Primary Hypertensive Patients Research Articles

Dry eye rate and its relationship with disease stage in patients with primary hypertension: a cross-sectional study in Vietnam.

To determine the dry eye (DE) rate and its relationship with disease stage in patients with primary hypertension. A cross-sectional study included 432 patients with primary hypertension (with an equal number of patients in each group: 144 in stage I, II, and III hypertension) and 144 healthy subjects as a control group. The Ocular Surface Disease Index (OSDI) and Schirmer I test without anesthetics were conducted on all 576 subjects. Subjects with OSDI scores <13 and Schirmer I values equal to or under 10 mm were diagnosed with DE. The ratio of DE in hypertension patients was higher than in the control group (41.7% versus 18.8%; P<0.001). The proportion of patients with DE increased gradually according to the hypertension stage: 27.1% in stage I, 40.3% in stage II, and 57.6% in stage III, P<0.001. Age, duration of hypertension, plasma urea, creatinine, and high-sensitivity C-reactive protein (CRP-hs) levels in hypertension patients with DE were higher than those without DE, P<0.001. Advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma creatinine, and CRP-hs levels were independent factors associated with DE in primary hypertension patients, P<0.001. DE is a common disorder associated with advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma CRP-hs, and creatinine levels in patients with primary hypertension.

Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension.

Endocrine hypertension (EHT) due to pheochromocytoma/paraganglioma (PPGL), Cushing's syndrome (CS), or primary aldosteronism (PA) is linked to a variety of metabolic alterations and comorbidities. Accordingly, patients with EHT and primary hypertension (PHT) are characterized by distinct metabolic profiles. However, it remains unclear whether the metabolomic differences relate solely to the disease-defining hormonal parameters. Therefore, our objective was to study the association of disease defining hormonal excess and concomitant adrenal steroids with metabolomic alterations in patients with EHT. Retrospective European multicenter study of 263 patients (mean age 49 years, 50% females; 58 PHT, 69 PPGL, 37 CS, 99 PA) in whom targeted metabolomic and adrenal steroid profiling was available. The association of 13 adrenal steroids with differences in 79 metabolites between PPGL, CS, PA and PHT was examined after correction for age, sex, BMI, and presence of diabetes mellitus. After adjustment for BMI and diabetes mellitus significant association between adrenal steroids and metabolites - 18 in PPGL, 15 in CS, and 23 in PA - were revealed. In PPGL, the majority of metabolite associations were linked to catecholamine excess, whereas in PA, only one metabolite was associated with aldosterone. In contrast, cortisone (16 metabolites), cortisol (6 metabolites), and DHEA (8 metabolites) had the highest number of associated metabolites in PA. In CS, 18-hydroxycortisol significantly influenced 5 metabolites, cortisol affected 4, and cortisone, 11-deoxycortisol, and DHEA each were linked to 3 metabolites. Our study indicates cortisol, cortisone, and catecholamine excess are significantly associated with metabolomic variances in EHT versus PHT patients. Notably, catecholamine excess is key to PPGL's metabolomic changes, whereas in PA, other non-defining adrenal steroids mainly account for metabolomic differences. In CS, cortisol, alongside other non-defining adrenal hormones, contributes to these differences, suggesting that metabolic disorders and cardiovascular morbidity in these conditions could also be affected by various adrenal steroids.

Untargeted metabolomics reveals potential plasma biomarkers for diagnosis of primary aldosteronism using liquid chromatography-mass spectrometry.

Metabolite profiling has the potential to comprehensively bridge phenotypes and complex heterogeneous physiological and pathological states. We performed a metabolomics study using parallel liquid chromatography-mass spectrometry (LC-MS) combined with multivariate data analysis to screen for biomarkers of primary aldosteronism (PA) from a cohort of 111 PA patients and 218 primary hypertension (PH) patients. Hydrophilic interaction chromatography and reversed-phase liquid chromatography separations were employed to obtain a global plasma metabolome of endogenous metabolites. The satisfactory classification between PA and PH patients was obtained using the MVDA model. A total of 35 differential metabolites were screened out and identified. A diagnostic biomarker panel was established using the least absolute shrinkage and selection operator (LASSO) binary logistic regression model and receiver operating characteristic analysis. Joint analysis with clinical indicators, including plasma supine aldosterone level, plasma orthostatic aldosterone level, body mass index, and blood potassium, revealed that the combination of metabolite biomarker panel and plasma supine aldosterone has the best clinical diagnostic efficacy.

