Therapy In Hypertensive Patients Research Articles

Salivary microbial shifting in hypertensive patients with chronic periodontitis after scaling and root surface debridement.

This study aimed to evaluate the impact of scaling and root surface debridement (SRP) on salivary bacterial counts and systolic and diastolic blood pressure in hypertensive patients with chronic periodontitis, with a focus on clinical significance. An observational trial included 24 chronic periodontitis patients, eleven of them were hypertensive patients. Non-surgical periodontal treatment was administered to all patients, with clinical parameters including gingival index (GI), plaque index (PI), and probing pocket depth (PPD) recorded. Saliva samples were collected before and after SRP to quantify total bacterial counts and specific bacterial counts. Two months following SRP, PI and PPD in every subject under study demonstrated good responses. In hypertension patients, the salivary bacterial count was significantly higher following SRP (P = 0.0221). The incidence of Porphyromonas gingivalis in hypertension patients significantly decreased after treatment (P = 0.0386). Despite this, there was no discernible decrease in blood pressure following treatment. SRP alone was ineffective in reducing overall bacterial counts, but P. gingivalis levels responded favorably. Regular periodontal assessment is crucial for hypertensive individuals to mitigate cardiovascular risk. Periodontal therapy in hypertensive patients may improve oral health but might not significantly impact blood pressure. Regular periodontal evaluation is essential for managing cardiovascular risk in hypertension.

WEIGHT LOSS IN HYPERTENSIVE PATIENTS WITH OBESITY UNDER THE INFLUENCE OF LIRAGULTIDE IS ASSOCIATED WITH A REDUCTION IN INSULIN RESISTANCE AND INCREASED EFFECTIVENESS OF THERAPY

Objective: One of the most important areas of treatment for patients with arterial hypertension (AH) with abdominal obesity (AO) is reduction of body weight (BW), which can be achieved using the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide. Objective: to study the relationship between the degree of weight loss under the influence of liraglutide and the effectiveness of antihypertensive and lipid-lowering therapy in hypertensive patients with AO. Design and method: 42 patients with AH of 2-3 degrees and AO of I-II degrees (24 men) aged from 46 to 60 years were examined using standard methods. Insulin resistance (IR) was determined by HOMA-IR. All patients received three-component antihypertensive therapy (a fixed combination of perindopril, indapamide and amlodipine) and, due to elevated low-density lipoprotein-cholesterol (LDL-C), atorvastatin in optimal doses. Liraglutide was administered as daily subcutaneous injections at a daily dose of 0.6 mg, with a gradual weekly dose increase of 0.6 mg to reach 3.0 mg/day. The duration of observation was 16 weeks. Results: After 16 weeks of treatment with liraglutide, 30 patients (71%) (the first subgroup) experienced a decrease in BW of 5% or more compared to baseline. At the same time, in 13 patients (29%) (second subgroup) BW decreased by less than 5% compared to the initial level or did not decrease. In the first subgroup of patients, a significant decrease in IR was detected from (5.06 ± 1.14) to (2.40 ± 1.22), p<0.05), whereas in the second subgroup the IR indicator did not change significantly. Among patients of the first subgroup, a significantly higher frequency of achieving target levels of “office” blood pressure (in 100% of patients) and target levels of LDL-C (in 73% of patients) was found in comparison with patients of the second subgroup (in 69% of patients, p<0.05) and in 39% of patients, p<0.05), respectively). Conclusions: A pronounced decrease in BW in hypertensive patients with AO under the influence of liraglutide is associated with a significant decrease in IR and also with a significant increase in the effectiveness of both antihypertensive and lipid-lowering therapy.

The Effectiveness of Warm Water Foot Soaks and Progressive Muscle Relaxation to Reduce Blood Pressure Among Patients with Hypertension in Cihanjuang Rahayu Village, West Bandung, Indonesia

