Types Of Antihypertensive Drugs Research Articles

Utilizing genetics and proteomics to assess the role of antihypertensive drugs in human longevity and the underlying pathways: a Mendelian randomization study.

Antihypertensive drugs are known to lower cardiovascular mortality, but the role of different types of antihypertensive drugs in lifespan has not been clarified. Moreover, the underlying mechanisms remain unclear. To minimize confounding, we used Mendelian randomization to assess the role of different antihypertensive drug classes in longevity and examined the pathways via proteins. Genetic variants associated with systolic blood pressure (SBP) corresponding to drug target genes were used as genetic instruments. The genetic associations with lifespan were obtained from a large genome-wide association study including 1 million European participants from UK Biobank and LifeGen. For significant antihypertensive drug classes, we performed sex-specific analysis, drug-target analysis and colocalization. To examine the mediation pathways, we assessed the associations of 2291 plasma proteins with lifespan, and examined the associations of drug classes with the proteins affecting lifespan. After correcting for multiple testing, genetically proxied beta-blockers (BBs), calcium channel blockers (CCBs) and vasodilators were related to longer life years (BBs: 2.03, 95% CI 0.78 to 3.28 per 5-mmHg reduction in SBP, CCBs: 3.40, 95% CI 1.47 to 5.33, and vasodilators: 2.92, 95% CI 1.08 to 4.77). The beneficial effects of BBs and CCBs were more obvious in men. ADRB1, CACNA2D2, CACNB3, CPT1A, CPT2, and EDNRA genes were related to extended lifespan with CPT2 further supported by colocalization evidence. 86 proteins were related to lifespan, of which 4 proteins were affected by CCBs. CDH1 may mediate the association between CCBs and lifespan. BBs, CCBs and vasodilators may prolong lifespan, with potential sex differences for BBs and CCBs. The role of CCBs in lifespan is partly mediated by CDH1. Prioritizing the potential protein targets can provide new insights into healthy aging.

Orthostatic Hypotension and Antihypertensive Treatment in Lung Transplant Recipients: A Cross-Sectional Study.

Lung transplant is the ultimate treatment of many end-stage lung diseases. Calcineurin inhibitors, crucial in immunosuppression for lung transplant recipients, are linked to secondary hypertension, necessitating antihypertensive treatment. In addition, lung transplant recipients frequently experience orthostatic hypotension, occasionally stemming from autonomic dysfunction, but also commonly attributed as a negative side effect of antihypertensive treatment. Our study aimed to evaluate the frequency of orthostatic blood pressure irregularities and investigate the involvement of antihypertensive treatment as a potential risk factor in the occurrence among lung transplant recipients. Fifty-six consecutive lung transplant recipients, both inpatient and outpatient, at the University Hospital Zurich (Switzerland) were monitored from 1999 to 2013. Transplant recipients underwent a Schellong test (an active standing test). Our evaluation encompassed their initial traits, such as the existence of supine hypertension. We computed the odds ratio for the comparison of the likelihood of experiencing orthostatic hypotension while using a minimum of 1 type of antihypertensive medication versus absence of antihypertensive drugs. Of the lung transplant recipients, 25% showed a positive Schellong test. Within this group, 64% had supine hypertension, and 29% displayed symptoms of orthostatic hypotension. Among the patients, 71% were using at least 1 type of antihypertensive medication. The odds ratio for showing orthostatic hypotension while taking at least 1 type of antihypertensive drug versus the absence of antihypertensive medications was 1.64 (95% exact CI, 0.39-6.90) with P = .50. This finding remained consistent regardless of age, sex, inpatient or outpatient status, and the duration since transplant. Orthostatic blood pressure dysregulation is prevalent among lung transplant recipients, frequently without noticeable symptoms. In our cohort, the use of antihypertensive medications did not elevate the risk of orthostatic hypotension.

Use of amlodipine in the treatment of cats with systemic hypertension in Japan.

