Treatment Of Mild Hypertension Research Articles

‘People say it is dangerous’

Introduction: Mild hypertension is a common asymptomatic condition present in people at low risk of future cardiovascular events. These people represent approximately two-thirds of those diagnosed with hypertension. The best available evidence does not support pharmacological treatment for mild hypertension to reduce cardiovascular mortality. Additionally, overdetection of hypertension also occurs, and this practice is supported by public awareness campaigns, screening, easy access to testing, and poor clinical practice, enhancing the overdiagnosis potential. Moreover, sparse qualitative patient-oriented evidence that diagnosing hypertension has harmful consequences is observed. Therefore, evidence regarding the potential for unintended psychosocial effects of diagnosing mild hypertension is required. Objective: The aim of this study was to investigate if diagnosing low-risk people with mild hypertension has unintended psychosocial consequences. Methods: Eleven semi-structured single interviews and four focus groups were conducted in São Paulo, Brazil, among people diagnosed with mild hypertension without comorbidities. Informants were selected among the general population from a list of patients, a primary healthcare clinic, or a social network. The informants had a broad range of characteristics, including sex, age, education level, race/skin colour, and time from diagnosis. Data were subjected to qualitative thematic content analysis by three of the authors independently, followed by discussions, to generate categories and themes. Results: The informants confirmed that the hypertension diagnosis was a label for psychosomatic reactions to stress, medicalised illness experiences, and set a biographical milestone. We observed unintended consequences of the diagnosis in a broad range of psychosocial dimensions, for example, fear of death, disabilities, or ageing; pressure and control from significant others; and guilt, shame, and anxiety regarding work and leisure. Although informants had a broad range of characteristics, they shared similar stories, understandings, and labelling effects of the diagnosis. Conclusion: The diagnosis of hypertension is a significant event and affects daily life. Most of the impact is regarded as negative psychosocial consequences or harm; however, sometimes the impact might be ambiguous. Patients’ explanatory models are key elements in understanding and changing the psychosocial consequences of the diagnosis, and healthcare providers must be aware of explanatory models and psychosocial consequences when evaluating blood pressure elevations.

Study protocol for the randomized controlled EVA (early vascular adjustments) trial: tailored treatment of mild hypertension in pregnancy to prevent severe hypertension and preeclampsia

BackgroundIn contrast to severe gestational hypertension, it is questioned whether antihypertensive medication for mild to moderate gestational hypertension prevents adverse maternal and offspring outcomes. Hypertensive drugs halve the risk of severe hypertension, but do not seem to prevent progression to preeclampsia or reduce the risk of complications in offspring. In fact, beta-blockers, a first line therapy option, are suspected to impair foetal growth. Disappointing effects of antihypertensive medication can be anticipated when the pharmacological mode of action does not match the underlying haemodynamic imbalance. Hypertension may result from 1) high cardiac output, low vascular resistance state, in which beta blockade is expected to be most effective, or 2) low cardiac output, high vascular resistance state where dihydropyridine calcium channel blockers or central-acting alpha agonists might be the best corrective medication. In the latter, beta-blockade might be maternally ineffective and even contribute to impaired foetal growth by keeping cardiac output low. We propose a randomized controlled trial to determine whether correcting the haemodynamic imbalance in women with mild to moderate hypertension reduces the development of severe hypertension and/or preeclampsia more than non-pharmacological treatment does, without alleged negative effects on foetal growth.MethodsWomen diagnosed with mild to moderate hypertension without proteinuria or signs of other organ damage before 37 weeks of pregnancy are invited to participate in this randomized controlled trial. Women randomized to the intervention group will be prescribed tailored antihypertensive medication, using a simple diagnostic and treatment algorithm based on the mean arterial pressure/heart rate ratio, which serves as an easy-to-determine proxy for maternal circulatory state. Women randomized to the control group will receive non-pharmacological standard care according to national and international guidelines. In total, 208 women will be randomized in a 1:1 ratio. The primary outcome is progression to severe hypertension and preeclampsia and the secondary outcomes are adverse maternal and neonatal outcomes.DiscussionThis trial will provide evidence of whether tailoring treatment of mild to moderate gestational hypertension to the individual haemodynamic profile prevents maternal disease progression.Trial registrationNCT02531490, registered on 24 August 2015.

