ambulatory blood pressure in 24 hours. Background:Hypertension in patients after renal transplantation is a cause of renal graft loss, and must be treated renal denervation is proposed as an alternative to invasive antihypertensive therapy that has not been applied in these patients. Methods: We studied 8 patients with renal transplantation and hypertension resistant to treatment of moderate to severe hypertension and confirmed by ambulatory blood pressure within 24 hours of diagnosis, renal denervation was performed using renal denervation “simplicity” catheter (Medtronic Inc, C.A.). Results: Patientschangingfrom first tosixth monthfoundstatisticallysignificant decreasein blood pressureanddecrease inthe numberof antihypertensive drugs. Conclusion: Ourdata showthat applying therenaldenervationimprovementin blood pressurewithin 24 hoursofrenaltransplant patients withhypertensionand is offered asan alternative treatmentto avoidgraft damageandothercomplicationsof hypertension.