Significant Reduction In Systolic Blood Pressure Research Articles

#1642 Influence of potassium intake on the renoprotective response to sodium restriction and hydrochlorothiazide in patients with diabetic nephropathy

Abstract Background and Aims Both salt restriction and hydrochlorothiazide (HCT) potentiate the antihypertensive and antiproteinuric effects of renin-angiotensin-aldosterone-system inhibitors (RAASi) in chronic kidney disease (CKD). Potassium intake is another dietary component that influences blood pressure (BP) and albuminuria. The influence of potassium intake on the response to sodium restriction during RAASi treatment in diabetic nephropathy is unknown. Method We performed a post-hoc analysis of a randomised, double blind, placebo-controlled cross-over trial (n = 43) investigating the combined and separate effects of low sodium (LS; aim 50 mmol Na+/d) and HCT (50 mg/d) on BP and albuminuria during background ACE inhibition (ACEi; lisinopril 40 mg/d) in patients with diabetic nephropathy. Each treatment (normal sodium (NS), LS, NS+HCT, LS+HCT) period consisted of six weeks. Participants were categorised as above or below median 24-hour urinary potassium excretion (UKV) at baseline, stratified by sex. Effects on BP and albuminuria were defined as % reduction from baseline systolic BP (SBP) and urinary albumin-creatinine ratio (ACR). Changes over time within both UKV subgroups were compared to baseline using repeated measures ANOVA (SBP) or paired Wilcoxon rank sum analysis (log-transformed ACR). Post-hoc between-group comparison was performed using Bonferroni testing. Results 43 patients (6 female; mean age 64.9±1.4 yrs) had UKV data available and were included in analysis. 33 patients had complete ACR data. Mean estimated glomerular filtration rate (eGFR) was 65.2 (±3.9), mean SBP was 146.6±2.4 mmHg and median albuminuria 648.6 [251.2 - 1883.0] mg/24 h. Median UKV in the high and low potassium groups was 64 [IQR 49-71] and 94 [90 – 111] mmol/24 u, respectively (p<0.0001). Mean baseline sodium excretion was higher in the high potassium group (191 vs. 260 mmol/d; P = .002), but percentual reduction in sodium excretion at SR was comparable between the two groups. There were no significant differences in baseline SBP, ACR, age and estimated glomerular filtration rate between the groups. LS led to a significant reduction of ACR in the high potassium group (P = .011), whereas in the low potassium group the ACR reduction was not significant (P = .058; Fig. 1). Similarly, addition of HCT to background ACEi therapy without salt restriction reduced ACR compared to ACEi monotherapy in the high potassium group (P < .0001), not the low potassium group (P = .211). LS+HCT combined led to a reduction in ACR in both high (P < .0001) and low potassium (P = .034) groups. A post-hoc between-group analysis showed a significantly larger ACR reduction for the high potassium group (P = .01) upon HCT therapy, and a trend towards larger reduction for HCT+LS (P = .05). The effect of LS alone was similar between high and low potassium groups (P = .485). During LS, within-group analysis showed a significant reduction in SBP compared to baseline for the low potassium group (P = .003), but not for the high potassium group (P = .208). In all further conditions, SBP was significantly reduced from baseline in both groups. Post-hoc analysis showed no significant differences in SBP reduction between high and low potassium groups, although there was a trend towards larger SBP reduction in the low potassium group during LS (P = .07). Conclusion Higher baseline potassium excretion is associated with stronger albuminuria lowering effects of salt restriction and HCT in patients with diabetic nephropathy on background ACEi therapy. These effects were not driven by similar effects on BP.

Hypotensive effects of exercise training: are postmenopausal women with hypertension non-responders or responders?

We tested the hypothesis that increasing the exercise dose or changing the exercise mode would augment hypotensive effects when traditional aerobic exercise training failed to produce it in postmenopausal women. Sixty-five postmenopausal women with essential hypertension were randomly allocated into the continuous aerobic training (CAT) and non-exercising control (CON) groups. CAT group cycled at moderate intensity 3 times a week for 12 weeks. Individuals who failed to decrease systolic blood pressure (BP) were classified as non-responders (n = 34) and performed an additional 12 weeks of exercise training with either increasing the exercise dose or changing the exercise mode. The 3 follow-up groups were continuous aerobic training 3 times a week, continuous aerobic training 4 times a week, and high-intensity interval training. After the first 12 weeks of exercise training, systolic BP decreased by 1.5 mmHg (NS) with a wide range of inter-individual responses (-23 to 23 mmHg). Sixty-seven percent of women who were initially classified as non-responders participated in the second training period. Sixty percent of women who participated in continuous exercise training 3 or 4 times a week at greater exercise intensities reduced systolic BP. All (100%) of the women who performed high-intensity interval training experienced significant reductions in systolic BP. Traditional aerobic exercise was not sufficient to decrease BP significantly in the majority of postmenopausal women. However, those women who were not sensitive to recommended exercise may reduce BP if they were exposed to continuous aerobic exercise at higher intensities and/or volumes or a different mode of exercise.

