Type Of Antihypertensive Medication Research Articles

Association between types of antihypertensive medication and the risk of atrial fibrillation: a nationwide population study.

Patients with hypertension are at a high risk of atrial fibrillation (AF). Recent research has indicated the varying effects of antihypertensive medications on developing AF. We investigated the relationship between different types of antihypertensive medications and the risk of AF occurrence. We analyzed data from 113,582 subjects with national health screening examinations between 2009 and 2014. The study population was categorized according to antihypertensive medication type. The primary outcome was the incidence of AF. Among 113,582 subjects (mean age 59.4 ± 12.0 years, 46.7% men), 93,557 received monotherapy [angiotensin receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), beta-blockers, calcium channel blockers (CCB), or diuretics], while 34,590 received combination therapy (ARB/beta-blockers, ARB/CCB, ARB/diuretics, or ARB/CCB/diuretics). During a mean follow-up duration of 7.6 ± 2.1 years, 3.9% of patients were newly diagnosed with AF. In monotherapy, ACEi and CCB had similar AF risks as ARB, while beta-blockers and diuretics showed higher AF risks than ARB. In combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers had the highest compared to ARB/CCB. Among the specific ARBs, the AF risk varied insignificantly, except for telmisartan and candesartan. In hypertensive patients receiving monotherapy, ACEi and CCB showed a similar AF risk as ARBs, while beta-blockers and diuretics were associated with a higher risk. Among those receiving combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers showed the highest risk. Various types of ARBs have different associations with AF risk.

Characteristics of Hypertension Patients with Chonic Kidney Disease at Ibnu Sina Hospital, Makassar City Year 2022-2023

Hypertension is a condition where the systole is more than or equal to 140 and the diastole is more than or equal to 90 mmHg. In Indonesia the number of hypertension sufferers reaches 70 million people. The prevalence of hypertension in adults is 6-15%. Hypertension that has been going on for a long time and is not controlled, impacts the blood vessels in the kidneys and causes sclerosis of the blood vessels resulting in glomerular damage and tubular atrophy leading to kidney damage. methods: This is a descriptive study with a cross design sectional Results : Hypertension sufferers with the highest incidence of chronic kidney disease are aged 55-64 years (32.9%), the gender is mostly male (57.6%) while female (424%), with a long history of suffering from hypertension is ≥5 year (63,5%), the highest blood pressure control was found in uncontrolled blood pressure (56.5%), and the use of antihypertensive drugs in the form of CCB drugs (51.8%).Conclusion: Hypertensive patients with the incidence of chronic kidney disease at Ibnu Sina Hospital, Makassar City in 2022-23 are mostly at the age of 55-64 years, male with a long history of suffering from hypertension of 5-10 years and control of uncontrolled blood pressure and use of other types of antihypertensive medication, namely Calcium Channel Blocker (CCB).

Pengaruh Edukasi Media Platform Tiktok Terhadap Pengetahuan Penderita Hipertensi di Wilayah Kerja Puskesmas Cireunghas

Hypertension is still a significant problem in the global health sector today. The general public recognizes this condition as "high blood pressure" because blood pressure increases beyond the normal threshold. Health education has a major role in increasing public understanding about hypertension. So media outreach using the Tiktok social media platform can expand public knowledge and understanding regarding the urgency of hypertension. Objective: To determine the influence of the TikTok educational media platform on the knowledge of hypertension sufferers. Method: The design in this research uses a quasi-experimental approach using a one group pretest posttest design. Results: based on the results of statistical tests using the Paired Samples Test, the resulting P value is 0.000 < 0.05. Conclusion: it can be concluded that there is an influence of the TikTok educational media platform on the knowledge of hypertension sufferers in the Cireunghas Health Center working area. Suggestion: It is recommended for future researchers to measure the influence of respondent characteristics such as age, gender, education level, length of time suffering from hypertension, type of work and type of anti-hypertensive medication used on the knowledge of hypertension sufferers

Efficacy and safety of 3D reconstruction and basket multi-electrode renal denervation (RDN) for refractory hypertensive patients with chronic kidney disease.

