Reduction In Mean Blood Pressure Research Articles

Comparative Analysis of Pharmacological and Non-Pharmacological Interventions in Hypertensive Patients at Cumilla Medical College Hospital

Background: Hypertension is a prevalent cardiovascular condition requiring effective management to reduce associated morbidity and mortality. Both pharmacological and non-pharmacological interventions play crucial roles in its treatment. This study aims to compare the effectiveness of these interventions in hypertensive patients at Cumilla Medical College Hospital, Bangladesh. Objective: To conduct a comparative analysis of pharmacological and non-pharmacological interventions in hypertension management. Method: A prospective study was conducted using data from the Department of Medicine at Cumilla Medical College Hospital, Bangladesh, from January 2023 to December 2023. A total of 184 patients were included in the study. Data on pharmacological and non-pharmacological interventions were collected, and blood pressure measurements were recorded. Result: Among the 184 patients, 65% received pharmacological interventions, while 35% received non-pharmacological interventions. Of those receiving pharmacological interventions, 82% achieved blood pressure control, compared to 73% in the non-pharmacological group. The mean reduction in systolic blood pressure was 20 mmHg in the pharmacological group and 15 mmHg in the non-pharmacological group. Regarding lifestyle modifications, 45% of patients in the non-pharmacological group reported improved dietary habits, and 55% reported increased physical activity. Conclusion: Both pharmacological and non-pharmacological interventions effectively manage hypertension, with pharmacological interventions showing slightly higher blood pressure control rates. However, non-pharmacological interventions are valuable for improving lifestyle factors. A combination of both approaches may be optimal for hypertension management.

Rate of Post Obstructive Diuresis in Rapid Versus Gradual Bladder Decompression in Patients with Chronic Urinary Retention

Background: Post-obstructive diuresis (POD) is a polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction. POD is a clinical diagnosis based on urine output exceeding 200 mL per hour for two or more consecutives hours or 3L in 24 hours after decompressing an obstructed bladder, bilateral ureteric obstruction or unilateral ureteric obstruction in a solitary kidney. Methodology: This was a prospective, randomized study in which patients with chronic urinary retention were randomized into two groups: A and B. Group A had rapid urinary decompression with 18Fr urethral catheter attached to a urine bag, while group B had gradual decompression using a urethral catheter attached to an intravenous fluid giving set which was then attached to urine bag. Post obstructive diuresis in each group were assessed at designated times. Data Analysis and Result Presentation: Data was analyzed using the Statistical Package for Social Sciences (IBM) SPSS version 21. Data was summarized by descriptive statistics. The two arms were compared for similarities in demographic variables. Continuous and categorical variables were compared using student t- test and Pearsons‘ Chi – square respectively. Significant p value was 0.05. Result: Sixty patients were recruited into the study and randomized into group A (rapid urinary decompression) and B (gradual urinary decompression) with 30 patients in each group. Thirteen patients (43.33%) had post obstructive diuresis in group A compared to 15 patients (50%) in group B. p value of 0.584. Diuresis resolved within 24 hours in 9 patients (30%) in group A and 11 patients (36.7%) in group B. p value of 0.999. The mean reduction in systolic blood pressure was 8.21 ± 2.63mmHg in group A and 7.63 ± 2.14mmHg in group B. p value of 0.583. The mean reduction diastolic blood pressure was 3.84 ± 1.31mmHg in group A and 3.41 ± 1.16mmHg in group B. P value of 0.624. No patient in both groups developed hypotension (BP of <90/60). Conclusion: There was no statistically significant different in post obstructive diuresis. However, over 46.7% of patients had diuresis in both groups without any one developing hypotension. This may be due to routine prophylactic fluid and electrolyte replacement using normal saline.

Association of pulse pressure and mean blood pressure to frailty, sarcopenia, and cognitive dysfunction in elderly outpatients with history of hypertension.

This study aimed to evaluate the relationship between pulse pressure (PP) and sarcopenia, frailty, and cognitive function in elderly patients with hypertension. We evaluated 435 elderly patients with a history of hypertension who visited the frail outpatient clinic between July 2015 and October 2021. Data at the 1-, 2-, and 3-year follow-ups were available for 222, 177, and 164 patients, respectively. Sarcopenia, frailty, and cognitive function, including Mini-Mental State Examination (MMSE) scores, were evaluated. The patients' mean age was 79.2 ± 6.3 years (male, 34.9%). PP and mean blood pressure (BP) were 60.1 ± 13.6 mmHg and 94.1 ± 13.0 mmHg, respectively. At baseline, lower PP was associated with probable dementia (MMSE score ≤23 points) (OR = 0.960 per 1 mmHg increase; 95% CI, 0.933-0.989; P = 0.006) in the model adjusted for conventional confounding factors and comorbidities, whereas higher PP was associated with low handgrip strength (OR = 1.018 per 1 mmHg increase; 95% CI, 1.001-1.036; P = 0.041). In multivariate-adjusted logistic regression analysis of patients with preserved handgrip strength at baseline, reductions in PP (OR = 0.844; 95% CI, 0.731-0.974; P = 0.020) and mean BP (OR = 0.861; 95% CI, 0.758-0.979; P = 0.022) were significantly associated with the incidence of low handgrip strength at 3 years. In conclusion, a higher PP induced by increased arterial stiffness was associated with lower handgrip strength, whereas a lower PP was associated with probable dementia. Reduced PP was associated with decreased handgrip strength after three years.

