DBP Reduction Research Articles

Trends in hypertension prevalence and control in England over the last 3 decades: Health Survey of England 1994-2019

Abstract Globally, raised blood pressure (BP) contributes to more than 10.8 million avoidable deaths from cardiovascular (CV) and renal disease. Understanding national BP control trends amongst hypertensive patients will help inform the effectiveness and gaps in existing pathways and policies. We used data from 13 nationally representative health surveys in England between 1994-2019 to compare nationwide trends in BP control and hypertension awareness over 25 years. We used ‘period’ definitions to define hypertension and BP control (i.e. using existing guidance at the time of the survey) to account for changes in BP targets and definitions. Analyses were also conducted using ‘current definitions’ (i.e. definition of hypertension and BP control targets as per NICE 2023), applied across the entire duration. Sample weights, accounting for oversampling and survey nonresponse, and other relevant transformations were applied. Python and STATA 18 were used to conduct analyses and Join Point regression software was used to compare trends. In England, between 1994-2019, the prevalence of hypertension initially increased sharply by 8% from 23.3% when the BP cut off was lowered in 1999. Thereafter for the next 12 years it remained static at 32-34%, and since 2011 has plateaued at 31-32%, showing only marginal improvement of 1.5% over this 25-year period (Figure 1). This is consistent with population-wide mean systolic (S) and diastolic (D) BPs, and amongst those with and without hypertension. Population-wide there was a reduction in SBP (8.5mmHg) and DBP (3.8mmHg) over the period. There was significantly greater reduction in SBP (11.9 vs 9.5mmHg) and DBP (4.1 vs 2.5mmHg) amongst those with diagnosed hypertension as compared to those without. Using the current target of below 140/90mmHg when evaluating BP control over this period suggests that we have improved. However, when we use ‘period definitions’ of BP targets at that time, it seems that over last 25 years there has been ‘no change’ in the proportion of diagnosed hypertensives with uncontrolled BPs (Figure 2). Additionally, although appearing to increase over the period, there has been no significant change in proportions of those with hypertension who are unaware of this condition since BP cut-offs were lowered in 1999. These findings indicate that in England, over last 25 years, whilst there have been some improvements in population wide mean SBP and DBP with slight reduction in hypertension prevalence, the proportions of those with known hypertension with uncontrolled BPs have remained static. This is despite improvement in medications and practice. Furthermore, there has been little progress in detection of those hypertensive patients who are unaware about and untreated for their condition. Clearly, these call in question the effectiveness of the current policies and clinical practice pathways and provide huge opportunity to improve population wide CV riskSytolic and Diastolic BP trendsTrends in the prevalence of BP control

Nationwide trends in blood pressure control among those with and without diabetes in England over last 2 decades: Health Survey of England 2003-2019

Abstract Diabetes and hypertension are both risk factors for cardiovascular disease (CVD), and often co-exist. Over recent decades practice guidance and health policy efforts have been made to improve population wide blood pressure (BP) control, particularly amongst those with diabetes, to reduce CVD. However, the nationwide impact of these ongoing efforts is yet to be documented comprehensively in England. We used data from 11 serial nationally representative health surveys of England between 2003 and 2019 and compared BP control and presence of untreated hypertension amongst those with and without diabetes. These cross-sectional, randomly sampled surveys included 94,100 individuals cumulatively. We applied sample weights, accounting for oversampling and survey nonresponse, and transformations mitigating for survey equipment changes during this period. We used ‘period definitions’ to define those with diabetes and quantify BP control at the time of each coinciding survey, facilitating accurate comparison of trends over the sixteen-year period, while accounting for changes in understanding, variations in definitions, and shifts in medical practices. Python and STATA were used to conduct analyses and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, the prevalence of hypertension amongst those with diabetes and without diabetes decreased from 74.4% to 66.5% and from 32.6% to 27.1% (7.9% vs. 5.5%), respectively. This corresponded to reductions in population-wide mean systolic (S) and diastolic (D) BPs: compared to those without diabetes, those with diabetes had greater reduction in both SBP (7.9mmHg vs. 4.8mmHg) and DBP (2.7mmHg vs. 1.9mmHg) (Figure1). Both groups showed similar temporal improvement in BP-control amongst those with diagnosed hypertension, with those with diabetes showing better improvement in BP control compared to those without diabetes (14% vs. 12%). There was a significant difference in proportions of those with undiagnosed (unaware) hypertension amongst those with and without diabetes (11.4% vs. 30.0% respectively) (Figure2). Notably, there was no change in proportion of those with hypertension unaware about the condition (i.e. detection rate for hypertension in either of the group did not show any improvement over time). These results suggest that we have been able to improve BP control over this period amongst those with and without diabetes, however, those without diabetes (more than 90% of population) have shown significantly poorer improvement. In addition, around one third of hypertensive patients amongst the no-diabetes group are unaware of the condition, and overall, the detection rates for hypertension in both groups have not improved in the last two decades. Lessons learnt from improving BP control amongst those with diabetes should be applied across the entire population, and newer strategies need to develop to improve detection of those with hypertension and are unaware.