Renal Artery Sympathetic Denervation (RDN) can lower blood pressure. Different ablation catheters (single electrode, multi-electrode) have different scopes of ablation (renal artery main stem and branches). Few studies have compared the advantages and disadvantages of different ablation catheters and different procedures in terms of antihypertensive efficacy. To compare the efficacy and safety of 3D reconstruction radiofrequency ablation (3DRA) and basket multi-electrode radiofrequency ablation (BMRA) in Renal Artery Sympathetic Denervation. Fifty-three patients with Refractory hypertension (RHT) were divided into BMRA, (n=28) and 3DRA(n=25). BMRA group used a stereobasket multi-electrode ablation catheter with a controlled ablation temperature of 60°C and an ablation time of 120s per site. 3DRA group used a NavStar pressure-monitored perfusion monopolar ablation catheter with a controlled ablation temperature of 40°C, an ablation time of 40s per site, and an ablation energy of 12W. Baseline and RDN parameters and complications were compared in both groups. Home and 24h ambulatory blood pressure, type of anti-hypertensive medication taken, and serum creatinine were followed up at 1, 3, 6, 12, and 24 months after the RDN. There were no differences in baseline characteristics between the two groups. (23.14±2.00)months of follow-up in the BMRA group resulted in a total of (25.86±8.61) loci ablation. (19.28±7.40)months of follow-up in the 3DRA group resulted in a total of (21.04±6.47)loci ablation. Home SBP was significantly lower in both groups at 1 month after RDN treatment compared to baseline(H-SBP/mmHg: BMRA 149.9±10.59vs. baseline 168.36±12.76; 3DRA 152.6±14.91vs. 164.89±12.96, both p<.05). The proportion of people with 24h ambulatory SBP attainment was significantly higher in both groups and was maintained for 24 months. At each follow-up time point, there were no differences in home and 24-h flow SBP, DBP, or Scr between the two groups. There were two cases of severe renal artery complications from implanted vascular stents and one case of femoral artery pseudoaneurysm in the 3DRA group. At follow-up, 1 (1.9%) patient in the 3DRA group died of unexplained death and 1 (1.9%) patient developed heart failure, and 1 (1.9%) patient in the BMRA group died of unexplained death. Basket multi-electrode radiofrequency ablation and 3D reconstruction radiofrequency ablation of the renal artery applied to RDN have comparable efficacy in reducing systolic blood pressure.

Sex-Specific Effects of Blood Pressure Lowering Pharmacotherapy for the Prevention of Cardiovascular Disease: An Individual Participant-Level Data Meta-Analysis.

Whether the relative effects of blood pressure (BP)-lowering treatment on cardiovascular outcomes differ by sex, particularly when BP is not substantially elevated, has been uncertain. We conducted an individual participant-level data meta-analysis of randomized controlled trials of pharmacological BP lowering. We pooled the data and categorized participants by sex, systolic BP categories in 10-mm Hg increments from <120 to ≥170 mm Hg, and age categories spanning from <55 to ≥85 years. We used fixed-effect one-stage individual participant-level data meta-analyses and applied Cox proportional hazard models, stratified by trial, to analyze the data. We included data from 51 randomized controlled trials involving 358 636 (42% women) participants. Over 4.2 years of median follow-up, a 5-mm Hg reduction in systolic BP decreased the risk of major cardiovascular events both in women and men (hazard ratio [95% CI], 0.92 [0.89-0.95] for women and 0.90 [0.88-0.93] for men; P for interaction, 1). There was no evidence for heterogeneity of relative treatment effects by sex for the major cardiovascular disease, its components, or across the different baseline BP categories (all P for interaction, ≥0.57). The effects in women and men were consistent across age categories and the types of antihypertensive medications (all P for interaction, ≥0.14). The effects of BP reduction were similar in women and men across all BP and age categories at randomization and with no evidence to suggest that drug classes had differing effects by sex. This study does not substantiate sex-based differences in BP-lowering treatment.

Outcomes Following Radiofrequency Renal Denervation According to Antihypertensive Medications: Subgroup Analysis of the Global SYMPLICITY Registry DEFINE.

