Successful Blood Pressure Control Research Articles

Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial.

Uncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting. This study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline. A total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90 mmHg; 54.4% vs. 32.9%, p = 0.011). Self-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration: ClinicalTrials.gov, identifier ISRCTN14433778.

Effectiveness of mHealth interventions for improving hypertension control in uncontrolled hypertensive patients: A meta‐analysis of randomized controlled trials

AbstractThe benefits of mHealth interventions in uncontrolled hypertension are unclear. To determine whether mHealth effectively improves the control rate of uncontrolled hypertension. PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library were searched for randomized controlled trials (RCTs) from January 2007 to September 2022. The intervention group consisted of mHealth intervention, and the control group was usual care. Random‐effects meta‐analysis models were used to assess pooled mHealth intervention effects and CIs. The primary outcome was the blood pressure (BP) control rate of uncontrolled hypertension. The secondary outcome was the change of BP. Thirteen RCTs were included in this meta‐analysis, of which eight reported the successful BP control rate, 13 reported the change of systolic blood pressure (SBP), and 11 reported the change in diastolic blood pressure (DBP). The mean age of trial participants ranged from 47.7 to 66.9 years old, with a female composition ratio of 40.0%–66.1%. The duration of follow‐up ranged from 3 to 18 months. This study showed a more robust effect size for improving BP control rate by mHealth interventions than usual care (57.5% vs. 40.8% of successful control rate; odds ratio [OR], 2.19 [95% CI, 1.32—3.62]). Furthermore, mHealth significantly reduced SBP by 4.45 mm Hg and DBP by 2.47 mm Hg, and subgroup analysis did not observe the major source of heterogeneity. This meta‐analysis found that mHealth could significantly improve the uncontrolled hypertension control rate and might be a feasible, acceptable, and effective tool for uncontrolled hypertension management.

CASE REPORT OF A RARE CAUSE OF SECONDARY HYPERTENSION ILLUSTRATING THE IMPORTANCE OF CARDIO-OBSTETRICS PRECONCEPTION COUNSELING

Objective: Our objective is to illustrate the value of preconception management of rare case of secondary hypertension namely Middle Aortic Coarctation (MAC), which is characterized by a constriction of the upper abdominal aorta. During pregnancy, MAC can lead to feto-maternal unfavorable hemodynamic balance (Fig.1). On the one hand, elevation of the arterial blood pressure (BP) of the upper part of the body increases the maternal cardiovascular risk i.e. stroke or aortic dissection. On the other hand, hypo-perfusion of the lower part of the body reduces uterine perfusion, increases fetal risk of preeclampsia, placental insufficiency or fetal growth restriction. Design and method: Here, we report the case of a 30-year-old woman with severe hypertension and plans to become pregnant. She previously underwent percutaneous transluminal angioplasty (PTA) and aortic stenting and presented with elevated BP in both arms (right 177/117 mmHg, left 180/121 mmHg) and decreased ABI bilaterally (Tab. 1). A computed tomography angiography of the aorta was performed showing an aortic stent in a supraceliac position with 79% in-stent stenosis. She underwent a new PTA with in-stent re-stenting (Fig. 2). Results: Post PCA, the four extremities BP measurements showed a reduction of her BP values and a normalization of the ABI bilaterally (Table 1). 24h-ABPM confirmed the BP reduction (mean 24h- systolic BP of 135 mmHg, diastolic BP of 101 mmHg), but still remaining-elevated. Therefore, we started an antihypertensive treatment with a successful BP control (125/82 mmHg). Conclusions: The management of MAC in already pregnant women can be particularly challenging. Indeed, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are contraindicated. Furthermore, PTA during pregnancy expose the fetus to radiation and reports for CoA angioplasty and stenting during pregnancy are very limited. Herby, we decided on an interventional rather than conservative approach. This case illustrates the importance of preconception screening and treatment of chronic hypertension in women with plans to become pregnant. It highlights the fact that secondary causes of hypertension do not have to be overlooked in this population.

