Blood Pressure Reduction Research Articles

An exploratory investigation of heart rate and heart rate variability responses to daylong heat exposure in young and older adults.

Heart rate variability (HRV) has shown potential as a tool for monitoring thermal strain, but there is limited data to support its efficacy in older adults during prolonged heat exposures. We compared HRV between young (19-31 years, n=20) and older (61-78 years, n=39) adults during 9 hours of heat exposure (40°C, 9% RH). We also explored whether heart rate (HR) and/or HRV could be used to distinguish older adults who achieved elevated thermal strain, defined as either 1) an increase in core temperature >1.0°C (occurring in 39% [15/39]) or 2) a reduction in systolic blood pressure >10 mm Hg (occurring in 67% [26/39]). Percentage of age-predicted maximal HR and percentage of heart rate reserve (HRR) were higher, whereas standard deviation of normal RR intervals (SDNN), the square root of the mean of squared differences between successive RR intervals (RMSSD), high frequency power (HF), and cardiac vagal index (CVI) were lower in older compared to young adults (P≤0.004) during heat exposure. In older adults, increases in core temperature were correlated with percentage of age-predicted maximal HR, percentage of HRR, RMSSD, and CVI (P≤0.031), whereas changes in systolic blood pressure were not significantly associated with HR or HRV indices (P≤0.327). Receiver operating characteristic curve analysis indicated that HR and HRV indices had generally poor ability to identify older adults with elevated thermal strain (area under the curve ≤0.65). Age-related differences in HRV, consistent with vagal withdrawal among older adults, remained during daylong heat exposure, but marked heterogeneity of response likely contributed to HRV providing limited discriminatory value in identifying changes in core temperature or blood pressure in older adults.

The Relationship Between Ambulatory Blood Pressure Monitoring and Uric Acid Level in Hypertensive Patients

Abstract Introduction: Serum uric acid (SUA) is the end product of purine metabolism. Excessive SUA production or decreased renal excretion causes hyperuricemia. Elevated SUA is known to be a risk factor for cardiovascular diseases. It was reported that blood pressure (BP) was higher in patients with elevated uric acid and a decrease in BP was observed after the administration of uric acid-lowering drugs. Methods: We examined the relationship between SUA levels and hypertension in patients admitted to our hospital with hypertension (HT) and undergoing ambulatory blood pressure monitoring (ABPM). A total of 310 patients were included in the study. SUA levels were determined using an enzymatic colorimetric autoanalyzer. ABPM was performed using noninvasive multitasking CR recorders (TM2425; A&D, Tokyo, Japan). Results: Hyperuricemia was observed in 49.6% of the patients. Daytime, nocturnal, and 24-hour diastolic blood pressure (DBP) were significantly higher in patients with hyperuricemia (p=0.021, p=0.029, and p=0.005, respectively). Mean arterial pressure (MAP) and nocturnal MAP values were higher in patients with hyperuricemia (p=0.022 and p=0.003, respectively). The rate of patients with dipper HT was lower in patients with hyperuricemia than those without hyperuricemia (p=0.041). The rate of reverse-dipper HT was found to be higher in patients with hyperuricemia compared to those without hyperuricemia (p=0.022). Conclusion: Elevated uric acid was correlated with DBP, reverse HT, and MAP. Measurement of SUA could provide a valuable aid for the assessment and reduction of cardiovascular risk. Further studies are required to assess the effect of lowering uric acid on the reduction of nocturnal BP and DBP. Key words: Ambulatory blood pressure monitoring, uric acid, dipper hypertension, non-dipper hypertension, reverse-dipper hypertension

Effects of Different Caloric Restriction Patterns on Blood Pressure and Other Cardiovascular Risk Factors: A Systematic Review and Network Meta-Analysis of Randomized Trials.