Correlation of Serum Plasminogen Activator Inhibitor-1 with Body Mass Index and Blood Pressure among Newly Diagnosed Primary Hypertensive Patients: A Cross-sectional Study

Introduction: Plasminogen Activator Inhibitor-1 (PAI-1), a serine protease inhibitor expressed in adipose tissue, causes inflammation in hypertension and vice versa. The excess adipose tissue increases the production of PAI-1. There have been no relevant studies conducted on PAI-1 in southern Odisha in relation to Body Mass Index (BMI) and hypertension. Aim: To compare the BMI, Waist Hip Ratio (WHR), Waist Circumference (WC), and serum levels of PAI-1 in hypertensive cases with controls, and also to correlate the serum level of PAI-1 with BMI and blood pressure. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine of MKCG Medical College and Hospital, Berhampur, Odisha, India from November 2020 to August 2021. A total of 45 newly diagnosed primary hypertensive patients and 43 healthy age and sex-matched individuals between the ages of 18 to 60 years were enrolled in the study. Serum PAI-1 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). BMI, WC, hip circumference, WHR, and blood pressures of the controls as well as cases were recorded. Data were statistically analysed using the Student’s t-test and Pearson’s correlation coefficient. Results: The proportion of males was higher (56%) than females (44%). The cases had a significantly higher level of serum PAI-1 (203.36 ng/mL) compared to the control group (60.11 ng/mL) (p-value&lt;0.001). The cases had a higher BMI, WC (meters), and WHR compared to the control group. The serum PAI-1 level positively correlated with Systolic Blood Pressure (SBP) (r-value=0.852, p-value&lt;0.001), Diastolic Blood Pressure (DBP) (r-value=0.726, p-value=0.000), BMI (r-value=0.620, p-value=0.001), WC (r-value=0.444, p-value=0.002), and WHR (r-value=0.593, p-value&lt;0.001). Conclusion: A high serum PAI-1 level was found in the newly diagnosed hypertensive cases, and a significant positive correlation was observed between PAI-1 and systolic and diastolic blood pressure, along with BMI, WC, and WHR.

Jujubes and Rosuvastatin: Comparison of Two Hypolipidemic Agents in Primary and Secondary Hyperlipidemic and Hypertensive Patients

Biotransformation in human body results accumulation of free radicals (reactive oxygen species or ROS). If patients LDL particles are more than normal in systemic circulation, get interacted with free radicals and form foamy cells; initial stage of coronary artery disease (CAD). Hyperlipidemia may be primary (genetic reason) or secondary which is acquired type of dyslipidemia. Free radicle formation in human body is very much normal phenomenon. Just reducing LDL or raising HDL may prevent interaction of LDL with reactive oxygen species (free radicals), escaping patient to develop CAD. Commonly used drugs in prophylaxis or treatment of dyslipidemia include statins (HMGCo-A reductase inhibitors), niacin, bile resins and fibric acids. There are alternative therapies for dyslipidemia including use of fibers, fruits, and vegetables. In Pakistan there are huge number of fruits and herbs which are getting popularity as hypolipidemic agents. One of the important fruit in Pakistan having hypolipidemic potential is JUJUBES (in urdu called Bair). In this study we have compared hypolipidemic effects of Bair with statin in hyperlipidemic patients. This study was conducted at Begum Jan hospital, Islamabad-Pakistan. Sixty hyperlipidemic patients were selected and divided in two groups. Their lipid profile (LP) was determined in the hospital and blood pressure (BP) was recorded at start of treatment. Group-1 was advised to take 10 mg tablet Rosuvastatin in divided doses, and group-2 was advised to use 500 mg Bair (JUJUBES) in divided times per day for the period of 2 months. RESULTS: after two months therapy their lipid profile and BP was re-determined and analyzed statistically by using SPSS version 22.00.01. It was observed that Rosuvastatin decreased systolic BP and LDL-c highly significantly (p-value &lt; 0.001), while diastolic BP was reduced significantly (p-value &lt;0.01) and HLD-c was increased significantly with p-value &lt;0.01. In group-2 JUJUBES (Bair) reduced systolic BP and LDL-c significantly (p-value &lt;0.01) but no significant changes were observed in diastolic BP and HDL-c in this group. CONCLUSION: It was concluded from the research study that Jujubes reduce LDL-c and systolic BP in hyperlipidemic patients, but lesser than statin group of antihyperlipidemic agents.

