Suboptimal Blood Research Articles

Combination therapy in the treatment of hypertension.

Hypertension is a major preventable risk factor for atherosclerosis and ischemic heart disease. Although modern and effective antihypertensive drugs are available, most patients remain with a suboptimal blood pressure control. Most hypertensive patients will need a combination of antihypertensive agents to achieve the therapeutic goals – recent guidelines recommend initiating treatment with two drugs in those patients with a systolic blood pressure >20 mmHg and/or a diastolic blood pressure >10 mmHg above the goals, and in those patients with high cardiovascular risk. In addition, approximately 25% of patients will require three antihypertensive agents to achieve the therapeutic targets. In this review, we analyse the latest information available regarding the treatment of hypertension with combination therapy.

Blunted peripheral blood supply and underdeveloped skeletal muscle in Fontan patients: The impact on functional capacity

BackgroundChanges in circulatory physiology are common in Fontan patients due to suboptimal cardiac output, which may reduce the peripheral blood flow and impair the skeletal muscle. The objective of this study was to investigate the forearm blood flow (FBF), cross-sectional area (CSA) of the thigh and functional capacity in asymptomatic clinically stable patients undergoing Fontan surgery. MethodsThirty Fontan patients and 27 healthy subjects underwent venous occlusion plethysmography, magnetic resonance imaging of the thigh musculature and maximal cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA), norepinephrine measures, cardiovascular magnetic resonance, handgrip strength and 6-minute walk test were also performed. ResultsFontan patients have blunted FBF (1.59 ± 0.33 vs 2.17 ± 0.52 mL/min/100 mL p < 0.001) and forearm vascular conductance (FVC) (1.69 ± 0.04 vs 2.34 ± 0.62 units p < 0.001), reduced CSA of the thigh (81.2 ± 18.6 vs 116.3 ± 26.4 cm2p < 0.001), lower peak VO2 (29.3 ± 6 vs 41.5 ± 9 mL/kg/min p < 0.001), walked distance (607 ± 60 vs 701 ± 58 m p < 0.001) and handgrip strength (21 ± 9 vs 30 ± 8 kgf p < 0.001). The MSNA (30 ± 4 vs 22 ± 3 bursts/min p < 0.001) and norepinephrine concentration [265 (236–344) vs 222 (147–262) pg/mL p = 0.006] were also higher in Fontan patients. Multivariate linear regression showed FVC (β = 0.653; CI = 0.102–1.205; p = 0.022) and stroke volume (β = 0.018; CI = 0.007–0.029; p = 0.002) to be independently associated with reduced CSA of the thigh adjusted for body mass index. The CSA of the thigh adjusted for body mass index (β = 5.283; CI = 2.254–8.312; p = 0.001) was independently associated with reduced peak VO2. ConclusionPatients with Fontan operation have underdeveloped skeletal muscle with reduced strength that is associated with suboptimal peripheral blood supply and diminished exercise capacity.

Blood Transfusion Practice among Healthcare Personnel in Nepal: An Observational Study.

Background The complications associated with errors in transfusion practice can be minimized by assessing transfusion practices. In Nepal, there is no standard protocol on blood transfusion. So, this study was conducted with an aim to assess the blood transfusion practice among healthcare personnel. Methods A descriptive observational study was conducted in two tertiary hospitals in Kathmandu, Nepal, over a period of 10 months. Bedside blood transfusion procedures were observed using structured checklist. Results Altogether, 86 observations were made. Time taken from dispatch from the blood bank to transfusion was >2 hours in 53.2% of cases. In majority of the cases, blood was kept in the ward in uncontrolled and unprotected manner by the patients' relatives. Only 8.2% of the patients and/or the relatives were informed about the reasons, associated probable risks (2.4%), and the benefits of transfusion (4.7%). Assessment of vital signs at 15 minutes of initiation of transfusion was done on about 2 to 4% of cases. Conclusion We found a suboptimal blood transfusion practice in Nepal, which could be attributable to substantial knowledge gap among healthcare personnel and the absence of quality culture, quality system, and quality management in the area of blood transfusion practices.

