Target Blood Pressure Control Research Articles

Determinants of hypertension in a young adult Ugandan population in epidemiological transition-the MEPI-CVD survey.

BackgroundHigh blood pressure is the principal risk factor for stroke, heart failure and kidney failure in the young population in Africa. Control of hypertension is associated with a larger reduction in morbidity and mortality in younger populations compared with the elderly; however, blood pressure control efforts in the young are hampered by scarcity of data on prevalence and factors influencing awareness, treatment and control of hypertension. We aimed to describe the prevalence of prehypertension and hypertension among young adults in a peri-urban district of Uganda and the factors associated with occurrence of hypertension in this population.MethodsThis cross-sectional study was conducted between August, 2012 and May 2013 in Wakiso district, a suburban district that that encircles Kampala, Uganda’s capital city. We collected data on socio-demographic characteristics and hypertension status using a modified STEPs questionnaire from 3685 subjects aged 18–40 years selected by multistage cluster sampling. Blood pressure and anthropometric measurements were performed using standardized protocols. Fasting blood sugar and HIV status were determined using a venous blood sample. Association between hypertension status and various biosocial factors was assessed using logistic regression.ResultsThe overall prevalence of hypertension was 15 % (95 % CI 14.2 – 19.6) and 40 % were pre-hypertensive. Among the 553 hypertensive participants, 76 (13.7 %) were aware of their diagnosis and all these participants had initiated therapy with target blood pressure control attained in 20 % of treated subjects. Hypertension was significantly associated with the older age-group, male sex and obesity. There was a significantly lower prevalence of hypertension among participants with HIV OR 0.6 (95 % CI 0.4–0.8, P = 0.007).ConclusionThere is a high prevalence of high blood pressure in this young periurban population of Uganda with sub-optimal diagnosis and control. There is previously undocumented high rate of treatment, a unique finding that may be exploited to drive efforts to control hypertension. Specific programs for early diagnosis and treatment of hypertension among the young should be developed to improve control of hypertension. The relationship between HIV infection and blood pressure requires further clarification by longitudinal studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2146-y) contains supplementary material, which is available to authorized users.

Prévalence de l’atteinte des organes cibles chez des patients traités pour une HTA : comparaison homme/femme. Étude ESSENTIELLE

ObjectivesTo compare the percentages of men and women treated for primary arterial hypertension presenting with at least one target organ damage; to identify factors associated with target organ damage and/or blood pressure control. MethodsObservational, transverse study carried out between March 2012 and July 2013 on a representative sample of 2666 outpatients (including 1343 men) consulting general practitioners (n=469) or cardiologists (n=250) in routine follow-up. ResultsCharacteristics “men vs. women” were: mean age (62.6±11.6 vs. 57.4±14.7 years; P<0.0001); ≥ 60 years (61.1% vs. 43.9%; P<0.0001); waist circumference (98.9±12.2 vs. 89.4±14.3cm; P<0.0001); SBP (146.5±16.1 vs. 145.8±17.0mmHg; NS); DBP (85.1±10.3 vs. 84.2±10.4; P=0,03). Target organ damage was more frequent in men (37.6% vs. 22.9%; P<0.0001), whether it was subclinical (20.4% vs. 13.6%; P<0.0001) or documented (26.3% vs. 13.5%; P<0.0001); some patients presented with both types of damages. Men developed more often microalbuminuria (6.5% vs. 4.3%; P=0.01) and LVH (16.3% vs. 10.5%; P<0.0001); some patients presented with both types of subclinical injuries. Target organ damage was more common in men without regular physical activity than in those exercising regularly (42.1% vs. 32.5%; P=0.0004). Regular exercises had no effect in women (24.1% vs. 21.3%). For both sexes, other factors associated with target organ damage were: age ≥ 60 years, myocardial infarction/sudden death in family history, LDL-cholesterol ≥ 1.60g/L, HDL-cholesterol ≤ 0.40g/L. Stroke before 45 years in family history was a predictive factor in women. Hypertension was controlled in one third of patients without difference between sexes. In women, hypertension was less often controlled in case of excessive alcohol consumption compared to normal alcohol intake (17.9% vs. 36.1%; P=0.0007); this factor had no effect in men (28.1% vs. 32.6%). Other factors associated with poor blood pressure control were: BMI (P=0.002), LDL-cholesterol ≥ 1.60g/L in women. In men, the factors were: tobacco, presence of LVH, absence of physical activity, HDL-cholesterol ≤ 0.40g/L, absence of diet. ConclusionIn a hypertensive population, target organ damage is more common among men despite similar blood pressure control rates for both sexes.

