Optimal Management Of Hypertension Research Articles

Desprescribing antihypertensives in older people in primary care: subgroup analysis of the MINOR randomised clinical trial.

Polypharmacy is often required for older adults with hypertension, and excessive treatment is associated with a high risk of adverse reactions, including hypotension. To evaluate the deprescribing of antihypertensive medications guided by pharmacists using home blood pressure monitoring in older adults with hypotension. A subgroup of older adults with signs or symptoms of hypotension, included in the MINOR clinical trial, was analysed. In the MINOR procedures, each patient was provided with a device to conduct blood pressure measurement at home for 1week, following which a report was generated and shared with pharmacists (intervention group) or family physicians (control group). In the intervention group, a pharmacist suggested optimising pharmacotherapy; meanwhile, in the control group, a family physician alone determined the necessary treatment adjustments. Differences in mean blood pressure, the patients with symptoms/signs of hypotension, and the antihypertensive medication deprescribing between both groups were analysed. Seventy-two patients were evaluated (35, control group; 37, intervention group). The intervention group showed a significant reduction in medication prescriptions (- 28.6%; P < 0.001), especially beta-blockers (- 74.2%), loop diuretics (- 83.3%), and aldosterone antagonists (- 80%). The mean office blood pressure in the intervention group increased (14.1mmHg systolic and 6.9mmHg diastolic), remaining below the target range (140/90mmHg). The intervention group showed a significantly reduction in hypotensive symptoms than the control group (64.9% vs. 20%) (P < 0.001). The data highlight an important role for pharmacists in optimizing hypertension management in older people. Deprescribing antihypertensives can limit symptomatic hypotension. Registered on ClinicalTrials.gov under number NCT04861727.

Pharmacological Management of Hypertension: New Drugs and Mechanisms

Hypertension remains a leading global health challenge, contributing significantly to morbidity and mortality due to cardiovascular diseases. Traditional antihypertensive therapies, while effective for many, often fall short in certain populations, necessitating the development of novel pharmacological agents. This review explores recent advancements in the pharmacological management of hypertension, focusing on new drug classes and their mechanisms of action. We discuss innovations such as angiotensin receptor-neprilysin inhibitors (ARNIs), endothelin receptor antagonists, and sodium-glucose co-transporter 2 (SGLT2) inhibitors, highlighting their clinical efficacy and safety profiles. Additionally, we examine emerging mechanisms targeted by these drugs, including modulation of the renin-angiotensin-aldosterone system (RAAS), endothelial function enhancement, and metabolic pathway alteration. The review also addresses the potential for personalized medicine approaches in optimizing hypertension management. By elucidating these advancements, we aim to provide a comprehensive understanding of the future directions in hypertensive therapy, paving the way for improved patient outcomes through more precise and effective treatment strategies.

Prevalence, awareness, and control of hypertension in Greece before and after the COVID-19 pandemic: May Measurement Month survey 2019–2022

ObjectiveThe COVID-19 pandemic had an adverse impact on several cardiovascular risk factors. This study investigated the prevalence, awareness and treatment of hypertension in Greece before and after the pandemic. Data were collected in the context of the May Measurement Month (MMM) global survey initiated by the International Society of Hypertension. MethodsAdult volunteers (age ≥ 18 years) were recruited through opportunistic screening in public areas across cities in Greece in 2019 and 2022. Medical history and triplicate sitting blood pressure (BP) measurements were taken using validated automated upper-arm cuff devices. The data were uploaded to the international MMM cloud platform. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic ≥90 mm Hg and/or self-reported use of drugs for hypertension. The same threshold was used to define uncontrolled BP in treated individuals. ResultsData from 12,080 adults were collected (5,727/6,353 in MMM 2019/2022; men 46/49%, p < 0.01; mean age 52.7 ± 16.6/54.8 ± 16.2, p < 0.001; smokers, 24.7/30.5, p < 0.001; diabetics 12/11.5%, p = NS; cardiovascular disease 5/5.8%, p = NS). The prevalence of hypertension was 41.6/42.6% (MMM 2019/2022, p = NS), with 21.3/27.5% of individuals with hypertension being unaware of their condition (p < 0.001), 5.6/2.4% aware untreated (p < 0.001), 24.8/22.1% treated uncontrolled (p < 0.05), and 48.3/47.8% treated controlled (p = NS). ConclusionIn Greece, the COVID-19 pandemic did not appear to affect the prevalence and control of hypertension; however, the rate of undiagnosed hypertension was higher after the pandemic. National strategies need to be implemented for the early detection and optimal management of hypertension in the general population in Greece.