Randomized study of the effects of empagliflozin and topiramate dual therapy on anthropometric and metabolic indices in non-diabetic individuals with overweight/obesity on a calorie-restricted diet

ObjectivesThe objective of this study was to evaluate the effectiveness of the combined use of empagliflozin (EMPA) and topiramate (TPM) versus a placebo in overweight/obese individuals without diabetes on a calorie-restricted diet.MethodsIn this study, 44 non-diabetic and overweight/obese subjects who were on a calorie restricted diet were randomly assigned into 2 groups: (1) Participants received a 10 mg EMPA tablet daily plus TPM tablet (at the 1st week 25 mg once a day and from the second week 25 mg twice a day); (2) Participants received an empagliflozin placebo (daily) plus a topiramate placebo (as mentioned for topiramate tablet in group 1), for 12 weeks. At baseline and weeks 4, 8, 12, weight, height, body mass index (BMI), waist circumference (WC), and body composition were evaluated. Before and after the intervention, blood pressure, C reactive protein, and glucose and lipid profile parameters were measured.ResultsThe EMPA/TPM group, compared to placebo, had a greater percent change of weight at week 12 (− 8.92 ± 1.80 vs. − 4.93 ± 1.17). The intervention group had a greater percent change of fat mass and fat percent at week 12 (P < 0.05). However, there was no difference in the percent of change in fat-free percent between the two groups at week 12 (P = 0.577). Within-group analysis found a significant reduction in SBP, DBP, FBS, insulin, HOMA-IR, TC, LDL, HDL, TG, and CRP in both groups (P < 0.05). At week 12, no statistically significant difference was observed between the two groups in any of mentioned variables (P > 0.05).ConclusionIn non-diabetic overweight/obese individuals, the combination of EMPA/TPM and calorie restriction led to a notable decrease in body weight and was generally well-tolerated. Further research is required to evaluate the potential advantages of utilizing this combination for sustained weight management in the long run.Level I Randomized clinical trial.

Permanent Pacing Reduces Blood Pressure in Older Patients with Drug-resistant Hypertension: A New Pacing Paradigm?

Hypertension (HTN) is a major contributor to cardiovascular mortality. Many patients with drug-resistant hypertension (DRH) also require permanent pacing (PP). This large retrospective study evaluated the effect of PP for conventional PP indications in older patients with DRH. We reviewed the charts of 176 patients with dual-chamber PP and DRH. The effects of PP on systolic and diastolic blood pressure (sBP and dBP), the number of HTN-related medications, and left ventricular ejection fraction (LVEF) were assessed at 6 months post-implantation and compared with pre-implantation values. Patients were followed up with for ≥72 months. Patients with a decline of >5 mmHg in sBP and decrease in at least one anti-HTN medication were defined as responders (126/176; P < .01). The mean decline in sBP was 9 mmHg, while that in dBP was 3 mmHg (P < .001 for both). Among responders, optimal reductions in sBP, dBP, and medications were seen at a stratification of >50% atrial pacing and <40% ventricular pacing (-12, -6.3, and -1.6, respectively). When right ventricular pacing of <50% was used for dichotomizing, the optimal atrial/ventricular pacing stratification was atrial pacing > 50% and ventricular pacing < 40% (-11.3, -6.3, and -1.6, respectively). A relationship between increasing atrial pacing and a decline in sBP was noted but did not reach statistical significance. However, of those responders who had a >10-mmHg decline in sBP, the majority were paced between 60%-100% in the atria. The LVEF did not change post-PP in either group. In conclusion, PP results in significant improvement in BP control. The observed association warrants further investigation.

Impact of Angiotensin Receptor Blockers (ARB) versus Other Antihypertensive Medication on Blood Pressure in Patients on Dialysis: A Meta-Analysis.