All types of caloric restriction are preventive against cardiovascular risk factors, but the best restriction method and most affected factors have not been identified. The objective of this study was to explore the effects of different caloric restriction methods on various cardiovascular risk factors by horizontally comparing program advantages and disadvantages via network meta-analysis. The PubMed, Web of Science, Cochrane Library, and Embase literature databases were searched (October 2013 to October 2023). Eligible randomized controlled trials involving participants who underwent caloric restriction and systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and high-density lipoprotein (HDL) cholesterol level measurements were included. Thirty-six of 13 208 records (0.27%) were included. Two researchers reviewed the articles, extracted data, and assessed article quality. Alternate-day fasting (ADF) reduced SBP (4.88 mmHg; CI, 2.06-7.15) and DBP (5.10 mmHg; CI, 2.44-7.76). Time-restricted eating reduced SBP (2.46 mmHg; CI, 0.16-4.76) but not DBP. Continuous energy restriction (CER) significantly reduced BMI (1.11 kg/m2; CI = 0.16, 2.06) and waist circumference (3.28 cm; CI, 0.62-5.94). This meta-analysis confirmed the preventive effect of CER and ADF on various cardiovascular risk factors. Additionally, CER is more likely to reduce obesity, and ADF is more likely to reduce blood pressure (BP). Based on this meta-analysis, CER is recommended to control obesity only for people who are obese and do not have elevated BP or other abnormal indicators. Additionally, ADF for early control or prevention is recommended for patients who have abnormal BP or other cardiovascular risk factors. PROSPERO registration no. CRD42023455889.

A 40-Year-Old Male Patient With Encephalopathy Hypertension And Emergency Hypertension With Sinus Tachycardia And Acute Kidney Injury. A Case Report.

We present the case of A male 40 years old with Encephalopathy Hypertension and Emergency Hypertension with Sinus Tachycardia and Acute Kidney Injury. the patient was diagnosed with hypertensive encephalopathy based on clinical criteria upon admission to the hospital, compared to the patient's condition when allowed to go home. Electrocardiography, chest x-ray, and laboratory examinations such as kidney function tests, liver function tests, and complete blood count were performed to identify other complications of hypertensive emergency. This patient was taken to the ER due to decreased consciousness after a seizure occurring shortly before being admitted. After a comprehensive physical examination, a blood pressure of 260/110 was recorded, and the patient exhibited decreased consciousness: GCS eye 4, verbal 3, motor 5. The patient was given intravenous anti-hypertensi to reduce blood pressure according to the recommended MAP, which is a 20-25% decrease in one hour. Subsequently, the patient's blood pressure normalized, and slowly, the patient's consciousness returned to normal. The patient was stable and, on the third day of treatment, was discharged with normal blood pressure and no neurological deficits.

Recent updates on the influence of iron and magnesium on vascular, renal, and adipose inflammation and possible consequences for hypertension.

The inflammatory status of the kidneys, vasculature, and perivascular adipose tissue (PVAT) has a significant influence on blood pressure and hypertension. Numerous micronutrients play an influential role in hypertension-driving inflammatory processes, and recent reports have provided bases for potential targeted modulation of these micronutrients to reduce hypertension. Iron overload in adipose tissue macrophages and adipocytes engenders an inflammatory environment and may contribute to impaired anticontractile signalling, and thus a treatment such as chelation therapy may hold a key to reducing blood pressure. Similarly, magnesium intake has proven to greatly influence inflammatory signalling and concurrent hypertension in both healthy animals and in a model for chronic kidney disease, demonstrating its potential clinical utility. These findings highlight the importance of further research to determine the efficacy of micronutrient-targeted treatments for the amelioration of hypertension and their potential translation into clinical application.

Efficacy and safety of fenoldopam for the treatment of hypertensive crises in children with kidney disease: a retrospective study.