Effectiveness of peer-led intervention in control of non-communicable diseases in rural areas of Khordha district: study protocol for a cluster randomized controlled trial

BackgroundThe main contributors to death and disability from chronic illnesses in developing nations are elevated blood pressure (hypertension), blood sugar (diabetes mellitus), and blood cholesterol (dyslipidaemia). Even though there are affordable treatments, the treatment gap for these conditions is still significant. Few pilot studies from industrialized nations discuss the value of peer-led interventions for achieving community-level management of blood pressure and blood sugar. This study aims to evaluate the effectiveness of peer-led intervention compared to standard care in achieving control of selected non-communicable diseases (NCDs) in Indian context at 1 year of intervention among people of 30–60 years with hypertension and/or diabetes mellitus and/or dyslipidaemia.MethodsA cluster-randomized controlled trial will be conducted in villages of two rural blocks of the Khordha district of Odisha from August 2023 to December 2024. A total of 720 eligible participants (360 in the intervention group and 360 in the control group) will be recruited and randomized into two study arms. The participants in the intervention arm will receive a peer-led intervention model for 6 months in addition to standard care. The sessions will be based on the six domains of NCDs — self-care, follow-up care, medication, physical activity, diet, limiting substance use, mental health and co-morbidities. The mean reduction in blood pressure, HbA1C, and blood cholesterol in the intervention arm compared to the standard care arm will be the main outcome.DiscussionThe increasing burden of NCDs demands for newer strategies for management. Peer-led interventions have proven to be useful at the international level. Incorporating it in India will have remarkable results in controlling NCDs.Trial registrationClinical Trial Registry of India (CTRI) CTRI/2023/02/050022. Registered on 23 February 2023.

Treatment with empagliflozin improves cardiac function in infarcted animals associated with increased baroreflex sensitivity

Abstract Background Several clinical and experimental studies have shown an improvement in cardiac function in infarcted patients and animals (diabetic or not) when treated with empagliflozin, as well as an improvement in outcomes in patients with heart failure with reduced ejection fraction or with preserved ejection fraction. Hypothesis: Treatment with empagliflozin for 14 days (10 mg/kg) improves cardiac function in infarcted rats, secondary to increased baroreflex sensitivity. Methods Wistar rats were divided into 2 groups: AMI - acute myocardial infarction (n=8) and AMI+EMPA - acute myocardial infarction + Empagliflozin (n=8). The animals in both groups were anesthetized and submitted to thoracotomy and ligature of the left coronary artery. The animals in the AMI+EMPA group received daily, through oral gavage, 10 mg/kg of empagliflozin, for 14 days. After this period, an echocardiographic examination was performed, followed by cannulation of the femoral vein and artery, to assess hemodynamic parameters and baroreflex activity. The results were evaluated for normality. Data were compared by Student's t tests. And the relationship between the parameters was tested by Pearson's correlation. Results are presented as mean and standard deviation. Results In the echocardiographic evaluation, an improvement in diastolic function indexes was observed in the AMI+EMPA group in relation to the AMI group: E'/A' ratio (1.584 ± 0.437 vs 0.589 ± 0.129), E/E' ratio (14.11 ± 3.946 vs 29.92 ± 6.878) and systolic function: SF (29.30% ± 7.974 vs 19.20% ± 2.445), EF (53.86% ± 11.78 vs 37.91% ± 4.212), FAC (39.31% ± 7.135 vs 23.51 ± 3.940). There was a reduction in mean blood pressure in the AMI+EMPA group (102.4 mmHg ± 6,408) compared to the AMI group (110.7 mmHg ± 8,514) and in diastolic blood pressure (84.4 mmHg ± 3.889 vs 92.8 mmHg ± 7.664). In the assessment of baroreflex sensitivity, an improvement in tachy and bradycardic indexes was observed in the treated animals: tachycardic index (5.021 bpm/mmHg ± 0.346 vs 3.214 bpm/mmHg ± 0.418) and bradycardic index (1.569 bpm/mmHg ± 0.148 vs 0.73 bpm/ mmHg ± 0.046). In addition, the systolic function expressed by the FAC was positively associated with the reflex tachycardic index (p: 0.008; r: 0.616) and to the E'/A' ratio (p: 0.025; r: 0.576) and negatively with PAD (p: 0.040; r: -0.503). Conclusion Treatment with Empagliflozin in infarcted rats was able to improve left ventricular systolic and diastolic function associated with improved performance of arterial baroreceptors.