The Global SYMPLICITY Registry DEFINE (Denervation Findings in Real World) investigates radiofrequency renal denervation (RDN) in a broad range of patients with hypertension. We evaluated whether the number or type of antihypertensive medications were associated with increased long-term blood pressure (BP) reductions and cardiovascular outcomes following radiofrequency RDN. Patients underwent radiofrequency RDN and were categorized by baseline number (0-3 and ≥4) and different combinations of medication classes. BP changes were compared between groups through 36 months. Individual and composite major adverse cardiovascular events were analyzed. Of 2746 evaluable patients, 18% were prescribed 0 to 3 and 82% prescribed ≥4 classes. At 36 months, office systolic BP significantly decreased (P<0.0001) by -19.0±28.3 and -16.2±28.6 mm Hg in the 0 to 3 and ≥4 class groups, respectively. Twenty-four-hour mean systolic BP significantly decreased (P<0.0001) by -10.7±19.7 and -8.9±20.5 mm Hg, respectively. BP reduction was similar between the medication subgroups. Antihypertensive medication classes decreased from 4.6±1.4 to 4.3±1.5 (P<0.0001). Most decreased (31%) or had no changes (47%) to the number of medications, while 22% increased. The number of baseline antihypertensive medication classes was inversely related to the change in prescribed classes at 36 months (P<0.001). Cardiovascular event rates were generally low. More patients in the ≥4 compared with 0 to 3 medication classes had myocardial infarction at 36 months (2.8% versus 0.3%; P=0.009). Radiofrequency RDN reduced BP safely through 36 months, independent of the number and type of baseline antihypertensive medication classes. More patients decreased than increased their number of medications. Radiofrequency RDN is a safe and effective adjunctive therapy regardless of antihypertensive medication regimen. URL: https://www. gov; Unique identifier: NCT01534299.

Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer.

Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors. To determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016. We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas in 2007-2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs. Crude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II-stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II-inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II-stimulating antihypertensive drugs, those who received angiotensin II-inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01-1.32), vascular dementias (1.27, 1.06-1.53), and total ADRD (1.21, 1.14-1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk. The risk of AD and ADRD in patients with hypertension who received angiotensin II-inhibiting antihypertensive medications was higher than in those receiving angiotensin II-stimulating antihypertensive drugs in patients with colorectal cancer.

Primary hypertension, anti-hypertensive medications and the risk of severe COVID-19 in UK Biobank.

Hypertension appears to be one of the commonest comorbidities in COVID-19 patients, although whether hypertensive individuals have a higher risk of severe COVID-19 compared with non-hypertensives is unclear. It is also unclear whether the absolute level of systolic blood pressure, or the type of anti-hypertensive medication is related to this risk. Analyses were conducted using data from the UK Biobank and linked health records. Logistic regression models were fitted to assess the impact of hypertension, systolic blood pressure (SBP) and medications on the risk of severe COVID-19. 16,134 individuals tested positive for severe acute respiratory syndrome-coronavirus, 22% (n = 3,584) developed severe COVID-19 and 40% (n = 6,517) were hypertensive. Hypertension was associated with 22% higher odds of severe COVID-19 (Odds ratio (OR) 1.22; 95% confidence interval (CI) 1.12, 1.33), compared with normotension after adjusting for confounding variables. In those taking anti-hypertensive medications, elevated SBP showed a dose-response relationship with severe COVID-19 (150-159mmHg versus 120-129mmHg (OR 1.91; 95% CI 1.44, 2.53), &gt;180+mmHg versus 120-129mmHg (OR 1.93; 95% CI 1.06, 3.51)). SBP &lt;120mmHg was associated with greater odds of severe COVID-19 (OR 1.40; 95% CI 1.11, 1.78). Angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers were not associated with altered risk of severe COVID-19. Hypertension is an important risk factor for COVID-19. A better understanding of the underlying mechanisms is warranted in case of more severe strains or other viruses in the future.

Insight on Efficacy of Renal Artery Denervation for Refractory Hypertension with Chronic Kidney Diseases: A Long-Term Follow-Up of 24-Hour Ambulatory Blood Pressure.