One of the highest cardiovascular diseases that cause premature death is hypertension. In addition to pharmacological therapy used to maintain blood pressure ≤ 140/90 mmHg, there are also non-pharmacological therapies, namely warm water foot soak and progressive muscle relaxation. This study aims to determine the effect of a warm water foot soak and progressive muscle relaxation therapy in hypertensive patients. The design used in this research is Quasi-Experiment, with the design with the pretest-posttest nonequivalent control group. The sampling technique is consecutive sampling, the number of samples was 20 patients with hypertension. The tests used were Paired T-test and Independent T-test. The results of the study 10 respondents who had received hydrotherapy soaked in warm water foot got an average systolic and diastolic value of 131,07 mmHg and 82,92 mmHg, while the other 10 respondents who received progressive muscle relaxation therapy received a mean of systolic and diastolic value 131,83 mmHg and 82,93 mmHg. Based on independent t-test significant with p-values of 0,872 and p-values > 0,993. There is no difference in effectiveness between interferences of a warm water foot soak and progressive muscle relaxation to decrease systolic and diastolic blood pressure among patients with hypertension in Cihanjuang Rahayu Village, West Bandung.

THE ROLE OF MEDICATION LITERACY IN THE TREATMENT OF HYPERTENSIVE PATIENTS: A REVIEW

Hypertension, or high blood pressure, has become a major contributor to cardiovascular disease globally. Its prevalence continues to increase, necessitating intensive healthcare efforts. Medication literacy, or the skill of understanding and applying medication information, is crucial for chronic patients, including those with hypertension. However, there has been limited research on this topic, highlighting the need for a literature review of the levels and roles of literacy in the therapy of hypertensive patients. This study used a narrative review approach to analyze the findings of articles on medication literacy in hypertensive patients. This study employs a narrative review approach to analyze findings from various journals. The data were derived from articles focusing on medication literacy in hypertensive patients, identified through literature searches on PubMed from 2013 to 2023. The selected articles were published in international journals, have a full text, can provide data on the role of medication literacy in hypertensive patients, and use quantitative, qualitative, or mixed-methods research designs.Two studies included in the review originated from China. Both articles reported low literacy levels among hypertensive patients. Factors, such as education and income, can also influence literacy. These findings underscore the importance of improving medication literacy in hypertension management, emphasizing the need for better education and more effective development strategies. Both articles also emphasized the significance of medication literacy in the context of hypertension management; that is, they highlighted the need for improved medication literacy and provided evidence of the positive impact of medication literacy on blood pressure control...

Initial treatment with a single capsule containing half-dose quadruple therapy versus standard-dose dual therapy in hypertensive patients (QUADUAL): statistical analysis plan for a randomized, blinded, crossover trial

BackgroundCombined antihypertensive therapy has obvious advantages over single drug therapy. Hypertension guidelines fully affirm the efficacy of dual combination in initial antihypertensive therapy. Recent studies have also pointed out that the quadruple combination of very low-dose antihypertensive drugs is superior to single drugs. However, whether low-dose quadruple therapy is better than dual combination is unknown.Methods/designA randomized double-blind crossover clinical trial will be conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg + metoprolol 23.75 mg + amlodipine 2.5 mg + indapamide 1.25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg + amlodipine 5 mg) in the initial treatment of patients with mild to moderate hypertension (140–179/90–109 mmHg). Ninety patients are required and will be recruited and randomly assigned in a 1:1 ratio to two crossover groups. Two groups will receive a different combination therapy for 4 weeks, then switch to the other combination therapy for 4 weeks, with a 2-week wash-out. Antihypertensive effects and related adverse effects of the two antihypertensive combination treatments will be compared. The primary outcome, i.e., mean 24-h systolic blood pressure in ambulatory blood pressure monitoring, will be assessed via linear mixed-effects model.DiscussionThis statistical analysis plan will be confirmed prior to blind review and data lock before un-blinding and is sought to increase the validity of the QUADUAL trial.Trial registrationClinicalTrials.gov, NCT05377203. Registered May 11, 2022, https://clinicaltrials.gov/study/NCT05377203.

The Relationship of Compliance With Medication on Blood Pressure Stability in Hypertension Patients at Cinere District Health Center 2023

Several reasons for hypertension sufferers who do not comply with taking medication will slow down healing time and worsen the patient's condition and can even cause death. This study aims to determine the characteristics of hypertensive patients at the Cinere Community Health Center, the results of antihypertensive therapy at the Cinere Community Health Center and to determine the relationship between adherence to medication use and the success of therapy at the Cinere Community Health Center. This research uses a correlational analytical research design. Based on the discussion above, it can be concluded that the characteristics of hypertensive patients at the Cinere Community Health Center are the majority aged 45-65 years, female with the highest education level being elementary school and having suffered for > 1 year. The majority of medication adherence among hypertensive patients at the Cinere Community Health Center is still relatively low. The success of therapy in hypertensive patients at the Cinere Community Health Center resulted in a reduction in blood pressure of 31 people and in patients who did not reduce blood pressure there were 71 people. There is a relationship between adherence to taking medication and blood pressure stability in hypertensive patients at the Cinere Community Health Center