Hypertensive crises in children represent critical medical situations characterized by severe hypertension and potential organ damage. Fenoldopam, a dopaminergic medication, offers a viable therapeutic option for managing such clinical scenarios. We aimed to evaluate efficacy and safety of fenoldopam in the management of hypertensive urgencies and emergencies. This retrospective analysis focused on pediatric patients affected by acute or chronic kidney disease, aged 1month-18years, admitted to the Pediatric Nephrology and the Pediatric Intensive Care Unit at University-Hospital of Padua, Italy, who presented witha hypertensive crisis treated with fenoldopam between March 2010 and December 2022. The study included 74 patients with median age 10years (interquartile range [IQR] 4-15years) who received 102 fenoldopam infusions. Seventy-two percent were already receiving antihypertensive treatment before admission. In all cases, fenoldopam was associated with a reduction of blood pressure (BP) after 8h of treatment, but in 87% of patients reduction of the initial mean arterial pressure (MAP) was higher than 25% of calculated drop pressure. MAP normalized in 26% of cases after 24h and in35% after 48h. Occurrence of hypotension was 7%, while hypokalemia was observed in 13% of cases. Patients who presented a MAP reduction not exceeding 25% of calculated drop pressure received a lower median fenoldopam dose (0.2 mcg/kg/min; IQR 0.1-0.2) compared with patients having a MAP reduction > 25% of calculated drop pressure (0.4 mcg/kg/min; IQR 0.2-0.6; p = 0.002). Fenoldopam seems effective and safe for the treatment of hypertensive crises in children with kidney disease, at a starting dose of 0.2 mcg/kg/min. Strict BP monitoring is required to identify possible excessive drop pressure in the first hours of infusion.

Effect of Dietary Enrichment with Hempseed (Cannabis sativa L.) on Blood Pressure Changes in Growing Mice between Ages of 5 and 30 Weeks

Dietary hempseed (Cannabis sativa L.) reduces blood pressure in adults and animal models of hypertension; however, whether hempseed consumption throughout early life reduces adult blood pressure is not known. This study tested the hypothesis that hempseed enrichment versus a control diet modifies the age-dependent pattern of blood pressure changes in growing female C57BL/6 mice and results in lower adult blood pressure. From ages 5 to 30 weeks, early post-weaning to mid-adulthood, mice were fed either a control AIN-93G (0%), 50 g/kg (5%), or 150 g/kg (15%) hempseed-supplemented diet (n = 8 per group). Biweekly measurements of systolic, diastolic, and mean arterial pressure were collected using the tail-cuff method. Mice fed 5% or 15% hempseed versus the control diet exhibited no significant differences in systolic, diastolic, or mean arterial blood pressure (repeated measures ANOVA main effect of diet, p > 0.05). Blood pressure did not differ significantly between diet groups in adulthood (p > 0.05). However, mice fed a control or 5% hempseed, but not 15% hempseed, diet exhibited blood pressure changes across age marked by significant increases during early adulthood (weeks 11–17) versus early post-weaning (week 5) (p < 0.05). In conclusion, long-term dietary hempseed enrichment at 5% and 15% concentrations during development does not reduce adult blood pressure, but a 15% dose blunts the temporary increase in blood pressure during early adulthood seen in mice fed a control diet.

Process Evaluation of an Ambulance-Delivered Early Intensive Blood Pressure-Lowering Stroke Trial: Design, Rationale, and Reflection

Introduction: The fourth INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4) is a large-scale, multicenter, prospective, randomized, open-label, blinded endpoint assessment trial, initiated in an ambulance in China, aiming at evaluating the effectiveness and safety of prehospital blood pressure (BP) lowering in patients with suspected acute stroke and elevated BP. A prespecified process evaluation is intended to explore the implementation of the trial intervention, provide support to interpret the trial outcomes and put forward suggestions to scale up the intervention in broader settings in the future. Methods: This process evaluation is a mixed-methods design, and follows the Normalization Process Theory (NPT) and the UK Medical Research Council (UK MRC) guidance. Fidelity, reach, acceptability, appropriateness, adoption, sustainability, and relevant contextual factors and mechanisms affecting the implementation of prehospital early intensive BP-lowering treatment will be analyzed. Semi-structured interviews with ambulance staff, ward and emergency department clinicians, and nurses are undertaken to explore perceptions of the intervention, contextual factors, and potential suggestions for future implementation in practice. Data from observational records, surveys, conventional monitoring data, on-site records, and case report forms will be analyzed to understand background care and context. Conclusion: The process evaluation of INTERACT4 will provide insights for the implementation of prehospital early intensive BP-lowering intervention in different health systems and help better explain the trial results for further scale up.