Targeting liver angiotensinogen using a GalNAc-siRNA improves cardiac remodeling in spontaneously hypertensive rats

Abstract Background Dysregulation of the Renin-Angiotensin-Aldosterone System (RAAS) leads to hypertension and cardiac hypertrophy. Angiotensinogen (AGT) is the only precursor of all angiotensin peptide products. Liver-specific AGT silencing has been proven to be a promising treatment option in lowering blood pressure (BP) in patients, characterized by full RAAS inhibition and little RAAS escape phenomena. However, the long-term effects of AGT knockdown on cardiac remodeling is still unclear. Purpose To explore the long-term effects of a GalNAc-conjugated siRNA drug R0797070 on AGT inhibition, BP and cardiac functions in Spontaneously Hypertensive Rats (SHRs). Methods In vitro inhibitory activities of siRNAs were assessed in primary rat hepatocytes. The selected siRNA was conjugated with GalNAc based on RIBO-GALSTAR liver targeting system and named R0797070. In vivo effects of repeated doses of R0797070 were evaluated in SHR model. The animals were treated with R0797070 (3 mg/kg, every 8 weeks; subcutaneous injection) or PBS (5 ml/kg, every 8 weeks; subcutaneous injection) for 7 months with the first dose (day1) at the 3 months of age. Captopril (100 mg/kg per day; oral administration) was taken as a positive drug control and Wistar rats were used as normotensive control group. Blood pressure was monitored by tail-cuff method after an initial acclimatization training period. Serum AGT protein was measured by ELISA and liver mRNA expression was detected by qPCR. Echocardiography was used to determine the changes of cardiac morphology and functions，and wheat germ agglutinin (WGA) staining was used to measure myocyte cross-sectional size. Results R0797070 showed 90-99% inhibitory activities on hepatic AGT mRNA at different doses. In SHRs, a single dose of R0797070 at 3 mg/kg resulted in a maximum inhibition of 97% for serum AGT protein with 27 mmHg mean blood pressure (MBP) reduction on Day 15. Daily administration of Captopril could reduce MBP by 33 mmHg on average, while the duration of drug efficacy of R0797070 could reach 2 months with the average 25 mmHg MBP reduction. At the end of study, the echocardiographic results showed that R0797070 significantly reduced left ventricular hypertrophy in the 10-month-old SHRs. Consistently, R0797070 treatment reduced the heart weight by 10%，and LV myocyte size by 17%. Conclusion We showed the long-term effects of a GalNAc-siRNA R0797070 on silencing angiotensinogen expression, reducing blood pressure and left ventricular hypertrophy. Compared to daily oral administration of Captopril and its effect on blood pressure R0797070 demonstrated significant effect on cardiac hypertrophy.Figure 1Figure 2

Antihypertensive treatment with hydrochlorothiazide-hydralazine combination aggravates medial vascular calcification in CKD rats with mineral bone disorder.

Arterial stiffness and medial vascular calcification, leading to isolated systolic blood pressure (BP), are major cardiovascular risk factors in patients with chronic kidney disease (CKD) and mineral bone disorders (MBD). The impact of BP on MBD-induced medial vascular calcification in CKD remains uncertain. We investigated whether BP reduction improves arterial stiffness and medial vascular calcification in a rat model of CKD-MBD. CKD was induced in Wistar rats by subtotal nephrectomy. Then, MBD was generated by a Ca/P-rich diet with calcitriol supplementation to induce medial vascular calcification. Two antihypertensive treatments were evaluated: (1) the angiotensin AT1 receptor antagonist losartan, and (2) the combination of the thiazide diuretic hydrochlorothiazide and the direct vasodilator hydralazine (HCTZ/HY). After 5 weeks, mean BP (MBP), pulse pressure (PP), and pulse wave velocity (PWV) were determined. Vascular calcification was assessed in the thoracic aorta. While MBP was similar in CKD-MBD and control CKD rats, PP and PWV were increased in CKD-MBD rats. The heightened arterial stiffness in CKD-MBD rats was associated with diffused medial calcification along the thoracic aorta. Although both losartan and HCTZ/HY reduced MBP in CKD-MBD rats, losartan did not affect PP and PWV nor medial vascular calcification, whereas HCTZ/HY, unexpectedly, further increased arterial stiffness and medial vascular calcification. In the rat model of CKD-MBD, antihypertensive treatment with losartan did not affect arterial stiffness or medial vascular calcification. However, HCTZ/HY treatment aggravated arterial stiffness and vascular calcification despite a similar reduction of MBP, suggesting a blood pressure-independent mechanism for vascular calcification.