An increase in systemic blood pressure causes bleeding and ischemia owing to peripheral vascular breakdown, leading to various forms of organ damage. The brain, eyes, kidneys, and cardiovascular system are known target organs for hypertension. To our knowledge, no reports in Japan describe, in detail, the types of antihypertensive drugs used to treat hypertension in cats or its underlying causes. Therefore, we aimed to investigate the use of antihypertensive drugs in domestic cats with hypertension in Japan, the causes of hypertension, and the vital prognosis of these patients. In the present survey, we found that amlodipine was used alone (60/80 cats) or concomitantly (20/80 cats) in all cat patients with hypertension in Japan. We also determined that blood pressure measurements were not yet routinely performed on cats at veterinary clinics in Japan. Furthermore, we have new information suggesting that amlodipine administration in cats with hypertension, which lowers systolic arterial pressure levels to within the normal range (<140 mmHg), may have a negative impact on their survival. Routine blood pressure measurements for cats during their regular health checkups can help identify hypertension, and proper interpretation of blood pressure readings can facilitate suitable treatment measures.

Treatment of arterial hypertension in patients with severe obesity

IntroductionObesity is one of the most important cardiovascular risk factors for mortality. It increases the risk of developing hypertension and influences the response to antihypertensive drugs. Ambulatory blood pressure measurement (ABPM) is a tool for a detailed analysis of mean blood pressure values and assessing the blood pressure (BP) profile during the night with the daily values and optimal treatment determination.AimThe study aimed to evaluation the type of antihypertensive drugs and control assessment of hypertension based on ABPM in patients with severe obesity.Material and methodsThe study group consisted of 129 overweight and obese patients (group 1: BMI &lt; 40 kg/m&lt;sup&gt;2&lt;/sup&gt;; group 2: BMI ≥ 40 kg/m&lt;sup&gt;2&lt;/sup&gt;).They were interviewed, taking into account the antihypertensive drugs taken. We divided drugs into 5 groups: beta-blockers, angiotensin converting enzyme inhibitors (ACE-I) / angiotensin II receptor blockers (ARB), diuretics, calcium channel blockers and others. Mean systolic BP and diastolic BP from the day, day and night, mean heart rate from day to day was assessed based on ABPM.Results and discussionThe most frequently administered drugs in both groups were ACE-I/ARB. The second most often taken drug was β-blocker and diuretics. Group 1 was significantly older than group 2. Based on the analysis, HR level was significantly dependent on age, BMI, and diabetes. The systolic BP and diastolic BP level was dependent on age and sex.ConclusionsOnly a combination of individually designed pharmacological therapy with personalized dietary interventions, regular exercise, cognitive behavioral therapy, and bariatric interventions, when needed, could guarantee the final success. ABPM should be used routinely in every patients to control assessment of hypertension.

Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery.

Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.

Effect of antihypertensive medications on the risk of open-angle glaucoma

The purpose of this study was to identify the effect of antihypertensive medication on risks of open-angle glaucoma (OAG) among patients diagnosed with hypertension (HTN). A total of 5,195 patients, who were diagnosed with HTN between January 1, 2006 and December 31, 2015, and subsequently diagnosed with OAG, were selected for analysis. For each OAG patient, 5 non-glaucomatous, hypertensive controls were matched (n = 25,975) in hypertension diagnosis date, residential area, insurance type and economic status. Antihypertensive medications were stratified into 5 types: angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), β-blockers and diuretics. Relative risks were calculated. After adjusting for age, sex, body mass index, lifestyle, comorbidities, blood pressure (BP), follow-up duration, and use of other types of antihypertensive drugs, ARB and CCB were found to slightly increase OAG risks (RR 1.1087 (95% CI 1.0293–1.1942); 1.0694 (1.0077–1.1349), respectively). Combinations of ARB with diuretics (1.0893 (1.0349–1.1466)) and CCB (1.0548 (1.0122–1.0991)) also increased OAG risks. The risks for OAG were found to increase by antihypertensive medication use, but the effects appeared to be small. Further studies are necessary to identify the associations of increased BP, medication and therapeutic effect with OAG.

Control status of ambulatory blood pressure and its relationship with arterial stiffness in the China nationwide registry of treated hypertensive patients: the REACTION-ABP study.