Benefits and harms of antihypertensive treatment for low risk mild hypertension: a real world, matched cohort study of over 38,000 adults

Benefits and harms of antihypertensive treatment for low risk mild hypertension: a real world, matched cohort study of over 38,000 adults

Abstract 115: Hydrochlorothiazide Lowers Systemic Blood Pressure Predominantly Through Vasodilation in Conditions Associated with Vasoconstriction

Thiazide derivatives are specific inhibitors of the Na+_Cl- Co-transporter (NCC) in the kidney distal tubules, and the most commonly used diuretic for the treatment of mild hypertension. The mechanism by which thiazides reduce the blood pressure (i.e. renal vs. extra renal) is not well understood. The blood pressure response to thiazides requires an initial volume loss (averaging about 1.5 kg) since it is not observed in individuals who are ingesting a high-salt diet. The objective of this study was to elucidate the renal and extra renal effects of thiazides. Using NCC deficient mice, we demonstrate that hydrochlorothiazide (HCTZ), a commonly used thiazide derivative, reduces blood pressure in the presence of volume-depletion and augmentation of circulating angiotensin levels but not in mice with normal vascular volume (NCC KO at baseline = 131.6 ± 4.4 vs. NCC KO with HCTZ = 125.8 ± 3.7 mm Hg) vs. (volume depleted NCC KO at baseline = 118.2 ± 4.1 vs. volume depleted NCC KO with HCTZ= 96.37± 4.5 mm Hg; p <0.05). The reduction in blood pressure by HCTZ occurs in the absence of increased salt excretion or urine output, indicating its extra-renal mechanism. Echocardiography demonstrated no significant changes in cardiac index in response to the drop in blood pressure by HCTZ (WT at baseline = 0.639 ± 0.05 vs. WT with HCTZ = 0.590 ± 0.01 ml/min/g) vs. (volume depleted NCC KO at baseline = 0.617± 0.07 vs. volume depleted NCC KO with HCTZ = 0.509 ± 0.04 ml/min/g). The antihypertensive effects of HCTZ were abrogated in the presence of paxilline, a specific blocker of large conductance calcium activated potassium channels (BK channels) in the vascular smooth muscle cell. Western blotting demonstrated enhanced expression of BK channels in vascular system of volume depleted NCC deficient mice vs. WT mice. Our results indicate that systemic vasoconstriction, as observed in volume depleted states, will amplify the extra-renal effects of HCTZ to lower blood pressure through vasodilation irrespective of the status of its renal target NCC. Patients with congestive heart failure who are on a combination of a loop diuretic and HCTZ are at increased risk of significant hypotension subsequent to the activation of extra-renal effects of HCTZ, specifically when they become volume depleted.

Waste and Harm in the Treatment of Mild Hypertension

Waste and Harm in the Treatment of Mild Hypertension

Angiotensin Converting Enzyme Inhibitory Peptides from a Lactotripeptide-Enriched Milk Beverage Are Absorbed Intact into the Circulation1