Exercise Effects on Maternal Vascular Health and Blood Pressure during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis.

This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP). The outcome of interest were pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy until 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted. In total, 20 RCTs involving 1,221 women were included. Exercise training, initiated from week 8 during gestation or between 6-14 weeks after delivery, with the program lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) (MD: -4.37 mmHg; 95% CI: -7.48 to -1.26; p = 0.006) and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; p = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods. Exercise training during pregnancy and the postpartum period demonstrates a favorable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.

Biological response of nonhuman primates to controlled levels of acute blood loss.

The global shortage of human blood for medical use has prompted the development of alternative blood sources. Nonhuman primates (NHPs) are commonly used owing to their physiological similarities to humans. The objective of the current study was to establish a controlled-blood-loss model in NHPs to explore their clinical and biological responses. Blood was sequentially withdrawn from 10 cynomolgus monkeys (10, 14, 18, 22, and 25% of the total blood volume); their vital signs were monitored, and blood parameters were serially analyzed. Humoral mediators in the blood were measured using flow cytometry and enzyme-linked immunosorbent assays. In NHPs subjects to 25% blood loss and presenting with related clinical symptoms, the systolic blood pressure ratio on day 0 after bleeding was significantly lower than that of the animals from the other groups (median: 0.65 vs. 0.88, P = 0.0444). Red blood cell counts from day 0-14 and hematocrit levels from day 0-7 were markedly decreased relative to the baseline (P < 0.01). These parameters showed a direct correlation with the extent of blood loss. The levels of creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase exhibited increases in response to blood loss and had a stronger correlation with the hemoglobin ratio than the volume of blood loss. The levels of C3a and C4a, as well as interleukin (IL)-1α and IL-15, displayed a strong correlation, with no apparent association with blood loss. The findings of the present study showed that only NHPs with 25% blood loss exhibited clinical decompensation and significant systolic blood pressure reduction without fatalities, suggesting that this level of blood loss is suitable for evaluating blood transfusion efficacy or other treatments in NHP models. In addition, the ratio of hemoglobin may serve as a more dependable marker for predicting clinical status than the actual volume of blood loss. Thus, our study could serve as a basis for future xenotransfusion research and to predict biological responses to massive blood loss in humans where controlled experiments cannot be ethically performed.

Effects of Galvanic Skin Resistance Biofeedback on Perceived Stress in Individuals with High Blood Pressure: A Quasi-experimental Study

Introduction: According to the World Health Organisation (WHO), hypertension is one of the leading causes of premature morbidity and mortality, both in industrialised and developing countries. Patients with arterial hypertension are advised to make lifestyle adjustments, such as increasing physical activity and reducing stress. Nowadays, a variety of relaxation techniques are used to reduce stress and tension. The practise of Biofeedback (BF) is regarded as a successful treatment for this purpose. Aim: To investigate the effect of Galvanic Skin Resistance Biofeedback (GSRBF) on perceived stress. Materials and Methods: In present quasi-experimental study, 53 individuals with high blood pressure, including prehypertensive and hypertensive individuals {Blood Pressure (BP)&gt; 120/80 mmHg}, were included. Participants were recruited from various Medical and Physiotherapy Outpatient Departments (OPD) of private and Government hospitals and clinics in Veraval, Gujarat, India, from March 2022 to September 2022. Basic demographic data was collected, Blood Pressure (BP) was measured, and the Perceived Stress Scale (PSS) was administered. Participants were then connected to the GSRBF instrument and instructed to relax using a relaxation response technique. After 12 sessions, BP was measured again, and the PSS was administered. As the data were not normally distributed, a t-test was performed at a significance level of 95% (p&lt;0.05). Results: The analysis revealed a significant decrease in PSS scores following GSRBF sessions, with a p-value of &lt;0.05. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) also showed a significant reduction, with a p-value of &lt;0.05. Conclusion: The GSRBF demonstrated a significant reduction in perceived stress among individuals with high blood pressure, and it also showed a significant reduction in SBP and DBP. The present study provides valuable insights into the potential of GSRBF as an adjunct therapy for managing hypertension and promoting overall well-being.