The control rate of ambulatory blood pressure (BP) is unclear in Chinese hypertensive patients, and whether it would be associated with the ambulatory arterial stiffness indices is also unknown. From June 2018 until December 2022, 4408 treated hypertensive patients (52.8% men, average age 58.2 years) from 77 hospitals in China were registered. Ambulatory BPs were measured with validated monitors and analyzed with a web-based standardized Shuoyun system ( www.shuoyun.com.cn ). The BP control rate was the highest in the office (65.7%), moderate in the daytime (45.0%), low in the morning (34.1%), and the lowest in the nighttime (27.6%, P < 0.001). Only 21.0% had their 24 h BP perfectly controlled. The stepwise regression analyses identified that the factors associated with an imperfect 24 h BP control included male sex, smoking and drinking habits, a higher body mass index, serum total cholesterol and triglycerides, and the use of several specific types of antihypertensive drugs. After adjustment for the above-mentioned factors, the 24 h pulse pressure (PP) and its components, the elastic and stiffening PPs, were all significantly associated with an uncontrolled office and ambulatory BP status with the standardized odds ratios ranging from 1.09 to 4.68 (P < 0.05). The ambulatory arterial stiffness index (AASI) was only associated with an uncontrolled nighttime and 24 h BP status. In conclusion, the control rates of 24 h ambulatory BP, especially that in the nighttime and morning time windows, were low in Chinese hypertensive patients, which might be associated with arterial stiffness in addition to other common risk factors.

DRUG-MEDIATED IMPROVEMENT IN GLOBAL DNA METHYLATION AMONG HYPERTENSIVE INDIVIDUALS: OBSERVATIONS FROM NORTH-INDIAN POPULATION-BASED STUDY

Objective: Hypertension has been reported to affect global DNA methylation levels negatively. However, the effect of anti-hypertensive drugs on methylation levels remains understudied. The present study aims to explore the relationship between the use of anti-hypertensive drugs and peripheral blood leucocyte global DNA methylation levels in two North-Indian populations. Design and method: The present study combines the observations of two population-based cross-sectional studies conducted among adult individuals (aged 30 years and above) of either sex belonging to the Jat community of Palwal, Haryana (n = 543) (completed), and the Jat Sikh community of Mansa district, Punjab (n = 148) (ongoing). Data pertaining to socio-demographic variables and the use of anti-hypertensive drugs were collected using pre-tested and modified interview schedules. Anthropometric measurements and blood pressure were captured from each participant using standard protocols. Peripheral blood leucocyte global DNA methylation levels were estimated using ELISA-based colorimetric technique. SPSS version 22 was used to perform statistical analysis. Results: Hypertensive cases were found to be significantly hypomethylated than the control groups in both communities. When stratified for medication, the median global DNA methylation level of hypertensive cases on any type of anti-hypertensive drug was found to be significantly higher than that of those hypertensive individuals who were not on medication. In fact, median DNA methylation levels of hypertensive cases on medication were comparable to that of controls. These trends were consistent in both the studied populations. Conclusions: The use of anti-hypertensive drugs appears to improve the global DNA methylation level among hypertensive cases. More studies are required to understand the pathway through which antihypertensive drugs act on DNA methylation levels and if improving DNA methylation levels through dietary interventions would have a similar antihypertensive effect.