Aims To explore the long-term efficacy and safety of renal denervation in patients with RHT and CKD, a post hoc analysis of eGFR subgroups was completed. Methods Fifty-four patients with refractory hypertension with chronic kidney disease were treated with RDN and enrolled in the study. Patients were divided into three groups according to eGFR: eGFR 46–90 ml/min group, eGFR 15–45 ml/min group, and eGFR <15 ml/min group. The planned follow-up period was 48 months to assess 24 h ambulatory blood pressure, renal function, type of antihypertensive medication, and RDN complications. Results The ablation sites of the GFR 46–90 ml/min group and GFR 15–45 ml/min group were 32.57 ± 2.99 and 29.53 ± 5.47, respectively. No complications occurred in the GFR 46–90 ml/min group. The GFR<15 ml/min group was treated with 27.07 ± 5.59 ablation. Renal artery dissection occurred in each group of GFR 15–45 ml/min and GFR <15 ml/min. And renal stent implantation artery was performed on these two patients. No severe renal artery stenosis occurred. There were no significant differences in Scr and eGFR between the three groups at each follow-up point. Compared with baseline, SBP was significantly of each group decreased to varying degrees at each follow-up time point. SBP decreased most in the GFR 46–90 ml/min group. Compared with baseline, the type of antihypertensive drugs used in the GFR46-90 ml/min group decreased significantly except for 36 and 48 months. At 48 months' postadmission, there was a significant decrease in the type of antihypertensive medication used in the GFR15-45 ml/min group, and there was no significant decrease in the type of antihypertensive medication used in the GFR<15 ml/min group. Conclusions RDN can safely reduce SBP in CKD patients combined with RHT for 48 months, with the most pronounced reduction in the GFR15-45 ml/min group. The variety of antihypertensive drugs was significantly reduced after RDN. This was particularly evident in patients with GFR 15–45 ml/min.

Rapid decrease in eGFR with concomitant use of tyrosine kinase inhibitors and renin-aldosterone-angiotensin system inhibitors in patients with chronic myelogenous leukemia.

Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML). However, TKI-related chronic renal toxicity has been reported, particularly in patients with hypertension. We assessed whether incidental use of specific types of antihypertensive drugs, including renin-aldosterone-angiotensin system inhibitors (RAASis), affects the change in estimated glomerular filtration rate (eGFR) during TKI treatment. We retrospectively analyzed all eGFR measurements during TKI treatment for 142 CML patients at Kyushu University Hospital, estimating the rate of eGFR change using a mixed-effects model. Overall, a significant interaction was found between the type of antihypertensive medication used and the yearly change in eGFR (P < 0.01), with RAASi users exhibiting the most rapid decrease in eGFR (- 5.5%/year). The analysis by TKI used showed that the interaction was significant only in imatinib and bosutinib users (P < 0.01 and P = 0.04, respectively). The yearly rate of eGFR decrease was the most notable in RAASi users, at - 5.7 (- 6.6, - 4.9) and - 10.1 (- 12.3, - 7.9) for imatinib and bosutinib users, respectively. Our findings indicate that eGFR should be carefully monitored in patients taking these TKIs.

The Clinical Pharmacy Specialists’ Role in Antihypertensive Management Surrounding Bariatric Surgery in a Veterans Affairs Population

Background: No guidelines exist for de-escalating antihypertensive medications surrounding bariatric surgery. This study analyzed clinical pharmacy specialist (CPS) management of antihypertensive medications in patients undergoing bariatric surgery at a Veterans Affairs medical center. Objectives: The primary objective was to describe the CPS role in antihypertensive management surrounding bariatric surgery through evaluation of number of CPS encounters, number and type of antihypertensive medications and medication interventions by CPSs and all other providers, over 5 time periods between a pre-operative assessment and up to 6 months post-operatively. Methods: Electronic medical records of patients taking antihypertensive medication who underwent bariatric surgery between 1/1/2014 and 2/27/2018, had primary care through our facility, and at least 1 encounter with a CPS were reviewed. Results: Forty patients were included out of 221 screened. There were 109 total medication interventions in 37 patients. CPSs provided 60 medication interventions (55% of total interventions) in 26 patients. Mean antihypertensive agents per patient was 2.18 at baseline versus 0.95 at 6-months post-operative. Dihydropyridine calcium channel blockers had the highest discontinuation rate. Thiazide diuretics were most commonly discontinued prior to surgery and angiotensin converting enzyme inhibitors were discontinued more steadily over the study duration. Nineteen patients (48.7%) had blood pressure <140/90 mmHg and were off all antihypertensive medications at the final CPS encounter. Conclusion: The results of this small study support the role of CPSs in antihypertensive medication management surrounding bariatric surgery.