Efficacy of fosinopril and amlodipine in pediatric primary hypertension: a single-center observational study.

Fosinopril and amlodipine are commonly prescribed as first-line pharmacotherapeutic agents for pediatric hypertension, but there is a lack of comparative studies regarding the efficacy of these two drugs. We aimed to evaluate and compare the efficacy of fosinopril and amlodipine monotherapy in pediatric primary hypertension. This was a single-center, bidirectional observational study. A total of 175 children and adolescents with primary hypertension receiving antihypertensive monotherapy from July 2020 to February 2023 were enrolled. According to antihypertensive drugs, they were divided into the fosinopril group (n = 96) and the amlodipine group (n = 79). Subgroup analysis was performed to compare the efficacy of the two groups in terms of blood pressure (BP) control rates and reductions following a 4-week treatment. After 4 weeks of treatment, both groups achieved significant reductions in systolic BP (SBP) and diastolic BP (DBP) by more than 18 mmHg and 6 mmHg, respectively, with BP control rates of 61.5% in the fosinopril group and 59.5% in the amlodipine group, revealing no significant differences in the antihypertensive efficacy between the two groups except for DBP control rate (FDR adjusted P > 0.05). Further subsequent subgroup analyses revealed that the reductions in SBP and DBP in the fosinopril group were significantly greater than those in the amlodipine group in patients of females and hypo-HDL-cholesterolemia (FDR adjusted P < 0.05), and there was a trend of difference, although not significant, in patients with central obesity and insulin resistance (IR) (FDR adjusted 0.05 < P ≤ 0.1). However, there were no significant differences in treatment efficacy in patients without these characteristics. Furthermore, hypertriglyceridemia did not exhibit a significant association with the difference in treatment efficacy between the two medications (FDR adjusted P > 0.05). Fosinopril and amlodipine monotherapy were both effective in pediatric primary hypertension during a short-term follow-up. Fosinopril may be particularly effective in reducing BP in hypertensive patients of females, central obesity, IR, and hypo-HDL-cholesterolemia. These findings indicate that optimizing antihypertensive medication selection based on the individualized characteristics of children with hypertension may improve the efficacy of antihypertensive treatment.

Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements.

Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110-115/70-75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of -1.37/-1.63 mm Hg and -2.79/-1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of -1.76 mm Hg and -2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.

Application of high-velocity low-amplitude technique in cervicothoracic junction produces cardiovascular responses in subjects with C7-T1 dysfunction: Randomized crossover trial

BackgroundNeural structures of cardiac sympathetic and parasympathetic conduction emerge from the segments of the cervicothoracic spine. The application of high-velocity low-amplitude (HVLA) techniques at this segment can generate responses in heart rate (HR), blood pressure and sympathetic nervous activity of the skin. However, it is not known whether these responses occur in subjects with C7-T1 dysfunction. ObjectiveTo evaluate the effects of HVLA technique in cervicothoracic junction in HR, blood pressure and skin temperature (ST), in subjects with C7-T1 dysfunction. DesignThis is a randomized crossover trial. MethodsTwelve male subjects were randomized into two groups: HVLA and Sham. HVLA group received a single manipulation technique for C7-T1 dysfunction, while the sham group received a simulated HVLA. HR, blood pressure and ST were measured pre, immediately after and 10 min after the application of the interventions. ResultsImmediately after the application of the interventions, an increase in HR, systolic blood pressure (SBP) and ST was observed, in addition to a reduction in diastolic blood pressure (DBP). Also, 10 min after, a significant reduction in SBP and DBP was observed in the HVLA group when compared to Sham group. ConclusionThe application of a single HVLA technique in the cervicothoracic junction produced significative effects on HR, BP and ST in subjects with C7-T1 dysfunction. Implications for Practice·This study showed that a musculoskeletal technique has effect on autonomic nervous system, suggesting that there are still hidden mechanisms behind HVLA techniques.·HVLA techniques for cervicothoracic junction can generate changes in cardiovascular variables.·HVLA techniques did not cause adverse hypertensive peaks.