Food products containing angiotensin converting enzyme (ACE) inhibitory peptides reportedly play a role in treatment of mild hypertension. The aim of this placebo-controlled crossover study was to assess the bioavailability of Ile-Pro-Pro and 7 other ACE-inhibiting peptides present in a lactotripeptide (LTP)-enriched yogurt beverage and whether meal intake affects Ile-Pro-Pro bioavailability. Six male and female subjects randomly consumed an LTP-enriched yogurt beverage or a placebo in the fasted state and an LTP-enriched yogurt beverage in the fed or fasted state. The area under the curve (AUC) of Ile-Pro-Pro after the LTP treatment in the fasted state was 2.1-fold of that after the placebo treatment (P < 0.001). The maximum peptide plasma concentration (Cmax) value was greater after consumption of the LTP-enriched beverage (897 ± 157 pmol/L) than after the placebo treatment (555 ± 0.09 pmol/L; P < 0.001) with a greater time after ingestion when reaching Cmax (Tmax) in the placebo treatment. Plasma concentrations of the peptides Leu-Trp, Phe-Tyr, Ile-Tyr, and Leu-Pro-Pro increased compared with baseline (P < 0.05) in the LTP-enriched and placebo treatment when consumed in the fasted state. However, ∆Cmax values differed significantly between the placebo and LTP-enriched treatment only for Leu-Pro-Pro. Meal intake affected Ile-Pro-Pro concentrations. When the beverage was consumed after a meal, the AUC of Ile-Pro-Pro was 1.3-fold (P < 0.05) of the AUC derived from premeal intake. This was due to an increase in the plasma elimination half-life (P < 0.05); Cmax and Tmax were not affected by meal intake. In summary, this is the first demonstration, to our knowledge, that the tripeptide Ile-Pro-Pro selectively escapes from intestinal degradation and reaches the circulation undegraded.

Hypertension artérielle chez l'enfant et l'adolescent

Hypertension is an under-recognized clinical entity in children. Blood pressure (BP) assessment should be one of the routine examinations in childhood and adolescence. Many particular features characterize hypertension in children: optimal BP determination in children requires the use of an appropriately sized cuff and BP measurement must be repeated for confirmation. The definition of hypertension is based on the normative distribution of BP in healthy children according to gender, height and age. It is graded to distinguish mild hypertension from confirmed or severe hypertension. Ambulatory BP monitoring may facilitate detection of borderline hypertension and treatment monitoring. Careful clinical assessment is the key for identifying predisposition to primary adult hypertension or secondary causes. Target organ abnormalities, additional cardiovascular risk factors and comorbidities have to be taken into account. High BP in childhood and primary hypertension have to be considered as risk factors for cardiovascular disease in early adulthood. Secondary hypertension is common in children with confirmed or severe hypertension and screening test should be individualized for each child. Renal or renovascular causes concern a majority of children but aortic coarctation or endocrine diseases can also be found. Symptomatic children and patients with severe hypertension require antihypertensive drug therapy. Lifestyle modifications including diet exercise and reduction of overweight remain the basic principles of the treatment in mild hypertension.

Treatment of Mild Hypertension with Hyzaar

1096 Hyzaar, a combination of losartan potassium-hydrochlorothiazide, reduces blood pressure (BP) via blockade of angiotensin II AT1 receptors and presumably by concomitant diuresis. PURPOSE: To examine the hemodynamic effects of Hyzaar on acute and chronic control of mild hypertension. METHODS: 12 newly diagnosed patients (49.25 ± 10.59 yrs) with mild hypertension received Hyzaar (50/12.5 mg) daily. 24-hour ambulatory blood pressure (ABPM), heart rate (HR), stroke volume (SV), cardiac output (CO), total peripheral vascular resistance (TPR), forearm blood flow (FBF), forearm vascular resistance (FVR), norepinephrine (NE), renin activity (RA), aldosterone, and hematocrit were measured before (baseline), after 1–2 wk (acute), and 3–4 mo treatment (chronic). RESULTS: See Table 1. CONCLUSION: Both acute and chronic antihypertensive effects of Hyzaar are mediated primarily by the reduction of regional and systemic vascular resistance. Despite inclusion of a diuretic, resting CO and SV were preserved. We speculate that these hemodynamic effects of Hyzaar make it an ideal antihypertensive for athletes or active patients with mild hypertension.Table: Acute and chronic hemodynamic effects of Hyzaar