Higher plasma aldosterone concentrations in patients with aortic diseases and hypertension: a retrospective observational study

BackgroundAortic diseases remain a highly perilous macrovascular condition. The relationship between circulating aldosterone and aortic diseases is rarely explored, thus we investigated the difference in plasma aldosterone concentration (PAC) between patients with and without aortic disease in hypertensive people.MethodsWe analyzed 926 patients with hypertension, ranging in age from 18 to 89 years, who had their PAC measured from the hospital's electronic database. The case group and control group were defined based on inclusion and exclusion criteria. The analysis included general information, clinical data, biochemical data, and medical imaging examination results as covariates. To further evaluate the difference in PAC between primary hypertension patients with aortic disease and those without, we used multivariate logistic regression analysis and also employed propensity score matching to minimize the influence of confounding factors.ResultsIn total, 394 participants were included in the analysis, with 66 individuals diagnosed with aortic diseases and 328 in the control group. The participants were predominantly male (64.5%) and over the age of 50 (68.5%), with an average PAC of 19.95 ng/dL. After controlling for confounding factors, the results showed hypertension patients with aortic disease were more likely to have high PAC levels than those without aortic disease (OR = 1.138, 95% CI [1.062 to 1.238]). Subgroup analysis revealed consistent relationship between PAC and primary hypertensive patients with aortic disease across the different stratification variables. Additionally, hypertensive patients with aortic disease still have a risk of higher PAC levels than those without aortic disease, even after propensity score matching.ConclusionsThe results of this study suggest that primary hypertensive patients with aortic diseases have elevated levels of PAC, but the causal relationship between PAC and aortic disease requires further study.

Characteristics of cardiac arrhythmia and heart rate variability in Chinese patients with primary aldosteronism.

We applied 24-h Holter monitoring to analyze the characteristics of arrhythmias and heart rate variability in Chinese patients with primary aldosteronism (PA) and compared them with age-, sex-, and blood pressure-matched primary hypertension (PH) patients. A total of 216 PA patients and 261 PH patients were enrolled. The nonstudy data were balanced using propensity score matching (PSM), and the risk variables for developing arrhythmias were then analyzed using logistic regression analysis. Before PSM, the proportion of PA patients with combined atrial premature beats and prolonged QT interval was higher than the corresponding proportion in the PH group. After PSM, the PA group had a larger percentage of transient atrial tachycardia and frequent atrial premature beats, and it had higher heart rate variability metrics. The proportion of unilateral PA combined with multiple ventricular premature beats was higher than that of bilateral PA. Older age, grade 3 hypertension, and hypokalemia were independent risk factors for the emergence of arrhythmias in PA patients. PA patients suffer from a greater prevalence of arrhythmias than well-matched PH patients.

Preliminary Consequences of Blood Pressure Management and Blood Homocysteine Levels with Perindopril in Newly Diagnosed Hypertensive Patients in the Vietnamese Population.

Perindopril is an ACE inhibitor that aids in both blood pressure regulation and homocysteine reduction. Our study aimed to evaluate the results of controlling blood pressure and blood homocysteine levels by perindopril in patients with primary hypertension. A cross-sectional descriptive study with a longitudinal follow-up was conducted on 105 primary hypertensive patients treated with perindopril. The results of our study showed that after 6 weeks of treatment with perindopril, the proportion of patients with the target blood pressure (BP) level accounted for 70.5%, the rate of grade 1 hypertension decreased from 61.0% to 25.7%, grade 2 blood pressure decreased from 17.1% to 3.8%, and there was no case of grade 3 hypertension. At the same time, we also found that the rate of BP control in the group of patients who controlled Hcy below a threshold of 15 μmol/L was significantly higher than in the other group (p < 0.05). Concerning the efficacy of decreasing homocysteine in blood, we discovered that after 6 weeks of treatment with perindopril, the proportion of patients with elevated homocysteine reduced considerably from 74.3% to 40% (p < 0.05). In addition, the homocysteine concentration was 4.33 mol/L lower after treatment than before treatment (95% CI: 3.69-4.97) (p < 0.05). Perindopril helps control blood pressure and reduces blood homocysteine levels in patients with primary hypertension.