Long term effect of renal denervation on 24 hour abpm blood pressure variability and blood pressure load parameters

The aim of the study was to evaluate the long-term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension. The study included 32 patients with treatment-resistant hypertension and performed successful RSD. The effect of renal denervation was significant both in terms of daytime, nighttime and 24-hour arterial pressure, with the most pronounced effect on nocturnal blood pressure. In addition to mean BP reduction we found out a significant improvement of weighted 24 h SD and BP load during follow-up. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mm Hg at month 12, was found in 22 patients (68.8%). In multivariate regression analysis, two parameters remained predictive for successful renal denervation – higher nighttime systolic blood pressure (OR 0.9, 95% CI 0.8-1.005, p = 0.05) and lower pulse pressure (OR 1.13, 95% CI 1.01-1.26, p = 0.03). 

Verification of the effect of an exercise programme using walking and diet adjustment in hypertension

One of the leading risk factors for cardiovascular disease is hypokinesis. Therefore, an exercise regimen is emphasized for the prevention and control of hypertension, while at the same time aiming to reduce overall cardiovascular risk in addition to achieving normal blood pressure values.
 The aim of this study was to verify the effect of an exercise programme using walking and dietary modification on the reduction of blood pressure values in hypertension, while the effect of the intervention on weight reduction and change in body composition was also studied.
 The research method in our work was case study. The proband was a physically inactive overweight woman, age 55 years, treated hypertensive, whose blood pressure at entry to the program reached the values of mild hypertension even with treatment. Baseline data were resting blood pressure values measured for 7 days in the morning and evening, a two-day record of physical activity, a seven-day record of diet, diagnosis and analysis of body composition with the InBody device, and calculation of the WHR index. The proband developed a physical activity intervention program using walking for 12 weeks, a minimum of 5 times per week, at moderate intensity, with a gradual increase in daily walking time from 30 to 60 min/day. As an adjunct to the exercise intervention, she was recommended a dietary modification. At the end of the follow-up period, blood pressure values were measured in the same way, a diagnostic and body composition analysis was performed with the InBody device, and the WHR index was calculated. The intervention program was also evaluated in relation to overweight and body composition as important factors in hypertension.
 After 12 weeks of the intervention programme, the mean reduction in systolic blood pressure was 6,29 mmHg in the morning and 4,86 mmHg in the evening. The average reduction in diastolic blood pressure was 4,57 mmHg in the morning and 3,14 mmHg in the evening. There was also a decrease in heart rate by an average of 4,07 beats per minute. At the same time, the intervention program led to a reduction in the proband's body weight (by 7,2 kg), a decrease in BMI (from 27,8 to 25,5 kg/m2), a decrease in body fat percentage (by 3,9 %) and a decrease in WHR index (from 0,91 to 0,88).
 These results confirmed that regular physical activity and dietary modification play an important role in the treatment of high blood pressure and verified the effectiveness of expert recommendations in hypertension. They also confirmed the positive effect of these recommendations on weight reduction and body composition. In summary, this work verified the beneficial effects of walking supported by dietary modification on the following risk factors for cardiovascular disease - high blood pressure, overweight, body fat, and central obesity.

The Effect of Slow Stroke Back Massage on Blood Pressure in Elderly Patients with Hypertension

Hypertension is a non-communicable disease that is often diagnosed in the elderly population in the world. Some previous studies have also suggested that slow stroke back massage, is effective in lowering blood pressure in hypertensive patients. However, limited studies examine this therapy in elderly group. This study aims to determine the effect of slow stroke back massage on blood pressure in elderly hypertensive patients. This research method uses a type of quantitative research using quasi experimental design with two group pre-post-test nonequivalent control group design. The number of samples used were 44 respondents. Sampling using the simple random sampling technique was carried out 3 times a week with a duration of 10 minutes for 4 weeks. Inclusion criteria in this study were hypertension sufferers who were willing to be respondents, patients aged 45-74 years both male and female and patients taking hypertension medication. Exclusion criteria were patients who experienced burns, bruises, skin rashes, inflammation of the skin of the back, patients who had spinal fractures. The analysis used was univariate and bivariate using the parametric Paired Sample t-test and Independent t-test. The results obtained mean a decrease in systolic and diastolic blood pressure in the intervention group was 21.04 mmHg and 11.68 mmHg, p-value (0.000 <0.05). Meanwhile, the mean reduction in systolic and diastolic blood pressure in the control group was 3.00 mmHg with a p-value (0.071>0.05) and 2.04 mmHg with a p-value (0.081>0.05). The results of data analysis using the independent sample t-test obtained a p-value of 0.000 <0.05, which means that there is an effect of slow stroke back massage on blood pressure in hypertension sufferers. This study recommended slow stroke back massage as an alternative or supporting therapy in managing hypertension in elderly individuals because it does not cause side effects.