HYPERTENSION AWARENESS, TREATMENT, AND CONTROL IN AUSTRALIA. A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Research from the NCD Risk Factor Collaboration indicated that the hypertension control rates in Australia are lagging behind other high-income countries, and a call to action to improve blood pressure (BP) control has been published. To understand the size of the problem, we will systematically examine contemporary evidence of hypertension awareness, treatment and control rates in Australia. Design and method: We performed a systematic literature search of reports of hypertension awareness, treatment and control rates in Australia. We undertook an individual participant data meta-analysis (IPDMA) shared by the NCD Risk Factor Collaboration. Where possible, data were pooled for meta-analysis by random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 23 studies, the pooled proportion of hypertension awareness, treatment and control rates in Australia was 61% (95% confidence interval: 47%–74%), 58% (53%-63%), 40% (33%-47%), respectively. The National Health Survey data (n = 61799) shows a higher proportion of hypertension among males than females was observed until the 7th decade of life, and among those with lower socioeconomic status in Australia. The proportion of hypertensive subjects who were on 1, 2, and 3 or more types of antihypertensives was 44.4%(43.5%-45.2%), 18.4% (17.7%-19.0%), 7.7%(7.3%-8.2%), respectively. Our IPDMA was of 12598 (26.3%, n = 57104) hypertensive subjects, among whom 7227 (57.4%) were on antihypertensives and 58.6% had uncontrolled hypertension (SBP equal to or greater than 140 mmHg or DBP equal to or greater than 90 mmHg, n = 4238). The proportion of uncontrolled hypertension was higher among males (62.7%) than females (55.5%, p&lt;0.0001). Conclusions: The hypertension burden in Australia is substantial, with a significant proportion of people with high BP who were unaware, untreated and uncontrolled. There is a lack of high-quality studies to identify barriers and enablers for hypertension treatment and control in Australia. These results will be key to informing the actions of the National Hypertension Taskforce that the Federal Minister of Health newly established.

Medication Use and Adherence in Patients with Hypertension: A Prospective Study in Vietnam

Objective: to document patients’ antihypertensive agents, determine their medication adherence, and identify factors associated with the adherence. Material and Methods: A prospective study was performed on a group of hypertensive outpatients, with social health insurance, in Can Tho, Vietnam. The study included 330 patients over 18 years old, who agreed to participate and could listen, speak and answer questions in Vietnamese. The data collection method was based on prescriptions and patient interviews. Data were analyzed using descriptive statistics, and Generalized Estimating Equations with Poisson-log linear distribution. Results: Among the drug use characteristics, 76.1% were prescribed beta-blockers, 91.5% polytherapy, and 63.0% changed drugs at the third follow-up visit. The percentage of patients who adhered to medication ranged from 70.0% to 91.2%. Factors that improved drug adherence included: the academic level at high school or higher (39.0% increase), living in urban areas (15.0% increase), having a job related to social interaction (11.2%), and having a family history of hypertension (9.0% increase). Factors that reduced adherence included: advanced age (22.0% decrease), prolonged disease duration (16.0% decrease), prolonged treatment duration (11.0% decrease), and changes in at least one type of antihypertensive drug (8.0% decrease). Conclusion: The highlight of this study is the demonstration of an inverse relationship between the adherence rate and the number of follow-up visits: the higher the number of visits, the lower the adherence rate. The 3rd follow-up adherence rate was 70.0%, and the decreased adherence rate is related to older age, higher education levels, and a longer duration of treatment.

Association between hypertension and Epstein-Barr virus reactivation among the population in a high-risk area for nasopharyngeal carcinoma

BackgroundHypertension may increase the infection risk of multiple viruses. The evidence for the association between hypertension and Epstein-Barr virus (EBV) reactivation is still largely lacking. MethodsThe study was based on the baseline information of a population-based prospective cohort from high-risk areas of nasopharyngeal carcinoma (NPC). Using two EBV reactivation classification criteria, we explored the relationship between hypertension and EBV reactivation through logistic regression models. ResultsWe included a total of 12,159 subjects. Among them, 3,945 (32.45%) were EBV arbitrary seropositive, and 1,547 (12.72%) were EBV comprehensive seropositive. Hypertension was associated with an increased risk of EBV reactivation, with odds ratios (ORs) of 1.17 (95% CI = 1.08–1.27) for EBV arbitrary seropositive subjects and 1.16 (95% CI = 1.03–1.30) for EBV comprehensive seropositive subjects. Two types of antihypertensive drugs were associated with decreased risk of EBV reactivation: β-adrenergic receptor-blocking agents (β-blockers) (OR = 0.51, 95% CI = 0.42–0.61 for EBV arbitrary seropositive subjects; OR = 0.62, 95% CI = 0.47–0.81 for EBV comprehensive seropositive subjects) and angiotensin converting enzyme inhibitors (ACEIs) (OR = 0.61, 95% CI = 0.41–0.88 for EBV arbitrary seropositive subjects; OR = 0.58, 95% CI = 0.32–0.98 for EBV comprehensive seropositive subjects). ConclusionsHypertension was associated with an increased risk of EBV reactivation in high-incidence areas of NPC. β-blockers and ACEIs reduce this risk, and thus might be used for NPC prevention in endemic areas.