The relationship between level of knowledge and adherence therapy in hypertensive patients at Ramadhan Pharmacy in Yogyakarta City

The relationship between level of knowledge and adherence therapy in hypertensive patients at Ramadhan Pharmacy in Yogyakarta City

Gagal Ginjal Kronik Yang Menjalani Terapi Hemodialisa Di RSUD dr ABDUL AZIZ

Hypertension is when a person experiences increased blood pressure on tissue and organ perfusion. One complication that can be caused by hypertension is kidney failure. Urea and creatinine are waste products of the body's metabolism. Ureum and creatinine levels will increase, indicating impaired kidney function. Damage that occurs to the kidneys must be treated one way with hemodialysis. The function of hemodialysis therapy is to reduce urea and creatinine levels in patients with chronic kidney failure.The study's general objective was to analyze urea and creatinine levels in hypertensive patients with chronic kidney failure undergoing hemodialysis therapy at dr. Abdul Aziz Singkawang General Hospital. The research design is analytically observational with a cross-sectional research design. Secondary data in this study were obtained from medical records and laboratory results of hypertensive patients with chronic kidney failure undergoing hemodialysis therapy without complications of DM, namely 37 respondents who performed urea and creatinine examinations before and after hemodialysis at dr. Abdul Aziz Singkawang by using a purposive sampling technique.The results of the study found 64 hypertensive patients undergoing hemodialysis and obtained a sample of 37 patients who met the criteria, namely hypertensive patients undergoing hemodialysis without complications of DM got an average urea level before hemodialysis 187.1919 mg/dl and after hemodialysis 136.0162 mg/dl. The intermediate creatinine level before hemodialysis was 14.0870 mg/dl and 11.0224 mg/dl after hemodialysis.The results of the Wilcoxon Signed Rank Test. They obtained p-value = 0.000 <α (0.05), which indicated differences in urea and creatinine levels before and after hemodialysis therapy in hypertensive patients with chronic kidney failure.

Pemanfaatan Hidrotherapy Jahe Merah untuk Menurunkan Tekanan Darah pada Keluarga di Kelurahan Legok

Based on profile data from Jambi Province, it shows that the incidence of hypertension ranks first from 2018 to 2020. The increasing incidence of hypertension requires community nurses to teach the public how to treat it with red ginger hydrotherapy. Research Before results show that red ginger hydrotherapy has an effect on blood pressure. For this reason, it is necessary to carry out community service regarding the use of red ginger hydrotherapy to treat hypertension problems. This service aims to provide education to the public on how to treat hypertension with red jehe hydrotherapy. This service will be carried out on 22-25 May 2022 to 15 people in Legok Village, Jambi City. The method for implementing this activity is 1). Pretest 2). Providing education about how to treat hypertension with red ginger hydrotherapy, 3). Post test. Education is carried out for 60 minutes. Based on the results of checking the highest systolic blood pressure before treatment was 180 mmHg and the lowest 140 mmHg, while the results of measuring diastolic blood pressure it can be concluded that the highest blood pressure before treatment was 100 and after giving hydrotherapy there was the highest change, namely 80 mmHg. These results indicate that there was a change in blood pressure after administering red ginger hydrotherapy. So red ginger hydrotherapy can be recommended as a therapy for hypertensive patients. For further service, research on red ginger and salt hydrotherapy to treat hypertension is recommended

Surgical management of intractable epistaxis:Endoscopic sphenopalatine artery coagulation