CLINICAL CHARACTERISTICS IN THE PATIENTS WITH MASKED UNCONTROLLED NOCTURNAL HYPERTENSION MEASURED BY NIGHTTIME HOME BLOOD PRESSURE MONITORING: THE J-HOP NOCTURNAL BLOOD PRESSURE ST

Objective: Various international guidelines on the management of hypertension recommend nighttime blood pressure (BP) measurements in specific conditions such as sleep apnea, secondary hypertension, etc. However, we physicians sometimes miss nocturnal hypertension in patients with controlled daytime (morning and evening) home BP (HBP), i.e. “masked uncontrolled nocturnal hypertension”. Risk factors of masked uncontrolled nocturnal hypertension remain unclear in clinical practice and we thus assessed that using a dataset of the Japan Morning Home-Surge BP (J-HOP) Nocturnal BP study. Design and method: This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP Nocturnal BP study, which recruited patients with risk factors of CVD. Participants underwent consecutive 14-day HBP measurements (morning and evening) and nighttime HBP measurements (a.m. 2, 3, and 4). In the present study, masked uncontrolled nocturnal hypertension was defined as controlled daytime HBP (mean of morning and evening home systolic BP [SBP] &lt; 135 mmHg and diastolic BP [DBP] &lt; 85 mmHg) and uncontrolled nighttime HBP (mean nighttime home SBP &gt; = 120 or DBP &gt; = 70 mmHg). To detect the risk factors of masked uncontrolled nocturnal hypertension, we used traditional host factors, using each type of antihypertensive medications, and markers of target organ damage (urine-albumin creatinine ratio [UACR] and b-type Natriuretic peptide) as covariant in stepwise logistic regression models. Results: Among 1490 participants with controlled daytime HBP levels (age, 62.5 ± 9.7yrs; 49% of male; antihypertensive medication use, 82.2%), male, diabetes, elevated office BP, and log-UACR were significant risk factors for masked uncontrolled nocturnal hypertension in multivariate logistic regression models (OR [95%CI]: male, 1.42 [1.11–1.82]; diabetes, 1.41 [1.09–1.83]; elevated office BP, 1.72 [1.38–2.14]; log-UACR, 1.35 [1.06–1.71]) (Table). Whereas, combination therapy of more than three antihypertensives including diuretics showed a lower odds ratio (0.56 [0.40–0.78]). Conclusions: In the present study, we revealed that male, diabetes, elevated office BP, and highly log-UACR were suggested to be risks for masked uncontrolled nocturnal hypertension. A nighttime HBP monitoring might be recommended for patients who have these risks even if they are controlled daytime HBP levels.

Type of antihypertensive medications in CKD-stage V patients on hemodialysis and its relationship with demographic variables: an observational study

Background: The majority of the patients with chronic kidney disease stage V on hemodialysis have been found to have hypertension and many studies have recommended that hypertension should be essentially controlled in these patients for better clinical outcome. But till now no study analyzing the relationship between antihypertensive medication and the demographics of the patient has been done, so with this objective in mind the present study was carried out. Aim and objectives were to analyse the types of antihypertensive being used in CKD stage V patients on hemodialysis and their relationship with the demographic variables.Methods: The present observational cross-sectional study was conducted in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.) from 01 January 2018 to 31 March 2018 on patients with chronic kidney disease stage V on hemodialysis. The demographic variables evaluated were age, sex, basic disease and duration of dialysis. The relationship with type of antihypertensive being used and these demographic variables was calculated using Pearson Chi-square test. A p value of&lt;0.05 was taken as statistically significant.Results: Diabetic nephropathy, CIN-CKD 5d, CGN-CKD 5d and hypertensive nephropathy were the commonest basic diseases in our study. Calcium channel blockers, beta blockers, ATRB, centrally acting antihypertensive, ACE inhibitors were the commonest antihypertensive used. Statistically significant relationship was seen between antihypertensive and basic disease (p&lt;0.05).Conclusions: The study revealed that all the antihypertensive medications are prescribed on the basis of basic disease while other demographic variables do not play a vital role prescribing antihypertensive in patients with CKD stage V on haemodialysis. And the prescription of antihypertensive medications also matches with the actual clinical practice.

Antihypertensives and their relation to mortality by SARS-CoV-2 infection.