A new use of transcutaneous electrical nerve stimulation: Role of bioelectric technology in resistant hypertension (Review).

Hypertension is an important risk factor for cardiovascular and cerebrovascular disease-associated death. Hypertension and its complications are the main problems that have an impact on public health at present. A portion of adults with hypertension fail to meet the recommended blood pressure (BP) treatment goals, despite strict clinical management. Those individuals requiring at least three types of antihypertensive drugs to achieve their BP goal may be classified as patients with resistant hypertension (RH). Bioelectric technology is an emerging method that functions with the help of the human body's own bioelectric system. It is widely used in auxiliary examination, pain relief and organ function rehabilitation. Bioelectrical technology, as an effective treatment for RH, has developed rapidly in recent years and mainly includes renal sympathetic denervation, carotid baroreflex activation therapy, Traditional Chinese Medicine electroacupuncture and transcutaneous electrical nerve stimulation (TENS). The present review describes the pathogenesis of hypertension and provides an understanding of bioelectrical technology as a treatment. In particular, the development of the application of TENS in RH is introduced. The aim is to provide a basis for the clinical treatment of RH and a new idea for further clinical trials in this field.

60. Prevalence and Management of Hypertension in Regular Hemodialysis Patients at Sanjiwani Gianyar Hospital

Background: Hypertension is a condition in which blood pressure is more than equal to 140/90 mmHg. Hypertension is often found in CKD patients undergoing regular hemodialysis (HD). The mechanism of hypertension in CKD is multifactorial, so it is difficult to control and is associated with cardiovascular complications. Methods: This study is a cross-sectional study to determine the prevalence and management of hypertension in regular hemodialysis patients at Sanjiwani Gianyar Hospital in 2021. Patients included in the study were over 18 years of age, who underwent regular hemodialysis twice a week, and were willing to participate in the study by signing an informed consent. Results: In this study, 108 regular HD patients consisted of 61.1% men with the mean age of 53.70 years, mean length of HD of 43.04 months. The mean of URR is 75.6% and KT/V is 1.73. Hypertension was found in 68.5%, in which 29.7% of them with comorbid DM. The mean systolic blood pressure was 130.37 ± 20.37 mmHg and the mean diastolic blood pressure was 79.17 ± 9.87 mmHg. Controlled hypertension &lt;140/90 mmHg, was found in 51.4% of cases, where the majority of patients (65.8%) took 2 types of antihypertensive drugs, however 34.2% of patients used 3 types of antihypertensive drugs or more. Conclusion: The prevalence of hypertension in regular HD patients is high, however most of them can be controlled with 2 types of antihypertensive drugs. Reference: Unger T., Borghi C., Charchar F,. et al. International Society of Hypertension Global Hypertension Practice Guidelines 2020;75:1334-1357.

Association of MPPED2 gene variant rs10767873 with kidney function and risk of cardiovascular disease in patients with hypertension.

Changes in kidney function and the progression of chronic kidney disease (CKD) are associated with the risk of cardiovascular disease (CVD) and influenced by genetic factors. However, the association between genetic variants and kidney function in patients treated with antihypertensive drugs remains uncertain. This study aimed to examine the association between 30 variants locating at the 22 genes and the risk of kidney function evaluated by the estimated glomerular filtration rate (eGFR) in 1911 patients with hypertension from a Chinese community-based longitudinal cohort (including 1220 participants with CKD and 691 without CKD at baseline). By using multivariate linear regression analysis after adjustment for age, sex, traditional cardiovascular risk factors, and the use of antihypertensive drugs, as well as after correction for multiple comparison, patients with rs10767873T allele of the metallophosphoesterase domain containing 2 (MPPED2) gene were associated with higher level of eGFR (β = 0.041, p = 0.01) and lower levels of serum creatinine (β = -0.068, p = 0.001) and serum uric acid (β = -0.047, p = 0.02). But variant rs10767873 was not found to be associated with the risk of CKD, regardless of the types of antihypertensive drugs used. During a median 2.25-year follow-up, 152 CVD events were documented. Interestingly, patients with the rs10767873TT genotype had an increased risk of CVD events (hazard ratio, 1.74, 95% confidence interval, 1.11 to 2.73; p = 0.02) compared with patients carrying the wild-type genotype of rs10767873CC. In conclusion, our findings suggest variant rs10767873 of the MPPED2 gene is associated with kidney function and risk of CVD in Chinese hypertensive patients.