Pressing Update: Aprocitentan for the Treatment of Hypertension.

This article reviews the published data including the pharmacology, efficacy, and safety of aprocitentan, a novel endothelin receptor antagonist developed to treat hypertension in conjunction with additional agents. A literature search was conducted from drug discovery until May 2024 through PubMed, MEDLINE, and National Institutes of Health Clinical Trials Registry utilizing the following search terms: Tryvio, aprocitentan, hypertension, resistant hypertension, endothelin receptor antagonist, and ACT-132577. All relevant English-language studies, or studies that could be appropriately translated into English, containing the pharmacology, pharmacokinetics, safety, and efficacy of aprocitentan, were selected for review. In the setting of resistant hypertension, aprocitentan has shown significant reductions in blood pressure in both medical office and 24-hour ambulatory settings at 4 weeks with a sustained effect at 40 weeks. Studies evaluating cardiovascular risk reduction have not been conducted at this time. Fluid retention and edema were the most frequent adverse events reported in clinical studies with aprocitentan. As a class, endothelin receptor antagonists may cause fetal harm; aprocitentan should be used with caution to avoid embryo-fetal toxicity. Owing to the existent barriers for the treatment of resistant hypertension, aprocitentan presents itself as an effective option when added to traditional antihypertensives. This single-strength, once-daily regimen may serve as an appealing option to both patients and prescribers. Aprocitentan is a safe and effective medication for the treatment of hypertension when added to other pharmacological therapies.

The Impact of DAZZEON αSleep® Far-Infrared Blanket on Sleep, Blood Pressure, Vascular Health, Muscle Function, Inflammation, and Fatigue.

The application of far-infrared blankets has shown certain benefits in health promotion and therapy, such as improving blood circulation and alleviating muscle pain. However, the effects of such blankets on increasing deep sleep, reducing blood pressure, enhancing memory, dilating microvessels for blood flow, reducing chronic inflammation, and decreasing fatigue remain to be studied. We aim to investigate the effects of the DAZZEON αSleep® far-infrared blanket on these indicators. This study adopted a double-blind design, recruiting 24 male participants aged over 45 years, divided into two groups of 12 each: (A) a placebo group and (B) a DAZZEON αSleep® group. The participants used the blanket every night for two weeks, with sleep records taken using a wearable device and blood pressure, blood oxygen levels, arterial stiffness, and surface temperature measured before and after the intervention. Blood samples were collected for an analysis of inflammation and sleep-related blood indicators (serotonin and melatonin), and exercise tests were conducted to assess fatigue improvement. Compared with before the intervention, the blanket significantly increased changes in grip strength and reaction time. Additionally, it significantly increased blood serotonin, melatonin, and nitric oxide concentrations (p < 0.05), thus significantly increasing deep sleep and REM sleep durations (p < 0.05) and improving subjective sleep quality (p < 0.05). This study confirmed that using the DAZZEON αSleep® far-infrared blanket for 14 consecutive days helps to improve blood circulation, reduce vascular age and arterial stiffness, increase serotonin and melatonin levels, and improve sleep quality, as well as enhances muscle strength and reaction time.

Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation in Chinese Patients With Uncontrolled Hypertension: The Randomized, Sham-Controlled, Multi-Center Iberis-HTN Trial.