Development of a machine learning-based model for predicting individual responses to antihypertensive treatments

Background and aimsPersonalized antihypertensive drug selection is essential for optimizing hypertension management. The study aimed to develop a machine learning (ML) model to predict individual blood pressure (BP) responses to different antihypertensive medications. Methods and resultsWe used data from a pragmatic, cluster-randomized trial on hypertension management in China. Each patient's multiple visit records were included, and two consecutive visits were paired as the index and subsequent visits. The least absolute shrinkage and selection operator method was used to select index visit variables for predicting subsequent BP. The dataset was randomly divided into training and test sets in a 7:3 ratio. Model performance was evaluated using mean absolute error (MAE) and R-square in the test set. A total of 19,013 hypertension management visit records (6282 patients) were included. The mean age of the study population was 63.9 years, and 2657 (42.3%) were females. A total of 12 phenotypical features (age, sex, smoking within seven days, body mass index, waist circumference, index visit systolic BP, diastolic BP, heart rate, comorbidities of diabetes, dyslipidemia, coronary heart disease, and stroke), together with currently taking any prescribed antihypertensive medication regimens and visits time interval were selected to build the model. The Extreme Gradient Boost model performed best among all candidate algorithms, with an MAE of 8.57 mmHg and an R2 = 0.28 in the test set. ConclusionThe ML techniques exhibit significant potential for predicting individual responses to antihypertensive treatments, thereby aiding clinicians in achieving optimal BP control safely and efficiently. Trial registrationClinicalTrials.gov, NCT03636334. Registered July 3, 2018, https://clinicaltrials.gov/study/NCT03636334.

Management of nocturnal hypertension: An expert consensus document from Chinese Hypertension League.

Nocturnal hypertension is highly prevalent among Chinese and Asian populations, which is mainly attributed to high salt intake and high salt sensitivity. Nocturnal hypertension increases the risk of cardiovascular and all-cause mortality, independent of daytime blood pressure (BP). However, it can usually be detected by 24-h ambulatory BP monitoring, rather than routine office or home BP measurement, thus is often underdiagnosed in clinical practice. Currently, no specific guidance is available for the management of nocturnal hypertension in China or worldwide. Experts from the Chinese Hypertension League summarized the epidemiologic and pathophysiologic characteristics and clinical phenotype of nocturnal hypertension and provided consensus recommendations on optimal management of nocturnal hypertension, with the goal of maximally reducing the cardiovascular disease risks. In this consensus document, 24-h ABPM is recommended for screening and diagnosis of nocturnal hypertension, especially in the elderly, patients with diabetes, chronic kidney diseases, obstructive sleep apnea and other conditions prone to high nocturnal BP. Lifestyle modifications including salt intake restriction, exercise, weight loss, sleep improvement, and mental stress relief are recommended. Long-acting antihypertensive medications are preferred for nocturnal and 24-h BP control. Some newly developed agents, renal denervation, and other device-based therapy on nocturnal BP reduction are evaluated.

Barriers and Facilitators to Risk Reduction of Cardiovascular Disease in Hypertensive Patients in Nigeria.

In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management. This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk. There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines. We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings.

Clinical and pharmacological management of hypertension in older patients

The article is presented the review of published sources devoted the strategy of treatment the older patients with hypertension according to the geriatric symptoms and syndromes. The definition of orthostatic and postprandial hypotension, hypotension-hypertension syndrome is shown. Based on the analyses of publication are taken the data related to prevalence, prognostic meaning, clinical outcomes of frailty in older people. The influence of geriatric signs on cardiovascular risk is pointed out. The discussion questions of the association between administration of medications and orthostatic hypertension in older patients are considered. The recommendations of optimal pharmacological management of hypertension in older patients into account of personification principles with assessment of aging changes and their dynamics during treatment are given.

Abstract P134: Does Co-morbid Obesity Change Hospitalization Outcomes In Patients With Hypertensive Crisis?