Drug safety among Hypertensive patients treated with antihypertensive drugs in Tertiary care Teaching Hospitals

Introduction:- Hypertension is one of the essential health problems Worldwide. According to JNC I to VIII guidelines treatment of hypertension with various type of antihypertensive drugs either mono therapy or combination therapy is updated time to time. Selection of a drug is often based on the benefit-risk ratio is also called drug safety even no one drug has totally safe and can be measured on the basis of occurrence of beneficial effect verses Adverse effect. The reporting of ADRs in nations is still low as comparison to providing 10% of total medication in the world. So the present study is proposed on entitled Drug safety among Hypertensive patient treated with antihypertensive drugs in Tertiary care teaching Hospitals. Materials and Methods:- This was a prospective and observational study carried out in the department of Pharmacology, Santosh Medical College and Hospital, Ghaziabad in collaboration with Department of Medicine, Muzaffarnagar Medical College, Muzaffarnagar, A total 234 hypertensive patient of both gender and age above 18 years treated with any types of antihypertensive drug were selected for the study. ADRs were recorded and evaluated with the help of ADRs form uploaded by CDSCO-PvPI of whose causality assessment and severity score that were calculated by appropriate scale and. Observation and Results:- A total 16.67% of prevalence of ADRs were found in this study of whose Risk/Benefit were calculated and found that ARBs and BBs groups were the safest group of antihypertensive drug with smallest number of ADRs prevelance 14.14% and 15.15% with risk benefit ratios 0.16 and 0.18 respectively. Conclusion:- The results of the above study would be useful for the physicians in rational selection of drug therapy for treatment of hypertensive patients. The present data suggest that the ADRs monitoring needs to be done in hospital settings continuously so that untoward effect caused by different medicines can be identified and documented to make better health care system and to stop further burden of unnecessary use of drug by patients health care system.

The Correlation between Various Types of Antihypertensive Drugs and the Incidence of Acute Stroke

Stroke is the second leading cause of death and the third leading cause of disability, whose incidence increase with hypertension. Various antihypertensives are used as secondary therapy for stroke. However, the effectiveness of each drug is still debated. This study aims to determine the correlation between various types of antihypertensive drugs on the incidence of acute stroke. This research is a cross-sectional study. Inclusion criteria included hypertensive patients who had used antihypertensive drugs for at least a year and were aged 36. We included 78 subjects, 47 men and 31 women. The drugs were ACEI + CCB (13), ARB (8), ARB + CCB (22), and CCB (35). The subject had an ischemic stroke (8) and a hemorrhagic stroke (1). The logistic regression test showed ACEI + CCB as a reference category. The result consecutively showed ARB (OR, 4.95; CI, 0.72 to 33.89; p = 0.103), CCB (OR, 2.61; CI, 0.39 to 17.01; p = 0.317), and ARB + CCB (OR, 2.36; CI, 0.19 to 29.75; p = 0.507). The antihypertensive drugs had no significant correlation with the incidence of acute stroke. It indicated that stroke risk was not triggered by antihypertensive and could effectively control hypertension and protect patients against stroke

S-35-2: THE IMPACT OF RENAL DENERVATION PROCEDURE ON THE USE OF ANTIHYPERTENSIVE DRUGS. A REAL-LIFE INVESTIGATION FROM ITALY