Efficacy of the combination of valsartan and hydrochlorothiazide in the treatment of hypertensive heart disease

Purpose: To investigate the effectiveness of the combination of valsartan and hydrochlorothiazide in managing hypertensive heart disease.Methods: From August 2020 to October 2022, the case data of 120 patients in Lu’an Hospital of Anhui Medical University, Lu’an, China were analyzed retrospectively. Based on the different treatment options, 54 patients with hypertensive heart disease who received valsartan alone (80 mg, once daily) for 3 months were placed in control group (CG), while 66 patients who received valsartan combined with Systolic blood pressure (SBP), therapeutic effect, diastolic blood pressure (DBP), and incidence of adverse effects were also recorded for CG and SG.Results: In the SG, there were significant reductions in SBP, DBP, LVMI and LVPWT compared to CG, while EF showed significant increase after treatment (p &lt; 0.05). In both groups, SBP, DBP, LVMI and LVPWT decreased significantly after treatment compared to pre-treatment values, but EF however showed a significant increase (p &lt; 0.05). In the SG, there was a significant increase (p &lt; 0.05) in the total effective rate compared to CG and there was also a significant reduction (p &lt; 0.05) in the total incidence of adverse effects compared to CG.Conclusion: Valsartan combined with hydrochlorothiazide is more effective in treating patients with hypertensive heart disease than valsartan monotherapy alone. However, the combination treatment should be subjected to further clinical trials prior to its introduction into clinical practice.

Evaluation of the Effectiveness of Homoeopathic Mother Tincture Sarothamnus Scoparius in Managing Essential Hypertension

Abstract Objectives The objective of this study was to evaluate the effectiveness of homoeopathic mother tincture Sarothamnus scoparius in the management of essential hypertension. Materials and Methods An open label, prospective, single arm, clinical trial was conducted on 35 participants recruited from outpatient department/inpatient department of a Govt. Homoeopathic Medical College and Hospital. All participants received Sarothamnus scoparius mother tincture, suffering from essential hypertension. The primary outcome was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months and the secondary outcome was to assess the QOL of the patient by using WHOQOL-BREF at baseline and after 3 months. The primary outcome and secondary outcome measures were analysed by repeated measure analysis of variance (ANOVA) and ‘Paired t-test’ respectively. Result Twenty-nine participants completed the study and six participants dropped out. Intention-to-treat sample (n = 35) was analysed. There was statistically significant reduction in SBP (146.40 ± 7.65 to 128.00 ± 12.34) as well as DBP (88.80 ± 3.26 to 86.07 ± 3.307). Repeated measure ANOVA was performed to compare the changes in SBP as well as DBP at different time interval. In SBP, the result was statistically significant on all occasions (p = 0.000, at 95% confidence interval [CI]). In DBP, the result was also found statistically significant (p = 0.000, at 95% CI). However, the result was not statistically significant when DBP was compared at 1 month with 2nd and 3rd months (p = 1.000, at 95% CI); 2 months with 1 and 3 months (p = 1.000, 0.863 at 95% CI respectively); 2 months with 3 months (p = 0.518, at 95% CI); and 3 months with 1 and 2 months (p = 1.000, 0.863 at 95% CI respectively).Paired t-test performed to measure the changes in WHOQOL-BREF score showed statistically significant (62.57 ± 10.81 to 96.07 ± 17.47; p = 0.000, at 95% CI). Conclusion The study findings suggest that Sarothamnus scoparius mother tincture is beneficial in the management of essential hypertension as well as improving QOL. Randomised controlled trials are further warranted. Trial Registration CTRI/2021/09/036584.

Effects of curcumin on blood pressure: A systematic review and dose-response meta-analysis

AimsThis systematic review and dose-response meta-analysis were conducted to summarize data from available clinical trials on the effects of curcumin supplementation on systolic BP (SBP) and diastolic BP (DBP). Data synthesisUsing related keywords, multiple databases, including the Web of Sciences, Scopus, Embase, PubMed, Cochrane Library, and Google Scholar, were searched until November 2022. We chose the studies that examined the effects of curcumin on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Seventeen eligible studies with a total sample size of 1377 participants were included in the meta-analysis. The findings of the meta-analysis did not indicate any significant effect of curcumin on SBP (WMD = −0.06 mmHg, 95% CI: −0.62, 0.50, p = 0.85; I2 = 44.2%) and DBP (WMD = −0.18 mmHg, 95% CI: −1.17, 0.82, p = 0.62; I2 = 77.2%). Moreover, in our dose-response analysis, we found that the dose and duration of curcumin supplementation were non-significantly associated with the reduction of SBP and DBP. However, subgroup analysis revealed a significant reduction only in DBP levels (WMD: −0.76 mmHg, 95% CI: −1.46,−0.05; P = 0.03) but not in SBP in studies with ≥12-week supplementation. Also, a significant reduction in SBP (WMD: −1.55 mmHg, 95% CI: −2.85, −0.25; P = 0.01) and DBP (WMD: −1.73 mmHg, 95% CI: 2.67, −0.79; P < 0.01) was noticed by curcumin supplementation in studies performed on women. ConclusionsThe current study suggests that consuming curcumin may improve DBP when administered for long durations ≥12 weeks. However, more trials are required to confirm these findings.