The Effect of Slow Stroke Back Massage on Blood Pressure in Elderly Patients with Hypertension

Hypertension is a non-communicable disease that is often diagnosed in the elderly population in the world. Some previous studies have also suggested that slow stroke back massage, is effective in lowering blood pressure in hypertensive patients. However, limited studies examine this therapy in elderly group. This study aims to determine the effect of slow stroke back massage on blood pressure in elderly hypertensive patients. This research method uses a type of quantitative research using quasi experimental design with two group pre-post-test nonequivalent control group design. The number of samples used were 44 respondents. Sampling using the simple random sampling technique was carried out 3 times a week with a duration of 10 minutes for 4 weeks. Inclusion criteria in this study were hypertension sufferers who were willing to be respondents, patients aged 45-74 years both male and female and patients taking hypertension medication. Exclusion criteria were patients who experienced burns, bruises, skin rashes, inflammation of the skin of the back, patients who had spinal fractures. The analysis used was univariate and bivariate using the parametric Paired Sample t-test and Independent t-test. The results obtained mean a decrease in systolic and diastolic blood pressure in the intervention group was 21.04 mmHg and 11.68 mmHg, p-value (0.000 <0.05). Meanwhile, the mean reduction in systolic and diastolic blood pressure in the control group was 3.00 mmHg with a p-value (0.071>0.05) and 2.04 mmHg with a p-value (0.081>0.05). The results of data analysis using the independent sample t-test obtained a p-value of 0.000 <0.05, which means that there is an effect of slow stroke back massage on blood pressure in hypertension sufferers. This study recommended slow stroke back massage as an alternative or supporting therapy in managing hypertension in elderly individuals because it does not cause side effects.

A Comparative Study of the Safety and Efficacy of Amlodipine and Enalapril when Prescribed as Monotherapy in Patients with Isolated Systolic Hypertension

Background: Most elderly patients with high blood pressure have isolated systolic hypertension. Enalapril and amlodipine are respectively the most commonly prescribed ACE inhibitors and calcium channel blockers in Nepal. The goal of the current study was to compare the adverse drug reaction associated with amlodipine and enalapril in the study population as well as to compare the mean blood pressure and pulse rate reductions caused by amlodipine and enalapril in isolated systolic hypertensive patients.
 Materials and Methods: A comparative cross-sectional study was performed on 72 patients of both genders within the age group of 30 to 90 years; with isolated systolic hypertension; attending the out-patients department of Medicine of Nobel Medical College and Teaching Hospital; from December 2022 to February 2023. Mean reductions in systolic and diastolic blood pressure in the two treatment groups over the eight-weeks study period was calculated and then compared. Frequencies of patients developing different side effects was also calculated and compared between the two groups.
 Results: Systolic blood pressure was reduced by 16.1% in amlodipine group and by 18.8 % in enalapril group. Enalapril was slightly more efficacious in reducing the systolic blood pressure but such changes were found to be of no significant difference when compared between the two groups. (p > 0.05). The incidence of adverse effect was more in the amlodipine group in comparison to the enalapril group. Dry cough, dizziness, headache and fatigue with enalapril; and headache, peripheral edema, shortness of breath, fatigue, and flushing and dizziness with amlodipine were the common adverse effects.
 Conclusion: Both amlodipine and enalapril were equally effective in lowering systolic blood pressure without significantly lowering diastolic blood pressure. They were also generally well tolerated, though amlodipine was slightly more likely to cause side effects.

THE INFLUENCE OF GLP-1RAS (ORAL SEMAGLUTIDE) ON TENSIONAL CONTROL IN DIABETIC PATIENTS WITH CHRONIC RENAL DISEASE

Objective: GLP-1 receptor agonists (GLP-1RAs) represent one of the pharmacological groups of choice for the diabetic management of patients with cardiovascular disease and chronic kidney disease (CKD). Their hypotensive effect has not been sufficiently evaluated in association with the usual antihypertensive drugs. The main objective is to study the hypotensive effect of oral semaglutide at a maintenance dose of 7mg per day in a cohort of patients with stage 3b CKD (glomerular filtration rate -GFR- 44 to 30ml/min by CKD-EPI) with poor diabetic control and without previous treatment with GLP-1 receptor agonists or iSGLT2. Design and method: Sixteen patients of both sexes were selected and divided into two follow-up arms of eight patients each. In one arm, the combination of oral semaglutide with an angiotensin receptor blocker (ARB) (such as losartan at a maintenance dose of 50-100mg per day) is evaluated, and in the other, dietary measures are intensified together with ARB at the same doses. After 4 months of treatment, the primary and secondary variables were assessed: body weight, glycosylated haemoglobin (HbA1c), renal function and albuminuria (albumin/creatinine ratio - ACC). Results: Mean age was similar in both groups (69 vs 70 years). The reduction in mean blood pressure (BP) values obtained with standardised measurements in a nephrology consultation in the semaglutide + ARB arm was -12mmHg (systolic) and -5mmHg (diastolic) compared to those in the ARB arm alone (-5mmHg systolic and -3mmHg diastolic), with statistical significance (p<0.05). The other comparative variables between the two groups were: reduction in body weight (-2.5kg vs -0.5kg, p<0.05); reduction in mean HbA1c (-1.2% vs -0.1%, p<0.05); changes in eGFR (+2ml/min/1.73m2 vs -3ml/min/1.73m2, p>0.05) and mean reduction in ACC (-257mg/g vs +12mg/g, p<0.05). Conclusions: Orally administered GLP-1 receptor agonists (semaglutide) are drugs with a hypotensive potential complementary to renin angiotensin system inhibitors in diabetic renal patients. This property, together with their antiproteinuric effect, makes them an ideal choice in situations of hypertension and moderate renal dysfunction. Larger, controlled studies are needed to measure the renal effect alongside the various antihypertensive groups.