Renal denervation (RDN) can lower blood pressure (BP) in patients with hypertension in both the presence and absence of medication. This is the first sham-controlled trial investigating the safety and efficacy of RDN in China. This prospective, multicenter, randomized, patient- and outcome-assessor-blinded, sham-controlled trial investigated radiofrequency RDN in patients with hypertension on standardized triple antihypertensive therapy. Eligible patients were randomized 1:1 to undergo RDN using a multi-electrode radiofrequency catheter (Iberis; AngioCare, Shanghai, China) or a sham procedure. The primary efficacy outcome was the between-group difference in baseline-adjusted change in mean 24-hour ambulatory systolic BP from randomization to 6 months. Of 217 randomized patients (mean age, 45.3±10.2 years; 21% female), 107 were randomized to RDN and 110 were randomized to sham control. At 6 months, there was a greater reduction in 24-hour systolic BP in the RDN (-13.0±12.1 mm Hg) compared with the sham control group (-3.0±13.0 mm Hg; baseline-adjusted between-group difference, -9.4 mm Hg [95% CI, -12.8 to -5.9]; P<0.001). Compared with sham, 24-hour diastolic BP was lowered by -5.0 mm Hg ([95% CI, -7.5 to -2.4]; P<0.001) 6 months after RDN, and office systolic and diastolic BP was lowered by -6.4 mm Hg ([95% CI, -10.5 to -2.3]; P=0.003) and -5.1 mm Hg ([95% CI, -8.2 to -2.0]; P=0.001), respectively. One patient in the RDN group experienced an access site complication (hematoma), which resolved without sequelae. No other major device- or procedure-related safety events occurred through follow-up. In this trial of Chinese patients with uncontrolled hypertension on a standardized triple pharmacotherapy, RDN was safe and reduced ambulatory and office BP at 6 months compared with sham. URL: https://clinicaltrials.gov; Unique identifier: NCT02901704.

Lifestyle Interventions for Managing Diabetes and Hypertension: A Holistic Approach

Diabetes and hypertension were two of the most prevalent chronic conditions globally, often occurring together and significantly increasing the risk of cardiovascular diseases. While traditional management strategies have focused on pharmacological treatments, there was a growing recognition of the need for lifestyle interventions to address the underlying risk factors such as obesity, physical inactivity, and poor diet. This review explored the scientific basis for lifestyle interventions including dietary modifications, physical activity, stress management, and behavioral changes in managing diabetes and hypertension. Evidence from landmark clinical studies demonstrated the effectiveness of these interventions in improving blood glucose control and reducing blood pressure, often rivaling or complementing medication. The integration of lifestyle interventions into clinical practice, however, presented challenges such as time constraints, patient adherence, and healthcare system limitations. Despite these challenges, opportunities existed to enhance patient outcomes through personalized care, technological advancements, and public health initiatives. The methodology utilized in this review involved a comprehensive analysis of current literature, synthesizing evidence from clinical studies and expert guidelines to provide a holistic approach to managing these chronic conditions. By embedding lifestyle interventions into standard care, healthcare providers can offer a more effective, sustainable, and patient-centered path to better health. Keywords: Diabetes Management, Hypertension, Lifestyle Interventions, Cardiovascular Health, Patient-Centered Care.

GPER Stimulation Attenuates Cardiac Dysfunction in a Rat Model of Preeclampsia.

Preeclampsia poses a substantial clinical challenge, characterized by maternal hypertension, cardiac dysfunction, and persistent cardiovascular risks for both the mother and offspring. Despite the known roles of the estrogen receptor (GPER [G protein-coupled estrogen receptor]) in placental development, its impact on cardiovascular aspects within a preeclampsia animal model remains unexplored. We propose that G-1, a GPER agonist, could have the potential to regulate not only hypertension but also cardiac dysfunction in rats with preeclampsia. To explore the influence of G-1 on preeclampsia, we used the reduced uterine perfusion pressure (RUPP) model. RUPP rats were administered either G-1 (100 µg/kg per day) or hydralazine (25 mg/kg per day). We conducted echocardiography to probe the intricate cardiac effects of G-1. The RUPP rat model revealed signs of hypertension and cardiac dysfunction and alterations in gene and protein expression within placental and heart tissues. G-1 treatment reduced blood pressure and reversed cardiac dysfunction in rats with preeclampsia. In contrast, administration of the vasodilator hydralazine reduced blood pressure without an improvement in cardiac function. In addition, while G-1 treatment restored the levels of sFLT-1 (soluble fms-like tyrosine kinase-1) in RUPP rats, hydralazine did not normalize this antiangiogenic factor. The therapeutic intervention of G-1 significantly mitigated the cardiovascular dysfunction observed in the RUPP rat model of preeclampsia. This discovery underscores the broader significance of understanding GPER's role in the context of preeclampsia-related cardiovascular complications.