Comparison of dexmedetomidine, lidocaine and fentanyl in attenuation of haemodynamic response to laryngoscopy and intubation in cardiac surgery patients

Objective: Laryngoscopy and intubation produce sympathoadrenal response posing risk especially in cardiac patients due to arrhythmias, myocardial ischemia increasing morbidity and mortality. Our aim is to compare lidocaine, fentanyl and dexmedetomidine in attenuation of this response in cardiac surgery patients. Material and Methods: Ninety patients were allocated into 3 groups of 30 participants each. Group A obtained 1µg/kg Dexmedetomidine for 10 minutes before laryngoscopy. Group B 1.5mg/kg of Lidocaine and Group C 2µg/kg Fentanyl 90 seconds before intubation. Hemodynamic parameters like Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Rate Pressure Product (RPP) were noted before intubation and 1,3,5,10 and 15 minutes after intubation. Statistical analysis was done using Epi info version 7.2.1.0 statistical software (Chi square test, ANOVA test). Results: Dexmedetomidine had significant reduction in SBP at 1st (p-value=0.003), 5th, 10th and 15th (p-value&lt;0.001) minute and in DBP at 3rd, 5th, 10th and 15th (p-value&lt; 0.001). MAP was significantly reduced with dexmedetomidine at 1st, 3rd, 5th, 10th and 15th minute (p-value&lt;/ = 0.001) and RPP at 1st (p-value=0.040), 3rd (p-value=0.001), 5th (p-value=0.001), 10th (p-value&lt;0.001) and 15th(p-value=0.002) minute. Dexmedetomidine had higher fall in HR at 1st, 3rd, 5th, 10th mins which was not statistically significant(p-value&gt;0.05). Conclusion: Dexmedetomidine 1µg/kg given as 10 min infusion before laryngoscopy was more effective than fentanyl and lidocaine in blunting hemodynamic response to laryngoscopy and intubation in cardiac surgery patients. However due to significant hypotension associated with dexmedetomidine, it has to be used with caution in these patients.

Isometric Exercise and Blood Pressure: 12 Weeks of Training and Detraining in the Elderly

ABSTRACTBackgroundElderly people are particularly affected by rising systolic blood pressure (SBP). We hypothesized that resting blood pressure (RBP)-reducing isometric exercise training (IET) can be delivered in a group setting with older adults.MethodsParticipants (63–88 years; N = 19) completed IET at 30% maximum voluntary contraction, 3 days a week for 12 weeks. RBP was measured weekly throughout, plus 6 weeks posttraining. Control participants did not engage in IET (N = 5). Changes in RBP were assessed using a 2-way repeated-measures analysis of variance.ResultsIET induced significant reductions in SBP (−10.5 mmHg; P &amp;lt; 0.05), but SBP also declined unexpectedly in the control group (−4.5 mmHg; P &amp;lt; 0.05). Diastolic blood pressure declined in the IET group only (−4.7 mmHg; P &amp;lt; 0.05). There were no significant differences between groups for SBP or diastolic blood pressure (P &amp;gt; 0.05). At 6 weeks posttraining, SBP was still 9.4 mmHg below baseline in the IET group only. A unique finding was that the clinically significant RBP reductions persisted for 6 weeks after IET.ConclusionsHandgrip IET may be an effective antihypertensive intervention, which persists for several weeks in older adults, even when training ceases.

PS-P12-7: IDENTIFYING THE EVIDENCE-POLICY GAP IN TASK-SHARING WITH COMMUNITY HEALTH WORKERS FOR MANAGEMENT OF HYPERTENSION: A MIXED-METHOD STUDY