Atrial fibrillation in heart failure patients: An update on renin-angiotensin-aldosterone system pathway blockade as a therapeutic and prevention target.

Heart failure (HF) and atrial fibrillation (AF) are two cardiovascular (CV) entities that affect millions of individuals worldwide and their prevalence is translated into a significant impact on health care systems. The common pathophysiological pathways that these two share have created an important clinical interrelation, as the coexistence of HF and AF is associated with worse prognosis and treatment challenges. Renin-angiotensin-aldosterone system (RAAS), a critical mechanism in blood pressure (BP) control, was proved to be involved in the pathogenesis of both conditions contributing to their further coexistence. Successful control of BP is of great importance to the management of HF, crucial for the prevention of arrhythmiogenic substrates, while RAAS antagonists may possibly affect the development of new-onset AF as well. There are numerous studies that evaluated the effectiveness of RAAS blockade in AF/HF population and despite comparable or modest results, there is a well-established suggestion that RAAS blockers may contribute to a reduction of HF, CV events and recurrence of AF, along with their potential effective role in the new-onset AF prophylaxis. Angiotensin receptor blockers, according to the evidence, are more effective in that direction, followed by angiotensin converting enzyme inhibitors, whereas the data on aldosterone antagonists are not encouraging, yet do have the potential of significant CV disease modificators regardless of their effects on BP.

Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm.

Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.

A web-based self-management program to improve lifestyle and blood pressure control in patients with primary hypertension: a randomized controlled trial

Abstract Background Hypertension contributes to the main risk factor of the high incidence of cardiovascular diseases and mortality. Successful control of blood pressure requires behavioral changes; therefore, it is of considerable importance to develop a web-based self-management program that assist patients to tailor their lifestyle and empower them manage their disease. Objective Our primary aims were to evaluate the effects of a web-based self-management program for improving blood pressure and blood lipids control in patients with primary hypertension. Our secondary aims were to evaluate the effects of the web-based self-management program on enhancing patients' lifestyle, medication adherence and self-efficacy. Methods This randomized controlled trial used permuted block randomization design and randomly divided the 222 patients into the intervention group (n=111) and control group (n=111). Patients in the intervention group received the web-based self-management program, and the control group received standard care. Lifestyle and medication adherence were assessed by using the Hypertension Self-Care Activity Level Effects Scale (H-SCALE). Self-efficacy was measured through using the Chinese version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C). The data of blood pressure and serum lipids were collected through web-based self-report and chart review. We used the generalized estimating equations to evaluate the effects of the intervention. Results There were no statistically significant differences of the baseline demographic characteristics and antihypertensive dosages from both groups. The intervention group received the web-based self-management program and showed a decrease in systolic blood pressures (−19.82 mmHg vs 7.99 mmHg, p&amp;lt;0.001) and diastolic blood pressures at 6 months (−9.17 mmHg vs 0.48 mmHg, p&amp;lt;0.001) compared to the control group. Regarding the H-SCALE scores measured at 6 months, the intervention group achieved a higher Medication Adherence Subscale scores (p&amp;lt;0.001), Diet Subscale scores (p&amp;lt;0.001), and Weight Management Subscale scores (p&amp;lt;0.001) than those of the control group. The intervention group achieved a higher SES6C scores than that of the control group (p&amp;lt;0.001) at 6 months. Finally, the intervention group had significantly lower serum levels of triglycerides and low-density lipoproteins than the control group at 6 months (−11.38 mg/dL vs 16.31 mg/dL, −9.93 mg/dL vs 3.12 mg/dL, respectively, p&amp;lt;0.001). Conclusion The greatest benefit of this program was allowing participants to consult dietary issues with us immediately. Since lifestyles vary among different individuals, we considered the individuality of each participant when providing feedback and involving them in the devising of interventions to increase their confidence in hypertension self-care and ultimately achieve the optimal control of blood pressure and blood lipid levels. Funding Acknowledgement Type of funding sources: None.