Hypertension is an important factor driving mortality among dialysis patients. Angiotensin-II receptor blocker (ARB) has been effective similarly to angiotensin-converting enzymes (ACEs) but with a low incidence of side effects. The meta-analysis included all published studies that investigated the effect of ARB on the hypertension in adult dialysis patients (≥18 years). Data extraction was guided by a predetermined checklist. Data sources of the retrieved studies were PubMed, MEDLINE, ScienceDirect, SCOPUS, Cochrane, Web of knowledge, and Google Scholar were systematically searched until February 2023. Using the RevMan 5 software, the mean difference for systolic and diastolic BP (SBP and DBP) and the risk ratio (RR) of the adverse events (AEs) were pooled from the selected studies. The random-effects model was used to compare the difference in the pre-and post-dialysis of the SBP and DBP. Data analyses were performed from December 2022 to February 2023. The primary outcome was the reduction in SBP and DBP in dialysis hypertensive patients who were on anti-hypertensive agents, and the secondary outcome was assessment of AE associated with the drug after dialysis (PROSPERO Registration: CRD42022355369). The initial search yielded 1,679 records, of which 84 studies underwent full-text evaluation, which identified 13 studies and 1,462 patients. The pooled standard MD for losartan with other anti-hypertensive agents, where the pre-dialysis SBP was 0.17 (95% confidence interval [CI]: -0.21-0.55) and the post-dialysis was 0.35 (95% CI: -0.17-1.02); yet, both are statistically non-significant, implies that there was no difference between Losartan and ARB drugs regarding the effect on the SBP. Diastolic BP for predialysis was -0.01 (95% CI: -0.65-0.63) and post-dialysis was 0.03 (95% CI: -0.24-0.30) and statistically non-significant. AEs by the ARB agents were lower compared to other anti-antihypertensive agents (relative risk [RR]: 1.01; 95% CI: 0.59-1.75) and statistically non-significant. This systematic review and meta-analysis of RCT demonstrated that ARB and other anti-hypertensive medications had similar impacts on the treatment of hypertension.

Impact of sheetali pranayama with kumbhaka on blood pressure and cerebrovascular hemodynamics in patients with hypertension: A pilot randomized controlled trial

BackgroundHypertension is associated with sympathetic dominance and altered cerebrovascular structure, which in turn reduces cerebral blood flow. Literature suggests Sheetali pranayama reduces blood pressure and Kumbhaka (breath retention) increases cerebral blood flow. However, no studies reported effect of Sheetali with Kumbhaka on blood pressure and cerebrovascular hemodynamics. Thus, the objective of this study was to find the impact of Sheetali pranayama with Kumbhaka on blood pressure and cerebrovascular hemodynamics in patients with hypertension. Materials and methodsTwenty-four patients with hypertension aged 30–65 years were randomly allocated into pranayama group and control group. The pranayama group underwent Sheetali pranayama with Kumbhaka (with the ratio of 1:2:2; Inhalation; Kumbhaka: Exhalation respectively), whereas the control group underwent breath awareness for 10 minutes. Blood pressure and cerebrovascular hemodynamic were assessed before and after each intervention. ResultsResults showed a significant reduction in systolic blood pressure (SBP) (p=0.049) in the pranayama group compared to control group. Likewise, within-group analysis showed a significant reduction in SBP (p = 0.002) and DBP (p = 0.007) in pranayama group; a significant reduction in SBP (p = 0.020) in control group; and no significant changes in rest of the variables in the post-test assessments compared to its respective pre-test assessments. ConclusionTen minutes of Sheetali pranayama with Kumbhaka reduces blood pressure compared to breath awareness, without affecting the cerebrovascular hemodynamics in patients with hypertension.

Comparative assessment of the impact of renal denervation on blood pressure values in resistant hypertensive patients with and without type 2 diabetes

Randomized clinical trial data confirm the effectiveness of renal artery denervation (RDN) not only among hypertensive patients, but also in other pathologies associated with increased SNS activity, such as type 2 diabetes, heart failure and others. Aim. Evaluation of the impact of RDN on blood pressure values in two categories of patients - resistant hypertension with and without type 2 diabetes. Materials and methods. The randomized prospective clinical study was designed that enrolled 250 resistant hypertensive patients divided into two equal groups of 125 patients depending to the presence of DM. The patients in the first two subgroups of each group were given standardized treatment supplemented with SNS blockers Moxonidine and Bisorpolol , while patients from subgroups III and VI underwent RDN. Patients were evaluated by dynamic ambulatory BP monitoring for a period of 3 years. Results. Authentic reduction of office SBP and DBP was noted starting from 6 months of assessment in all research groups, the comparative analysis of dynamics of office SBP at all stages of evaluation demonstrating a clear superiority of groups of minimally invasive treatment by RDN versus pharmacological treatment with the SNS blockers Moxonidine and Bisoprolol in improving these parameters. At the same time, a statistically significant reduction in the average values of SBP and DBP 24 hours was recorded in both the pharmacological and interventional treatment groups independent ofthe presence of type 2 diabetes, the maximum antihypertensive effect being expressed at 36 months of evaluation. Diabetic and non-diabetic patient groups undergoing RDN demonstrated superiority to both pharmacotherapeutic regimens at all follow-up stages.Conclusions. The obtained results demonstrated the comparable antihypertensive efficacy of RDN in resistant hypertensive patients with or without type 2 diabetes. At the same time, the groups of diabetic and non-diabetic patients undergoing RDN showed superiority over both pharmacotherapeutic regimens with SNS blockers in reducing blood pressure values, the beneficial effect being maintained for a three-year follow-up period.