Individualised treatment targets in patients with type-2 diabetes and hypertension

AimPatients with type-2 diabetes mellitus (T2DM) are at high risk of cardiovascular events, accentuated in the presence of hypertension. At present, it is unclear to what extent the guidelines for the management of T2DM, advocating reduction in HbA1c levels to below target levels, are being adhered to in clinical practice.MethodsDIALOGUE was a prospective, observational, non‐interventional registry performed across multiple centres in Germany. Patients aged 18 years or older who had T2DM and hypertension for whom the treating physician considered blood glucose lowering medication as inadequate and/or not safe/tolerable and chose to add a further oral drug or switch drug treatment were included. Patients were assigned a treatment target HbA1c value (≤ 6.5% [strict]; > 6.5 to ≤ 7.0% [intermediate]; > 7.0 to ≤ 7.5% [lenient]).Results8568 patients with T2DM and hypertension were enrolled. 6691 (78.1%) had 12-month follow-up. Patients who were assigned a strict HbA1c treatment target (n = 2644) were younger, had shorter diabetes duration, and less comorbidity in comparison to those with intermediate (n = 2912) or lenient targets (n = 1135). Only 53.1% of patients achieved their HbA1c treatment target (46.2% [strict], 56.8% [intermediate], 59.4% [lenient]). There was little sign of treatment intensification for patients that had not achieved their HbA1c target.ConclusionsAchievement of treatment targets was poor, leaving many patients with sub-optimal blood glucose levels. The apparent reluctance of physicians to intensify antidiabetic drug therapy is alarming, especially considering the evidence pointing to an association of hyperglycaemia and microvascular complications in patients with T2DM.

Therapeutic Inertia and Treatment Intensification.

This review aims to emphasize how therapeutic inertia, the failure of clinicians to intensify treatment when blood pressure rises or remains above therapeutic goals, contributes to suboptimal blood pressure control in hypertensive populations. Studies reveal that the therapeutic inertia is quite common and contributes to suboptimal blood pressure control. Quality improvement programs and standardized approaches to support antihypertensive treatment intensification are ways to combat therapeutic inertia. Furthermore, programs that utilize non-physician medical professionals such as pharmacists and nurses demonstrate promise in mitigating the effects of this important problem. Therapeutic inertia impedes antihypertensive management and requires a broad effort to reduce its effects. There is an ongoing need for renewed focus and research in this area to improve hypertension control.

Citric Acid Metabolism in Resistant Hypertension: Underlying Mechanisms and Metabolic Prediction of Treatment Response.

Resistant hypertension (RH) affects 9% to 12% of hypertensive adults. Prolonged exposure to suboptimal blood pressure control results in end-organ damage and cardiovascular risk. Spironolactone is the most effective drug for treatment, but not all patients respond and side effects are not negligible. Little is known on the mechanisms responsible for RH. We aimed to identify metabolic alterations in urine. In addition, a potential capacity of metabolites to predict response to spironolactone was investigated. Urine was collected from 29 patients with RH and from a group of 13 subjects with pseudo-RH. For patients, samples were collected before and after spironolactone administration and were classified in responders (n=19) and nonresponders (n=10). Nuclear magnetic resonance was applied to identify altered metabolites and pathways. Metabolites were confirmed by liquid chromatography-mass spectrometry. Citric acid cycle was the pathway most significantly altered (P<0.0001). Metabolic concentrations were quantified and ranged from ng/mL malate to μg/mL citrate. Citrate and oxaloacetate increased in RH versus pseudoresistant. Together with α-ketoglutarate and malate, they were able to discriminate between responders and nonresponders, being the 4 metabolites increased in nonresponders. Combined as a prediction panel, they showed receiver operating characteristiccurve with area under the curve of 0.96. We show that citric acid cycle and deregulation of reactive oxygen species homeostasis control continue its activation after hypertension was developed. A metabolic panel showing alteration before spironolactone treatment and predicting future response of patients is shown. These molecular indicators will contribute optimizing the rate of control of RH patients with spironolactone.