<b>Introduction:</b> Epistaxis is one of the most common challenges for emergency departments. Hypertension is regarded as a risk factor of epistaxis. Anticoagulant therapy in hypertensive patients increases the risk of nosebleed even more. Approximately 10% of patients with epistaxis require hospital admission for this condition, some of which need surgical intervention. Management can be problematic, mainly in case of recurrent posterior epistaxis. Over the past decade, with the widespread popularization of endoscopic sinus surgery and the deeper understanding of local regional anatomy, endoscopic control of the sphenopalatine artery (SPA) has been advocated as an effective alternative for the control of posterior epistaxis.</br></br> <b>Aim:</b> The aim of this article is to familiarize the reader with local anatomy and surgical technique of SPA ligation/coagulation.</br></br> <b>Material and method:</b> The SPA ligation or coagulation is indicated for intractable epistaxis, which is defined as recurrent bleeding despite adequate anterior and posterior nasal packing. The sphenopalatine artery (SPA) is a terminal branch of the internal maxillary artery, which is a branch of the external carotid artery. The SPA supplies the turbinates, the lateral nasal wall and nasal septum. The most important anatomical landmark enabling to identify the artery at its entry to the nasal cavity is crista ethmoidalis, which is typically located above the sphenopalatine foramen. The artery can be localized with or without creating the middle antrostomy. Locating the SPA without opening of the maxillary sinus can be challenging for inexperienced surgeon. The middle-meatal antrostomy prior to SPA ligation reveals more anatomical landmarks. Efficacy of SPA coagulation/ligation ranges between 74 to 100%. Failure to localize all the branches of the SPA is regarded as the most common reason for re-bleeding. Complications of the procedure are rare, mild and transient.</br></br> <b>Conclusion:</b> Endoscopic sphenopalatine artery coagulation or ligation is a safe and effective technique for controlling persistent posterior epistaxis. Understanding the anatomic relationships is important in performing this procedure. It has become established standard treatment for intractable epistaxis.

The Impact of Pharmaceutical Care Implementation on The Incidence of Drug-Related Problem and Clinical Outcome of Hypertension Patients at Puskesmas Lubuk Pakam in 2021


 
 
 
 The role of pharmacists in the implementation of pharmaceutical care has been shown to improve the outcome of therapy in hypertension patients in various countries. This study aimed to implement pharmaceutical care for hypertension patients and determine its impact on the incidence of drug-related problems (DRPs) and clinical outcomes of hypertension patients in Puskesmas Lubuk Pakam. This study used a comparative experimental method before and after the intervention of 73 hypertension patients in March-August 2021. Identification of the of DRPs was using the PCNE V9.00 standard and blood pressure values were obtained from direct examination of patients. Data were analyzed using the Wilcoxon Signed-Rank test. The results showed that the average DRPs incidence was significantly reduced after the intervention (observation, interview, and education) on the hypertension patients. The average blood pressure before intervention was 154.38 ± 16.20 mmHg and after intervention became 144.04 ± 15.94 mmHg (p value = 0.000). Based on the results of the study, it can be concluded that the application of pharmaceutical care can reduce the incidence of DRPs and improve clinical outcomes in hypertension patients in Puskesmas Lubuk Pakam.
 
 
 

Initial treatment with a single capsule containing half-dose quadruple therapy vs standard-dose dual therapy in hypertensive patients (QUADUAL): Study protocol for a randomized, blinded, crossover trial

Combined antihypertensive therapy has obvious advantages over single drug therapy. Hypertension guidelines fully affirm the efficacy of dual combination in initial antihypertensive therapy. Recent studies have also pointed out that the quadruple combination of very low-dose antihypertensive drugs is superior to single drugs. However, whether low-dose quadruple therapy is better than dual combination is unknown. To evaluate and compare the efficacy and safety of half-dose quadruple therapy vs standard-dose dual therapy in the initial treatment of hypertensive patients with systolic/diastolic blood pressure 140-179/90-109 mm Hg. A randomized double-blind crossover clinical trial will be conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg+metoprolol 23.75 mg+amlodipine 2.5 mg+indapamide 1.25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg+amlodipine 5 mg) in the initial treatment of patients with mild to moderate hypertension (140-179/90-109 mm Hg). Ninety patients are required and will be recruited and randomly assigned in a 1:1 ratio to 2 crossover groups. Two groups will receive a different combination therapy for 4 weeks, then switch to the other combination therapy for 4 weeks, with a 2-week wash-out. The patients will be followed up for 4 weeks to compare the antihypertensive effects and related adverse effects of the 2 antihypertensive combination treatments. We present the rationale for the design of the QUADUAL trial. The trial started in July 2022 and is expected to be completed by August 2023. The study aims to evaluate if an initial treatment regimen of quadruple combination of half-dose blood pressure medications will result in greater reduction in blood pressure and fewer side effects compared to standard dose dual therapy. www. gov (NCT05377203).