THE EFFECT OF TEXT MESSAGES BY CELL PHONE IN THE CONTROL OF HYPERTENSION: A RANDOMIZED CLINICAL TRIAL

Objective: To compare the effects of texting by cell phone plus standard usual guidance for hypertension versus standard usual guidance alone, on blood pressure control, among hypertensive patients undergoing outpatient treatment. Design and method: Randomized controlled clinical trial, composed of two groups: Intervention Group, who received SMS text messages twice a week for 10 weeks; and Comparison Group, who received the usual care. Both groups received an educational pamphlet about the hypertension. The primary outcome was BP control by office blood pressure measurement (OBPM; <140/90 mmHg) or by daytime Ambulatory Blood Pressure Monitoring (ABPM; <135/85 mmHg). Adherence to treatment was assessed indirectly using the 4 item Morisky Medication Adherence Scale and, directly, by assessing antihypertensive drugs in the urine, using a high-performance liquid chromatography technique associated with mass spectrometry. The significance level was 5%. Results: In the study, 178 patients were randomized, (90 in the Intervention Group and 88 in the Comparison Group). The sample was 60 (10) years old, women (63.8%), non-white (58.9%) and married (54.6%). The hypertensive patients were classified as having high cardiovascular risk (77.3%). The result of the intervention effect showed that there was no difference between the Intervention Group and Comparison Group (RR = 1.05; 95%CI = 0.75-1.47, and RR = 1.23; 95%CI = 0.87-1.74, respectively) in the control of OBPM, or by the daytime ABPM. However, in the Intervention Group and Comparison Group, respectively, there was a mean reduction in BP (-8.6 and -7.3 mmHg in systolic OBPM and -2.19 mmHg and -2.09 mmHg in systolic daytime ABPM); and increase in the BP control by the OBPM (19.8% to 36.0% and 19.7% to 38.2%) and daytime ABPM (38.6% to 42.5% and 41.3% to 52.2%); and in the assessment of adherence indirectly (45.3% to 69.4% and 57.1% to 59.2%). In the assessment of adherence directly, there was little difference between the groups and the two moments evaluated. Conclusions: The effect of texting by cell phone was similar to usual treatment for hypertension on BP control. On the other hand, both groups improved BP control and increased adherence to treatment.

SELF-MONITORING OF BLOOD PRESSURE AND FEEDBACK USING APP IN TREATMENT OF UNCONTROLLED HYPERTENSION: SMART APP STUDY

Objective: Self-monitoring of blood pressure (SMBP) is a reliable method used to assess blood pressure (BP) accurately. However, patients do not often know how to respond to the measured BP value. We developed a mobile application-based feedback for tailored recommendations and aimed to evaluate whether this feedback is superior to SMBP alone in terms of BP reduction and drug compliance improvement in patients with hypertension. Design and method: Self-Monitoring of and Feed-back using APP in TReatment of UnconTrolled Blood Pressure (SMART-BP) is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App compared with SMBP alone. In the SMBP alone group, the patients performed home BP measurement and receive the standard care, whereas in the SMBP-App group, the patients received additional recommendations from the application using feedback algorithm in response to the obtained BP value. The primary endpoints were mean home BP and adherence of antihypertensive medication. Follow-up visits were scheduled at 12 and 24 weeks after randomization. Results: Among total 173 patients (88 for SBMP-app and 85 for SMBP alone) with full-analysis set, 53% were men, and the mean age was 59.8 years. Baseline characteristics including BP were not significantly different between two groups. At 6 months, mean reduction in home systolic BP was significantly higher in SMBP-App group than SBMP alone group (-20.0±13.5 vs. -14.9±12.9, = 0.012). Also, SMBP-app group showed higher drug adherence value and proportion of adherence over 95% than in SMBP alone group (95.2% vs. 90.4%, P = 0.004; 72/88 vs. 46/85, P = 0.010). Reduction in home systolic BP at 3 months and office systolic BP at 3 months were also higher in SBMP-App, similar with primary end point. Conclusions: SMBP-App is superior to SMBP alone in terms of blood pressure reduction and improved drug adherence in patients with hypertension.