Circadian blood pressure patterns and blood pressure control in patients with chronic kidney disease

Background and aimsHypertension is a major risk factor for chronic kidney disease (CKD), and CKD progression is associated with suboptimal blood pressure (BP) control. Here we evaluate the impact of CKD on the attainment of BP control and the circadian BP profile in older subjects. MethodsIn this observational study, we studied 547 patients referred to the hypertension clinic, of whom 224 (40.9%) had CKD. Blood pressure (BP) control and circadian BP patterns were evaluated by 24-hour ambulatory BP monitoring. Circadian BP variability was measured as the within-subject SD of BP, the percentage of measurements exceeding normal values, hypotension, and dipping status. ResultsThe attainment of adequate BP control was similar in subjects with or without CKD (around 31%). Logistic regression analysis indicated that CKD was not a determinant of adequate BP control (OR 1.004; 95% CI 0.989–1.019; p = 0.58). Patients with CKD presented as twice as higher prevalence of reverse dipper (night-time peak) for systolic BP and episodes of hypotension during daytime, independently of BP control. ConclusionsKnowledge of the circadian pattern of BP in hypertensive subjects with CKD could inform better than attainment of BP target about risky condition for CKD progression and cognitive decline and allow a more personalized antihypertensive treatment.

Penetration and antiviral efficacy of total and unbound maraviroc, raltegravir and rilpivirine in both female and male genital fluids from HIV-positive patients receiving regimens containing these antiretrovirals.

Sub-optimal penetration of antiretroviral drugs in genital compartments might promote local HIV persistence and increase the risk of HIV transmission. To describe the penetration of maraviroc, raltegravir, raltegravir glucuronide and rilpivirine in seminal plasma and cervico-vaginal secretions (CVS) and to assess local antiretroviral efficacy in HIV-1-positive patients. This was a prospective, multicentre study. Inclusion criteria were HIV-1 positive, age >18 years, receiving regimens containing maraviroc and/or raltegravir and/or rilpivirine for >1 month, and good self-reported adherence. Paired blood and genital samples were collected 12 h (raltegravir and maraviroc) or 24 h (rilpivirine) post-dose. These concentrations were determined (UPLC-MS/MS) in blood and seminal plasma (total and unbound) and CVS (total, dried spots) and HIV-RNA was quantified in paired blood and genital samples. Among the 54 enrolled patients, 15 received maraviroc (6 men), 27 received raltegravir (14 men) and 20 received rilpivirine (10 men), corresponding to 54 total and 52 unbound plasma concentrations, 29 total CVS samples and 23 total and 18 unbound seminal plasma samples. Maraviroc and raltegravir displayed a ratio of genital fluids/plasma concentrations >0.5 in both male and female genital tracts. Conversely, rilpivirine displayed a low ratio. Antiretroviral free fractions were consistent with historical data. Nine patients had blood plasma HIV-RNA >50 copies/mL (2/9 had sub-optimal antiretroviral blood plasma exposure) and two other patients had detectable HIV-RNA in genital fluids. Maraviroc and raltegravir demonstrated good penetration in genital compartments, yielding good local virological response in genital compartments, whereas rilpivirine presented a low penetration profile but good local response.

Risk Factors for Nonadherence to Antihypertensive Treatment.

Nonadherence to antihypertensive treatment is a critical contributor to suboptimal blood pressure control. There are limited and heterogeneous data on the risk factors for nonadherence because few studies used objective-direct diagnostic methods. We used high-performance liquid chromatography-tandem mass spectrometry of urine and serum to detect nonadherence and explored its association with the main demographic- and therapy-related factors in 1348 patients with hypertension from 2 European countries. The rates of nonadherence to antihypertensive treatment were 41.6% and 31.5% in the UK and Czech populations, respectively. Nonadherence was inversely related to age and male sex. Each increase in the number of antihypertensive medications led to 85% and 77% increase in nonadherence (P<0.001) in the UK and Czech populations, respectively. The odds of nonadherence to diuretics were the highest among 5 classes of antihypertensive medications (P≤0.005 in both populations). The predictive model for nonadherence, including age, sex, diuretics, and the number of prescribed antihypertensives, showed area under the curves of 0.758 and 0.710 in the UK and Czech populations, respectively. The area under the curves for the UK model tested on the Czech data and for the Czech model tested on UK data were calculated at 0.708 and 0.756, respectively. We demonstrate that the number and class of prescribed antihypertensives are modifiable risk factors for biochemically confirmed nonadherence to blood pressure-lowering therapy. Further development of discriminatory models incorporating these parameters might prove clinically useful in assessment of nonadherence in countries where biochemical analysis is unavailable.