Introduction: The prevalence of hypertension and obesity has been soaring, emerging as major global health problems. Similarly, optimal management of hypertension in obese individuals has been a perpetual struggle due to barriers to accurate diagnosis, monitoring, and treatment, primarily due to complex body habitus and intricate underlying pathological facets. Methods: The National Inpatient Sample database (NIS) 2020 was employed to identify hospitalizations with Hypertensive crisis which were further dichotomized based on Co-morbid obesity using ICD-10 codes. The primary outcome was inpatient mortality. The secondary outcomes were inpatient complications, mean length of stay (LOS), and mean total hospital charge (THC). Multivariate linear and logistic regression analyses were utilized to adjust for possible confounders. Results: There were 132,995 patients with primary diagnosis of hypertensive crisis, of which 31,400 (23.6%) were obese. Analysis showed similar adjusted odds of inpatient mortality (Adjusted Odds Ratio [aOR]: 0.85, [95% CI: 0.43-1.67], p=0.57). Obese patients were more likely to develop acute coronary syndrome (ACS) during hospitalization (2.4% vs 2%, P=0.036), and acute kidney injury (AKI) (27.1% vs 23.7%, p&lt;0.001) than non-obese patients with hypertensive crisis (Figure 1) Conclusion: Hospitalizations for hypertensive crisis among obese individuals had similar inpatient mortality compared to those with normal BMI. However, obese patients had higher odds for ACS and AKI. Further clinical studies should be directed toward this patient population to mitigate the associated risk and improve outcomes.

Preferences for deprescribing antihypertensive medications amongst clinicians, carers and people living with dementia: a discrete choice experiment.

Optimal management of hypertension in people with dementia may involve deprescribing antihypertensives. Understanding differing treatment priorities is important to enable patient-centred care. This study explored preferences for antihypertensive deprescribing amongst people living with dementia, carers and clinicians. Discrete choice experiments (DCEs) are a stated preference survey method, underpinned by economic theory. A DCE was conducted, and respondents completed 12 labelled choice-questions, each presenting a status quo (continuing antihypertensives) and antihypertensive deprescribing option. The questions included six attributes, including pill burden, and event risks for stroke, myocardial infarction, increased blood pressure, cognitive decline, falls. Overall, 112 respondents (33 carers, 19 people living with dementia, and 60 clinicians) completed the survey. For people with dementia, lower pill burden increased preferences for deprescribing (odds ratio (OR) 1.95, 95% confidence interval (95% CI) 1.08-3.52). Increased stroke risk (for each additional person out of 100 having a stroke) decreased the likelihood of deprescribing for geriatricians (OR 0.71, 95% CI 0.55-0.92) and non-geriatrician clinicians (OR 0.62, 95% CI 0.45-0.86), and carers (OR 0.71, 95% CI 0.58-0.88). Increased myocardial infarction risk decreased preferences for deprescribing for non-geriatricians (OR 0.81, 95% CI 0.69-0.95) and carers (OR 0.84, 95% CI 0.73-0.98). Avoiding cognitive decline increased preferences for deprescribing for geriatricians (OR 1.17, 95% CI 1.03-1.33) and carers (OR 1.27, 95% CI 1.09-1.48). Avoiding falls increased preferences for deprescribing for clinicians (geriatricians (OR 1.20, 95% CI 1.11-1.29); non-geriatricians (OR 1.16, 95% CI 1.07-1.25)). Other attributes did not significantly influence respondent preferences. Antihypertensive deprescribing preferences differ amongst people with dementia, carers and clinicians. The study emphasises the importance of shared decision-making within the deprescribing process.

Hypertension in Pediatric Solid Organ Transplant Recipients.