Objective: Randomized controlled trials have shown that renal denervation lowers office and ambulatory blood pressure. However, the clinical environment of controlled trials is different from that characterizing medical practice, making real-life data appropriate to provide information on a number of issues, e.g. whether renal denervation is followed by a change in the intensity and type of antihypertensive drug use. The aim of the present study was to evaluate whether patients undergoing renal denervation procedure in a real-life setting have a reduction in antihypertensive drug prescription over the subsequent years. Design and method: Using the healthcare utilization database of the Lombardy Region (Italy), the 136 patients who, during the period 2011–2016, were prescribed four or more antihypertensive drugs and underwent renal denervation were included in the study cohort. The number and type of antihypertensive drugs were assessed over the year before and during the three-year period after renal denervation. Hospitalizations for cardiovascular diseases were also assessed during the three years before and during the three years after renal denervation. Results: The median age of the patients was 67 years and 68% of them were men. Based on a multisource comorbidity score, about 40% of patients showed a poor or very poor clinical status. Before renal denervation, about 80% of the patients were prescribed four or five antihypertensive drugs. The number of drugs decreased after the denervation: after three years, patients prescribed 4/5 drugs were 57% and patients prescribed six drugs decreased from 18% to 2%. Reduced prescription extended to all antihypertensive drugs throughout the post-denervation period. Compared to the year before the denervation, after three years prescription of diuretics was reduced by 15%, calcium channel blockers by 21%, angiotensin-converting enzyme inhibitors by 32%, angiotensin receptor blockers by 22%, beta-blockers by 20%, alfa-blockers by 30%, and mineralocorticoid receptor antagonists by 30%. Hospitalizations for cardiovascular diseases did not show appreciable differences between the two periods (before and after the renal denervation). Conclusions: In the real-life setting, patients who underwent renal denervation had a clearcut reduction in antihypertensive drug prescription over the following years.

S-45-1: ONCO-HYPERTENSION: CONCEPT AND FUTURE PERSPECTIVES

In these decades, the morbidity of cancer has been increasing worldwide. On the other hand, the development of cancer treatment, such as small-molecule inhibitors, had improved the prognosis of patients with cancer. Consequently, cardiovascular diseases in cancer-survivors have become a matter of global concern. As a matter of fact, the mortality from cardiovascular events surpasses the mortality from cancers themselves in several types of cancer. Hypertension is reported to be the most frequent comorbidity and a significant risk factor for cardiovascular diseases among cancer-survivors. Besides, many types of newly discovered small-molecule inhibitors, including vascular endothelial growth factor signaling pathway inhibitors, proteasome inhibitors and Bruton-type tyrosine kinase inhibitors have been reported to be associated with blood pressure elevation. On the other hand, there have been reports that hypertension itself is associated with the occurrence of certain types of cancer, such as kidney or colon cancer, and some researchers have raised the possibility that antihypertensive drugs, such as thiazide diuretics, could elevate the risk of skin cancer from cancer registry database. From these, there is a close relationship between hypertension and cancers. However, many issues have remained to be solved regarding this field. For example, few guidelines mentioned the optimal target blood pressure and appropriate types of antihypertensive drugs during and after cancer therapy. Indeed, cancer patients are excluded from major large-scale trials evaluating the effects of antihypertensive drugs, and the patients with cardiovascular diseases are excluded from trials studying the effect of anticancer therapy, which makes it difficult to draw a definite conclusion regarding these issues. Additionally, it has not been clarified whether hypertension itself or the use of antihypertensive drugs are real risk factors for certain types of cancer and the screening for cancer occurrence is necessary for patients with hypertension or antihypertensive drugs. From these, we have been proposed a new concept, Onco-Hypertension, to better understand the complex association between hypertension and cancer. The concept, Onco-Hypertension, not only covers experimental and clinical studies exploring the bidirectional association between hypertension and cancer but also pursues comprehensive management of hypertensive cancer patients to improve their prognosis and quality of life. We think that multidisciplinary team approach including experts in hypertension, oncology, cardiology, nursing and so on, is necessary to clarify the unsolved issues regarding this, Onco-Hypertension, field.