Continuous Monitoring of Advanced Hemodynamic Parameters during Hemodialysis Demonstrated Early Variations in Patients Experiencing Intradialytic Hypotension.

Intradialytic hypotension (IDH) is a severe complication of hemodialysis (HD) with a significant impact on morbidity and mortality. In this study, we used a wearable device for the continuous monitoring of hemodynamic vitals to detect hemodynamic changes during HD and attempted to identify IDH. End-stage kidney disease patients were continuously monitored 15 min before starting the session and until 15 min after completion of the session, measuring heart rate (HR), noninvasive cuffless systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). Data were analyzed retrospectively and included comparing BP measured by the wearable devices (recorded continuously every 5 s) and the cuff-based devices. A total of 98 dialysis sessions were included in the final analysis, and IDH was identified in 22 sessions (22.5%). Both SBP and DBP were highly correlated (r > 0.62, p < 0.001 for all) between the wearable device and the cuff-based measurements. Based on the continuous monitoring, patients with IDH had earlier and more profound reductions in SBP and DBP during the HD treatment. In addition, nearly all of the advanced vitals differed between groups. Further studies should be conducted in order to fully understand the potential of noninvasive advanced continuous monitoring in the prediction and prevention of IDH events.

EFFECT OF SEQUENTIAL NEPHRON BLOCKADE X DUAL RENIN-ANGIOTENSIN SYSTEM BLOCKADE + BISOPROLOL IN THE TREATMENT OF RESISTANT HYPERTENSION, A RANDOMIZED CONTROLLED TRIAL (RESHYPOT)

Objective: The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Design and method: This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug uptitration. Participants were evaluated during five visits at 28-day intervals. Results: The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p&lt;0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p&lt;0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p&lt;0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p&lt;0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p&lt;0.0001). Central systolic blood pressure had a greater reduction in the SNB group pre x post-intervention (128.8± 22.1 x 117.4± 17.9) (p = 0.03). Conclusions: In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction and a greater reduction in Central systolic blood pressure.

EFFECT OF SEMAGLUTIDE VERSUS OTHER GLP-1 RECEPTOR AGONISTS ON OFFICE BLOOD PRESSURE LEVELS AMONG SUBJECTS WITH TYPE 2 DIABETES: A META-ANALYSIS

Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone treatment for type 2 diabetes (T2D). The aim of the present meta-analysis was to assess whether semaglutide exerts greater effects on office blood pressure (BP) levels compared to other commercially available GLP-1RAs in patients with T2D. Design and method: We searched PubMed and Cochrane Library databases, along with grey literature sources, from inception to February 2023, in order to retrieve head-to-head, phase 3 randomized controlled trials (RCTs) assessing the effect of semaglutide versus other GLP-1RAs on office systolic and diastolic BP (SBP and DBP, respectively) levels in patients with T2D. Results: We finally pooled data from 5 RCTs in a total of 3,760 randomized participants with T2D. Subjects treated with semaglutide versus other GLP-1RAs experienced a significantly greater reduction in office SBP by 1.20 mm Hg (p = 0.006), and in office DBP by 0.67 mm Hg (p = 0.01). Regarding office SBP, the results were primarily driven by the comparison between semaglutide and exenatide, while, regarding office DBP, the results were mainly driven by the comparison between semaglutide and dulaglutide. However, no significant subgroup difference for none of the above-mentioned comparisons was shown. Conclusions: It is evident that semaglutide use is accompanied with a greater reduction in both office SBP and DBP, compared to other GLP-1 RAs, in patients with T2D. Therefore, its use should be prioritized for patients with T2DM and concomitant hypertension or other cardiovascular risk factors.