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Objective: To compare the percentages of men and women treated for primary arterial hypertension presenting with at least one target organ damage; to identify factors associated with target organ damage and/or blood pressure control. Design and method: Observational, transverse study carried out between March 2012 and July 2013 on a representative sample of 2666 outpatients (including 1343 men) consulting general practitioners (n = 469) or cardiologists (n = 250) in routine follow-up. Results: Characteristics «men vs women» were: mean age (62.6 ± 11.6 vs 57.4 ± 14.7 years; p < 0.0001); >or = 60 years (61.1% vs 43.9%; p < 0.0001); waist circumference (98.9 ± 12.2 vs 89.4 ± 14.3 cm; p < 0.0001); SBP (146.5 ± 16.1 vs 145.8 ± 17.0 mmHg; NS); DBP (85.1 ± 10.3 vs 84.2 ± 10.4; p = 0,03). Target organ damage was more frequent in men (37.6% vs 22.9%; p < 0.0001), whether it was subclinical (20.4% vs 13.6%; p < 0.0001) or documented (26.3% vs 13.5%; p < 0.0001); some patients presented with both types of damages. Men developed more often microalbuminuria (6.5% vs 4.3%; p = 0.01) and LVH (16.3% vs 10.5%; p < 0.0001); some patients presented with both types of subclinical injuries. Target organ damage was more common in men without regular physical activity than in those exercising regularly (42.1% vs 32.5%; p = 0.0004). Regular exercises had no effect in women (24.1% vs 21.3%). For both sexes, other factors associated with target organ damage were: age >or = 60 years, myocardial infarction/sudden death in family history, LDL-cholesterol >or = 1.60 g/L, HDL-cholesterol < or = 0.40 g/L. Stroke before 45 years in family history was a predictive factor in women. Hypertension was controlled in one third of patients without difference between sexes. In women, hypertension was less often controlled in case of excessive alcohol consumption compared to normal alcohol intake (17.9% vs 36.1%; p = 0.0007); this factor had no effect in men (28.1% vs 32.6%). Other factors associated with poor blood pressure control were: BMI (p = 0.002), LDL-cholesterol >or = 1.60 g/L in women. In men, the factors were: tobacco, presence of LVH, absence of physical activity, HDL-cholesterol <or = 0.40 g/L, absence of diet. Conclusions: In a hypertensive population, target organ damage is more common among men despite similar blood pressure control rates for both sexes.