FRI135 Differential Expression Of Circulating MicroRNAs In Primary Aldosteronism: Potential Biomarkers For Improved Diagnosis

Abstract Disclosure: S. Lamprou: None. S.M. MacKenzie: None. J.D. McClure: None. S. Robertson: None. A. Riddell: None. J.C. van Kralingen: None. A. Gimenez-Roqueplo: None. P. Reel: None. S. Reel: None. G. Assié: None. A. Laurence: None. F. Beuschlein: None. G. Rossi: None. J. Deinum: None. M. Reincke: None. G. Eisenhofer: None. E. Jefferson: None. M. Zennaro: None. E. Davies: None. Primary Aldosteronism (PA) is the most common endocrine hypertension subtype, caused by autonomous aldosterone secretion. While readily treatable, accurate diagnosis of PA – particularly its differentiation from primary hypertension (PHT) – is a complex and protracted process that can entail delays in effective treatment and lead to more severe comorbidities. Given the established role of microRNAs (miRNA) in regulating aldosterone biosynthesis, we hypothesize that circulating miRNAs are potentially viable biomarkers for PA that could inform more accurate and rapid diagnosis. To detect changes in circulating miRNA profiles specific to PA, we analyzed plasma levels of 172 selected microRNAs in a retrospectively-generated cohort of PHT (n=111) and PA patients (n=109). The dataset consisted of ΔCt values for each miRNA (normalized to multiple endogenous miRNAs), as determined by real time RT-qPCR assay. Two-sample t-tests were used to assess whether the means of the two disease groups are equal, corrected using False Discovery Rate (FDR; significance level q &amp;lt; 0.05). Ingenuity Pathway Analysis software (QIAGEN) was employed to analyze the miRNAs bioinformatically and identify mRNA targets involved in blood pressure regulation. Pathway analysis was performed to discover associations between PA and differentially-expressed miRNAs. We identified 83 circulating microRNAs that showed significant differential expression: 27 were upregulated and 56 downregulated in PA relative to PHT. The upregulated miRNA demonstrating the greatest fold change was hsa-miR-451a (FC:1.8, q=0.001), while the most downregulated was hsa-miR-409-3p (FC:0.5, q=0.001). Bioinformatics analysis predicted several dysregulated miRNAs to target mRNAs in PA-related pathways. For example, the most upregulated miRNA, hsa-miR-451a, is predicted to target mRNAs in biochemical pathways relevant to PA pathophysiology, including SGK1 and MAP3K1. SGK1 contributes to the signaling cascade induced by the mineralocorticoid receptor-aldosterone complex that stimulates Na+ reabsorption in the kidney, while MAP3K1 participates in the Renin-Angiotensin system, a key regulator of aldosterone secretion, as part of a signaling cascade that leads to the activation of the AP1 complex in the nucleus. In addition to hsa-miR-451a, other differentially-expressed miRNAs were also revealed to target multiple mRNAs with direct and indirect connections to PA. In summary, analysis has identified miRNAs that are significantly differentially expressed in the plasma of PA patients compared to PHT patients, indicating promise for a biomarker-based approach to PA diagnosis utilizing distinctive circulating microRNA signatures. Further analysis is now being conducted to validate our findings in an independent population of hypertensive patients. Presentation: Friday, June 16, 2023

COMfort Eye Trial (COMET) results - a non-inferiority, randomized, investigator-masked, two-parallel group, phase III clinical trial, to evaluate the efficacy and safety of a preservative free formulation of latanoprost versus a reference drug (Xalatan®) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT)

ABSTRACT Aim To prove non-inferiority of preservative-free (PF) latanoprost versus benzalkonium chloride (BAK) containing latanoprost in lowering intraocular pressure (IOP) in primary open-angle glaucoma (POAG) or ocular hypertension (OHT) patients. Design and methods This phase III, randomized, investigator-masked trial primarily aimed to demonstrate non-inferiority of YSLT PF latanoprost 50 μg/ml (Yonsung GmbH) to latanoprost (Xalatan®) 50 μg/ml (Pfizer) in reducing IOP from Baseline to Week 12. Secondary aims included conjunctival hyperemia evaluation and difference in ocular comfort levels. Total 130 patients with POAG or OHT were enrolled and randomized (1:1 ratio) to receive YSLT or latanoprost, instilling eye drops daily for 12 weeks. Results At Week 12, mean diurnal IOP reduction was −7.67 ± 2.104 mmHg for YSLT PF latanoprost and −7.77 ± 2.500 for latanoprost. The 97.5% confidence interval of between-treatment group difference in IOP reduction from Baseline to Week 12 was [−0.846, +∞), not crossing the non-inferiority margin of −1.5 mmHg. A low incidence of mild topical treatment emergent adverse events (TEAEs) was observed in both groups, while no serious TEAEs were reported. Conclusions YSLT eye drops demonstrated non-inferiority to latanoprost in reducing IOP. Both products were well tolerated without serious TEAEs reported.