Comparative Study on the Efficacy of Lignocaine Nebulisation Vs Topical Lignocaine Spray in Attenuation of Haemodynamic Surge in Patients Undergoing Surgery Under General Anaesthesia - A Single Blinded Randomized Controlled Study

Introduction: Laryngoscopy and tracheal intubation are powerful noxious stimuli that should be attenuated. The present study is to compare the efficacy of lignocaine nebulisation vs topical lignocaine spray in attenuation of haemodynamic surge in patients undergoing surgery under general anaesthesia. Methodology: After ethical committee clearance, a single blind randomized control study was done on sixty patients of either sex aged between 18-55 years of ASA status I undergoing elective surgery under general anaesthesia with endotracheal intubation. Patients were randomly allocated into 2 groups: GROUP A:received nebulised Lignocaine Hydrochloride 4% at 2 mg/kg. GROUP B: received Topical Lignocaine spray 10% at 2mg/kg. Heart rate, Systolic, diastolic and mean blood pressure was documented before administering premedication (T0), at the time of intubation (TI) and at 1min (T-1), 2min (T-2) &amp; 5min (T-5) after intubation. Attenuation in HR, SBP, DBP and MBP were found statistically significant (p&lt;0.05) in group A in comparison to group B. Thus in conclusion Lignocaine nebulisation is far more effective in comparison to topical lignocaine spray in attenuation of the laryngoscopic surge. Results: After conducting the study on a total of sixty patients it was found that there was statistically significant reduction in SBP, DBP, MBP and HR in GROUP A receiving lignocaine nebulisation compared to GROUP B receiving topical lignocaine spray. Conclusion: Lignocaine nebulisation is more effective than topical lignocaine spray in attenuation of haemodynamic surge following laryngoscopy and intubation in patients undergoing surgery under general anaesthesia. Keywords: Laryngoscopy, Tracheal Intubation, Lignocaine Nebulisation, Lignocaine Spray, Heamodynamic Surge

The Effects of Topical Anesthesia With Lidocaine 10% Spray Compared to Trans Tracheal and Glossopharyngeal Nerve Block in Hemodynamic Stability During Awake Intubation: A Randomized Controlled Trial

Hemodynamic changes is of great concern during awake intubation, particularly in patients with underlying medical conditions. As heterogeneities exist in regard to the best anesthesia drugs and techniques, herein, we aimed to investigate the effects of Lidocaine 10% spray compared to trans tracheal glossopharyngeal nerve block in hemodynamic stability in patients undergoing awake intubation. A total of 62 patients were included in this randomized clinical trial. Using a longitudinal interventional design, hemodynamic measures were statistically compared before intubation, one minute after intubation, and five minutes after intubation. The first group underwent topical anesthesia with Lidocaine 10% sprayed on the base of tongue and tonsillar pillar while the second group underwent trans tracheal and glossopharyngeal nerve block with simultaneous injection of Lidocaine 2%. Our results indicated that all hemodynamic parameters except for the pulse rate in both groups were significantly reduced after the intubation, which indicates the effectiveness of the interventions. However, the reduction in SBP, DBP, and MAP was significantly lower in the nerve block group compared to the Lidocaine spray group. Regarding the pulse rate, despite the significant decrease in the group of patients undergoing nerve block, those undergoing anesthesia with Lidocaine spray experienced a significant increase in the heart rate in the first minute after the operation. Finally, our research provides substantiation that employing a glossopharyngeal nerve block and trans tracheal block constitutes an efficacious method for local anesthetic during conscious intubation and can be a promising technique.

Chronic kidney disease and orthostatic hypotension in hospitalised older adults

Purpose Orthostatic hypotension (OH) may predispose older adults to health complications leading to functional impairment. Despite the central role of the kidney in blood pressure control, the contribution of renal function in orthostatic hypotension is poorly investigated. To verify the association between Chronic Kidney Disease (CKD) and OH a population of hospitalised elderly patients with comorbidities was studied. Materials and methods 174 patients were consecutively admitted to Acute Geriatric Wards. On admission, patients underwent postural systolic (SBP) and diastolic (DBP) blood pressure evaluation by automatic oscillometric device after 10 min rest in lying position, and in standing position at time 0, 1, 3 and 5 min. CKD was assumed for estimated glomerular filtration rate (e-GFR) less than 60 mL/min/1.73 m2. Results The mean age of the population enrolled was 74.4 ± 7.0. OH was found in 46.0% and CKD in 56.3% of patients, respectively. A lower e-GFR was observed in patients with (56.1 ± 16.7 mL/min/1.73 m2) than in those without OH (61.1 ± 15.9 mL/min/1.73 m2) (p < 0.05). A greater fall in SBP at 0-min (12.8 ± 6.3 vs. 7.7 ± 3.2 mmHg) and at 1-min (8.4 ± 4.5 vs. 5.7 ± 2.8 mmHg) was found in CKD patients in respect to patients without CKD during active standing test (p < 0.05). Similarly, a DBP reduction at 0-min and at 1-min was observed in CKD patients in respect to patients without CKD (p < 0.05). A multivariate logistic regression analysis showed that CKD was associated to OH (OR 2.426; 95%CI 1.192–4.937; p = 0.014). Conclusions CKD is associated to OH in hospitalised older adults.