PS-R04-2: A CASE OF SUCCESSFUL PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY (PTRA) FOR RENAL ARTERY STENOSIS ASSOCIATED WITH TAKAYASU'S ARTERITIS

Introduction: In Japan, renal vascular hypertension based on renal artery stenosis (RAS) accounts for 1% of all hypertensive patients, and RAS is present in approximately 10% of autopsy cases of coronary artery disease and cerebrovascular disease. As ischemic nephropathy and complications of cardiovascular disease (CVD) due to RAS are common, early diagnosis and treatment for RAS is important. However, results of several large clinical trials have not shown the efficacy of percutaneous transluminal renal angioplasty (PTRA) for atherosclerotic RAS. Case: 51-year-old woman who diagnosed as Takayasu's arteritis (TA) 35 years ago, had been treated with 5 mg daily of prednisone. She presented with hypertension and edema in both legs a year before admission. Her examination at that time revealed increased serum creatinine from 1.0 to 1.7 mg/dL, high proteinuria (7.3 g/gCr), high renin activity (47.0 ng/mL/hr) and right RAS. Eight months before admission, she had an operation for ruptured descending aorta. She had recurrent episodes of dyspnea on exertion, worsening leg edema and severe hypertension and was admitted to the hospital for the treatment. Clinical course: In addition to severe hypertension (190/80 mmHg) and progression of RAS, she had pulmonary congestion, high brain natriuretic peptide (BNP) level (1149.5 pg/mL), increasing creatinine levels (Cr 3.1 mg/dL), and left non-functioning kidney on admission. Despite taking 8 types of antihypertensive drugs and diuretics without renin-angiotensin system inhibitors, blood pressure and fluid retention were poorly controlled, and thus we decided to perform PTRA for the right RAS. After the PTRA, edema, hypertension and pleural effusion had been dramatically improved. In addition, we could observe decrease of serum creatinine (Cr 1.6 mg/dL), proteinuria (0.5 g/gCr) and plasma renin activity (1.9 ng/mL/hr). Therefore, we reduced the antihypertensive drugs from 8 to 2. Discussions: Although the benefit of PTRA for RAS associated with TA remains unclear, the clinical course suggests that the success of PTRA in this case may be related to the fact that the RAS was complicated by TA. It also suggests that we should consider PTRA in cases of hypertension and pulmonary congestion associated with RAS which are difficult to control like this case. Conclusion: We have experienced a case of RAS associated with TA that was successfully treated with PTRA.

PS-C19-8: A COMPARISON OF THE MEDICATION COST AND INCIDENCE RATE OF CARDIOVASCULAR EVENTS BETWEEN INTENSIVE AND STANDARD ANTIHYPERTENSIVE PHARMACOTHERAPIES IN JAPAN

Objective: Hypertension is a major health challenge, imposing an enormous economic burden as well as health burden worldwide. In Japan, the economic burden of hypertension and related diseases is estimated to be JPY1.7 trillion (USD 13 billion) per year, around 4% of total healthcare expenditures. This study aimed to compare treatment outcomes and costs between intensive and standard pharmacotherapies, focusing on the types of antihypertensive drugs and prescribing patterns. Design and method: We performed a retrospective cohort study using electronic medical record data obtained from 34 healthcare facilities in Japan. The incidence of cardiovascular events captured via claims data was set to be the outcome measure. Multivariable mixed effects Cox-proportional hazards model was applied to compare the costs and the outcomes from intensive pharmacotherapy arm (i.e., short prescribing interval/expensive drugs) and standard one (i.e., long prescribing interval/low-cost drugs). Results: During 6,013 person-years of follow-up, 74 events were observed. While age at the beginning of treatment had significant impact on the incidence of cardiovascular events [Hazard Ratio, 1.05 (95%CI 1.02 - 1.07); p &lt; 0.001], no associations with cardiovascular events were found for mechanism of drug action (CCB) [1.37, (95%CI 0.839 - 2.24); p = 0.21] and for short prescribing interval (less than 30 days) [1.17 (95%CI 0.695 - 1.98); p = 0.55]. The mean medication costs per day per patient of CCB and ARB were JPY 28.9 and JPY 51.8, respectively. Conclusions: No significant impacts on treatment outcomes were observed for drug type and prescribing interval, although the medication costs of intensive pharmacotherapy arm were more expensive than standard arm.