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Objective: Hypertension is the leading risk factor contributing for the cardiovascular morbidity and mortality in the Portuguese population. However its association with diabetes is very frequent and synergistically increase cardiovascular risk in these patients. It's management is predominantly undertaken by primary physicians. Estimates of the prevalence, treatment and control of Blood Pressure (BP) in the primary care patients with diabetes, are needed to adequately address the high burden of hypertension and diabetes in Portugal. Design and method: A retrospective analysis of patient-based electronic medical records was conducted during the year of 2013. To examine the effect of regular General practitioner (GP) management and control on BP across at least two annual visits. A subgroup of patients with elevated BP and ageequal or more than 18 years old and diabetes, were selected in a total of 528 242 patients (51,5 % women). Hypertension was defined as Systolic BP and or Diastolic BP equal or more than 140/90 mmHg. Results: The overall prevalence of hypertension and diabetes was 20,0% (men 23,1% and women 17,8%). Among those patients under hypertensive treatment, the control rates were 23,7% (men 28,7% and women 20,5%). The main classes of antihypertensive prescribed were tiazide diuretics 30,2% (men 23,7% and women 29,7%), beta-blockers 27,1% (men 26,5% and women 27,4%), calcium channel blockers 22,4% (men 21,1% and women 19,5%); ECAI 26,5% (men 24,5%, women 21,7%) and AII antagonists 46,9% (men 47,9% %, and women 42,3 %). Conclusions: The prevalence of hypertension with hypertension was lower than in other studies. Arterial blood pressure control was very poor, only four out of ten in the subgroup of Portuguese patients aged 18 years or older with diabetes. Blood pressure control assessment was significantly better in men. A more intensive approach in the management of the BP in primary care is required to ensure that more patients achieve BP control targets.

Benefit of initial dual-therapy on stroke prevention in Chinese hypertensive patients: a real world cohort study.

Studies have shown that combination anti-hypertensive therapy is superior to mono-therapy in blood pressure control and prevention of cardiovascular events. However, whether such advantage exists in the prevention of stroke in Chinese hypertensive patients remains unclear. This study aimed to compare the impact of initial combination versus mono-therapy on stroke events in a large cohort of Chinese hypertensive patients. Hypertensive patients with uncontrolled blood pressure and without a history of stroke were screened from the Shanghai Community-dwelling Hypertensive Population Follow-up Database. Based on the initial treatment, individuals were divided into an initial mono-therapy group and initial dual combination group. Patients were followed for 42 months. 32,682 and 4,926 patients were included in the initial mono- and dual-therapy group. The achieved target blood pressure control rates of mono vs. combination groups at 6, 12, 24, and 42 months of follow-up, were 59.47% vs. 60.05%, 78.23% vs. 77.06%, 85.51% vs. 84.02%, and 86.90% vs. 85.44%, respectively. Their corresponding incidence densities of stroke were 0.792 vs. 0.489, 1.49 vs. 1.15, 2.79 vs. 2.38, and 4.25 vs. 4.32 (cases per 100 person-year), respectively. The 6-month incidence of stroke in dual-therapy group was significantly lower than mono-therapy group (adjusted HR 0.64; 95% CI: 0.30-0.93). However, no significant group differences in the incidence density were observed at 12, 24, and 42 months. Our study demonstrates that, for patients with uncontrolled hypertension, initial dual therapy is more effective in the prevention of stroke during the first 6 months of treatment, but not thereafter. Combination antihypertensive therapy may be a beneficial initial strategy for early stroke prevention.

Loss of Hydrogen Sulfide‐Stimulated Ca 2+ Spark Activity in Arteries from Rats with Intermittent Hypoxia‐Induced Hypertension

Obstructive sleep apnea (OSA) is a risk factor for hypertension. Previous studies from our laboratory demonstrate increased blood pressure and increased myogenic vascular tone in mesenteric arteries from rats exposed to intermittent hypoxia (IH), a model of OSA. We have also observed that hydrogen sulfide (H2S) activates Ca2+ sparks in mesenteric arteries, and that IH exposure in rats decreases H2S-dependent dilation in mesenteric arteries. Therefore, we hypothesized that IH exposure would decrease H2S-activated Ca2+spark activity in mesenteric arteries to augment vasoconstriction. Mesenteric arteries collected from male Sprague-Dawley rats exposed to IH (20 exposures/hr of 5% O2/5% CO2 7 hr/day for 14 days) were loaded with the Ca2+indicators fluo-4 AM and Oregon Green BAPTA-1 and then cannulated and pressurized to 75 mmHg. Basal Ca2+spark activity was decreased in arteries from IH rats (0.31±0.04 vs. 0.43±0.02 sparks/cell/sec in Sham). The inhibitor of H2S synthesis (beta cyanoalanine, BCA) decreased spark activity activity in Sham arteries te abolish this diffference. Vascular smooth muscle cell (VSMC) depolarization induced by elevating extracellular [K+] or by increasing luminal pressure) increased Ca2+ spark activity in arteries from Sham but not IH rats and this increase in Ca2+ spark activity was prevented by removing the endothelium or by incubating with BCA. Ryanodine (10 µM) eliminated basal Ca2+ spark activity and prevented both H2S-induced dilation and H2S-induced spark activation. Our results provide evidence of impaired H2S-induced Ca2+ spark regulation of vascular reactivity in a rodent model of OSA and point to this pathway as a target for blood pressure control in hypertensives.