Effect of Azilsartan on clinical blood pressure reduction compared to other angiotensin receptor blockers: a systematic review and meta-analysis

Background: Hypertension has significantly contributed to morbidity and mortality, necessitating effective management. Angiotensin receptor blockers (ARBs) have emerged as a cornerstone in hypertension treatment. Azilsartan, a relatively recent addition to the ARB family, offers unique characteristics, including prodrug activation. This systematic review and meta-analysis aimed to evaluate Azilsartan’s role in reducing clinical blood pressure compared to other ARBs and determine the most effective dosage. Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in Medline, Web of Science, Cochrane Library, and clinicaltrials.gov. Eligible studies included adult hypertensive patients receiving Azilsartan compared to other ARBs, with clinical systolic blood pressure (SBP) and diastolic blood pressure (DBP) outcomes. Data extraction and quality assessment were performed, and statistical analysis employed comprehensive meta-analysis (CMA) software. Results: Eleven randomized controlled trials encompassing 18 studies involving 6024 patients were included. Azilsartan demonstrated significant reductions in clinical SBP (mean difference=−2.85 mmHg) and DBP (mean difference=−2.095 mmHg) compared to other ARBs. Higher doses of Azilsartan showed greater efficacy, with 80 mg exhibiting the most substantial reduction in SBP. The analysis emphasized the need for more studies investigating lower Azilsartan doses (10 and 20 mg). Conclusion: This systematic review and meta-analysis underscore Azilsartan’s effectiveness in reducing SBP and DBP. Dose-dependent effects emphasize the importance of optimal dosing when prescribing Azilsartan. These findings provide valuable insights for clinicians in managing hypertension effectively and call for further research, primarily focusing on lower Azilsartan doses and a more diverse patient population.

Physiological effect of Bhastrika Pranayama on Cardio-Pulmonary variables among healthy individuals - A Randomized Controlled Trial

Background And Objectives: Bhastrika Pranayama boosts airflow into the body, which produces heat both physically and subtly, igniting both the body's and mind's internal fires. This fast-breathing Pranayama increases energy, cleanses and regenerates the lungs, tones the diaphragm, heart, and abdominal muscles, improves circulation. Hence, the objective of this study was to assess the physiological impact of Bhastrika Pranayama on healthy individuals using cardio-pulmonary variables. Materials and Methods: 110 healthy male and female participants between the ages of 18 and 25 were enrolled, and they were randomly divided into a control group and a Pranayama group. The parameters SpO2, SBP, DBP, HR, RR, and PEFR were noted for pre and post values for both groups were recorded. The parameters were measured using a peak flow metre, cardiac monitor, and pulse oximeter. The Pranayama group received Bhastrika Pranayama for 4 weeks whereas the control group received no intervention. Result: The Pranayama group showed a significant improvement in SpO2 (p≤0.05), RR (p≤0.05) and PEFR (p≤0.05) and a small reduction in SBP, DBP and HR. Whereas, no significant changes were observed in the control group. Discussion: Following 4-week of Bhastrika Pranayama shows improvement in PEFR, RR, and SpO2 while lowers HR, SBP, and DBP somewhat. The benefits of Bhastrika Pranayama in healthy people in terms of fitness-related health conditions, both in the short and long term, may also be revealed by future research.

Effect of Vitamin D supplementation on blood pressure in hypertensive individuals with hypovitaminosis D: a systematic review and meta-analysis.

In the present study, we aimed to conduct a literature review and meta-analysis to assess the effect of Vitamin D supplementation on SBP and DBP levels in individuals with hypertension and hypovitaminosis D. PubMed, Scopus, Web of Science, and SciELO were systematically searched for relevant publications until January 2023. The review has been registered at PROSPERO (CRD42023400035). To compare the effects of vitamin D with placebo, the mean differences with 95% confidence intervals (95% CIs) were pooled based on the random-effects model. Subgroup analyses were performed to identify the source of heterogeneity, and assessment of study quality was conducted using the GRADE approach. Publication bias was evaluated using funnel plots and Egger's tests. In total, 14 randomized controlled trials (RCTs) were included in this systematic review, and 11 trials were selected for meta-analysis. The data showed that Vitamin D significantly decreased SBP levels; however, it did not affect DBP levels. In subgroup analysis, Vitamin D supplementation significantly decreased in SBP in studies involving individuals over 60 years of age, with a dose greater than 400 000 IU, duration greater than 8 weeks, frequency of weekly supplementation in studies conducted in Asia. In addition, subgroup analysis revealed a significant reduction in DBP in the weekly frequency subgroups and in the studies carried out in Asia. This meta-analysis indicated that Vitamin D significantly reduced the SBP in individuals with hypertension and hypovitaminosis D. Further, well designed trials are necessary to validate these results.