Decreased left atrial myocardial strain in patients with suboptimal blood pressure control

ABSTRACTBackground: Suboptimal blood pressure (BP) control is commonly observed in patients receiving antihypertensive agents, but the relationship between uncontrolled BP and left atrial (LA) impairment remains unknown. Methods: This study enrolled 279 hypertensive patients who had been medicated, as well as 85 matched normal controls. The BP of systolic <140 mmHg and diastolic<90 mmHg was defined as optimal (HT1 group, n=146), otherwise as suboptimal BP control (HT2 group, n = 133). LA myocardial function was assessed by the systolic (SSa), early diastolic (SEa), and late diastolic (SAa) LA strains. Results: Both the HT1 group and HT2 group had higher BP reading, thicker interventricular septum, larger LA volume index, and enhanced active atrial emptying fraction than the control group (all <0.05). When compared with normal subjects, hypertensive patients displayed obvious reduction in the SSa (50.0 ± 10.9 vs. 35.9 ± 8.0%), SEa (30.1 ± 7.7 vs. 18.5 ± 7.1%) and SAa (19.9 ± 6.4 vs. 17.8 ± 4.2%) (all p < 0.001). In addition to a further impaired SEa found in the HT2 group than in the HT1 group (17.2 ± 5.3 vs. 19.8 ± 8.3%, p = 0.002), the treated BP of >140/90 mmHg appeared an independent risk factor associated with the abnormal SEa (odds ratio, 2.957; interval of confidence, 1.614-5.415; p = 0.001). Conclusions: Suboptimal BP control status in hypertensive patients is related to a further reduction of LA myocardial function assessed by the novel 2DSTI free strain, and suboptimal BP might be regarded as a composite risk factor and therefore a simplified treatment target. However, the prognostic value of LA free strain in patients with inability to achieve the BP target needs to be evaluated in future prospective studies.

Determinants of decline of renal function in treated hypertensive patients: the Campania Salute Network.

Hypertension is a leading cause of chronic kidney disease (CKD) and a decrease in glomerular filtration rate (GFR) is associated with a higher prevalence of hypertension and an increased proportion of suboptimal blood pressure (BP) control. To investigate characteristics associated with GFR decline, we selected 4539 hypertensive patients from the Campania Salute Network (mean age 53 ± 11 years) with at least 3 years of follow-up (FU) and no more than Stage III CKD. GFR was calculated at baseline and at the last available visit using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. GFR decline was defined as a ≥30% decrease from initial GFR for patients in Stage III CKD or by a composite ≥30% decrease from baseline and a final value of <60 for those < with Stage III or higher CKD. At a mean FU of 7.5 years, 432 patients (10%) presented with GFR decline. Those patients were older, more likely to be diabetic, with lower GFR and ejection fraction, higher systolic and lower diastolic BP and higher left ventricular (LV) mass and relative wall thickness at baseline; during FU, patients with GFR decline exhibited higher systolic BP, took more drugs and developed more atrial fibrillation (all P < 0.02). The probability of GFR decline was independently associated with older age, prevalent diabetes, baseline lower GFR, higher systolic BP during FU, FU duration, increased LV mass and incident AF with no impact from antihypertensive and antiplatelet medications. During antihypertensive therapy, kidney function declines in patients with initially lower GFR, increased LV mass and suboptimal BP control during FU.