From the Epidemiologist to the Physician: A Complex Issue for a Labile Risk.

In a recent study of elderly, rural-dwelling Tanzanians, the incorrect classification of more than a quarter of patients as hypertensive was attributed to the white-coat effect. Although the white-coat effect might contribute to the overestimation of the prevalence of hypertension (HTN), systolic blood pressure (SBP) variability is known to enhance cardiovascular (CV) risk. In addition, white-coat HTN is now regarded as an intermediate phenotype between normotension and HTN. On the other hand, relatively high nocturnal blood pressure (BP) resulted in nighttime HTN in more than two thirds of the cohort of elderly, rural-dwelling Tanzanians. SubSaharan Africans were already reported to have higher nighttime BPs than Caucasians with a blunted nocturnal decline, so that ambulatory BP monitoring (ABPM) might be especially useful in this ethnic group. As recently underlined by the Global Burden of Disease study, HTN results in more deaths than any other risk factors, including diabetes and cigarette smoking. High prevalence, inadequate awareness, suboptimal treatment, and low rates of guideline-recommended target BP control are key factors that lead to severe CV complications that impose a heavy socioeconomic burden, especially in developing countries. A systematic review and meta-analysis pooling data from 33 surveys published between 2000 and 2013, involving more than 110,414 participants with a mean age of 40 years, shows that in sub-Saharan Africa the predicted prevalence of HTN at mean participant ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval [CI], 27–34). Most importantly, of those with HTN, only between 7% and 56% (pooled prevalence: 27%; 95% CI, 23–31) were aware of their hypertensive status before the surveys. Overall, 18% (95% CI, 14–22) of individuals with HTN were receiving treatment across the studies, and only 7% (95% CI, 5–8) had controlled BP. The HTN burden is likely to grow in the next few decades as the population ages and the prevalence of obesity and diabetes increases. These data clearly highlight the need for implementation of timely and appropriate strategies for diagnosis, control, and prevention. However, the direct transfer of data obtained in an epidemiological study in a real estimate of the costs necessary to the country for the treatment of CV risk hides some uncertainties. Although data from observational studies indicate that this risk is continuous, to have a precise estimate in terms of prevalence in population studies may not be straightforward. In the individual patient, the clinician performs the diagnosis of HTN on the basis of repeated BP values above 140/ 90 mm Hg at several visits. Although these criteria may be met in epidemiological surveys performed in high-income countries (in the third report of the National Health and Nutrition Examination Survey, nearly 80% of participants had up to six BP measurements on two occasions), estimates of HTN prevalence in lowand middle-income countries (LMICs) are often based on data collected at a single visit, causing a potential systematic error. This discrepancy is mainly the result of the difficulty to bear the costs of more visits in an epidemiological study. A similar problem also arises in the case of diabetes. The strategy used in the clinic to make measurements of fasting blood glucose on separate days is not easily feasible in epidemiological studies so that attempts are made to obtain reliable estimates using different strategies based on glycated hemoglobin or the response to the oral glucose tolerance test. Comparisons between estimations of diabetes prevalence assessed with these different strategies are often given in the same survey, whereas only a few studies have assessed the impact of one or two visits on the estimation of HTN burden in LMICs. Taking BP multiple times can attenuate the influence of within-person variability because of physiological variation or measurement error. Another source of nonrandom variation is the phenomenon of “white-coat hypertension,” which may lead to an overestimation of HTN prevalence. The National Institute for Health and Care Excellence (NICE) recommends ABPM for all patients suspected of having HTN because of a previously elevated office BP measurement aiming to exclude patients with whitecoat HTN. According to the study by Ivy and colleagues, the white-coat effect was responsible for an increase in recorded BP in more than two thirds of a cohort of elderly, rural-dwelling Tanzanians. Those data are in agreement with a recent study performed in a different world area. At least three points have to be considered. First, could the adoption of a strategy based on ABPM lead us Address for correspondence: Pietro Amedeo Modesti, European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings (Chair), Department of Medicina Sperimentale e Clinica, University of Florence, Largo Brambilla 3, Florence, Italy. E-mail: pamodesti@unifi.it