Effects of an oral biodegradable device used for 12 weeks on weight reduction, cardiovascular risk factors, satiety, snacking, and meal size

BackgroundThe Epitomee Capsule (EC) is an, oral, self‐use, bio-degradable device for weight management, composed of absorbent polymers that self-expands in the stomach (pH-sensitive) and creates a triangular shape, space-occupying super-absorbent gel structure. A recent study reported that 42 % of study completers obtained >5 % weight reduction at 12 weeks. We performed exploratory analyses of this study to evaluate its effect on cardiovascular risk factors and on self-reported satiety, between-meal snacking and meal-size. MethodsThis single-center observational study (Israel) enrolled 78 volunteers, with mean age 41 years, BMI 32.5 kg/m2, systolic/diastolic blood pressure (SBP/DBP) 124/77 mmHg. The EC was given in addition to diet and physical activity counseling. Assessments included anthropometrics, BP, lipids, and three questions (translated from Hebrew) scored 1 (not at all) to 5 (very much) for “Do you feel the EC - Q1:helps you to consume less snacks in between meals? Q2:helps you to eat less in the meal?; Q3:is causing an early sense of satiety?”. Changes from baseline were assessed using a mixed model and included all patients with at least one measure. Correlation-analysis between weight-change and PROs used Kendall's tau. ResultCompared to baseline, at 12 weeks, SBP/DBP were reduced (ΔSBP: −5.5 mmHg, p = 0.0003/ΔDBP: −1.9 mmHg, p = 0.1341), with a larger effect in people with hypertension at baseline (ΔSBP: −13.2 mmHg, p < 0.00001/ΔDBP: −6.1, p = 0.008). Triglyceride-level was also significantly reduced, but not other lipids. Mean scores to Q1-3 were high throughout, with slight decreases (Q1 at W2 3.9 ± 1.1/W12 3.0 ± 1.6; Q2 at W2 3.7 ± 1.1/W12 3.1 ± 1.6; Q3 at W2 3.8 ± 1.2/W12 2.9 ± 1.6). There was a moderate correlation between PROs and weight reduction, although significance was not observed for all weeks. ConclusionsExploratory analyses of 12 weeks treatment with EC demonstrated significant reductions in SBP, DBP, and triglycerides. The weight reduction correlated with satiety, less snacking, and reduced meal size.

Abstract 15280: Does Weight Reduction Drive the Reduction in Blood Pressure in People Living With Obesity Treated With Tirzepatide?: Insights From SURMOUNT-1 Study

Background: Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and in development for chronic weight management. In SURMOUNT-1, in participants with obesity or overweight, TZP 5, 10 and 15 mg reduced body weight (-15 to -20.9%), SBP (-7 to -8.2 mmHg) and DBP (-4.6 to -5.5 mmHg) after 72 weeks of intervention. Aim: To assess the effects of TZP on SBP and DBP by baseline (BL) blood pressure (BP) levels and to evaluate the contribution of weight loss to the effect. Methods: Adults with a BMI ≥30 kg/m2, or ≥27 kg/m2 and ≥ 1 diagnosed weight-related complication, excluding diabetes, received TZP (5, 10, or 15 mg) or placebo (PBO) for 72 weeks. Participants with a valid BL BP value and ≥1 post-BL value were included in the analysis using the efficacy analysis set (excluding off-treatment data). Changes from BL through 72 weeks in SBP and DBP were compared between pooled TZP doses and PBO with mixed models for repeated measures (MMRM) by BL BP levels. The proportion of participants reaching recommended BP thresholds was also evaluated. Post-hoc mediation analyses evaluated the weight-loss dependent, and independent, effects of TZP in SBP and DBP reduction. Results: Regardless of BL BP values, pooled TZP showed consistent SBP and DBP reduction at 72 weeks from BL, relative to PBO (Figure 1a). At 72 weeks, a greater proportion of TZP treated participants achieved recommended SBP and DBP levels than participants treated with PBO (Figure 1b), nearly doubling the proportion of patients with normal BP values. Changes in body weight with SBP (r=0.24) and DBP (r=0.24) were moderately correlated. Mediation analysis indicated that SBP and DBP reductions were primarily mediated through weight loss (77% and 99% respectively). Conclusions: Effects of TZP on blood pressure were consistent regardless of SBP or DBP values at BL, increasing the proportion of patients reaching normal BP levels. Reductions in SBP and DBP were substantially mediated by weight reduction.