Objective: Few studies are addressing the evidence-policy gap in task-sharing with community health workers (CHWs) to manage hypertension. We aimed to identify the gap by 1) performing a scoping review of peer-reviewed journals and 2) conducting in-depth interviews with key informants who have been involved in national CHW programs. Design and Methods: We searched PubMed for studies published from 2010–2021 following the PRISMA extension for scooping review guideline. We included all type of studies on task-sharing with CHWs for hypertension management. We extracted data on types, places, and the frequency of CHWs’ activities and other relevant indicators. The primary outcomes were changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), BP control, and medication adherence. In the corresponding countries, key informants with policy and implementation experience in national CHW programs were identified and interviewed. Result: A single reviewer screened 2,316 records, of which 166 were assessed for eligibility, and 85 were included in the final review. There were 29 randomized controlled trials, 2 quasi-experimental trials, 11 pre-post studies, 2 prospective cohorts, 19 cross-sectional studies, and 22 qualitative studies. CHWs performed health education and BP measurement in 80% (60/75) and 63% (47/75) of studies, respectively. 89% (33/37) used digital BP device. Patients’ home (64%, 47/71) was used the most with a median of one visit per month, followed by public space (11%, 8/71) and home/clinic (6%, 4/71). One CHW was responsible for an average of 116 participant with the range from 3 to 612. Significant reduction in SBP was seen in 56% (9/16) of the included trials. Eight informants from six countries (Brazil, India, Iran, Liberia, Thailand, Zimbabwe) participated in in-depth interviews. Brazil, India, Iran, Thailand, and Zimbabwe involved CHWs in health education, whereas only Thailand and Iran involved in BP measurement and both use manual BP devices. In these five countries, one CHW was responsible for an average of 1,250 people with the range from 250 to 3,000 in a national program. Conclusion: Despite clinically relevant BP reduction in CHW programs, there was suboptimal translation of this evidence into policy. The size of the population served per CHW and the type of BP device differed between research studies and national programs. Global health partners (i.e. those who generate evidence) and local governments need to work together to bridge the gap between evidence and policy. Figure 1: Forest plot of difference in systolic and diastolic blood pressure change in included studies.

S-21-5: COMPARISON OF THIRD-DOSE TRIPLE VERSUS THIRD-DOSE DUAL ANTIHYPERTENSIVE COMBINATION THERAPIES IN PATIENTS WITH ESSENTIAL HYPERTENSION DURING 8-WEEK FOLLOW-UP

Objective: We compared efficacy and safety of low-dose triple versus low-dose dual antihypertensive combination therapies in patients with essential hypertension. Design and method: This trial was a multicenter, randomized, double-blind, parallel, phase II study. After a 4-week placebo run-in period, 243 patients were randomized to the third -dose triple combination (ALC group, amlodipine 1.67 mg + losartan potassium 16.67 mg + chlorthalidone 4.17 mg), third-dose dual combination (AL group, amlodipine 1.67 mg + losartan potassium 16.67 mg), (LC group, losartan potassium 16.67 mg + chlorthalidone 4.17 mg), or (AC group, amlodipine 1.67 mg + chlorthalidone 4.17 mg) for 8 weeks. The primary outcome was to compare the mean changes in systolic blood pressure (SBP) from baseline to week 8. Results: Baseline patient characteristics and blood pressure did not show significant differences among 4 groups. The mean SBP reductions of ALC group, AL group, LC group and AC group were -18.30 ± 13.23, -13.03 ± 13.30, -16.29 ± 12.36, and -13.80 ± 13.21 mmHg at week 8 from baseline, respectively. The ALC group showed significant SBP reductions in comparison to the AL and AC groups at week 4 (p = 0.0097 and p = 0.0179, respectively) and week 8 (p = 0.0170 and p = 0.0357, respectively). The mean diastolic blood pressure (DBP) reduction from baseline was significantly greater in the ALC group when compared to the AL group (-7.93 ± 7.05 and -4.95 ± 7.96 mmHg, respectively, p = 0.0307). The proportion of responders for SBP was significantly greater in the ALC group (42.6%) compared to the AL (22.0%), LC (23.3%) and AC (27.1%) groups (p = 0.0126, 0.0210 and 0.0445, respectively) at week 4. Furthermore, the proportion of responders for SBP and DBP was significantly greater in the ALC group (59.7%) compared to the AL (39.3%) and AC (42.4%) groups (p = 0.0222 and 0.0491, respectively) at Week 8. Study drug-related adverse reactions were rare and did not show significant differences among 4 study groups. Conclusions: Low-dose triple antihypertensive combination therapy when compared to the low-dose dual combination therapies demonstrated early effective BP control without increasing adverse drug reactions in patients with essential hypertension during 8-week follow-up.