Post‐intubation hypotension risk factors in patients with COVID‐19 undergoing endotracheal intubation in the emergency department: A prospective observational study

AbstractIntroductionAcute respiratory distress syndrome, a severe manifestation of COVID‐19, prompts the critical intervention of endotracheal intubation (ETI). However, ETI is associated with complications, notably post‐intubation hypotension (PIH), linked to an increased adverse prognosis. Our purpose was to investigate risk factors for PIH in COVID‐19 patients in the emergency department (ED).MethodsThis observational study was conducted at the Afzalipour Hospital, Iran. Adult COVID‐19 patients undergoing ETI were included, with data collected on demographic variables, medical history, and hemodynamic parameters. PIH was defined as the occurrence of any of the following: reduction of systolic blood pressure (SBP) to 90 mmHg or less; reduction of mean arterial pressure (MAP) to 65 mmHg or less; reduction of SBP by at least 20% of the initial value; or the need for vasopressor support during the 30 min after intubation.ResultsAmong 145 patients, the mortality rate was 82.7%, and PIH occured in 22.7%. Univariate analysis revealed associations between PIH and initial SBP (SBP‐0) and initial MAP. Multivariable regression revealed that each 1 mmHg decrease in SBP‐0 increased the risk of PIH by 5%. Patients with SBP‐0 of less than 116 mmHg had a PIH odds ratio of 4.1. A history of hypertension (HTN) or ischemic heart disease (IHD) increased the likelihood of PIH sixfold. The receiver operating characteristic curves for SBP‐0 had an area under the curve (AUC) of 0.67 (95% CI: 0.54–0.79), lower than the AUC of 0.77 (95% CI: 0.64–0.86) for the model incorporating SBP‐0, history of HTN or IHD, and total severity score. Despite this, the Z score comparing the AUCs of SBP‐0 and the multivariable model did not indicate a statistically significant difference.ConclusionsHistory of HTN or IHD, as well as low SBP‐0, are independently associated with an increased risk of PIH in COVID‐19 patients.

Efektivitas Terapi Bekam Titik Alkahil dan Terapi Akupuntur Terhadap Tekanan Darah pada Penderita Hipertensi di Desa Karangbong Kecamatan Pajarakan Kabupaten Probolinggo

Hypertension is a widespread health problem and is often called a "silent killer" because it often has no warning signs or symptoms, and many people don't realize they have it. The purpose of this study is to determine the effectiveness of alkahil point cupping therapy and acupuncture therapy on blood pressure in hypertensive patients in Karangbong Village, Pajarakan District, Probolinggo Regency. The method in this study is Pre-Experiment, with a Two-group pre-post test design, the sample in this study is patients with hypertension totaling 36 patients who were taken using the purposive sampling instrument technique which was used were cupping devices, acupuncture tools, tension meters and observation sheets. Furthermore, it was analyzed using the Paired t-test, the Wilxocon test, the Independent t-test, and the Mann-Whitney test. The results of the study showed that before the alkahil point cupping therapy was carried out, an average value of 149/102 mmHg was obtained, and the average value before acupuncture therapy was 149/99 mmHg. After alkahil point cupping therapy , an average value of 139/92 mmHg was obtained and after acupuncture therapy was 134/90 mmHg. It is known that the average value of the pre-post sistole difference of alkahil point cupping therapy is 10.33, and the average value of the pre-post difference of acupuncture therapy is 15.00 with a pV of 0.000 which means &lt; 0.05. Meanwhile, the average value of the pre-post diastole difference in alkahil point cupping therapy was 19.61 and acupuncture therapy was 17.39 with a pV &gt; 0.05. It can be concluded that the average value of the difference in pre-post sistole of acupuncture therapy is more effective than alkalil point cupping therapy in reducing blood pressure in hypertensive patients Alkahil point cupping therapy and acupuncture therapy can be traditional alternative treatments that can be done routinely for the hypertension healing process by doing acupuncture therapy.