24-Hour efficacy of single primary selective laser trabeculoplasty versus latanoprost eye drops for Naïve primary open-angle glaucoma and ocular hypertension patients

This prospective, observer-masked, randomized clinical trial was conducted between December 2018 and June 2021 at Eye Hospital, China Academy of Chinese Medical Sciences. A total of 45 glaucoma patients from Beijing, China, were enrolled in this clinical trial to compare the short-term efficacy of primary single-selective laser trabeculoplasty (SLT) to 0.005% latanoprost eye drops for the treatment of 24-h intraocular pressure (IOP) in patients with newly diagnosed primary open angle glaucoma (POAG) and ocular hypertension (OHT). Both SLT and latanoprost significantly decreased mean 24-h IOP and peak IOP, although the latanoprost group effect was more potent when compared to the SLT group (both Ps < 0.05). Compared with the SLT group, the latanoprost group had a significant and stable decrease in IOP after treatment. The latanoprost group had a more pronounced reduction in IOP at weeks 4 and 12 (P < 0.05) but had no difference at week 1 (P = 0.097). As a first-line treatment, both SLT and latanoprost eye drops are effective in newly diagnosed POAG and OHT patients. However, the latanoprost eye drops may be better in decreasing mean and peak 24-h IOP and thus controlling 24-h IOP fluctuation compared to SLT.

P-wave peak time and P-wave dispersion in surface electrocardiography as initial predictors of new-onset atrial fibrillation in early-onset hypertension.

Atrial fibrillation (AF) is common in hypertension, and electrophysiological remodelling may contribute to the early stage of the disease. This study aimed to develop electrocardiography (ECG) prediction models on new-onset AF (NAF) in early-onset hypertension (e-HTN). This matched case-control study included primary hypertension patients with onset <5 years defined as e-HTN and without documented AF. Developed NAF was the risk group and non-developed NAF was control group with 1:2 ratio. Group was matched according to age, gender, follow-up time, and duration of hypertension. Parameters of ECG and echocardiography between the groups at the baseline and end of follow-up will be compared. A total of 348 e-HTN with 116 developed NAF during follow-up (60.2 ± 14.5 months) were included. At baseline ECG, duration of QRS (100.84 ms ± 15.69 ms vs 94.80 ms ± 15.68 ms), Pmax (106.75 ms ± 7.93 ms vs 101.77 ms ± 6.78 ms), Pmin (70.24 ms ± 5.59 ms vs 68.17 ms ± 5.61 ms), P-wave dispersion (PD) (36.50 ms ± 5.25 ms vs 33.60 ms ± 5.46 ms), P-wave Peak Time (PWPT) II (62.01 ms ± 3.92 ms vs 54.29 ms ± 6.73 ms), and PWPT V1 (55.31 ms ± 2.89 ms vs 51.24 ms ± 4.05 ms) were significantly higher in developed NAF (all P-value < 0.05). LVMI was also significantly higher in bivariate analysis, but only Pmax, Pmin, PD, PWPT, non-RAAS inhibitor, and uncontrolled hypertension were independently associated with developed NAF. Baseline PWPT II with cut-off ≥57.9 ms and PD ≥ 35.5 ms has high sensitivity and specificity on NAF prediction. In conclusion, baseline PWPT and PD are potential electrophysiological parameters for predicting NAF in e-HTN.

The effect of statins on mortality and cardiovascular disease in primary care hypertensive patients without other cardiovascular disease or diabetes.