Abstract 13673: Effects of Bariatric Surgery on Blood Pressure Management in Type 2 Diabetes: Analysis From a Thirteen-Year Cohort Study

Introduction: Bariatric surgery (BS) is an effective intervention for both weight loss and improved metabolic health in those with Type 2 diabetes (T2D), yet there is limited data on its long-term effect on blood pressure (BP) control. Aim: This prospective cohort study aims to evaluate the long-term effect of BS on BP and metabolic health in T2D patients in a tertiary centre in North-West England. Methods: Patients who underwent BS (gastric bypass/sleeve gastrectomy) between 2009 - 2012 at a single tertiary surgical centre in North-West England were followed for up to 13 years. Preoperative and follow-up data including BP readings, HbA1c, BMI and antihypertensive medication use was obtained from electronic patient records at regular intervals to ascertain longitudinal outcomes in BP, BMI and HbA1c. Results: 119 patients were included in the study. Optimal metabolic health state was achieved at 12 months post-surgery for BMI (-14.78kg/m 2 (95%CI: 13.37-16.20, p&lt;0.001)), systolic BP (sBP) (-15.02mmHg 95%CI: 8.23-21.81mmHg, p&lt;0.001)), diastolic BP (dBP) (-8.1mmHg, 95%CI: 4.26-11.91, p&lt;0.001)) and HbA1c (-24.41mmol/mol, 95%CI: 18.25-30.58, p&lt;0.001). A sustained reduction in both sBP and dBP was maintained for up to 5 years, mirroring a reduction in concurrent use of antihypertensive medications (164 prescriptions v 66 at 5 years). However, at latest follow-up, there was an observed increase in antihypertensive prescription (95 v 66) yet there was no statistically significant change in mean BP. Furthermore, the number of patients with clinically diagnosed hypertension (BP 140/90 or more was lowest at 5 years (n=53 v 86 pre-op) before rising at the latest follow-up (n=57). Conclusions: Our study demonstrates that BS has a sustained benefit on BP as reflected by both absolute measurements and reduction in antihypertensive medication use. It remains an effective strategy not only for weight loss but also for the comprehensive management of metabolic comorbidities in T2D patients as evidenced by reductions in antihypertensive use, HbA1c, BMI and BP. However, more research is needed to explore the longer-term effects of these benefits at ≥ 10 years given the increases in antihypertensive use, BMI and HbA1c after this period.

Abstract P332: Asynchronous Management Of Hypertension: The Effectiveness Of Remote Patient Monitoring In Mixed Populations

Background: This study evaluated the effectiveness of a remote patient monitoring (RPM) program for hypertension (HTN) management in cardiology (CV) and primary care (PC) populations. Methods: Patients were provided cellular-enabled blood pressure (BP) cuffs that transmitted data to a practice-integrated portal. Patients who uploaded ≥ 30 BP readings for ≥ 90 days (n=2,761) were included. Clinical staff trained patients to take BP measurements, and patients received calls to discuss medication adherence and care plans. If readings were outside the predetermined range, alerts were sent to practice providers for medical management. Results: The study included 2,761 patients, with an average transmission index of 67% for CV (60.7 times per 90 days) and 63% (56.7 times per 90 days) for PC. At enrollment, uncontrolled HTN was prevalent in 65.4% (1345/2057) of CV and 68% (479/704) of PC patients. Post-intervention, there was a significant decrease in uncontrolled HTN to 49.3% (1014/2057) and 60.0% (422/704), respectively (p &lt; 0.001). Both systolic and diastolic HTN improved with reductions of 11.4 mmHg and 8.6 mmHg in SBP and DBP, respectively, in CV patients, and 8.0 mmHg and 4.6 mmHg in PC patients (p &lt; 0.0001). The most significant improvements were observed in patients with stage 2 HTN, achieving SBP and DBP reductions of 20.81 mmHg and 13.9 mmHg in CV patients and 15.9 mmHg and 10.0 mmHg in PC patients (p &lt; 0.0001), respectively. The treatment was also effective in patients with high pulse pressure (PP), with PC patients experiencing an average PP reduction of 6.2 mmHg and a reduction of 5.8 mmHg among CV patients (p &lt; 0.0001). Conclusion: RPM can be an effective adjunct therapy to improve HTN management in both primary care and specialty care populations.