Associations of arsenic exposure with blood pressure and platelet indices in pregnant women: A cross-sectional study in Wuhan, China

BackgroundEnvironmental inorganic arsenic (iAs) exposure is potentially related to abnormal blood pressure (BP) changes and abnormal platelet activation. However, limited epidemiological studies have explored the impacts of iAs exposure on platelet change mediated by BP, especially for pregnant women. ObjectivesOur purpose was to investigate the associations of arsenic exposure with blood pressure and platelet indices among pregnant women. MethodsThe present study population included 765 pregnant women drawn from a prospective birth cohort study in Wuhan, China, recruited between October 2013 and April 2016. Urine sampled in the second trimester were used to assess arsenic species concentrations. The relative distribution of urinary arsenic species was used to measure human methylation capacity. BP parameters and platelet indices originated from the medical record. We applied multivariable linear regression models to explore the cross-sectional relationships between urinary arsenic metabolites, BP parameters, and platelet indices. We utilized mediation analysis to investigate the impacts of arsenic exposure on platelet indices through BP as mediator variables. ResultsWe observed significant positive correlations between iAs and systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP). Pregnant women with higher methylation capacity to metabolize iAs characterized by higher secondary methylation index (SMI) and total methylation index (TMI) had a more significant reduction in SBP, DBP, and MAP. Pregnant women with higher DBP and MAP had higher platelet counts (PLC). A decreased PLC was found in subjects wither higher SMI. Additionally, SMI was negatively linked to PLC mediated through MAP. ConclusionsObtained results suggested that higher methylation capacity to metabolize iAs might contribute to decreased PLC among pregnant women, and MAP might mediate the influence of SMI on PLC.

Effect of salt reduction interventions in lowering blood pressure: Acomprehensive systematic review and meta-analysis ofcontrolled clinical trials.

Excessive salt intake results in hypertension (HTN), which is a major risk factor for cardiovascular disease (CVD). This review and meta-analysis aimed to evaluate the effect of salt reduction interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Studies were identified via systematic searches of the databases, including PubMed, Embase, Scopus, and Web of Science. All the studies examining the effectiveness of salt reduction interventions on blood pressure (BP), regardless of age, sex, and HTN status, were included in the systematic review, and eligible studies were used in the meta-analysis. A random-effect model was applied for quantitative data synthesis. A total of 50 trials extracted from 40 articles (21 trials on nutrition education,10 on self-help materials,17 on salt substitutes, and 2 on food reformulation) were included in the systematic review. The pooled results of 44 eligible trials showed that salt substitution and nutrition education interventions had significant effects on both SBP (WMD: -7.44 mmHg, P<0.001 and WMD: -2.75 mmHg, P<0.001, respectively), and DBP (WMD: -3.77 mmHg, P<0.001 and WMD: -2.11 mmHg, P<0.001, respectively). Furthermore, using self-help materials led to a significant reduction in SBP among subjects aged 25-60 years (WMD: -2.60 mmHg, P = 0.008); it also decreased both SBP and DBP among those who were hypertensive (WMD: -3.87 mmHg, P = 0.003 and WMD: -2.91 mmHg, P<0.001, respectively). Our results supported that salt substitution and nutrition education are effective nutrition strategies to lower BP. It seems that multi-component approaches could be more effective in improving BP status. However, further trials are required.

Impact of ellagitannin-rich fruit consumption on blood pressure: A systematic review and meta-analysis of randomized controlled trials

• Ellagitannin-rich food has been implicated in lowering blood pressure. • ET-rich fruit consumption reduced SBP among hypertensives and those with MetS. • A dosage of 500–1000 mg polyphenol in ET-rich fruits can improve SBP. • Meta-regression confirmed a positive association between polyphenol dosage and SBP. • Fruits rich in ET may be considered anti-hypertensive functional food/drinks. Ellagitannin-rich food has been implicated to ameliorate cardiovascular risk, particularly blood pressure (BP). This systematic review and meta -analysis investigated the effect of ellagitannin-rich fruit consumption on BP. Five databases were screened and RCTs reporting the effect of ellagitannin-rich fruit consumption on BP and polyphenol content were included. Nineteen studies with 1,249 participants, showed a non-significant systolic blood pressure (SBP) and significant diastolic blood pressure (DBP) reduction, with ET-rich fruit consumption. Subgroup analysis revealed significant SBP reduction among hypertensives receiving 500–1000 mg polyphenol (-4.95 mmHg, 95 % CI: [-7.24, −2.66]) and among metabolic syndrome (MS) patients (-3.44 mmHg; 95 % CI: [-5.25, −1.63]). meta-regression revealed a positive association between polyphenol dosage and SBP changes. In conclusion, the consumption of ellagitannin-rich fruits may be considered an anti-hypertensive functional food/drink and recommended for patients who are at high risk for hypertension. Further well-designed trials are required to resolve the significant heterogeneities identified in the current literature.