To review the current literature regarding hypertension (HTN) following pediatric solid organ transplant (SOTx), including definition, prevalence, risk factors, outcomes, and treatment. In recent years several new guidelines for the definition, monitoring, and management of pediatric HTN have been published, but with no specific recommendations regarding SOTx recipients. HTN remains highly prevalent, yet underdiagnosed and undertreated in kidney transplant (KTx) recipients, especially when ambulatory blood pressure monitoring (ABPM) is utilized. There are little data regarding its prevalence in other SOTx recipients. HTN in this population is multifactorial and is associated with HTN status prior to Tx, demographic factors (age, sex, and race), weight status, and immunosuppression protocol. HTN is associated with subclinical cardiovascular (CV) end-organ damage, including left ventricular hypertrophy (LVH) and arterial stiffness, yet there are no recent data regarding its long-term outcomes. There are also no updated recommendations regarding the optimal management of HTN in this population. Given its high prevalence and the young age of this population facing years at increased CV risk, post-Tx HTN requires more clinical attention (routine monitoring, frequent application of ABPM, better BP control). Additional research is needed for a better understanding of its long-term outcomes as well as its treatment and treatment goals. Much more research is needed regarding HTN in other pediatric SOTx populations.

PS-R04-3: A CASE OF RESISTANT HYPERTENSION

Background: Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg despite the use of three antihypertensive medications of different classes at the maximally tolerated doses, one of which is a diuretic. It is reported that approximately 10% of patients with hypertension have resistant hypertension, but the optimal management of resistant hypertension remains to be unclear. Case presentation: A 56-year-old Japanese woman visited our hospital because she presented high blood pressure of about 170/100 mm Hg even after the treatment by her primary physician. She had hypertension after giving birth at age 26 and her blood pressure was about 170/100 mm Hg. She was suspected of having secondary hypertension and the laboratory and imaging examination were conducted. The functions of the adrenal gland and thyroid were normal, and the renal artery stenosis and chronic kidney disease were excluded. She did not have NSAIDs, oral contraceptives, and herbal products. Although she had been intensively treated for hypertension, she suffered from a brain hemorrhage. Her systolic blood pressure has been still not controlled appropriately by 80 mg of nifedipine, 400 mg of the combination of sacubitril/valsartan, 2.5 mg of esaxerenone, 2 mg of trichlormethiazide, and 9 mg of bisoprolol transdermal patch daily. Conclusion: Because patients with resistant hypertension have a higher risk of stroke, kidney disease, and heart failure, the careful examination and intensive treatment are necessary.

ISH-PP-2: VIRTUAL MANAGEMENT OF HYPERTENSION: ISH POSITION PAPER

The COVID-19 pandemic caused an unprecedented shift from in-person care to delivering health care remotely. To limit the infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. However, many patients and care providers were unprepared for this rapid shift and may not be delivering optimal hypertension assessment and management. Given that it is likely that virtual care of chronic diseases including hypertension will continue into the future, the International Society of Hypertension developed a position paper to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control. This position paper is based on the currently available evidence, hypertension guidelines, and international expert opinion. Virtual care is defined as the delivery of healthcare remotely between patients, their carers, and healthcare providers. As different regions and patients have varying degrees of virtual care resources, skills, and preferences, we conceptualize the basic, advanced and complete virtual care models representing advancing degrees of virtual care. This presentation will review the position statements in these three levels of virtual care and discuss the position statements and rationale for selecting blood pressure monitoring devices, cuffless devices, accurate home blood pressure assessments, optimizing patient education, health behavior change, medication adjustment, and long-term monitoring in a virtual care environment.

Opportunities for improving hypertension control in sub-Saharan Africa.

Hypertension is currently one of the most common risk factors for the development of cardiovascular disease. An estimated 46% of the adult population in sub-Saharan Africa (SSA) has hypertension and its increasing prevalence is associated with factors such as urbanization and adverse lifestyle behavior. The process of managing hypertension in SSA includes increasing screening and diagnosis, and treatment of diagnosed patients. In addition to this process, community-based interventions have also highlighted promotion of educating healthcare providers and building capacity within the health system. Although there seems to be a process in place to control blood pressure of hypertensive individuals in SSA, optimal management of hypertension in this region remains a challenge, and the need for implementation of innovative strategies to achieve optimal BP control in hypertensive individuals remains critical. Various hypertension guidelines recommend the use of out-of-office blood pressure monitoring as a technique to control hypertension. Thus far, several publications have highlighted the potential of implementing the use of home blood pressure telemonitoring (HTM) in general practice, globally. HTM is a telemedicine strategy that is implemented to remotely transmit blood pressure data and additional health information of patients from the comfort of their home to the health practitioner. To date, there is evidence from various controlled trials reporting that prolonged and regular use of HTM is associated with a significant reduction of blood pressure in hypertensive patients compared with usual care. Despite HTM being reported as a potential measure for control of hypertension, there are no known estimates of hypertensive patients being managed using HTM in SSA and there have been few successful HTM programs implemented in SSA. HTM activity is reported in only 4 out of 46 countries in SSA using telephone calls, text messages and mobile phone health applications. In these HTM programs, significant reduction in blood pressure of patients was reported showing the great potential that HTM has in controlling blood pressure of hypertensive patients in SSA.