Studies in primary healthcare (PHC) assessing the effect of primary prevention with statins on mortality and cardiovascular disease (CVD) are scarce. This study aimed to estimate the effect of statins on all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke in individuals in PHC with hypertension without CVD or diabetes. Using the Swedish PHC quality assurance register QregPV, the study included 13 193 individuals with hypertension without CVD or diabetes, who had filled a first statin prescription between 2010 and 2016, and 13 193 matched controls without a filled statin prescription at the index date. Controls were matched on sex and propensity score using clinical data and data from national registers on comorbidities, prescriptions, and socioeconomic status. The effect of statins was estimated in Cox regression models. During a median of 4.2 years of follow-up, 395 individuals in the statin group vs. 475 in the control group died, 197 vs. 232 died of cardiovascular disease, 171 vs. 191 had an MI, and 161 vs. 181 had a stroke. The treatment effect of statins was significant for all-cause mortality [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74-0.93] and cardiovascular mortality (HR 0.85, 95% CI 0.72-0.998). Overall, no significant treatment effect of statins was seen for MI (HR 0.89, 95% CI 0.74-1.07), but there was a significant interaction with sex (P = 0.008) with decreased risk of MI for women but not for men (HR 0.66, 95% CI 0.49-0.88 vs. HR 1.09, 95% CI 0.86-1.38). Primary prevention with statins in PHC was associated with reduced risk of all-cause mortality, cardiovascular mortality, and in women, lower risk of MI.

Slow stroke back massage (SSBM) therapy with lavender essential oil effectively lowers blood pressure

Hypertension is a global health problem that is a major factor causing cardiovascular disease and premature death. While pharmacological therapy is still the main choice, non-pharmacological therapies with minimal side effects, such as a combination of slow stroke back massage (SSBM) and aromatherapy, are expected to increase relaxation so as to increase the effectiveness of lowering blood pressure in hypertensive patients. This study aimed to test the effectiveness of SSBM therapy with lavender essential oil in lowering blood pressure in patients with primary hypertension. The research used a quasi-experiment method with a pretest-posttest design with a control group. In this study, the samples used were hospitalized patients with primary hypertension who met the inclusion and exclusion criteria, with as many as 40 respondents using purposive sampling techniques. Slow stroke back massage (SSBM) therapy with lavender essential oil significantly lowers blood pressure values in primary hypertensive patients compared to SSBM therapy with baby oil (P value 0.05). The mean difference in systolic and diastolic blood pressure in the intervention and control groups was 6.25 and 2.65, respectively. This therapy has been proven to be effective in lowering blood pressure in primary hypertensive patients. Therefore, hospital management may consider applying this nonpharmacological therapy to manage primary hypertension patients.

Comparison of Efficacy and Safety of Ripasudil 0.4% and Bimatoprost 0.01% in Patients of Primary Open Angle Glaucoma and Ocular Hypertension

Objective: To compare Mean Intraocular pressure reduction produced POAG and OHT patients, classified according to their baseline Intraocular pressure (Group A with baseline Intraocular pressure between 22-25mmHg, Group B with baseline Intraocular pressure between 26-30mmHg), at last follow-up visit at 3 months.

THE CIRCADIAN PATTERN OF 24-HOUR AMBULATORY BLOOD PRESSURE AND HEART RATE IN THE CEREBRAL INFRACTION PATIENTS WITH HYPERTENSION AND HYPERTENSIVES PATIENTS

Aims: Evaluation of the circadian rhythm of 24-hour ambulatory blood pressure and pulse rate in the cerebral infraction patients with hypertension and hypertensives patients with purpose prognostic, prevention and treatment in two group.&#x0D; Objects and methods: This study included 140 cerebral infarction patients with hypertension, hospitalized for the first 7 days (mean age 65.5±10.4 years) and 143 primary hypertensive patients (mean age of 64.4±7.5 years). All had 24-h ambulatory recording, with measurement 30 every minutes in the daytime (6.00 am - 10.00 pm) and every 60 minutes at night (10.00 pm - 6.00 am). Results: Blood pressure in patients with cerebral infarction oscillated significantly more than in hypertensive patients; mean standard deviation of systolic blood pressure (25.8 mmHg) and diastolic blood pressure (15.8 mmHg) in patients with cerebral infarction respectively was significantly higher than those with hypertension (20 mmHg and 12.1 mmHg) with p &lt;0.01. The rate of non-dipping blood pressure at night, the overload of systolic and diastolic blood pressure, morning surge blood pressure in patients with cerebral infarction was significantly higher than that of hypertensive patients (92.1; 75.5; 60.2; 57.8 versus 64.3; 60.1; 49.1; 36.3 respectively; p &lt;0.01). Conclusion: It is necessary to monitor 24-hours ambulatory blood pressure in hypertensive patients and patients with cerebral infarction in the first week of admission to identify some phenomena such as nocturnal non-dipping blood pressure, the overload of blood pressure, especially morning surge blood pressure early to plan for prevention of target organ damage, particularly cerebral stroke in hypertensive patients.