The relationship between the pan-immune-inflammation value and long-term prognoses in patients with hypertension: National Health and Nutrition Examination Study, 1999-2018.

Direct antihypertensive therapy in hypertensive patients with a high CVD risk can reduce the incidence of cardiovascular death but increase adverse cardiovascular events, so additional ways to identify hypertensive patients at high risk may be needed. Studies have shown that immunity and inflammation affect the prognoses of patients with hypertension and that the pan-immune-inflammation value (PIV) is an index to assess immunity and inflammation, but few studies have applied the PIV index to patients with hypertension. To explore the relationship between the PIV and long-term all-cause and cardiovascular mortality in patients with hypertension. Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 with a mortality follow-up through December 31, 2019, were analyzed. A total of 26,781 participants were evaluated. The patients were grouped based on PIV levels as follows: T1 group (n = 8,938), T2 group (n = 8,893), and T3 group (n = 8,950). The relationship between the PIV and long-term all-cause and cardiovascular death was assessed by survival curves and Cox regression analysis based on the NHANES recommended weights. The PIV was significantly associated with long-term all-cause and cardiovascular mortality in patients with hypertension. After full adjustment, patients with higher PIV have a higher risk of all-cause [Group 3: HR: 1.37, 95% CI: 1.20-1.55, p < 0.001] and cardiovascular [Group 3: HR: 1.62, 95% CI: 1.22-2.15, p < 0.001] mortality. Elevated PIV was associated with increased all-cause mortality and cardiovascular mortality in hypertensive patients.

Different clinical characteristics and outcomes of hypertrophic cardiomyopathy with and without hypertension: seeking the truth.

To determine the different clinical characteristics and outcomes of hypertrophic cardiomyopathy (HCM) patients with and without hypertension (HT). A total of 696 HCM patients were included in this study and all HCM diagnoses were confirmed by the genetic test. Patients were analyzed separately in the septal reduction therapy (SRT) cohort and the non-SRT cohort. The primary endpoint was cardiovascular death and the secondary endpoint was all-cause death. Outcome analyses were conducted to evaluate the associations between HT and outcomes in HCM. Medications before enrollment and at discharge were collected in the post-hoc analyses. HCM patients without HT were younger, had a lower body mass index, were more likely to have a family history of HCM, and had a smaller left ventricular (LV) end-diastolic diameter than those with HT in both cohorts. A thicker LV wall, a higher level of N-terminal pro-B-type natriuretic peptide, and a higher extent of LV late gadolinium enhancement were additionally observed in patients without HT in the non-SRT cohort. The presence of HT did not alter the distribution pattern of late gadolinium enhancement, as well as the constituent ratio of eight disease-causing sarcomeric gene variants in both cohorts. Outcome analyses showed that in the non-SRT cohort, patients without HT had higher risks of cardiovascular death (HR = 2.537, P = 0.032) and all-cause death (HR = 3.309, P = 0.032). While such prognostic divergence was not observed in the SRT cohort. Further post-hoc analyses in the non-SRT cohort found that patients without HT received fewer non-dihydropyridine calcium channel blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before enrollment and at discharge. HCM patients without HT had worse clinical conditions and higher mortality than patients with HT overall, which may result from active medical therapy in HT patients. Active SRT may have a substantial de-risking effect on patients meeting the indications.

Training, detraining and retraining effects of moderate vs. high intensity exercise training programme on cardiovascular risk factors.

The aim of the present study was to analyse the effect of 12 weeks of training, 7 weeks of detraining and 16 weeks of retraining using a moderate or high intensity training programme on cardiovascular risk factors in hypertensive patients. Thirty-four patients took part in the study. The intensity training was 80-90% of maximum heart rate for the high-intensity training (HIT) group ( n = 15) and at 50-70% of maximum heart rate for the moderate training (MT) group ( n = 19). Blood pressure, body composition, lipid profile, fasting glucose, strength and cardiovascular fitness were analysed. The first training period did not decrease blood pressure, but the second training period saw significant decreases in blood pressures in HIT group. Moreover, 12 weeks of MT or HIT did not decrease body mass, body mass index or fat mass. However, after 7 weeks of detraining, the inclusion of a second training period using HIT saw decreases in these body composition variables. Both training periods and intensities improved high-density lipoprotein and low-density lipoprotein, but only HIT decreased total cholesterol. In addition, after 7 weeks of detraining, the lipid profile variables returned to baseline values. Additionally, 16 weeks of retraining with HIT or MT decreased blood glucose significantly. Moreover, MT and HIT training programmes in both periods improved cardiorespiratory fitness, but with 7 weeks of detraining, it returned to baseline values. Our data demonstrated the effectiveness of the inclusion of a MT or HIT programme as adjuvant therapy in hypertensive patients.