Automated blood pressure measuring devices: how are they clinically validated for accuracy?

Accurate blood pressure (BP) assessment is essential for the optimal diagnosis and management of hypertension. Contemporary clinical practice guidelines strongly endorse use of automated cuff blood pressure measuring devices (BPMD) as the preferred means of measuring and monitoring BP in the office, at home and with ambulatory blood pressure monitoring. To ensure that they are accurate, automated BPMDs should undergo clinical validation testing, performed using an established clinical validation standard. Unfortunately, most BPMDs sold on the global market have not been clinically validated. Furthermore, in the last thirty years, several different clinical validation protocols have been published, with major differences apparent between these standards, causing controversy with respect to which standard is considered acceptable for clinical validation. Complexly worded standards, multiple revisions, and firewalled access also contribute to a lack of understanding and use of clinical validation standards and the number of expert centers performing clinical validations is small. Recently, joint society collaborations have led to creation of the AAMI/ESH/ISO universal standard for the clinical validation of automated cuff BPMDs. Not only is this unified standard a necessary step, but oversight from regulators and influential stakeholders to ensure that only clinically validated BPMDs can be marketed is additionally needed.

Intervention for asymptomatic carotid artery stenosis

Thrombosis or embolism originating from large artery atherosclerosis causes 15% of the ischaemic strokes with transient or permanent functional deficit.1 In 2016, there were globally 9·6 million cases of ischaemic stroke, leading to 2·7 million deaths.2 The primary prevention of stroke is based on the control of lifestyle-related risk factors and the best medical therapy including optimal management of hypertension and diabetes, antithrombotic and lipid-lowering therapy, and smoking cessation.3 Patients with a significant atherosclerotic narrowing in their carotid artery can benefit from an additional surgical or endovascular intervention of the stenosis to reduce the risk of ischaemic stroke.

Clinical Characteristics and Outcomes of Hypertensive Patients Infected with COVID-19: A Retrospective Study.

BackgroundHypertension has been reported as the most prevalent comorbidity in patients with coronavirus disease 2019 (COVID-19). This retrospective study aims to compare the clinical characteristics and outcomes in COVID-19 patients with or without hypertension.MethodsA total of 944 hospitalized patients with laboratory-confirmed COVID-19 were included from January to March 2020. Information from the medical record, including clinical features, radiographic and laboratory results, complications, treatments, and clinical outcomes, were extracted for the analysis.ResultsA total of 311 (32.94%) patients had comorbidity with hypertension. In COVID-19 patients with hypertension, the coexistence of type 2 diabetes (56.06% vs 43.94%), coronary heart disease (65.71% vs 34.29%), poststroke syndrome (68.75% vs 31.25%) and chronic kidney diseases (77.78% vs 22.22%) was significantly higher, while the coexistence of hepatitis B infection (13.04% vs 86.96%) was significantly lower than in COVID-19 patients without hypertension. Computed tomography (CT) chest scans show that COVID-19 patients with hypertension have higher rates of pleural effusion than those without hypertension (56.60% vs 43.40%). In addition, the levels of blood glucose [5.80 (IQR, 5.05–7.50) vs 5.39 (IQR, 4.81–6.60)], erythrocyte sedimentation rate (ESR) [28 (IQR, 17.1–55.6) vs 21.8 (IQR, 11.5–44.1), P=0.008], C-reactive protein (CRP) [17.92 (IQR, 3.11–46.6) vs 3.15 (IQR, 3.11–23.4), P=0.013] and serum amyloid A (SAA) [99.28 (IQR, 8.85–300) vs 15.97 (IQR, 5.97–236.1), P=0.005] in COVID-19 patients with hypertension were significantly higher than in patients without hypertension.ConclusionIt is common for patients with COVID-19 to have the coexistence of hypertension, type 2 diabetes, coronary heart disease and so on, which may exacerbate the severity of COVID-19. Therefore, optimal management of hypertension and other comorbidities is essential for better clinical outcomes.