Depletion of Esterase‐Harboring Bacteria Increases Antihypertensive Efficacy of ACE Inhibitor Quinapril

Introduction Resistant hypertension (rHTN) is a critical impediment to successful control of high blood pressure (BP) and hypertension-linked pathophysiology in 15-20% of all hypertensive patients. rHTN is of importance in African American patients because they experience early onset, increased prevalence and severe outcomes. The mechanisms for drug resistance in rHTN remain unknown. Eggerthellaceae family harbors biotransformative enzymes including esterase, which influences drug catabolism in the gut prior to absorption. Thus, we hypothesized that an increased abundance of bacteria with catabolic capacity for an antihypertensive drug will decrease its efficacy (Fig. A) and may thereby serve as a novel treatment target for rHTN. Methods Ten human feces (4 controlled HTN (cHTN), 6 rHTN) were analyzed by metatranscriptomics. 16-week old male Spontaneously Hypertensive Rats (SHR) were gavaged with (N=12) or without (N=6) Vancomycin, Meropenem, and Omeprazole (VMO), at 50 mg/kg/day for five days to deplete the gut microbiota. To test the quinapril efficacy, a single 8mg/kg dose was gavaged to both SHR and SHR+VMO before BP recording via telemetry. Quinapril catabolism was quantified by liquid chromatography-mass spectrometry. Bacterial esterase activity was monitored by the hydrolysis of p-nitro-phenylbutyrate. Cecal microbiota was analyzed by 16S rDNA. Pearson r correlation was plotted using GraphPad. Results Patients with rHTN showed ~3-fold more Eggerthellaceae compared to cHTN (p=0.0027, Fig. B). With 50% reduction in bacterial 16S copy numbers (P<0.0001, Fig. C), the SHR+VMO group showed (1) reduced Eggerthellaceae (P<0.0001, Fig. D); (2) lower esterase activity per gram of cecal microbiota to hydrolyze quinapril (p=0.0065, Fig. E); (3) a 50% lower reduction in quinapril quantity (Δquinapril, nmol) after incubation with 1mg of cecal lysate (P<0.0001, Fig. F); (4) decreased bacterial genes in KEGG drug metabolism pathway (P<0.0001, Fig. G). The abundance of Eggerthellaceae positively correlated with Δquinapril (P=0.029, Fig. H) and genes in drug metabolism (P<0.0001, Fig. I). Importantly, administration of quinapril to the SHR+VMO led to lowering of BP, compared to SHR (Fig. J). Conclusion Eggerthellaceae was enriched ~3-fold in rHTN. Using SHR, we showed that depletion of Eggerthellaceae and esterase activity of the gut microbiota by VMO increased the antihypertensive efficacy of quinapril, due to protection of quinapril from catabolism in the gut. Therefore, our study, for the first time, provides evidence for a previously unrecognized role of gut microbiota in rHTN. Innovative approaches can now be considered for rHTN based on strategies to protect antihypertensive drugs from catabolism by gut bacteria before reaching the systemic circulation for improved efficacy.

FACTORS ASSOCIATED WITH A SUCCESSFUL BLOOD PRESSURE CONTROL IN HYPERTENSIVE URGENCY PATIENTS

Objective: Hypertensive urgency (blood pressure (BP) &gt; 180/110 mmHg without target organ damages) is a common presentation in the emergency room (ER). Standard treatments in the ER are resting and oral anti-hypertensive drugs. Guidelines state that a short-term outcome is not necessary to meet a strict BP target. But, patients should be in the targeted BP within weeks or a few months. However, there is limited data on the follow-up BP outcome and its determinants. We aimed to evaluate the factors that associated with a successful BP control after a few months of treatment. Design and method: This was a retrospective cohort study conducted at a university hospital in the Northeast of Thailand from 1st January 2012 to 31st December 2016. We enrolled hypertensive urgency patients who visited the ER and were received standard treatment and followed up in the hypertensive crisis clinic for at least 8–12 weeks. Pharmacological and non-pharmacological treatments were given in all enrolled patients. Office BP at the second follow up were measured and analysed. Results: A successful BP control (&lt;140/90 mmHg) was observed in 129 patients (56.1%). The factor that was associated with a successful BP control was the achievement of three-lifestyle modification including medication adherence, aerobic exercise, and salt restriction (OR 1.79; 95%CI, 1.01–3.19; P = 0.048), while the baseline BP, type of medications, and underlying diseases were not. Conclusions: Lifestyle modification was an effective strategy to achieve a targeted BP in the hypertensive urgency patient. Therefore, patients should be educated and encouraged to have a healthy lifestyle in conjunction with the pharmacological treatment.