S-29-2: MEDICAL THERAPY FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION

Hypertension constitutes the major risk factor for heart failure (HF) with preserved ejection fraction (HFpEF); prevalences above 90% have been reported. HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality comparable to HFrEF. Long specific guideline-directed medical therapy (GDMT) for HFpEF was hard to establish due to lack of convincing positive outcome data from randomized controlled trials (RCTs) mainly because of major limitations of the available studies. Available evidence has however increased with recent and larger RCTs with statistical power. Besides, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) provides the backbone of BP lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, except for in re-analysis with adjustment for commonly available baseline characteristics or repeat event analysis, we propose that this core drug treatment strategy is applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone (MRA) apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor (ARNi). In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors (SGLT2-i) and finerenone (non-steroidal MRA) represent promising therapies. Besides, beta-blocker therapy is widely indicated in 60–80% of HFpEF patients due to HT with rapid heart rate (&gt;80 beats/min), rapid atrial fibrillation and/or coronary heart disease. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high quality RCTs are coming towards firmer conclusions.

Genetic approaches in the choice of therapy for hypertension in the population of Mountain Shoria

Objective. To determine the prognostic role of the polymorphism of candidate genes for hypertension (HTN) in the effectiveness of antihypertensive therapy in the population of Mountain Shoria, taking into account the ethnic factor. Design and methods. The material for the study was the population of indigenous (Shors) and nonindigenous inhabitants of Mountain Shoria. In the first stage of the study (2013–2017), 901 indigenous people and 508 non-indigenous people were included in the continuous method. A group of patients with HTN was identified — 367 (40,7 %) shors and 230 (45,3 %) representatives of non-indigenous ethnic group. The second stage of the study involved 525 patients with HTN (317 shors, 208 non-indigenous representatives). According to the recommendations of National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010), antihypertensive therapy was prescribed by a cardiologist. A re-examination of patients with HTN included in the prospective stage of the study was carried out after a month, 3 months and 6 months by a paramedic of the local feldsher-obstetric center and after 12 months by a cardiologist. Gene polymorphism ACE (I/D, rs 4340), AGT (c. 803T &gt; C, rs699), AGTR 1 (А1166С, rs5186), ADRB 1 (с. 145A &gt; G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c. 677C &gt; T, Ala222Val, rs1801133) and NOS 3 (VNTR, 4b/4a) were tested using polymerase chain reaction. Results. In the Shors cohort, the minor allele D of the ACE gene and the favorable allele A of the AGTR 1 gene were associated with a significant decrease in blood pressure (BP) with the 2-component therapy for HTN using blockers of the renin-angiotensin-aldosterone system (RAAS) with a diuretic (odds ratio (OR) = 5,01 and OR = 6,28). The carriage of the mutant allele D of the ACE gene in subjects with the 3-component therapy (RAAS blocker, calcium channel blocker (CCB), diuretic) also determined the achievement of the target BP level (OR = 3,11). In the cohort of non-indigenous nationality, allele A of the AGTR 1 gene was associated with positive dynamics of BP with the use of another combination therapy with a RAAS blocker and CCB (OR = 5,38). Conclusions. Taking into account the ethnicity, genetic characteristics of the patient when choosing drugs is a key point in the effectiveness of therapy in HTN patients. The possibility of using pharmacogenetics in the practice of a cardiologist opens up promising areas and has a great future.

Role of plasma extracellular vesicles in prediction of cardiovascular risk and alterations in response to statin therapy in hypertensive patients.