The effect of progressive muscle relaxation technique on physical parameters and anxiety among patients with myocardial infarction

The main aim of the study is to assess the effect of progressive muscle relaxation therapy on physical parameter and anxiety among patient with myocardial infarction admitted at selected hospitals of Durg (C.G). The study was conducted at B.M Shah Hopsital and K. Gurunath Cardiac Hospital for patient with myocardial infacrtion.Quasi experimental pretest posttest control group design was adopted for this study. Convenient sampling technique was used to select the study participants. The patient with myocardial infarction was assigned to experimental group (n=23) and the other to the control group (n=23). Progressive muscle relaxation therapy was given for 20 minutes once daily in the morning between 6-8AM for 7 days. Physical parameter and anxiety measurements were taken from the first day and 7 day and was documented. The study showed a significant reduction of physical parameters mean blood pressure from 5.75 to 5.5 mm of Hg, for pulse 5.5 to 5, for respiration 7 to 5.7, and SPO2 7 to 5.8. calculated ‘t’ value was greater than the table value at 0.001 level of significance. Level of anxiety before and after progressive muscle relaxation among the experimental group was 50and 44.5. respectively. Standard deviation was 7.0, 6.6 and the calculated ‘t’ value was 3.4. While comparing with table value, it showed that the calculated ‘t’ value was greater than the table value at 0.001 level of significance.Hence it is concluded that progressive muscle relaxation therapy is an effective measure to maintain the level of physical parameters and reduce the level of anxiety among patient with myocardial infarction at selected hospitals of Durg (C.G).

Efficacy and Safety of Fixed-Dose Combination of Efonidipine and Telmisartan in Stage II Hypertensive Patients: Results from Randomized Clinical Trial

Aim: The aim of this study was to evaluate the anti-hypertensive efficacy of a fixed-dose combination (FDC) of Efonidipine 40 mg and Telmisartan 40 mg in Stage II hypertensive patients.
 Study Design: Multicentric, randomized, double-blind, parallel, comparative Phase III clinical trial.
 Methodology: This clinical trial was conducted at six geographically distributed sites across India and enrolled 240 Stage II hypertensive patients. They were randomized into two groups in a ratio of 1:1 using computer-generated block randomization to receive E+T (FDC of Efonidipine 40 mg + Telmisartan 40mg) or C+T (FDC of Cilnidipine 10 mg + Telmisartan 40 mg) group intervention once daily for a period of 90 days. The study site staff, investigator and patients were blinded to the treatment allocation. The primary endpoint of the study evaluated the mean reduction in sitting systolic BP (SBP) and diastolic BP (DBP) from baseline to day 90 whereas the secondary endpoints assessed were mean reduction in BP from baseline to day 30 & 60, patients achieving target BP (<140/90 mmHg) and the safety and tolerability of the investigational products based on the incidences of adverse events (AEs) reported.
 Results: A total of 118 subjects were randomized to the E+T group wherein the mean (±SD) SBP and DBP at baseline was 167.25 ± 4.68/107.26 ± 5.19 mmHg. After 30 days of treatment with the E+T group, the mean reduction in SBP/DBP of 29.37/18.06 mmHg was observed whereas at Day 60 reduction of 38.55/22.69 mmHg was seen from the baseline. At Day 90, SBP/DBP decreased to 119.41±14.99/81.67±4.29 mmHg with a mean reduction of 47.94/25.89 mmHg in the E+T group. During the study period, the difference in systolic blood pressure between the treatments with E+T and C+T was -0.48 mmHg, with the two-sided 95% confidence interval (CI) ranging from -4.54 to 3.58 mmHg. The corresponding difference in diastolic blood pressure was -0.77 (95% CI: -2.60 to 1.06) mm Hg. The upper boundary of the 95% CI was below the margin of 10 mmHg, confirming the non-inferiority of E+T to C+T. A total of 92% of patients who had been assigned to E+T treatment achieved their target BP goal. Only one patient reported an adverse event with E+T treatment. No unexpected AEs were reported in the E+T group suggesting its good safety and tolerability. Overall, the E+T treatment was effective, safe and well-tolerated by the patients for 90 days.
 Conclusion: It was concluded that the FDC of Efonidipine 40 mg and Telmisartan 40 mg was efficacious in the management of Stage II hypertension.

Prospective evaluation of digital therapeutic intervention on blood pressure control in Indian patients with uncontrolled primary hypertension