The role of antihypertensives, especially Renin–Angiotensin–Aldosterone System inhibitors, is still debatable in COVID‐19‐related severity and outcome. Therefore, we search for a more global analysis of antihypertensive medication in relation to SAS‐CoV‐2 severity using prescription data worldwide. The association between the percentage use of different types of antihypertensive medications and mortality rates due to a SARS‐CoV‐2 infection during the first 3 weeks of the pandemic was analyzed using random effects linear regression models for 30 countries worldwide. Higher percentages of prescribed angiotensin receptor blockers (ARBs) (β, 95% confidence interval [CI]; −0.02 [−0.04 to −0.0012]; p = .042) and calcium channel blockers (CCBs) (β, 95% CI; −0.023 [−0.05 to −0.0028]; p = .0304) were associated with a lower first 3‐week SARS‐CoV‐2‐related death rate, whereas a higher percentage of prescribed angiotensin‐converting enzyme inhibitors (ACEis) (β, 95% CI; 0.03 [0.0061–0.05]; p = .0103) was associated with a higher first 3‐week death rate, even when adjusted for age and metformin use. There was no association between the amount of prescribed beta‐blockers (BBs) and diuretics (Diu) and the first 3‐week death rate. When analyzing the combination of drugs that is used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3‐week death rates had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications (ARBs/CCBs: [β, 95% CI; −0.02 [−0.03 to −0.004]; p = .009], ARBs/BBs: [β, 95% CI; −0.03 [−0.05 to −0.006]; p = .01]). Finally, countries prescribing high‐potency ARBs had lower first 3‐week ARBs. In conclusion, ARBs and CCB seem to have a protective effect against death from SARS‐CoV‐2 infection.

Anti-Hypertensive Medication in Geriatric Population with HFpEF

INTRODUCTION Heart failure with preserved ejection fraction (HFpEF) is a condition where the left ventricular function is ≥50%. This population has a high morbidity and mortality compared to its counter-part heart failure with reduced ejection fraction (HFrEF). However treatment in this group remain spares. Hypertension medications are widely used in practice for patients with heart failure with reduced ejection fraction, however its efficacy in HFpEF is still an ongoing research. METHOD Evidence based research from various different search engines such as Medline® , Cochrane ® , and Proquest® with inclusion of high quality evidence such as meta-analysis, systematic review, RCT, and cohort studies. The selected papers were screened for validity, importance and applicability to the case in question. RESULT The two different RCTs studies showed that ACE-I had no effects in HFpEF. Research by Kitzman et al. showed that ACE-I did not show any improvement of left ventricular mass, neuro-hormonal profile, and 6 minutes walking test. This was also confirmed by Zi et al., which in addition showed that ACE-I did not increase the quality of life in the geriatric subjects. CONCLUSION All in all, ACE-I as a type of anti-hypertensive medication does not benefit geriatric population of HFpEF

Types of anti-hypertensive medication for post-transplant hypertension and risk of graft failure

Types of anti-hypertensive medication for post-transplant hypertension and risk of graft failure

Association of Antihypertensive Medication with Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness

To evaluate the association between different classes of antihypertensive medication with retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness in a nonglaucomatous multiethnic Asian population. Population-based, cross-sectional study. A total of 9144 eyes for RNFL analysis (2668 Malays, 3554 Indians, and 2922 Chinese) and 8549 eyes for GC-IPL analysis (2460 Malays, 3230 Indians, and 2859 Chinese) aged 44 to 86 years. Participants underwent standardized systemic and ocular examinations and interviewer-administered questionnaires for collection of data on medication and other variables. Intraocular pressure (IOP) readings were obtained by Goldmann applanation tonometry before pupil dilation for fundoscopy and OCT imaging. Blood pressure (BP) was measured with an automatic BP monitor. Mean arterial pressure (MAP) was defined as diastolic BP plus 1/3 (systolic BP - diastolic BP). Regression models were used to investigate the association of antihypertensive medication with OCT measurements of RNFL and GC-IPL. Average and sectoral RNFL and GC-IPL thickness. After adjusting for age, gender, ethnicity, MAP, IOP, body mass index (BMI), and presence of diabetes, we found that participants taking any type of antihypertensive medication (β=-0.83; 95% confidence interval [CI],-1.46 to-0.02; P= 0.01), specifically angiotensin-converting enzyme inhibitors (ACEIs) (β=-1.66; 95% CI,-2.57 to-0.75; P < 0.001) or diuretics (β=-1.38; 95% CI,-2.59 to-0.17; P < 0.05), had thinner average RNFL in comparison with participants who were not receiving antihypertensive treatment. Use of a greater number of antihypertensive medications was significantly associated with thinner average RNFL (P for trend= 0.001). This association was most evident in the inferior RNFL quadrant in participants using ACEIs (β=-2.44; 95% CI,-3.99 to-0.89; P= 0.002) or diuretics (β=-2.76; 95% CI,-4.76 to-0.76; P= 0.007). A similar trend was noted in our analysis of macular GC-IPL thickness. Use of 2 or more antihypertensive medications, ACEI, and diuretics were associated with a loss of structural markers of retinal ganglion cell health in a multiethnic Asian population.

Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients.

PurposeWe investigated the impact of four types of antihypertensive medications, angiotensin receptor blockers (ARBs), beta blockers (BBs; both selective and non-selective), calcium channel blockers (CCBs), and thiazide diuretics (TDs) on survival outcomes in epithelial ovarian cancer (EOC).Materials and MethodsA single-institutional retrospective chart review of 878 patients with EOC was performed. Survival was compared according to use of the four antihypertensive medications during primary treatment. Propensity score matching (ratio 1:3) was performed to control possible associated covariates, such as age, International Federation of Gynecology and Obstetrics stage, residual status after primary debulking surgery, and co-morbidity.ResultsAmong 878 patients, 56 patients (6.4%) were ARB users, 62 (7.1%) were BB users, 107 (12.2%) were CCBs users and 32 (3.6%) used TDs. Median progression-free survival (PFS) for ARB, BB, and CCB users was 37.8, 27.2, and 23.6 months compared with 33.6 months for non-users. ARB was associated with 35% decreased risk of disease progression (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.42 to 0.99; p=0.046) in multivariate analysis. After propensity score matching, median PFS for ARB users was 37.8 months and ARB use remained to be associated with lower recurrence rate in univariate (p=0.035) and multivariate analysis (HR, 0.60; 95% CI, 0.39 to 0.93; p=0.022).ConclusionIn this study, ARBs use during primary treatment is associated with lower recurrence in EOC patients. However, CCBs, BBs, and TDs did not show beneficial impact.

Is There Any Role for Device Therapies in Resistant Hypertension? Commentary.

In this issue of Kidney360 , two titans of hypertension, Drs. Ray Townsend and Aldo Peixoto, debate whether there is any role for device therapies in resistant hypertension. As the debate’s moderator, I will provide background information to set the stage for this epic showdown and offer a nonpartisan opinion on the topic. First, what is meant by “resistant hypertension?” According to the most recent ACC/AHA High Blood Pressure Clinical Guidelines, the diagnosis of resistant hypertension is made when a patient takes three antihypertensive medications, including at least one diuretic, but does not achieve control or when BP control is achieved but requires four or more medications (1). Using the BP target of <130/80 mm Hg, the prevalence of resistant hypertension among United States adults taking antihypertensive medication is estimated at 20% or 10.3 million persons (2). Second, with so many different types of antihypertensive medications that can effectively and reliably lower BP, why turn to device therapy for hypertension management given the inherent risks that come with these invasive procedures? Many patients cannot or will not take antihypertensive medications as prescribed due to unacceptable side effects or other factors. Moreover, even patients with perfect medication adherence to multiple antihypertensive medications will sometimes still have poorly controlled BP (3). Thus, …

Renin-angiotensin inhibitors were associated with improving outcomes of hepatocellular carcinoma with primary hypertension after hepatectomy.

The activation of the renin-angiotensin system (RAS) promotes tumor progression. In this study, we aimed to assess whether RAS inhibitors (RASIs) could improve the outcome of hepatocellular carcinoma (HCC) patients with primary hypertension after curative liver resection. Data on 387 consecutive patients with primary hypertension who underwent curative liver resection for HCC were reviewed. The study population was divided into two groups based on the type of anti-hypertensive medications: the RASI group (patients using RASIs) and the non-RASI group (patients using other anti-hypertensive drugs but not RASIs). Kaplan-Meier curves, log-rank tests and cox proportional hazards regression models were used to analyze time to recurrence (TTR) and overall survival (OS). There were 144 (37.2%) patients in RASI group and 243 (62.8%) in non-RASI group. The preoperative clinicopathological features were comparable between the two groups. Kaplan-Meier curves demonstrated HCC patients with RASIs had a longer TTR and OS than the patients with non-RASIs (both P<0.001). On multivariate analysis, RASIs administration was identified as an independent prognostic factor for TTR [hazard ratio (HR) =0.52, 95% confidence interval (CI), 0.38-0.70, P<0.001] and OS (HR =0.50, 95% CI, 0.34-0.74, P<0.001). Patients in the RASI group had lower rates of extrahepatic metastases than patients in the non-RASI group (2.8% vs. 7.8%, P<0.042). Targeting the RAS was associated with a reduced risk of recurrence, decreased rate of extrahepatic metastases and prolonged survival of HCC patients with primary hypertension after curative liver resection.