Treatment of Mild Hypertension with Hyzaar

1096 Hyzaar, a combination of losartan potassium-hydrochlorothiazide, reduces blood pressure (BP) via blockade of angiotensin II AT1 receptors and presumably by concomitant diuresis. PURPOSE: To examine the hemodynamic effects of Hyzaar on acute and chronic control of mild hypertension. METHODS: 12 newly diagnosed patients (49.25 ± 10.59 yrs) with mild hypertension received Hyzaar (50/12.5 mg) daily. 24-hour ambulatory blood pressure (ABPM), heart rate (HR), stroke volume (SV), cardiac output (CO), total peripheral vascular resistance (TPR), forearm blood flow (FBF), forearm vascular resistance (FVR), norepinephrine (NE), renin activity (RA), aldosterone, and hematocrit were measured before (baseline), after 1–2 wk (acute), and 3–4 mo treatment (chronic). RESULTS: See Table 1. CONCLUSION: Both acute and chronic antihypertensive effects of Hyzaar are mediated primarily by the reduction of regional and systemic vascular resistance. Despite inclusion of a diuretic, resting CO and SV were preserved. We speculate that these hemodynamic effects of Hyzaar make it an ideal antihypertensive for athletes or active patients with mild hypertension.Table: Acute and chronic hemodynamic effects of Hyzaar

Maximizing the benefit of treatment in mild hypertension:three simple steps to improve diagnostic accuracy.

Most patients only have three measurements of blood pressure before being labelled as hypertensive. This may lead to inaccurate classification, unnecessary treatment and dilution in treatment benefit for the population. To examine the accuracy of current methods of diagnosing mild hypertension, and to explore ways to improving targeting of antihypertensive treatment without entailing lengthy observation. Re-analysis of published data. We tested current diagnostic methods using the data for 3965 individuals who were followed for a year in the placebo arm of the MRC Mild Hypertension Trial. We calculated the proportion selected for treatment by current methods and the diagnostic accuracy, using average blood pressure beyond 6 months as representing 'true' long-term blood pressure. We examined the benefit of averaging blood pressures, of prolonging observation modestly and of estimating within-person blood pressure variability. Prolonging observation to 3 months selects a smaller (by about 12%) proportion of the sample for treatment, a proportion similar to that defined as 'truly' hypertensive. The diagnostic accuracy of current methods is poor, with up to 69% discrepancy in classification. This discrepancy was improved by up to 18% in absolute terms by prolonging observation to 3 months and using average blood pressures. Identifying those individuals with low within-person variability allows marked improvement in the prediction of 'true' hypertension. Although some inaccuracy in the diagnosis of hypertension is inevitable, observation for 3 months, averaging blood pressures and estimating within-person blood pressure variability can markedly improve upon current practice.

Treatment of mild hypertension: is it worthwhile?

Treatment of mild hypertension: is it worthwhile?

Drug treatment of mild hypertension: is it safe?

Drug treatment of mild hypertension: is it safe?

Is coronary risk an accurate surrogate for cardiovascular risk for treatment decisions in mild hypertension? A population validation.

To examine the relationship between coronary (CHD) and cardiovascular (CVD) risk in patients with uncomplicated mild hypertension and to determine the accuracy of using CHD risk > or = 15% over 10 years to identify for antihypertensive treatment those patients with CVD risk > or = 20% over 10 years as advised in recent British guidelines. Comparison of decisions made using CHD risk > or = 15% over 10 years calculated by the Framingham risk function and estimated using a simple table with CVD risk > or = 20% over 10 years. British population. People aged 35-64 years with uncomplicated mild systolic hypertension (SBP 140-159 mmHg, n = 624) from the 1995 Scottish Health Survey. Relationship between CHD and CVD risk. Sensitivity, specificity, positive and negative predictive values (PPV and NPV). CHD risk 15% over 10 years was equivalent to CVD risk 21% over 10 years. Exact CHD risk > or = 15% over 10 years had sensitivity 79%, specificity 98%, PPV 94% and NPV 93% in detecting CVD risk > or = 20% over 10 years. Use of the table to estimate CHD risk > or = 15% over 10 years gave sensitivity 88%, specificity 90%, PPV 76% and NPV 95%. CHD risk appears acceptably accurate for targeting treatment in mild hypertension. The risk assessment table, which slightly overestimates CHD risk, was more sensitive in identifying patients with CVD risk > or = 20% over 10 years and may be preferable to using exact CHD risk. European guidelines which suggest targeting treatment for mild hypertension at CHD risk > or = 20% over 10 years are over-conservative compared with British guidelines.