HYPERTENSION: A GLOBAL EPIDEMIC AND ROLE OF LIFE STYLE MODIFICATION IN ITS MANAGEMENT

Objective: Hypertension is one of the epidemic disease that contributes globally as a crisis that relates to co-morbidity. The co-relation of body mass index and obesity are autonomous risk factors along with some physiological and environmental factors, leading to the development of hypertension and high blood pressure which is directly associated with other diseases such as chronic kidney disease, ischemic heart disease, stroke, dementia, non-alcoholic fatty liver disease, and obstructive sleep apnoea leading to disability &amp; mortality among the patients. The current study analyze the impact of life style management as a primary therapy of hypertensive patients. Design and method: An interventional study was designed among 500 patients selected via purposive sampling for a period of one year from Aug 2018 to Aug 2019. The study was based to analyse the life style of hypertensive patients using an approved questionnaire with the recommended guidelines of WHO. Follow-up questionnaires were administered at 5th, 9th, and 12th week. Our operational definition of successful blood pressure control is 120 mm Hg systolic and 90 mm Hg diastolic. Results: Out of 500 patients, 76.4% of the patients reported to have had sedentary life style. About 23.4% hypertensive patients, with 30–35 kg/m2 were observed. The interventional technique i.e. Patient's attitude (treatment, diet intake, sleeping and exercise habits) mean scores, pre-counselling and post-counselling for patients was applied and results were assessed after six months’ time. Post interventions results showed that patients who intermittently checked their blood pressure levels, controlled smoking habit and maintained their life styles had significantly improved levels. Conclusions: The current study demonstrates that the positive results were noted by life style modification. This shows that our interventions had positive impact on the awareness, knowledge, life style, disease management and practices of patients.

Hypertension-related risk for dementia: A summary review with future directions

Chronic hypertension, or high blood pressure, is the most prevalent vascular risk factor that accelerates cognitive aging and increases risk for Alzheimer’s disease and related dementia. Decades of observational and clinical trials have demonstrated that midlife hypertension is associated with greater gray matter atrophy, white matter damage commiserate with demyelination, and functional deficits as compared to normotension over the adult lifespan. Critically, hypertension is a modifiable dementia risk factor: successful blood pressure control with antihypertensive treatment improves outcomes as compared to uncontrolled hypertension, but does not completely negate the risk for dementia. This suggests that hypertension-related risk for neural and cognitive decline in aging cannot be due to elevations in blood pressure alone. This summary review describes three putative pathways for hypertension-related dementia risk: oxidative damage and metabolic dysfunction; systemic inflammation; and autonomic control of heart rate variability. The same processes contribute to pre-clinical hypertension, and therefore hypertension may be an early symptom of an aging nervous system that then exacerbates cumulative and progressive neurodegeneration. Current evidence is reviewed and future directions for research are outlined, including blood biomarkers and novel neuroimaging methods that may be sensitive to test the specific hypotheses.