Abstract 14493: Strength- and Aerobic-Based Cardiac Rehabilitation Improves Intermediate Outcomes and Functional Capacity in Patients With Diabetes

Background: Improvement in cardiorespiratory fitness during comprehensive cardiac rehabilitation (CR) is associated with improved cardiovascular prognosis. However, data on the improvement of intermediate outcomes (IOs) also associated with improved prognosis, i.e., low density lipoprotein (LDL) cholesterol and systolic blood pressure (SBP), in patients living with diabetes (DM) has been conflicting. The aim of this study is to characterize the integrated effects of combining strength and aerobic training on these IOs and functional capacity for patients living with and without DM. Methods: We retrospectively reviewed 377 CR program enrollments from 333 individual patients from 12/2019 - 3/2022. Paired functional capacity was assessed by the metabolic equivalent of task (METs) in a 6-minute walk test (6-MWT), arm curl reps, chair-to-stand reps, and timed up and go test. Demographics and IOs were obtained from the electronic records. P-values were determined by the Chi-square test for categorical variables and Mann-Whitney U test for continuous variables. Results: Baseline demographics and comorbidities of our cohort are described in Table 1. Patients with DM had more CAD and CKD. All patients undergoing CR showed integrated improvements in LDL with functional capacity in this paired analysis. However, patients without DM demonstrated a more significant reduction in SBP (Table 2). Conclusions: Combining strength and aerobic training resulted in integrated improvements in lipids and functional outcomes between patients with and without DM. Our results highlight the efficacy of this combined training for all CR patients, and the need for closer monitoring and management of SBP, a critical disease driver in patients with DM, CAD, and CKD.

Long-term antihypertensive effect of renal denervation in resistant hypertension: three years follow-up

Abstract Background Recent studies have shown proven efficacy of renal denervation in arterial hypertension, but there is a continuing need to assess the duration of antihypertensive effect. Purpose Evaluation of the long-term antihypertensive effect of renal denervation in patients with resistant hypertension. Methods 125 apparently resistant patients without comorbidities after a 3-week standardized treatment with Losartan 100 mg, Amlodipin 10 mg and Indapamid 1.5 mg and confirmation of their resistance were randomly assigned into three groups depending on treatment supplemented to previously administered: group I - selective I1-imidazoline agonist Moxonidine, group II - cardioselective beta-blocker Bisoprolol and group III – renal artery denervation. The compliance to treatment was confirmed using 8-item Morisky Medication Adherence Scale. Renal denervation was performed in the main renal arteries and their branches. Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 12, 24 and 36 months follow-up. Results The mean 24 hour systolic blood pressure (SBP) at baseline were 179.0±2.02 mmHg in group I versus 177.96±2.44 mmHg in group II and 176.92±1.97 mmHg in group III, p&amp;gt;0.05. A statistically significant reduction in SBP m/24 h was noted in all three groups starting at 3 months, the group of patients undergoing renal denervation showing superiority over both groups of pharmacological treatment: −6.48±0.81 mmHg in group I versus −6.2±0.88 mmHg in group II and −23.28±1.9 mmHg in group III, p&amp;lt;0.001. The progressive improvement continued until the end of the study, so at 3 years of evaluation in observational group supplemented with Moxonidine SBP m/24 h were 146.36±1.36 mmHg with a total reduction of −32.64±1.56 mmHg from baseline, in Bisoprolol group −152.88±1.56 mmHg with a reduction of −25.08±1.65 mmHg and 133.16±0.73 mmHg in renal denervation group with a total reduction of −282±1.30 mmHg in group III, p&amp;lt;0.001. The mean 24 hour diastolic blood pressure (DBP) increased at baseline in all three observational groups (105.52±1.28 mmHg in group I versus 108.6±1.6 mmHg in group II and 107.24±0.92 mmHg in group III, p&amp;gt;0.05) similar with SBP m/24 h noted an authentic reduction at 3 months follow-up. The maximum reduction in DBP m/24 h were registered at 3 years of evaluation, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation in amelioration of this parameter: −18.36±1.88 mmHg in group I versus −16.84±1.76 mmHg in group II and −28.2±1.30 mmHg in group III, p&amp;lt;0.001. Conclusions All three regimens have been shown to be effective in reducing SBP and DBP m/24 h in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment, the beneficial effect being maintained for a period of 3 years. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Agency for Research and Development