Professionals' and Patients' Perspectives on Criteria for Referring Hypertensive Patients to Comprehensive Medication Management Services in Public Primary Health Care.

Patient prioritization in comprehensive medication management services allows coordinating care and guiding patients according to their clinical profile and their medication use. The aim of the study is to identify and describe factors that indicate the need for comprehensive medication management services among primary care hypertension patients within a public health system from the perspective of patients, pharmacists, nurses and physicians. A qualitative study was carried out with interviews with nurses, pharmacists and physicians (n = 20), and two focus groups with hypertensive patients (n = 12) at primary health care facilities and a public outdoor fitness area between January and February 2019 in Brazil. All interviews were transcribed and analyzed using the Atlas.ti® software. The data analysis revealed the following factors indicative of the need to refer hypertension patients to a pharmacist: lifestyle habits, comorbidities, health care utilization and medication use. The issues identified and the information obtained from the qualitative research and compared with literature studies reviewed allowed defining dimensions that should be considered as an aid in the selection of uncontrolled hypertensive patients for comprehensive medication management services.

A STUDY ON SERUM SODIUM AND POTASSIUM IN NEWLY DIAGNOSED PRIMARY HYPERTENSION

Background Of Study: Hypertension is one of the worlds leading causes of death and disability among adults. It is the major risk factor responsible for coronary, cerebral and peripheral vascular disease. Primary hypertension comprises more than 90% of hypertension. Objective: To study the levels of serum sodium and potassium in newly diagnosed primary hypertension patients. To correlate the sodium and potassium levels with the blood pressure. Method: The work was carried out in the outpatient Medicine department of Chalmeda Anand Rao institute of medical sciences.Cross-sectional Study (Analytical Study) Sample size: 50 cases (35 cases and 15 controls) Results: Serum sodium was higher in the hypertensive group than in the control group even though both were within the normal range. The mean and standard deviation of serum sodium among cases was 147.94 ± 2.88 meq/L while in the control group, it was 138.86 ± 3.44 meq/L respectively. Serum potassium was found to be lower in the hypertensive group when compared with the control group even though both were within the normal range. The mean serum potassium in the study group was 3.55 ± 0.29 meq/L. The mean potassium in the control group was 4.67 ± 0.22 meq/L. Conclusion: Serum sodium was significantly more among the hypertensive population and it was independent of gender. Serum potassium was significantly less among the hypertensive population and it correlated negatively with the level of blood pressure. Serum sodium level also correlated positively with the level of blood pressure.

Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study

BackgroundImplementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices.MethodsWe conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention.ResultsSeventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients −51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73–3.22) in the provider and 2.00 (95% CI, 1.68–2.37) in the provider plus patient intervention arm.ConclusionsThe intervention’s patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.

Hyperhomocysteinemia in Patients with Newly Diagnosed Primary Hypertension in Can Tho City, Vietnam.

Elevated levels of blood total homocysteine is one of the cardiovascular risk factors in hypertensive patients. Determine the prevalence of hyperhomocysteinemia and its associated factors in newly diagnosed primary hypertension patients. A cross-sectional descriptive study on 105 patients with newly diagnosed primary hypertension at Can Tho University of Medicine and Pharmacy Hospital from May 2017 to May 2018. Total homocysteine levels and related factors were collected at the study time. The mean plasma total homocysteine level was 16.24 ± 4.49 µmol/L. There were 78 patients with elevated plasma total homocysteine levels ≥15 µmol/L, accounting for 74.3% of all patients. Being elderly, gender, hypertension stage, and diabetes were factors associated with hyperhomocysteinemia (p &lt; 0.05). Total homocysteine levels were positively correlated with SBP, DBP, and age with r(SBP) = 0.696, r(DBP) = 0.585, and r(age) = 0.286. Research on the subpopulation of Vietnamese people shows that hyperhomocysteinemia is common in patients with newly diagnosed primary hypertension, and high blood total homocysteine levels are often related to age, sex, hypertension stage, and diabetes.