The Contributions of Hypertension Diagnosis and Blood Pressure Control to Subjective Life Expectancy in a Representative Sample of Older U.S. Adults

Abstract Objectives High blood pressure (BP) or hypertension, a major risk factor for death and disease, is pervasive among older adults. While reducing BP to targeted levels can prevent adverse outcomes, rates of successful BP control remain suboptimal, and it is unclear whether older adults recognize its proven benefits. The current study sheds light on older adults’ beliefs about the consequences of hypertension and benefits of BP control by examining how their self-reports of hypertension diagnosis and BP control, as well as measured BP, contribute to subjective life expectancy (SLE), their perceived probability of surviving to a target age. Methods In a representative sample of U.S. adults aged 50–89 from the 2006–2014 Health and Retirement Study (n = 18,979 respondents), we analyze SLE using generalized linear regression. Results Diagnosed hypertension is associated with lower SLE, regardless of measured BP. Among diagnosed hypertensives, those who self-report controlled BP expect to live longer than those who do not. Finally, about 1 in 10 older adults have high measured BP but have never been diagnosed with hypertension, and most diagnosed hypertensives with uncontrolled measured BP self-report their BP as controlled. Discussion Older adults appear to recognize the harmful effects of hypertension and the benefits of BP control, but often lack knowledge of their own hypertension and BP control statuses. Health communications should continue to stress the value of BP control, although improvements may require increased hypertension awareness and BP monitoring.

Moving the Needle on Hypertension: What Knowledge Is Needed?

This review highlights the gaps in knowledge and methodological challenges discussed during the Experimental Biology 2019 expert panel session titled "Moving the Needle on Hypertension: What Knowledge Is Needed?" Hypertension is a critical public health burden. Despite a demonstrated benefit of blood pressure reduction on measures of hypertension-related morbidity and mortality, rates for successful blood pressure control remain low. Dietary sodium reduction has been shown to reduce both systolic blood pressure by approximately 3.2 mm Hg and diastolic blood pressure by 2.3 mm Hg, depending on baseline blood pressure and degree of sodium reduction. The updated Dietary Reference Intakes for adults released by the National Academies of Sciences, Engineering, and Medicine include a Chronic Disease Risk Reduction sodium intake level of 2300 mg/d, highlighting the importance of dietary sodium intake in reducing elevated blood pressure and indicating that reducing intakes to this level is expected to reduce blood pressure and risk of cardiovascular disease. The average US daily sodium intake of 3400 mg/d is well above the Chronic Disease Risk Reduction of 2300 mg/d, suggesting that dietary sodium reduction has the potential to significantly improve public health. Although the National Academies of Sciences, Engineering, and Medicine report presents intake recommendations based on a systematic, comprehensive, and thorough evaluation of the evidence, several challenges to moving the needle on hypertension remain. Success will require a more advanced understanding of sodium and potassium physiology, as well as development of the tools needed to effectively address existing research gaps and reduce barriers to sodium intake reduction.

MISC 10. Improved Perfusion as Predictor of Successful Perioperative Blood Pressure Control

MISC 10. Improved Perfusion as Predictor of Successful Perioperative Blood Pressure Control

Study of type 2 diabetes management among patients in a Macau primary care setting

In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and...

Antihypertensive Efficacy of a Triple Fixed-Dose Combination of Perindopril, Indapamide, and Amlodipine: Clinical Effectiveness in Ambulatory Practice (Results of the PETRA Study)

Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30 % of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6 % women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10 / 91.56±9.33 mm Hg, AH duration - 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47 / 11.41±9.90 mm Hg (p&lt;0.0001). Doses of perindopril, indapamide, and amlodipine in combination at the final visit were 5 / 1.25 / 5, 10 / 2.5 / 5, and 10 / 2.5 / 10 mg. 24-hour ambulatory BP monitoring (ABPM) was carried out in 76 patients. Mean 24-hour BP lowed from mean 155.51±17.43 / 85.28±11.48 down to 134.63±12.51 / 77.83±8.99 mm Hg (p&lt;0.0001). Clinically relevant improvement of a number of parameters of metabolism occurred after 3 months of the study (in particular, lowering of levels of total and low-density lipoprotein cholesterol [-8.6 and - 11.4 %, respectively], triglycerides [-12,1 %], fasting blood glucose [-6.6 %]). Thus, results of the PETRA study confirmed 24-hour long antihypertensive efficacy of triple fixed dose combination of perindopril, indapamide, and amlodipine. This drug combination can present novel possibility in treatment of patients with AH who have not achieved target BP values on preceding dual combination therapy and fully corresponds with the single pill concept for formation of adherence to therapy.