Background:Rapid and accurate new biomarkers to predict risk of cardiovascular disease (CVD) are essential. The utility of extracellular vesicles in predicting the CVD risk is postulated, yet it remains unknown whether their expression is altered in response to statin therapy.Methods:We performed in-vitro studies with human umbilical vein endothelial cells (HUVEC) and vascular smooth muscle cells (hVSMC), and conducted a nested case–control study (nCCS) in hypertensive patients (n = 40) randomized to either atorvastatin or placebo in the ASCOT-LLA. Cases had a major adverse cardiovascular event or death (MACE) during 3.5 years of follow-up (median) from the time of extracellular vesicle characterization while controls, matched for age and duration of treatment, remained event-free. Conditional logistic regression models determined the risk of MACE. Additionally, the relationship of extracellular vesicle levels with statin therapy was assessed.Results:Added to HUVEC, extracellular vesicles increased neutrophil recruitment, and to hVSMC, aggravated calcification and proliferation. In the nCCS, compared with controls, cases (i.e. with MACE) had preceding higher levels of CD14+ and CD14+/CD41+ extracellular vesicles (P = 0.009 and P = 0.012, respectively) and a significant reduction in the median size of the vesicles (P = 0.037). On matched analysis, higher CD14+ extracellular vesicles were associated with a 3.7-fold increased risk of MACE (P = 0.032). Patients treated with atorvastatin (vs. placebo) had both reduced size of extracellular vesicles and the proportion of CD146+ extracellular vesicles (P = 0.034 and P = 0.020, respectively).Conclusion and relevance:These pilot analyses suggest a mechanistic role for extracellular vesicles in the development of CVD, with significant and differential changes in extracellular vesicles amongst those at risk of MACE, and those on atorvastatin therapy.

Patient preference for renal denervation therapy in hypertension: A cross-sectional survey in Chengdu, China.

This study investigated patient preferences for renal denervation (RDN) therapy in hypertension patients in Chengdu, China. A questionnaire-based cross-sectional study was conducted between August and December 2020. First, we collected and analyzed information on demographics, the duration of hypertension, the presence or absence of medication, the medication regimen, the duration of medication, maximal and minimal blood pressure levels, self-reported comorbidities, the willingness of patients to choose RDN as a blood pressure control strategy, choice determinants and expectations for RDN. In total, 485 patients were interviewed, and 402 questionnaires were eligible for analysis. The mean age of the participants was 61 years, 53.9% of the participants were male, and 32.6% of the patients demonstrated a willingness to choose RDN as a blood pressure control strategy. The proportion of patients who were already on medication was 34.7%, whereas the proportion of those who were not on medication was 23.3%. Furthermore, 47.3% of the patients would choose RDN treatment if the procedure could decrease their blood pressure by over 20 mmHg, while no patient would choose the device treatment if their blood pressure would decrease by less than 5 mmHg. In addition, 56.5% of the patients expected that they could take one less medication after RDN. Approximately 70% of the patients expected that RDN could consistently decrease their blood pressure for at least 15 years. In summary, among hypertensive patients in Chengdu, an estimated one-third were willing to choose RDN therapy as a blood pressure control approach; these patients were younger, more likely to be male, took more antihypertensive drugs, and had concomitant metabolic disorders. The perspectives of patients on RDN were not dependent on their education levels; also, their expectations for RDN were high.

Why not change the therapy of hypertension in patients with COVID-19. Dual role of angiotensin-converting enzyme 2

Despite many organizational and medical efforts, the COVID-19 epidemic continues and is taking a lethal toll. Preliminary reports have already reported that the mortality associated with this disease is much higher in people with comorbidities, including hypertension. SARS-CoV-2 virus enters the body through the receptor which is the angiotensin converting enzyme 2 (ACE2). The administration of angiotensin converting enzyme inhibitors or sartans increases the activity of this enzyme. Therefore, there was a suspicion that patients treated with these preparations become more easily infected, and the infection itself is more severe and is associated with greater mortality. On the other hand, the ACE2 enzyme is known to reduce the risk of lung damage. The paper presents current reports describing the frequency of SARS-CoV-2 virus infection in patients with hypertension, the course of infection and the effect of administration of ACE inhibitors and sartans on the mortality of these patients. The presented data indicate that the use of angiotensin converting enzyme inhibitors and sartans in patients with COVID-19 does not worsen the course of the disease, and according to some authors this treatment even reduces the mortality of this infection.