Penerapan Senam Anti Stroke Terhadap Tekanan Darah pada Penderita Hipertensi di Kampungsewu Surakarta

Background: Hypertension or what can be called high blood pressure that occurs when blood vessel pressure is too high, said to be high if the blood pressure is 140/90 mmHg or more. According to the World Health Organization (WHO), the prevalence year is 1.28 billion people who experience hypertension aged 30-79 years. The prevalence of hypertension in Pucangsawit Health Center in 2022 was 4.492 hypertensive patients in Surakarta City, One of the non-pharmacological therapies that can be given to hypertensive patients is anti-stroke gymnastics. Objective: Describe the results of blood pressure comparison and after the application of Anti- Stroke Gymnastics in patients with hypertension. Method: This study uses a descriptive research design with a case study approach by observing blood pressure in 2 respondents with hypertension, conducted 2 weeks for 6x within 30 minutes. The instruments used are observation sheets, Blood Pressure Monitors, and anti-stroke gymnastics SOP videos. Results: There is a decrease in blood pressure after giving Anti-Stroke Gymnastics to Mrs. E from 148/81 mmHg to 130/78 mmHg and to Mrs. S from 157/111 mmHg to 143/101 mmHg. Conclusion: The application of anti-stroke gymnastics can potentially reduce blood pressure in hypertensive patients in both respondents.

Penerapan Isometric Handgrip Exercise untuk Menurunkan Tekanan Darah pada Penderita Hipertensi di Wilayah Puskesmas Pucangsawit

Background: Hypertension that occurs in the world of the entire world population is 22% (WHO, 2021). Based on data obtained from the Pucangsawit Community Health Center, in 2023 there were 1,623 cases of Primary Hypertension. Isometric handgrip exercise therapy is a non-pharmacological therapy to help lower blood pressure. Objective: determine changes in blood pressure values in two respondents with hypertension before and after being given isometric handgrip therapy. Method: This research is a case study research using descriptive methods, namely by observing and interviewing two respondents with hypertension who are at risk of developing kidney disease and other diseases with a decrease in blood pressure results that become normal. Results: There was a decrease in blood pressure values in Mrs. S from 143/90 mmHg to 135/85 mmHg, while in Mr. N decreased from 160/98 to 150/90 mmHg. Conclusion: after applying isometric handgrip therapy to Mrs. S and Mr. N there is a decrease in blood pressure values ​​in hypertensive sufferers. This shows that the isometric handgrip can reduce blood pressure to normal.

P082 HOW LONG DO BLOOD PRESSURE LOWERING DRUGS TAKE TO WORK? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALS

Background: Evidence on the time course of antihypertensive drug (AHTD) efficacy is crucial to guide the frequency of visits recommended in guidelines and when it is appropriate to wait for further effects to accrue. Objective: To assess how quickly AHTD therapy works to lower blood pressure (BP). Methods: We systematically searched multiple electronic databases for relevant randomized, double-blind, placebo-controlled trials of untreated adults. These trials compared fixed doses of AHTDs from the five major classes to a placebo for a minimum of four weeks and reported BP data at baseline, and at least at weeks 2 and 4. Primary outcomes were systolic and diastolic BP reduction at weeks 2, 4, and 8. A fixed-effect meta-analysis was conducted, and a best-fit exponential association model was used to evaluate BP-lowering efficacy over time. Results: A total of 94 trials (25,637 participants) were included. Trial duration ranged from 4-16 (median 8) weeks. The best-fit exponential association model predicted that the reductions in systolic BP (SBP) at weeks 1, 2 and 3 were 64%, 79%, 85% of the reductions seen at week 4. There was no evidence of additional BP reduction after week 4. In absolute terms, after week 2 the additional reduction in BP averaged only 1.8/0.8 mmHg by week 4 and 0.4/0.2 mmHg between week 4 and week 8. This finding was consistent across trials by drug class, with no evidence that renin-angiotensin-aldosterone system inhibitors, diuretics, beta-blockers, calcium channel blockers, diuretics or combinations took longer to work. Baseline BP did appear to modify the effect, but still there was no additional benefit after 4 weeks. Conclusion: BP lowering drugs work quickly, with little additional BP lowering occurring after 2 weeks. These findings have relevance for guidelines and for addressing treatment inertia related to expectation of time needed for drugs to work fully.