Messen, Bewerten, Handeln: Qualitätsindikatoren zur Koronaren Herzkrankheit im Praxistest

BackgroundThere are only limited possibilities for doctors in outpatient services to establish quality management that is based on data-driven feedback regarding the quality of health care. However, transparency about one's own activities is a prerequisite for refining this quality. The aim of this project was to make the quality of care for patients with coronary heart disease (CHD) more transparent, use this as a basis to initiate improvement processes, and explore the framework conditions and factors promoting or inhibiting the intended improvement of health care quality. Method48 general practitioners (GPs) in 32 GP practices from a Bavarian doctors’ network (Qualität und Effizienz, QuE) participated in the project. On the basis of claims data from the AOK-Bayern (a statutory health insurance in Bavaria), data from disease management programs (DMP) and medically documented data, 11 quality indicators for patients with CHD were calculated. The indicator scores were individually presented in feedback reports for each doctor's practice. These were the basis for two quality circles. The indicators were measured again after 12 months, and changes against the baseline measurement were registered. GPs from Bavaria formed the control group. Focus groups with the quality circle moderators and two participant surveys were used to identify promoting and inhibiting factors. ResultsThe baseline values showed a good level of care. Potential for improvement became apparent for pharmacotherapy with beta blockers and statins. After conducting the quality circles four of the eleven indicators showed an increase as intended (“beta blockers for CHD and cardiac insufficiency”, “beta blockers after myocardial infarction”, “statins”, “successful blood pressure control”). For three of these indicators the increase rates were higher than those in the Bavarian control group. One indicator (“statins”) was striking because of the wide variation of practice values suggesting differences in care within the network.The majority of participating doctors regarded the database as valid. Quality circles were highly appreciated as an opportunity for professional exchange among colleagues. The data-based feedback reports helped to make deficits in health care transparent and to identify actions that need to be taken. Barriers to implementing quality improvement measures in clinical practice became apparent. DiscussionReflecting quality indicators in quality circles can effectively trigger quality improvement processes. Barriers would appear to exist, in particular, to the implementation of measures into daily practice routine. Additional organizational support offered by higher-level quality management structures, IT solutions for patient-related data processing as well as a system of financial compensation, which rewards professional concern for quality, may help to overcome the existing barriers.

Lifestyle and self-management determinants of hypertension control in a sample of Australian adults

ABSTRACTBackground: Poor hypertension control can increase the risk of cardiovascular, renal and kidney diseases, and increase the social and economic burden of the disease.Methods: This study aimed to explore the lifestyle and self-management skills (medication adherence, self-monitoring, self-efficacy) determinants of hypertension control in a sample of hypertensive Australians. In a cross-sectional design, a total of 233 hypertensive adults completed a survey. Hypertension control was categorised as good control if hypertensive individuals managed to reduce their blood pressure (BP) < 140/90 mmHg, otherwise it was categorised as poor control. Data were analysed using bivariate analysis and hierarchical logistic regression.Results: 55% of the participants had poor BP control. A significantly higher frequency of poor BP self-monitoring was observed in individuals with poor control compared to their counterparts. Poor self-monitoring and a sedentary lifestyle were associated with higher odds of poor control (OR: 5.33, 95% CI: 1.78 – 15.93; p < 0.01, and OR: 4.69, 95% CI: 1.00 – 22.25; p < 0.05, respectively). No significant association was observed between other variables and hypertension control.Conclusion: Successful BP control for hypertensive individuals may require interventions and strategies that assist with improving BP self-monitoring skills and increasing physical activity.