Folic acid intake among U.S. women of childbearing age with suboptimal red blood cell folate concentrations for neural tube defect prevention

BackgroundA recent study reported that 22.8% of U.S. women of childbearing age have folate insufficiency, defined as red blood cell (RBC) folate below optimal concentrations needed for neural tube defect (NTD) prevention per guidelines established by the World Health Organization. Clinical trials have shown that consuming 400 μg of folic acid daily prevents NTDs.ObjectiveWe assessed the daily usual total folic acid intake and RBC folate status of women of childbearing age. We estimated the proportion of women consuming ≥400 μg folic acid/day, the daily amount recommended for NTD prevention for all women capable of becoming pregnant.MethodsWe used 2007–2012 data on non‐pregnant women aged 12–49 years (n = 4783) from the National Health and Nutrition Examination Survey (NHANES) and estimated daily usual total folic acid intake from all fortified foods and dietary supplements. Folate insufficiency was defined as an RBC folate concentration of &lt;748 nmol/L using the NHANES microbiologic assay, which is associated with prevalence of NTDs of ≥9 cases per 10,000 live births.ResultsAmong all women in our study, 21.2% (95% confidence interval [CI]: 18.0, 24.3) had an average total folic acid intake of ≥400 μg /day from fortified foods and supplements. The prevalence of folate insufficiency was 22.5% (95% CI: 20.3, 24.9). Among the subgroup of women with folate insufficiency (n = 1196), only 3.9% (95% CI: 2.0, 5.7) achieved the recommended daily intake of folic acid. Among all women in our study, median usual daily total folic acid intake was highest among non‐Hispanic Whites (264 μg) and lowest among non‐Hispanic Blacks (185 μg). However, among women with folate insufficiency, the median usual daily total folic acid intake did not differ by race/ethnicity. Among women with folate insufficiency, 69.7% (95%CI: 64.8, 74.1) had mandatorily fortified foods (i.e., enriched cereal grain products) as their only source of folic acid; 12.6% (95% CI: 9.7, 16.1) reported taking supplements containing folic acid in the previous 30 days. Among folate‐insufficient women who did not use supplements, less than 1% had usual total folic acid intake ≥400 μg/day.ConclusionsThe majority of U.S. women of childbearing age with RBC folate below the optimal concentration do not consume the amount of folic acid recommended for NTD prevention. Targeted programs and guidance might increase folic acid intake among groups of women at higher risks for folate insufficiency.Support or Funding InformationThis work was supported by the CDC.

Author response: Influence of sodium consumption and associated knowledge on poststroke hypertension in Uganda.

We thank Dr. Chin for the interest and comments on our article.1 We agree that stroke survivors in our study may have received some informal health education, supporting the case for even lower knowledge rates in the public population.1 In Uganda, suboptimal blood pressure control remains a challenge with varied prevalence and excessively low awareness, treatment, and control.2 We agree that the effect of invisible salt in Uganda's urban areas relates to an increasing prevalence of high blood pressure in this population. If not addressed, this portends a high burden of cardiovascular stroke events.3 Because hypertension is the single most important treatable risk factor for stroke, based on the results of our study,1 we agree that a public education campaign aimed at reducing added salt in the diet of Ugandans is urgently needed.

Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

BackgroundRegression of left ventricular (LV) hypertrophy (LVH) has been a goal in clinical trials. This study tests the external validity of results of clinical trials on LVH regression using a large registry from a tertiary care center, to identify phenotypes less likely to achieve regression of LVH.Methods and ResultsPatients from the Campania Salute Network, free of prevalent cardiovascular disease, but with echocardiographic LVH (defined as LV mass index [LVMi] >47 g/m2.7 in women and >50 g/m2.7 in men) were included. During a median follow‐up of 67 months, clear‐cut regression of LVH was documented in 14% of patients (13±8% reduction of initial LVMi) or 23% when also considering those with a reduction of LVMi ≥5 g/m2.7. Patients with persistent LVH were older with longer duration of hypertension, suboptimal blood pressure (BP) control, larger body mass index, LV mass, and carotid intima‐media thickness and included more women and subjects with diabetes mellitus, isolated systolic hypertension, and metabolic syndrome (all P<0.05). Number and class of antihypertensive drugs during follow‐up did not differ between groups. In multiple logistic regression analysis, older age, female sex, obesity, higher baseline LVMi and carotid intima‐media thickness, and suboptimal BP control were significant covariates of persistent LVH (all P≤0.01), independent of diabetes, duration of hypertension, isolated systolic hypertension, follow‐up time and number and class of antihypertensive drugs.ConclusionsEarly initiation of antihypertensive treatment, aggressive BP control, and attention to metabolic aspects are critical to avoid irreversible LVH.