Role of hypertension in kidney transplant recipients.

Cardiovascular events are one of the leading causes of mortality in kidney transplant recipients. Hypertension is the most common comorbidity accompanying chronic kidney disease, with prevalence remaining as high as 90% even after kidney transplantation. It is often poorly controlled. Abnormal blood pressure profiles, such as masked or white-coat hypertension, are also extremely common in these patients. The pathophysiology of blood pressure elevation in kidney transplant recipients is complex and includes transplantation-specific risk factors, which are added to the traditional or chronic kidney disease-related factors. Despite these observations, hypertension management has been an under-researched area in kidney transplantation. Thus, relevant evidence derives either from studies in the general population or from small trials in kidney transplant recipients. Based on the relevant guidelines in the general population, lifestyle modifications should probably be applied as the first step of hypertension management in kidney transplant recipients. The optimal pharmacological management of hypertension in kidney transplant recipients is also not clear. Dihydropyridine calcium channel blockers are commonly used as first line agents because of their lack of adverse effects on the kidney, while other antihypertensive drug classes are under-utilised due to fear of the possible haemodynamic consequences on renal function. This review summarizes the existing data on the pathophysiology, diagnosis, prognostic significance and management of hypertension in kidney transplantation.

34. BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS IN SANGLAH GENERAL HOSPITAL DURING COVID-19 PANDEMIC

Background: The COVID-19 pandemic presents a challenge to control patients with chronic disease and conditions, because many people have postponed regular visit for chronic health condition such as hypertension. To make things worse, hypertension is the most important comorbidities and predictor of poor outcomes from COVID-19. Blood pressure control become more crucial to be top priority during this pandemic and beyond. Objective: The aim of this study is to determine the blood pressure control status among hypertensive patient in outpatient settings during the pandemic, as compared to before the pandemic of COVID-19. Methods: This retrospective, comparative cross-sectional study included 108 medical records of patients with hypertension diagnosis in outpatient cardiology clinic, at Sanglah General Hospital in January 2021. The data obtained were blood pressure during pandemic in January 2021, compared to blood pressure in the same patient before the pandemic (before March 2020). Result: The proportion of controlled hypertension before pandemic era was 49.1%, and has decreased during the pandemic to 39.8% (p value = 0.123). Wilcoxon signed rank test showed that there was increased systolic blood pressure level between before pandemic compared to during pandemic of COVID-19 (p value = 0.041). Conclusion: The optimal management of hypertension become a very important issue during pandemic of COVID-19, since patients with this pre-existing condition could experience severe complications when infected with SARS-CoV-2. The alternatives to hospital and community-based care, such as mobile phone consultation or telemedicine can be developed by the multidiscipline collaboration to increase control status of hypertension.

Hypertension and Prohypertensive Antineoplastic Therapies in Cancer Patients.

The development of a wide range of novel antineoplastic therapies has improved the prognosis for patients with a wide range of malignancies, which has increased the number of cancer survivors substantially. Despite the oncological benefit, cancer survivors are exposed to short- and long-term adverse cardiovascular toxicities associated with anticancer therapies. Systemic hypertension, the most common comorbidity among cancer patients, is a major contributor to the increased risk for developing these adverse cardiovascular events. Cancer and hypertension have common risk factors, have overlapping pathophysiological mechanisms and hypertension may also be a risk factor for some tumor types. Many cancer therapies have prohypertensive effects. Although some of the mechanisms by which these antineoplastic agents lead to hypertension have been characterized, further preclinical and clinical studies are required to investigate the exact pathophysiology and the optimal management of hypertension associated with anticancer therapy. In this way, monitoring and management of hypertension before, during, and after cancer treatment can be improved to minimize cardiovascular risks. This is vital to optimize cardiovascular health in patients with cancer and survivors, and to ensure that advances in terms of cancer survivorship do not come at the expense of increased cardiovascular toxicities.

Pathophysiology and Optimal Management of Hypertension in Patients with Cardiometabolic Syndrome

Pathophysiology and Optimal Management of Hypertension in Patients with Cardiometabolic Syndrome