Treatment of severe hypertension in a 14-year-old child: Successful blood pressure control with additive administration of captopril, an angiotensin-converting enzyme inhibitor, in a patient with bilateral renovascular hypertension

ABSTRACTWe report a 14-year-old boy with recurrent episodes of headache caused by uncontrolled hypertension. The diagnosis of renovascular hypertension due to Takaysu arteritis (TA) was made based on an increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and computed tomography (CT) image of bilateral renal artery stenosis was taken. Renal scintigraphy revealed normal perfusion and function of the right kidney and severe reduction of the perfusion and function of the left kidney. Careful drug adjustments significantly improved but did not fully control the blood pressure (BP); further, angioplasty, which showed almost occlusion of the left renal artery opening and the minor narrowing of the right renal artery, failed to regain sufficient BP control. The addition of captopril, an angiotensin-converting enzyme (ACE) inhibitor, to conventional antihypertensive drugs successfully and safely lowered BP and preserved the renal function. This unique case suggested that ACE inhibitors achieved better control of BP in a patient with bilateral renal stenosis and that the patient may have hemodynamically significant stenosis caused by unilateral renal artery.

Safety of Temporary Discontinuation of Antihypertensive Medication in Patients With Difficult-to-Control Hypertension.

Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension. We assessed the occurrence of adverse cardiovascular and cerebrovascular events potentially attributable to temporary discontinuation of antihypertensive medication between February 2010 and March 2016 (n=604) in our Analysis of Complicated Hypertension screening program. A reference group (n=604) was extracted from the SMART study (Second Manifestations of Arterial Disease) cohort (comprising a similar cohort at our hospital in whom medication was not stopped) and individually matched for blood pressure, age, sex, and history of cardiovascular disease. Discontinuation of medication was well tolerated; 62% reported no complaints, 24% had mild discomfort that could be left untreated, and 14% experienced complaints that required prescription of antihypertensive escape medication. Three major adverse events were observed in the Analysis of Complicated Hypertension group between discontinuation of medication and 30 days after restart of medication (event rate=31.2 events per 1000 patient-year). In the reference cohort, 5 cardiovascular events were observed during a similar follow-up period (event rate=51.2 events per 1000 patient-year). In conclusion, discontinuation of antihypertensive medication for the diagnostic evaluation of hypertension does not increase the acute risk of cardiovascular events when performed in a well-controlled setting in specialized hospitals with appropriate protocols for monitoring safety.

EVALUATION OF TRANSITION EFFICACY TO ANGIOTENSINE CONVERTING ENZYME INHIBITORS IN PATIENTS WITH INSUFFICIENT BLOOD PRESSURE CONTROL. THE RESULTS FROM REGIONAL PROGRAM “SARA”

Aim. To evaluate an additional antihypertension efficacy and tolerability of perindopril comparing to sartans in real clinical practice. Material and methods . The study had been designed, that included 208 patients. Main inculsion criteria was arterial hypertension (AH) with insufficient blood pressure (BP) control on treatment by angiotensine receptor blocker (ARB) as monotherapy, with 1 or 2 risk factors by SCORE system and on treatment by a free ARB combination with other drugs classes. In inclusion to program, instead of ARB perindopril (Prestarium A) 10 mg was added or its disperging form 10 mg in the morning. Duration of program lasted for 3 months. The evaluation of BP decrease was done, as the target BP levels reach and treatment response. Results. On treatment with perindopril, in 2 weeks there was statistically significant (p&lt;0,05) decrease of BP, and this positive dynamics remained for all follow-up period. Target BP was reached in 42,4% patients. Assessment of efficacy criteria of SARA program revealed in all participants BP decrease from baseline level, with median of systolic BP decrease as 30 [25;42] mmHg, diastolic — 20 [10;20] mmHg. Target BP was reached in 42,4%. Conclusion . Transition from non-effective former sartans treatment to perindopril makes for successful BP control with high treatment tolerance. Such approach can be recommended for patient’s management in real clinical practice.