Coronary and cardiovascular risk estimation for primary prevention:validation of a new Sheffield table in the 1995 Scottish health survey population

Objective: To examine the accuracy of a new version of the Sheffield table designed to aid decisions on lipids screening and detect thresholds for risk of coronary heart disease needed...

Cost-effectiveness of cardiovascular prevention programs in Spain.

Individual programs for prevention of cardiovascular disease include dietary and drug treatment of hypercholesterolemia, hypertension treatment, and smoking cessation therapies. In this study, the cost-effectiveness of available cardiovascular prevention programs was assessed in Spain in terms of net cost per life-year gained (LYG). Cost-effectiveness ratios ranged from US $2,600 to $80,000 per LYG in men and from $4,500 to $230,000 per LYG in women. In men aged 40-59 years, the ranking of increasing cost-effectiveness was: smoking cessation ($2,608-3,738 per LYG); treatment of moderate and severe hypertension ($8,564-38,678 per LYG); treatment of mild hypertension ($11,906-59,840 per LYG); dietary treatment ($16,143-20,158 per LYG); and drug treatment of hypercholesterolemia ($33,850-81,010 per LYG). In women, the ranking list was:smoking cessation ($4,482-5,756 per LYG), treatment of moderate and severe hypertension ($9,585-57,983 per LYG), treatment of mild hypertension ($15,248-86,075 per LYG), dietary treatment ($57,175-62,154 per LYG); and drug treatment of hypercholesterolemia ($104,100-259,150 per LYG).

Primary prevention of cardiovascular disease endpoints using beta-blockers

To the Editor. —In their meta-analysis of the effect of antihypertensive therapies on preventing disease end points, such as stroke, coronary heart disease, congestive heart failure, and total and cardiovascular mortality, Dr Psaty and colleagues 1 concluded that the data provide strong support for the use of β-blockers and diuretics as first-line agents. However, after a closer look at their data, these conclusions are not supported by the data in the case of β-blockers. When calculating the relative risk associated with β-blocker therapy, the authors used 4 studies: (1) Medical Research Council trial of treatment of mild hypertension (MRC) 2 ; (2) Medical Research Council trial of treatment of hypertension in older adults (MRC-O) 3 ; (3) Swedish Trial in Old Patients With Hypertension (STOP-H) 4 ; and (4) Coope and Warrender. 5 By doing so, they glossed over the fact that in STOP-H, two thirds of the patients in the active treatment

Transdermal Clonidine Therapy and Blood Pressure Nocturnal Fall in Mild Hypertensive Male Subjects

Treatment of mild hypertension with an antihypertensive drug administered by means of a transdermal therapeutic system (TTS) could produce favorable results, when compared with a traditional oral regimen. Purpose: Using 24-h ambulatory blood pressure (BP) monitoring (ABPM) in mild hypertensive male subjects, to analyze three aspects which have not been completely clarified: a) whether a latency in the antihypertensive effect may be present, recording BP already from the first day of application of the patch, b) the eventual hazardous enhancement of circadian nocturnal fall in BP values in treated mild hypertensive patients and, c) the possible overlapping of antihypertensive effect between the administration of two consecutive patches. Subjects and methods: In 12 caucasian male outpatients (yrs 55 ± 3 SEM) with uncomplicated essential mild hypertension, a patch containing placebo was applied for the first week (T 0 period). At the end of the T 0 period, a 5 mg TTS-2 clonidine patch was applied for one week, and, subsequently, a new patch of 5 mg TTS-2 clonidine was kept for another week. ABPM was performed on the last day of the placebo period (T 0) and on the 1st day (T1), the 7th day (T2) and the 14th day (T3) of transdermal clonidine therapy. Results: Both systolic and diastolic BP (24 h mean, day-night-time) decreased on the 1st, 7th and 14th day, when compared with T0. However, no significant differences were documented between the BP levels on the 1st and the 7th day of treatment. The incidence of nocturnal fall in systolic and diastolic BP was evaluated and no significant differences were found, when compared with night-time reference values. Conclusions: When compared with the placebo period, TTS-2 clonidine lowers SBP and DBP within the first 24 hours of application. The antihypertensive effect persists at the end of the first week, as well as after 14 days. The lowest values of systolic-diastolic BP documented were not below the levels reported in normotensive men. Therefore, TTS-2 clonidine seems to act as an antihypertensive agent rather than a hypotensive drug since it normalizes BP without lowering it below physiological levels.