Abstract 209: Intracranial Wall Irregularity and Recurrent Stroke: the SPS3 Trial

Background and Purpose: Intracranial atherosclerosis is an important cause of ischemic stroke and even mild stenosis or subtle wall changes may be a marker for subsequent stroke risk. We tested whether any arterial wall irregularity was predictive of recurrent stroke in participants of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Methods: SPS3 was a randomized trial investigating optimal blood pressure target and antiplatelet regimen in patients with recent, symptomatic, MRI-confirmed lacunar stroke patients. Magnetic resonance angiography (MRA) proximate to study entry was adequate and available for 2169 of 3020 study patients. Seven intracranial arteries (basilar [BA], vertebral [VA], internal carotid [ICA], and middle cerebral artery [MCA]) were assessed on time-of-flight MRA for wall irregularities including stenosis and changes of arterial diameter. Cox Proportional Hazards models adjusted for assigned treatments and clinical risk factors were used to estimate risk for recurrent stroke associated with any wall irregularity overall and in specific arteries. Results: Mean age of the 2169 patients was 63 yr with 63% male; hypertension, diabetes, and prior lacunar stroke were present in 75%, 36%, and 10%, respectively. Wall irregularities in ≥1 artery (325 one artery, 250 &gt; 1 artery) were observed in 575 patients (27%). Recurrent stroke occurred in 195 patients during mean follow-up of 3.5 years (annualized rate 2.5% per patient-year). Patients with at least one wall irregularity had an increased risk of recurrent stroke (adjusted HR 1.4, 95% CI 1.0-1.9). There was no interaction between either randomized treatment arm (antiplatelet therapy or blood pressure control target) and wall irregularities. Irregularity by any individual artery (BA, n = 115, 14 strokes; VA, n = 150, 17 strokes; ICA, n = 268, 31 strokes; or MCA, n = 316, 37 strokes) was not predictive of recurrent stroke (each p &gt;0.1). Conclusion: In this large well characterized cohort of lacunar stroke patients, any wall irregularity in at least one artery was associated with recurrent stroke independent of clinical risk factors and assigned treatment groups.

Strategies for preserving residual renal function in peritoneal dialysis patients.

Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis patients are at risk of sudden intravascular volume shifts associated with dialysis treatments. On the other hand, peritoneal dialysis patients are exposed to a variety of hypertonic dialysates and episodes of peritonitis. Whereas blood pressure control, using an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and low-protein diets along with keto acid supplementation have been shown to reduce the rate of progression in patients with earlier stages of CKD, the strategies to preserve residual renal function (RRF) in dialysis patients are not well established. For peritoneal dialysis patients, there are additional technical factors that might aggravate the rate of loss of residual renal function including peritoneal dialysis prescriptions and modality, bio-incompatible dialysis fluid and over ultrafiltration of fluid causing dehydration. In this review, we aim to evaluate the evidence of interventions and treatments, which may sustain residual renal function in peritoneal dialysis patients.