P032 THE IMPACT OF NATURE IMMERSION THERAPY ON BLOOD PRESSURE IN HYPERTENSIVE SUBJECTS: A PILOT STUDY

Background and Objective: Conscious nature immersion therapy, termed “Vitamin N”, has shown promise in reducing blood pressure levels in individuals with or without hypertension. This pilot study aims to assess the effect of nature immersion on blood pressure specifically in hypertensive subjects. Methods: A convenience sample of stable hypertensive individuals participated in a standardized 3-hour nature immersion session. Systolic and diastolic blood pressure levels were recorded before the intervention (Phase I), after 30 minutes of the intervention (Phase II), and 48 hours post-intervention (Phase III). Statistical analysis employed a one-way non-parametric ANOVA, Kruskal-Wallis test, and Dunn's post hoc test, with a bilateral significance level of 95%. A criterion of at least 3 mmHg reduction in blood pressure was set for clinical significance. Results Eighteen participants, comprising 12 women (64.67%) and 6 men (33.33%), with a mean age of 60±9.04 years and 61±6.88 years, respectively, were included. Six individuals had a medical history of Diabetes Mellitus Type 2, and one had a history of coronary heart disease. Significant differences in median systolic (MSP) and diastolic pressures (MDP) were observed across the three phases (p&lt;0.05). Notably, Phase II and Phase III showed consistent reductions in blood pressure compared to Phase I, exceeding the established 3 mmHg reduction criterion. Conclusions: Conscious nature immersion therapy (“Vitamin N”) exhibited a significant effect in lowering both systolic and diastolic blood pressure levels among hypertensive individuals. These findings suggest the potential of nature immersion as a non-pharmacological intervention for managing hypertension.

O90 EFFICACY AND SAFETY OF DUAL COMBINATIONS OF ANTIHYPERTENSIVE DRUGS AS FIRST-LINE THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background: Hypertension remains the primary cause of mortality worldwide, resulting in about 11 million deaths annually. Despite recent hypertension guidelines advocating for dual combination of antihypertensive drugs as the first-line therapy for most patients, many patients do not receive this therapy. Objective: To assess, among adults with hypertension, dual combinations of AHTDs compared to monotherapy as first-line treatment for blood pressure (BP)-lowering efficacy and safety. Methods: We systematically searched multiple electronic databases until December 2022 to identify relevant randomized, double-blind trials. We included trials involving adults with hypertension who were either treatment naive or untreated for at least 2 weeks, compared dual combinations of drugs with monotherapy from 5 major classes of AHTDs (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics), for a duration of at least 4 weeks and reported data on BP reduction. AHTDs and their combinations were categorized based on standard daily doses. Outcomes were reduction in BP, treatment related adverse events (TRAE) and withdrawals from the treatment due to adverse events (WDAE). Meta-analyses were conducted using random-effects model. Results: We included 98 trials (636 comparisons and 25892 participants). Overall, baseline mean BP was 159/102 mmHg. Overall BP reduction with dual combination compared to monotherapy was 4.4 (CI: 3.8-5.1)/3.5 (CI:3.2-3.9) mmHg. Compared with standard-dose monotherapy, dual combinations of &lt;1 + &lt;1, 1 + &lt;1 and 1 + 1 (i.e. low-to-standard dose), showed a dose-response relationship in reducing BP by 1.4 (CI: 0.01-2.7)/2.3 (CI: 1.4-3.1), 4.4 (CI: 3.6-5.2)/ 3.3 (CI: 2.9-3.8) and 7.8 (CI: 6.2-8.9)/5.2 (CI: 4.4-5.9) mmHg, respectively. TRAEs [4.8% vs 4.9%; RR 0.92 (0.80 to 1.06)] and WDAEs [0.8% vs 0.9%; RR 1.8 (1.5 to 2.1)] were uncommon with low-to-standard dose dual combinations, with no significant difference compared with standard-dose monotherapy. Conclusion: First-line treatment with low-to-standard dose dual combination therapy is more efficacious and equally safe compared to monotherapy to reduce BP.