Moderate Intensity Aerobic Exercise for the Treatment of Mild Hypertension

Moderate Intensity Aerobic Exercise for the Treatment of Mild Hypertension

Treatment of Mild Hypertension with Low Once‐Daily Doses of a Sustained‐Release Capsule Formulation of Verapamil

The efficacy and safety of a low dose (120 mg) of a sustained-release capsule formulation of verapamil administered once daily in the treatment of 42 patients with mild hypertension were assessed in this clinical trial. After a 4-week placebo washout period (baseline), patients with diastolic clinic blood pressures of 91 to 100 mm Hg inclusive were treated for 4 weeks with once-daily verapamil sustained-release 120 mg capsules. Clinic blood pressure was measured and 24-hour ambulatory blood pressure monitoring was performed at the end of both the baseline and the 4-week treatment periods. Twenty-four hour, day, and night systolic and diastolic ambulatory blood pressure were significantly (P < 0.01) reduced in the entire study population (24-hour, -5/-4 mm Hg; day, -6/-4 mm Hg; night, -4/-3 mm Hg). On the basis of mean daytime (6 AM to 6 PM) ambulatory diastolic blood pressure, patients were stratified into subgroups of patients with confirmed (> 85 mm Hg) and unconfirmed mild hypertension (< or = 85 mm Hg). The magnitude of the mean change in systolic and diastolic blood pressure was greater in the group of patients with confirmed mild hypertension than the group with unconfirmed hypertension. The incidence of adverse experiences was low in frequency and events were of mild severity; quality of life scores improved (P = 0.02). Low daily doses (120 mg) of verapamil sustained-release capsules provide a well-tolerated and sustained antihypertensive effect over 24 hours in patients with mild hypertension.

Gender differences and similarities in effects of nonpharmacologic approaches to the treatment of mild hypertension.

TAIM, the Trial of Antihypertensive Interventions and Management, studied the effects of dietary sodium restriction or weight reduction, alone and in combination with low-dose diuretic or beta blocker on blood pressure after 6 months. The responses to these interventions of men compared to women are presented for those persons randomized to placebo drug. Men undergoing a weight-reduction intervention were able to lose more weight (5.9 kg) than women (3.1 kg), P ⩽ 05. Men also had a greater percentage of wright loss and a greater reduction in body mass index (BMI), although not significantly so. Weight loss was correlated to a decrease in triglycerides (r = 0.37), but not in cholesterol. The weight-reduction intervention lowered triglycerides more in men (-81 mg/dl) than in women(-21 mg/dl; P = .008). There were no sex differences in abiility to reduce sodium or increase potassium for those in the sodium restriction group. Both men and women decreased their sodium to the same extent by 36 mmol/day and 25 mmol, respectively, and increased their potassium by 13 mmol and 11 mmol, respectively. Blood pressure response at 6 months was greater in men than in women on weight reduction (a drop in diastolic pressure of -11 mmHg in men and 7 mmHg in women, P =.04). Sodium restriction had a similar effect on blood pressure in both sexes, and among men resulted in a significantly smaller reduction in blood pressure than did weight reduction. © 1995 Wiley-Liss, Inc.