Optimal targets for blood pressure control in chronic kidney disease: the debate continues.

Because advanced chronic kidney disease (CKD) is often an exclusion criterion for large randomized trials of the management of hypertension, clinical decision making for these patients has relied on a few small, specific studies and much extrapolation. Several blood pressure treatment guidelines have recently been reissued. This review explores the applicability of the revised recommendations to CKD. Many new publications are meta-analyses, guidelines and debates about guidelines. New data from trials are scant. Three revised guidelines (KDIGO, JNC8, KHA-CARI) recommend a target of less than 140/90. Most antihypertensive drugs are equally effective - but this rule may not apply to advanced CKD. Proteinuric renal disease is seen as an exception; all three guidelines set a target of 130/80 and the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (but not both) is preferred. There is no shortage of new commentary and advice, but evidence strength and generalizability diminish as the kidneys fail and the impact of calcified vessels and salt and water overload increases. A risk-based approach to intervention may be no less valuable than targets. Clinical trials of individuals with advanced CKD will be needed to identify effective treatments and may see a resurgence of the role of spironolactone.

Check it, change it: a community-based, multifaceted intervention to improve blood pressure control.

Although home blood pressure (BP) monitoring interventions have shown potential in selected populations, it is unclear whether such strategies can be generalized. We sought to determine whether a multifaceted BP control program that uses a web-based health portal (Heart360), community health coaches, and physician assistant guidance could improve hypertension control in a diverse community setting. Between September 12, 2010, and November 11, 2011 Check It, Change It, a community-based hypertension quality improvement program, enrolled 1756 patients with hypertension from 8 clinics in Durham County, NC. The Check It, Change It community intervention was evaluated using a prepost study design without a concurrent control. Participants were stratified into 3 tiers according to their initial BP: tier 0 (BP <140/90 mm Hg)=51% of population, tier 1 (BP=140/90-159/99 mm Hg)=30% of total, and tier 2 (BP ≥159/99 mm Hg)=19% of total. Overall, median age was 59 years (interquartile range, 49-69), 67% were female, and 76% black. After 6 months, the mean overall systolic BP declined 4.7 mm Hg. Rates of achieving target BP control (<140/90) increased overall from 51% at baseline to 63% by 6 months, and 69% had either reached their BP target or had reduced their baseline systolic BP by 10 mm Hg or more. A multicomponent-tiered hypertension program was associated with improved BP control in a diverse community-based population.

Telemonitoring: use in the management of hypertension.

Hypertension is a major modifiable risk factor for cardiovascular, retinal, and kidney disease. In the past decade, attainment rates of treatment targets for blood pressure control in the UK and US have increased; however, <11% of adult men and women have achieved adequate blood pressure control. Technological advances in blood pressure measurement and data transmission may improve the capture of information but also alter the relationship between the patient and the provider of care. Telemonitoring systems can be used to manage patients with hypertension, and have the ability to enable best-practice decisions more consistently. The improvement in choice for patients as to where and who manages their hypertension, as well as better adherence to treatment, are potential benefits. An evidence base is growing that shows that telemonitoring can be more effective than usual care in improving attainment rates of goal blood pressure in the short-to-medium term. In addition, studies are in progress to assess whether this technology could be a part of the solution to address the health care needs of an aging population and improve access for those suffering health inequalities. The variation in methods and systems used in these studies make generalizability to the general hypertension population difficult. Concerns over the reliability of technology, impact on patient quality of life, longer-term utility and cost–benefit analyses all need to be investigated further if wider adoption is to occur.

Liver-specific angiotensinogen suppression: an old yet novel target for blood pressure control through RAS inhibition?

Liver-specific angiotensinogen suppression: an old yet novel target for blood pressure control through RAS inhibition?