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Terrals Technologies Private Limited Background Digital therapeutics (DTx) has emerged as a new approach in recent years making use of connected devices, smartphone software and electronic communication tools to help manage chronic cardiovascular diseases such as hypertension. Considering its nascent stage, many questions still remain with respect to its applicability, effectiveness and limitations. Purpose Assess the effectiveness of digital therapeutic intervention in controlling blood pressure in Indian patients with primary hypertension Methods We conducted a prospective, 12 week, single arm, interventional study, including 125 subjects at multiple sites in India. Subjects with uncontrolled primary hypertension (≥140 mmHg systolic and/or ≥90 mmHg diastolic) in the age group of 30-65 years who were under routine antihypertensive treatment were enrolled. They were provided supplementary DTx intervention comprising of smartphone application based personalized management of diet, exercise, self monitoring and health education by nutritionists and health coaches. Efficacy endpoints such as blood pressure (BP), body mass index (BMI), lipids, etc. were measured before and after the intervention. Results A total of 122 subjects who completed the trial had mean age of 47.44 ± 9.43 years, comprising 58 (48%) male and 64 (52%) female patients and mean BMI of 27.21 ±4.7 kg/m². Post-intervention change in mean systolic BP (SBP) was -25.61 mmHg (95% CI 22.55 - 28.66, 154.98 mmHg vs 129.37 mmHg, P<.001). The post-intervention change in mean diastolic BP (DBP) was -18.62 mmHg (95% CI 16.29 - 20.96, 100.04 mmHg vs 81.42 mmHg, P<.001). Patients with stage 1 hypertension (69.6%) achieved mean systolic reduction of 20.87 ± 13.9 mmHg, (148.54 mmHg vs 127.67 mmHg, P<.001). The patients with stage 2 (27.04%) and stage 3 (3.27%) hypertension achieved a higher mean SBP reduction of 34.67 ± 15.19 mmHg (167.24 mmHg vs 132.58 mmHg, P<.001) and 51.5 ± 40.45 mmHg (190.75 mmHg vs 139.25 mmHg, P=.084), respectively. Male and female patients showed almost similar reduction in systolic BP of 25.47 ± 14.72 and 25.73 ± 19.39 mmHg, respectively. Also, the subjects with other chronic comorbidities (23.9%) achieved a mean systolic BP reduction of 29.51 ± 15.25 mmHg. A total of 79.51% (n=97) patients achieved the SBP <140 mmHg, while 59.84% (n=73) patients achieved SBP <130 mmHg. Combining both the systolic and diastolic targets together, 65.57% (n=80) patients achieved the target of <140/90 mmHg, while ESC/ESH 2018 recommended BP target of <130/80 mmHg was achieved by 31.15% (n=38) patients. Conclusion The implementation of Digital therapeutic application integrated with primary healthcare resulted in significant reduction in blood pressure in participants with uncontrolled hypertension. Greater improvement was observed in participants with higher baseline blood pressure.

Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis

Background and objective Thiazide diuretics are first-line drugs for the treatment of hypertension, but hypertension treatment guidelines have systematically discouraged their use in patients with advanced chronic kidney disease (CKD). For the first time, a systematic review and random-effects meta-analysis were performed to assess the effectiveness of thiazides and thiazide-like diuretics to treat hypertension in patients with stages 3b, 4, and 5 CKD. Design, setting, participants, & measurements A systematic review and random-effects meta-analysis that included a literature search using the following databases were performed: MEDLINE through PubMed, Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) through the Cochrane Library, Embase, and ISI – Web of Science (all databases). Prospective studies that evaluated the effectiveness of thiazide and thiazide-like diuretics in individuals with a GFR < 45 mL/min/1.73 m2 were included. Results Five clinical trials, totaling 214 participants, were included, and the mean GFR ranged from 13.0 ± 5.9 mL/min/1.73 m2 to 26.8 ± 8.8 mL/min/1.73 m2. There was evidence of a reduction in mean blood pressure and in GFR, as well as in fractional sodium excretion and fractional chloride excretion. Conclusion Thiazide and thiazide-like diuretics seem to maintain their effectiveness in lowering blood pressure in patients with advanced chronic kidney disease. These findings should spur new prospective randomized trials and spark discussions, particularly about upcoming hypertension guidelines.

Comparison between the Efficacy of Amlodipine with Captopril in the Management of Uncontrolled Blood Pressure in the Emergency Department

Objective: To compare the efficacy of Amlodipine with Captopril in the management of patients presenting to the emergency department with uncontrolled blood pressure.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Emergency Department, Combined Military Hospital, Malir Pakistan, from Jul to Dec 2021.&#x0D; Methodology: A total of 127 individuals presenting to the Emergency Department with two readings of uncontrolled blood pressure (Systolic blood pressure ≥ 160mmHg and Diastolic blood pressure ≥90mmHg) were included. They were administered a tablet of Captopril 12.5mg per oral and a tablet of Amlodipine 10mg per oral on the turn by turn basis. Patients were observed for 3 hours and monitored for the reduction in blood. The efficacy of medication was judged based on the ability to achieve target blood pressure reduction, which was at least a 20-30% reduction in systolic blood pressure.&#x0D; Results: Out of 127 individuals, 65(51.2%) patients were given a tablet of Captopril 12.5mg orally, and 62(48.8%) were given a tablet of Amlodipine 10mg orally. The mean reduction in systolic blood pressure was 20.73±5.17 in all patients. In addition,target blood pressure reduction was achieved in 35(53.8%) individuals of the Captopril-Group and 33(53.2%) of the Amlodipine-Group, with a total of 68(53.5%) individuals achieving target blood pressure within 3 hours after medication.&#x0D; Conclusion: Both medications were efficient in achieving target blood pressure levels. However, no drug was superior to another in reducing blood pressure in an emergency.