Treatment adherence and factors contributing to non adherence among type 2 diabetes mellitus patients in a tertiary care hospital: a cross sectional study

Background: Diabetes mellitus (DM) is the most common endocrine disorder and major global public health problem. Lack of adherence to antidiabetic medication has lead to suboptimal blood sugar control, treatment failure, accelerated development of complications and increased mortality, thus medication adherence plays an important role in disease control. Hence present study was taken to evaluate the treatment adherence and factors affecting non adherence among Type 2 diabetes mellitus patients.Methods: A cross sectional study carried out by Department of Pharmacology and Medicine, Hassan Institute of Medical Sciences, Hassan. Total 150 patients of type 2 diabetes were recruited after taking their informed consent. Adherence to treatment and factors associated with non adherence has been assessed during a personal interview with each patient using standardized questionnaire.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to anti diabetic treatment. Other reasons contributing to non-adherence to treatment were forget fullness (86.66 %), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11 %) and lack of assistance (48.88 %).Conclusions: Results showed that patients in the area of study were moderately adherent to anti-diabetic medications. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence.

Statin therapy reduces the likelihood of suboptimal blood pressure control among Ugandan adult diabetic patients.

BackgroundHypertension is one of the recognized risk factors of cardiovascular diseases in adult diabetic patients. High prevalence of suboptimal blood pressure (BP) control has been well documented in the majority of studies assessing BP control in diabetic patients in sub-Saharan Africa. In Uganda, there is a dearth of similar studies. This study evaluated the prevalence and correlates of suboptimal BP control in an adult diabetic population in Uganda.Patients and methodsThis was a cross-sectional study that enrolled 425 eligible ambulatory adult diabetic patients attending three urban diabetic outpatient clinics over 11 months. Data about their sociodemographic characteristics and clinical history were collected using pre-tested questionnaires. Suboptimal BP control was defined according to the 2015 American Diabetes Association standards of diabetes care guideline as BP levels ≥140/90 mmHg.ResultsThe mean age of the study participants was 52.2±14.4 years, with the majority being females (283, 66.9%). Suboptimal BP control was documented in 192 (45.3%) study participants and was independently associated with the study site (private hospitals; odds ratio 2.01, 95% confidence interval 1.18–3.43, P=0.01) and use of statin therapy (odds ratio 0.5, 95% confidence interval 0.26–0.96, P=0.037).ConclusionSuboptimal BP control was highly prevalent in this study population. Strategies to improve optimal BP control, especially in the private hospitals, and the use of statin therapy should be encouraged in adult diabetic patients.

Lower total and regional grey matter brain volumes in youth with perinatally-acquired HIV infection: Associations with HIV disease severity, substance use, and cognition

Despite improved survival due to combination antiretroviral therapy (cART), youth with perinatally-acquired HIV (PHIV) show cognitive deficits and developmental delay at increased rates. HIV affects the brain during critical periods of development, and the brain may be a persistent reservoir for HIV due to suboptimal blood brain barrier penetration of cART. We conducted structural magnetic resonance imaging (sMRI) and cognitive testing in 40 PHIV youth (mean age=16.7years) recruited from the NIH Pediatric HIV/AIDS Cohort Study (PHACS) who are part of the first generation of PHIV youth surviving into adulthood. Historical and current HIV disease severity and substance use measures were also collected. Total and regional cortical grey matter brain volumes were compared to a group of 334 typically-developing, HIV-unexposed and uninfected youth (frequency-matched for age and sex) from the Pediatric Imaging, Neurocognition, and Genetics (PING) study (mean age=16.1years). PHIV youth had smaller (2.8–5.1%) total and regional grey matter volumes than HIV-unexposed and uninfected youth, with smallest volumes seen among PHIV youth with higher past peak viral load (VL) and recent unsuppressed VL. In PHIV youth, worse cognitive performance correlated with smaller volumes. This pattern of smaller grey matter volumes suggests that PHIV infection may influence brain development and underlie cognitive dysfunction seen in this population. Among PHIV youth, smaller volumes were also linked to substance use (alcohol use: 9.0–13.4%; marijuana use: 10.1–16.0%). In this study, collection of substance use information was limited to the PHIV cohort; future studies should also collect substance use information in controls to further address interactions between HIV and substance use on brain volume.

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

Non-adherence of antihypertensive therapy: A serious public health issue in Sri Lanka

Hypertension is the commonest risk factor for the most of the common causes of death in Sri Lanka; coronary heart disease, stroke, heart and renal failure. Nearly one-fifth to one-third of adult Sri Lankans have blood pressure levels that are above normal and the prevalence is comparable to those in the developed countries.1, 2, 3 The problem of hypertension is further compounded by the underuse of effective and generallywell tolerated antihypertensive medications. A large study carried out in the Gampaha district showed that 31.8% of patients had undetected hypertension and of the diagnosed hypertensives 19.5% were not on any medications. Only about 32.1% had optimal blood pressure control.3 Among hypertensive patients attending cardiology unit of National Hospital Colombo uncontrolled hypertension was present in 41.1% of the patients and 19.1% of them had resistant hypertension.4 The data available from the recent yet unpublished studies indicate that sub-optimal blood pressure control is a serious public health issue in Sri Lanka. It has been shown that 50% of individuals discontinue antihypertensive drugs within 6 to 12 months of their initiation.5 A multicenter observational study of blood pressure control among clinic attendees done in Colombo, Galle and Kandy showed that only 22% achieved a blood pressure target of less than 140/90 mmHg.6

OP.LB03.08] EFFECTS OF LTP2 PEPTIDE RICH WHEAT PRODUCTS ON BLOOD PRESSURE, ENDOTHELIAL REACTIVITY AND OTHER CARDIOVASCULAR RISK FACTORS

Objective: Different wheats contain different amounts of bioactive peptides and with different pharmacological effects. Some wheat peptides as LTP2 have known ACE-inhibitory activity in vitro. Our aim was to test the haemodynamic and metabolic effect of two kind of commercial wheat product made by wheat naturally containing a high (Khamut®) or low amount of LTP2. Design and method: Methods: in the context of the 7FP EU “Beneficial Effects of Bioactive Compounds in Humans (BACCHUS)” project, we enrolled 60 non-diabetic subjects (age 40–70 years old), at increased estimated CV risk (ESC/EAS SCORE), with SBP 130–139 mmHg and/or DBP 85–90 mmHg (pre-hypertensive/borderline high pressure subjects), in primary prevention for CVD, and we randomized then to the two experimental arms. The trial was a double-blind, cross-over, randomized clinical trial. Each treatment phase had a 4-week duration. Results: Anthropometric parameters, office blood pressure, cholesterol, liver and renal parameters did not change during both wheat products intake. Diurnal and nocturnal systolic blood pressure significantly improved only after Khamut intake versus baseline and versus control (from 136,3 ± 4,2 to 132,4 ± 4,5 mmHg, p < 0.05, and from 120,8 ± 5,4 to 116,4 ± 4,1 mmHg, p < 0,05, respectively). Pulse volume change (as a marker of endothelial reactivity) significantly improved only after Khamut intake versus baseline and versus control (from 64,3 ± 6,6 to 68,1 ± 4,2, p < 0.05). Pulse wave velocity and augmentation index did not change during both wheat products intake. Plasma fasting triglycerides and glucose significantly improved only after Khamut intake versus baseline and versus control (from 123,5 ± 32,9 to 107,2 ± 21,5 mg/dL, p < 0.05, and from 86,3 ± 8,8 to 84,2 ± 6,3 mg/dL, p < 0,05, respectively). Conclusions: Substituting standard wheat products in diet with products rich in LTP2 peptide seems to mildly improve 24-hour systolic blood pressure, endothelial reactivity, fasting triglycerides and glucose level in overall healthy subjects with suboptimal blood pressure control.