Managing blood pressure control in Asian patients: safety and efficacy of losartan

Hypertension is common in Asian populations and is a major cause of cardiovascular diseases. The prevalence of hypertension is increasing in many Asian countries. The overall prevalence of hypertension in India and the People’s Republic of China has been estimated to be 20.6% in men and 22.6% in women. However, the rates of detection, treatment, and control of hypertension remain low in Asia. This reflects a low level of literacy and education, as well as a low level of access to medical care. To overcome these obstacles, strategies targeted at education, promotion, and optimization of medical care, are crucial to achieve target blood pressure control. Angiotensin receptor blockers are one of the first-line treatments for essential hypertension because they confer better cardiovascular outcomes. Losartan has been widely evaluated for the management of hypertension. Although some studies suggested that the blood pressure-lowering effect of losartan is perhaps lower than for other angiotensin receptor blockers, losartan has been demonstrated to be beneficial in terms of renal protection in patients with diabetes, heart failure resulting from either systolic or diastolic dysfunction, and diuretic-induced hyperuricemia. However, most of these data were obtained from Caucasian populations. The efficacy and safety of losartan in Asian populations may be different because of genetic and ethnic variations. Therefore, the efficacy and safety of losartan in Asian patients with hypertension warrant further study.

An assessment of discriminatory power of office blood pressure measurements in predicting optimal ambulatory blood pressure control in people with type 2 diabetes.

IntroductionAmbulatory blood pressure (BP) measurements (ABPM) predict health outcomes better than office BP, and are recommended for assessing BP control, particularly in high-risk patients. We assessed the performance of office BP in predicting optimal ambulatory BP control in sub-Saharan Africans with type 2 diabetes (T2DM).MethodsParticipants were a random sample of 51 T2DM patients (25 men) drug-treated for hypertension, receiving care in a referral diabetes clinic in Yaounde, Cameroon. A quality control group included 46 non-diabetic individuals with hypertension. Targets for BP control were systolic (and diastolic) BP.ResultsMean age of diabetic participants was 60 years (standard deviation: 10) and median duration of diabetes was 6 years (min-max: 0-29). Correlation coefficients between each office-based variable and the 24-h ABPM equivalent (diabetic vs. non-diabetic participants) were 0.571 and 0.601 for systolic (SBP), 0.520 and 0.539 for diastolic (DBP), 0.631 and 0.549 for pulse pressure (PP), and 0.522 and 0.583 for mean arterial pressure (MAP). The c-statistic for the prediction of optimal ambulatory control from office-BP in diabetic participants was 0.717 for SBP, 0.494 for DBP, 0.712 for PP, 0.582 for MAP, and 0.721 for either SBP + DBP or PP + MAP. Equivalents in diabetes-free participants were 0.805, 0.763, 0.695, 0.801 and 0.813.ConclusionOffice DBP was ineffective in discriminating optimal ambulatory BP control in diabetic patients, and did not improve predictions based on office SBP alone. Targeting ABPM to those T2DM patients who are already at optimal office-based SBP would likely be more cost effective in this setting.

Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease.

Both strict blood pressure (BP) control and improvements in BP profile such as BP variability are important for suppression of renal deterioration and cardiovascular complication in hypertension and chronic kidney disease (CKD). In the present study, we examined the beneficial effects of the single pill-based combination therapy of amlodipine and atorvastatin on achievement of the target BP and clinic BP profile, as well as markers of vascular and renal damages in twenty hypertensive CKD patients. The combination therapy with amlodipine and atorvastatin for 16 weeks significantly decreased clinic BP, and achievement of target BP control was attained in an average of 45% after the combination therapy in spite of the presence of no achievement at baseline. In addition, the combination therapy significantly decreased the within-visit BP variability. With respect to the effects on renal damage markers, combination therapy with amlodipine and atorvastatin for 16 weeks significantly decreased albuminuria (urine albumin-to-creatinine ratio, 1034 ± 1480 versus 733 ± 1218 mg/g-Cr, P < 0.05) without decline in estimated glomerular filtration rate. Concerning parameters of vascular function, the combination therapy significantly improved both brachial-ankle pulse wave velocity (baPWV) and central systolic BP (cSBP) (baPWV, 1903 ± 353 versus 1786 ± 382 cm/s, P < 0.05; cSBP, 148 ± 19 versus 129 ± 23 mmHg, P < 0.01). Collectively, these results suggest that the combination therapy with amlodipine and atorvastatin may exert additional beneficial effects on renal and vascular damages as well as BP profile in addition to BP lowering in hypertension with CKD.

Guideline-adherent therapy in patients with cardiovascular diseases in Taiwan

Aggressive and persistent control of risk factors is recommended for prevention of secondary comorbidities in patients with cardiovascular diseases. This study aimed to evaluate guideline recommendations for achieving targets for lipid and blood pressure (BP) control in patients with cardiovascular diseases in Taiwan. This multicenter cohort study was conducted in 14 hospitals in Taiwan. A total of 3316 outpatients who had established cerebrovascular disease (CVD), coronary artery disease (CAD), or both were recruited. Risk factors for comorbid conditions such as high BP, sugar, hemoglobin A1C, abnormal lipids, lipoproteins, and medication use were compared between patients with CVD, CAD, or both. Of all patients, 503 (15.2%) had CVD only, 2568 (77.4%) had CAD only, and 245 (7.4%) had both CVD and CAD. Compared with patients who had only CAD, those with CVD were older, had higher frequency of hypertension, and lower frequency of diabetes mellitus. Patients with CAD were more likely to receive lipid-lowering and antihypertensive drugs than those with CVD (p<0.001). Only 54.8% and 55.9% of patients achieved the recommended lipid and BP control targets, respectively. Patients with CVD (adjusted odds ratio: 0.61; 95% confidence interval: 0.48-0.78; p<0.001) and women (adjusted odds ratio: 0.65; 95% confidence interval: 0.55-0.78; p<0.001) were less likely to achieve the recommended lipid and BP targets. The guideline-recommended targets for lipids and BP in patients with CAD and CVD were still suboptimal in Taiwan. Greater efforts are required to achieve the targets, particularly in patients with CVD and in women.

The healthcare burden of hypertension in Asia

As the leading global risk for mortality, hypertension (HT) is a common healthcare problem in the world. The total number of patients with HT is likely to grow in the...

Prevalence, awareness, treatment and control of hypertension in the Palestinian population

We determined the prevalence of hypertension and the level of awareness, treatment and control of hypertension among Palestinian adults in a population-based cross-sectional survey. Two-stage stratified sampling method was used to select 2077 participants from the general population aged 25 years and over. Trained observers obtained two blood pressure (BP) measurements from each individual by the use of a standardized mercury sphygmomanometer after a 5-min sitting rest. Information on sociogeographical factors and antihypertensive medications was obtained using a standard questionnaire. Hypertension was defined as a mean systolic BP (SBP) 140 mm Hg, diastolic BP (DBP) 90 mm Hg, and/or use of antihypertensive medications. The overall prevalence of hypertension was 27.6%, with a higher percentage among men (29.2 vs 26.4%; P=0.04). Hypertension increased with age in both men and women. Among hypertensive patients, 51.0% were aware of their elevated BP, 40.2% had treatment and only 9.5% achieved targeted BP control (<140/90 mm Hg). Patients under antihypertensive treatment showed SBP and DBP that were only 3.1 mm Hg and 2.5 mm Hg lower than individuals without antihypertensive treatment, respectively. The data show that hypertension prevalence among Palestinian adults is high, whereas the proportions of awareness treatment and control of hypertension were low. Concerted public health effort is urgently required to improve the detection, treatment and control of hypertension in Palestine.

Blood Pressure Control Among Hypertensive Patients With and Without Diabetes Mellitus in Six Public Primary Care Clinics in Malaysia

Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension.