Uncontrolled Hypertensive Patients Research Articles

Sociodemographic and Clinical Correlates of Uncontrolled Hypertension in Patients on Treatment for Hypertension in a Family Practice in Southwest Nigeria

Abstract Context: Hypertension causes cardiovascular morbidities globally, particularly in Africa. Hypertension is a disease that is difficult to manage, and there are reports of suboptimal control in hypertensive patients despite clinic attendance. This study sought to characterize the profile of outpatients with uncontrolled hypertension while on treatment. Materials and Methods: There was a purposive consecutive sampling of 78 registered hypertensive patients diagnosed at least six months before recruitment and having clinic blood pressures at ≥ 140/90 mmHg in at least two previous consecutive clinic visits in an outpatient clinic. Their sociodemographic and clinical variables were collected using a semi-structured questionnaire, which incorporated the Hillbone Compliance to High Blood Pressure Scale. Results: There were 52 (66.7%) females and 26 (33.3%) males. The mean age was 54.3 years ± 11.48. The mean blood Pressure (BP) at initial contact was 143.92/89 mmHg. About 40.3% of participants were obese. Most 71.4% of the patients were adherent to prescribed medications. There were no significant socio-demographic factors associated with uncontrolled hypertension after multiple linear regression analysis. There was a significant positive linear correlation between poorer medication adherence and higher diastolic blood pressure r = 2.57, P = 0.024. Conclusion: Physicians ought to recognize the pattern of uncontrolled blood pressure in patients despite treatment and institute an appropriate intervention.

Prevalence and prediction of masked uncontrolled hypertension in patients recently hospitalised for an acute coronary syndrome

Abstract Background Masked uncontrolled hypertension (MUCH) is defined as normal office blood pressure (BP) but elevated out-of-office BP in patients on antihypertensive treatment. MUCH is associated with similar cardiovascular risk as sustained hypertension and is clinically challenging since this often remains undetected without out-of-office BP measurements. Purpose To study the prevalence of MUCH following an acute coronary syndrome and to utilise machine learning methods to develop prediction models for identifying MUCH. Methods Ambulatory 24-h BP measurement (ABPM) was performed in 100 patients attending the cardiology outpatient clinic at a Swedish university hospital following an acute coronary syndrome, as part of a study which screened for co-morbidities. From the SWEDEHEART registry, 106 variables during the hospital care period and subsequent follow-up visit (after 6-10 weeks) were pre-processed including filtering on 5 or more missing values and zero or near-zero variance. Variable importance for the prediction of MUCH (office BP < 140/90 mm Hg at ABPM start but mean 24-h BP ≥ 130/80 mm Hg) was assessed using the Boruta and least absolute shrinkage and selection operator (LASSO) machine learning algorithms. Subsequently, logistic regression, LASSO and random forest models using different variable subsets were evaluated by receiver operating characteristic area under the curve (AUC) in repeated cross-validation. Results Age was 62.0±8.4 years, 74% male, 54% had NSTEMI and 46% STEMI. The follow-up visit and ABPM were performed at median 7 and 11 weeks, respectively, after hospital discharge. Among 90 patients with complete data and ABPM recordings, 31 had mean 24-h BP above target levels, of which 18 were identified with MUCH. Patients with MUCH had lower eGFR (68±11 vs 76±12 ml/min/1.73m², P=0.009), and more often a history of hypertension (89 vs 53%, P=0.005) and diabetes mellitus (44 vs 11%, P=0.003). In total, 65 variables where eligible for machine learning after filtering. Boruta and LASSO identified pulse pressure at the follow-up visit, serum creatinine, diabetes mellitus and history of hypertension as important predictors. Random forest, logistic regression and LASSO showed mean AUC 0.826, 0.822, and 822, respectively, in cross validation using these predictors. Conclusions In this small trial, one in five had MUCH at follow-up after an acute coronary syndrome, which highlights the importance of out-of-office BP measurements. The easily accessible measures of pulse pressure at the follow-up visit, serum creatinine, diabetes mellitus and history of hypertension were identified as important predictors of MUCH. A simple prediction model may be used as a clinical decision support tool after appropriate external validation.

Abstract P398: The effects of care by hypertension specialists on cardiovascular outcome, blood pressure control and cost-effectiveness among uncontrolled hypertensive patients

Background: Studies suggested that physician specialty had an impact on patient outcomes of cardiovascular disease. However, the effects of care by hypertension specialists on clinical outcomes and financial burden among uncontrolled hypertensive patients are unknown. Objective: This study was to assess the effects of care by hypertension specialists on risk of cardiovascular outcomes, blood pressure (BP) control, and cost-effectiveness among patients with uncontrolled hypertension. Methods: A retrospective cohort study of patients aged 45-79 years who were admitted for uncontrolled hypertension was conducted. We assessed the relationship between care by hypertension specialists and major adverse cardiovascular events (MACE), BP control, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) by the Cox regression, the generalized estimating equations (GEE) model, and the Markov model, respectively. Results: A total of 10680 patients with uncontrolled hypertension were followed up for a median of 4.0 years. Among the 5646 (52.9%) patients received care by hypertension specialists and had fewer MACE than the non-specialists group (21.5 vs 39.7 per 1000-person-year; hazard ratio 0.67; 95% CI: 0.57 to 0.79) according to multiple Cox regression after stabilized inverse probability of treatment weighting. At 4 years, the odds ratio between the hypertension specialist group and the non-specialist group was 0.83 (95% CI: 0.79 to 0.86). Odds ratios with declining trend were observed at 1, 2, and 3 years. Over a lifetime horizon, the ICERs of the hypertension specialists group was USD 6295.37 per QALY gained compared with the non-specialists group. Conclusions: This study provided some evidence that care by hypertension specialists was associated with reduced risk of MACE and improved BP control in patients with uncontrolled hypertension, and was cost-effective.

P042 EFFECTIVENESS OF STRUCTURED TELEMONITORING BLOOD PRESSURE IN PRIMARY CARE: UNCONTROLLED HYPERTENSE COHORTS

Introduction: E-health has emerged as a pivotal resource in healthcare delivery due to its widespread coverage, ease, and acceptance, particularly for chronic diseases. We aim to establish the effectiveness of structured telemonitoring in managing blood pressure among patients with uncontrolled essential arterial hypertension. Methods: An analytical observational retrospective cohort study of uncontrolled hypertensive patients aged ≥ 18 was conducted, with follow-ups at 150 and 240 days. Patients in the telemonitoring cohort were provided with validated digital blood pressure monitors, underwent remote monitoring, and received weekly feedback for 30 days from a multidisciplinary team. Conversely, the non-telemonitoring cohort received usual care consisting of attendance to in-person medical consultations as part of our institution's cardiovascular-risk-prevention program. Results: 350 patients were included, with median ages of 55 and 66 years in the telemonitoring and non-telemonitoring cohorts, respectively. Over the 240-day follow-up, the telemonitoring group achieved a significant reduction in systolic (-20.99 mmHg; 95% CI 14.99- 27.50; p 0.000) and diastolic blood pressure (- 14.99 mmHg; 95% CI 10.00- 18.99; p 0.000) compared to usual care, which demonstrated reductions of 19.99 mmHg (95% CI 16.49- 22.50; p 0.000) in systolic blood pressure and 6.50 mmHg, (95% CI 4.50- 9.00; p 0.000) in diastolic blood pressure. Conclusion: Telemonitoring is an effective strategy for patients with uncontrolled arterial hypertension, leading to earlier and significant blood pressure reductions.

Uncontrolled blood pressure among the established hypertensive elderly people in Jashore, Bangladesh: A cross‐sectional type of observational study

AbstractObjectivesHypertension is one of the major modifiable risk factors for cardiovascular mortality and morbidity throughout the world. Increased life expectancy leads to increase prevalence of non‐communicable diseases among the elderly people including Bangladesh. However, different studies reported high prevalence of uncontrolled hypertension ranging from 52.6% to 67.9% among the elderly people in different countries. With this view, we aimed to assess the frequency of uncontrolled blood pressure (BP) among the elderly hypertensive people and its associated risk factors and treatment pattern in Bangladesh.MethodologyThis cross‐sectional type of observational study recruited 246 eligible hypertensive elderly patients attending in 250 Bedded General Hospital, Jashore, Bangladesh dated from 1st July to 31st December 2022. A structured questionnaire was developed and data on associated risk factors, treatment pattern and current blood pressure (BP) measurement were collected by face‐to‐face interview for the purposive sampling technique.ResultsThe mean age of our study patients was 72 ± 7 years with a male and female ratio nearly 1:1. Of the total hypertensive patients aged over 65 years or more, 56.5% remained with uncontrolled hypertension even on their prescribed antihypertensive medications. The mean systolic (SBP) and diastolic (DBP) blood pressure were significantly high (P < 0.001) as 167 ± 22 mm Hg and 95 ± 11 mm Hg, respectively, among the uncontrolled hypertensive patients. However, we noticed the mean SBP and DBP among the total hypertensive patients were also significantly high (P < 0.001) as 148 ± 27 mm Hg and 87 ± 13 mm Hg, respectively. In this study, we reported that the mean number of last prescribed antihypertensive medications used by the total patients was 2 ± 1 (P =0.224) which was similar among the controlled and uncontrolled hypertensive patient groups. Among the elderly hypertensive patients, the most commonly prescribed antihypertensive medications were Amlodipine 39.8% (P =0.006), Olmesartan 29.3% (P = 0.186), Losartan 24.4% (P = 0.127), Bisoprolol 15.0% (P = 0.266) and Atenolol 14.6% (P = 0.224).ConclusionWe noticed high frequency of uncontrolled blood pressure among the elderly hypertensive patients, despite of using multiple antihypertensive medications in Jashore, Bangladesh.

Cost-effectiveness Analysis of Lercanidipine Compared to Amlodipine as an Addition to Renin-angiotensin System Blockers in Diabetic Hypertensive Patients with Albuminuria in Thailand

Objective: Dihydropyridine calcium channel blocker (DHP-CCBs) is an appropriate add-on antihypertensive option for uncontrolled blood pressure diabetic hypertensive patients with albuminuria who are already taking renin-angiotensin system blockers (RASBs). Among DHP-CCBs, amlodipine is the first-line medication in combination with RASBs. However, new-generation DHP-CCBs like lercanidipine has demonstrated superior effectiveness and fewer side effects, although at a higher cost than amlodipine. This study aims to assess the cost-effectiveness of lercanidipine versus amlodipine when added to RASBs in diabetic hypertensive patients with albuminuria. The objective is to provide robust evidence guiding the selection of the most suitable and worthwhile treatment option in Thailand. Materials and Methods: This study analyses the cost-effectiveness of lercanidipine versus amlodipine as an addition to RASBs in diabetic hypertensive patients with albuminuria. The analysis was conducted from a societal perspective using a Markov model. Results: The total costs of lercanidipine and amlodipine treatments were 370,392.83 baht and 384,221.85 baht, respectively. The life years gained for lercanidipine and amlodipine treatments were 11.33 years and 10.96 years respectively. Additionally, the quality-adjusted life years (QALYs) of lercanidipine and amlodipine treatments were 8.06 years and 7.51 years respectively. Conclusion: Due to lercanidipine's noticeable cost-effectiveness, lower costs, and longer QALYs. Adding lercanidipine has proven to be more cost-effective than amlodipine for diabetic hypertensive patients with albuminuria who have been unable to achieve their blood pressure goals with RASBs alone. Therefore, lercanidipine should be the preferred choice as an add-on to RASBs in Thailand. These results could significantly aid policymakers in making informed decisions.

Profile of hypertensive Indonesian patients in a cardiovascular hospital using ambulatory blood pressure monitoring focused on resistant hypertension

ObjectiveDespite being the gold standard for diagnosing hypertension, the utilization of ambulatory blood pressure monitoring (ABPM) in clinical practice in Indonesia is still uncommon. This study aims to determine the blood pressure profile of hypertensive patients, with a focus on resistant hypertension (RH), by using ABPM reports and assessing its correlation with CV comorbidities. MethodsThis cross-sectional study analyzed 164 ABPM reports of hypertensive patients who were referred for 24-h ABPM at Hasna Medika Palimanan Cardiovascular Hospital, Cirebon. These patients were on one or more antihypertensive medications. Only ABPM with valid readings (at least 70 % successful recording) were included in the study. The final total of ABPM reports that were included is 149. ResultsThere were 120 (80.5 %) women and 29 (19.5 %) men. The mean age was 57.3 ± 9.3 years. Sixty-four percent of the patients had coronary artery disease (CAD), and 51 % were diagnosed with heart failure (HF). Fifty percent had uncontrolled hypertension, 36 % had a white coat effect, and 13 % of patients had controlled hypertension. A total of 53 (70 %) of uncontrolled hypertensive patients had resistant hypertension. The majority of these patients were women (71.7 %) and under 55 years old (39.6 %). CAD was found to be the most prevalent comorbidity in this group. ConclusionResistant hypertension had a high prevalence in this study, with several possible causes. Therefore, RH should be managed more intensively, as it can increase the risk of major cardiovascular events and mortality.

Assessment of Juxta Papillary Retinal Fiber Layer in Normal Blood Pressure, Controlled and Uncontrolled Hypertensive Patients

Assessment of Juxta Papillary Retinal Fiber Layer in Normal Blood Pressure, Controlled and Uncontrolled Hypertensive Patients

A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study.

Non-adherence to medication severely affects chronic disease control. To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients. A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period. The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (±8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (±13.6)/97.7 (±8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg). The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.

Effect of Therapeutic Drug Monitoring on Adherence and Blood Pressure: A Multicenter Randomized Clinical Trial.

Drug concentration in blood or urine is an acknowledged method to detect nonadherence. Observational studies suggest that informing patients about low or absent serum drug levels improves blood pressure (BP). We performed a multicenter randomized clinical trial to test the hypothesis that therapeutic drug monitoring (TDM) could improve drug adherence and BP in patients with uncontrolled hypertension (HT). Patients were ≥18 years on stable treatment with at least 2 antihypertensive agents. We planned to randomize 80 nonadherent patients with a systolic daytime ambulatory BP ≥135 mm Hg to TDM intervention or not. The control group and the study personnel who measured BP remained uninformed about serum drug measurements throughout. All patients and physicians were blinded for BPs. Lifestyle advice and detailed information on the disease process and the importance of BP treatment were given to both groups. From 2017 to 2022, we randomized 46 diagnosed nonadherent from a total of 606 patients with uncontrolled HT. The TDM group had a 6.7 (±14.5) mm Hg reduction from 147.9 (±10.3) to 141.1 (±14.1) mm Hg, and the control group experienced a 7.3 (±13.2) mm Hg reduction from 147.1 (±9.2) to 139.1 (±17.4) mm Hg, P = 0.9 between groups. Adherence improved in both groups, 73% in the TDM group and 59% in the control group became adherent at 3 months, P = 0.51. In our prospective multicenter clinical trial of uncontrolled and nonadherent hypertensive patients, we found no additional effect of TDM on BP and drug adherence compared with standard care. Trial Number NCT03209154, www.clinicaltrials.gov.

COMPARATIVE EFFECTIVENESS OF FREE AND FIXED COMBINED ANTIHYPERTENSIVE THERAPY IN ACHIEVING TARGET BLOOD PRESSURE VALUES IN UNCONTROLLED ARTERIAL HYPERTENSION

Objective: Aim of our study was to assess the achievement of target blood pressure in uncontrolled hypertensive patients with high and very high-risk, resistant to double AHT, depending on the treatment regimen - free and fixed combinations of three antihypertensive drugs. Design and method: The study included 143 patients II-III AH stage, who were on double AHT, who are not reached the target blood pressure level. The average age of patients was 55.8±9.35 years, including men n=70 (49%), women n=73 (51%). All patients underwent a physical examination with three measurements of office blood pressure using the Korotkoff method. Patients were randomized into 2 groups: group 1- triple antihypertensive therapy with a free combination of indapamide, amlodipine, and perindopril (n=71), and 2 nd group- a fixed combination therapy (n=72). Statistics were carried out between the stages before treatment and 6 months. Results: Research results. Against the background of triple AHT, target blood pressure levels were achieved in both groups: in group 1, initial SBP/DBP before treatment was 171.29±16.6 mmHg/99.64±9.03 mmHg, in dynamics 128.38±8.5 mmHg/80.89±6.38 mmHg. (p=0.0001); in group 2: initially SBP/DBP before treatment 170.76±17.75 mmHg/100.63±8.39 mmHg, 6 months of therapy 121.95±6.7 mmHg st./77.23±5.59 mmHg (p=0.0001). The results showed a significant decrease in SBP (p=0.0001) and DBP (p=0.0001) in group 2 compared to group 1. At the same time, the primary target level in group 1 was achieved in 83.3%, in group 2 in 94.4% of patients (χ2 = 7.471; p = 0.006). The target blood pressure level &lt;130/80 according to SBP was achieved by 42% and 67% of patients, respectively, for groups 1 and 2 (χ2=11.61; p=0.0001); for DBP – 10% and 33.3%, respectively, for groups 1 and 2 (χ2=9.011; p=0.003). Conclusions: Obtained results showed the high antihypertensive effectiveness of 6-month AHT with a triple fixed combination therapy compared to free, achieving the primary target blood pressure level and the main target blood pressure level in a significantly larger number of patients with hypertension on a triple fixed combination of antihypertensive drugs.

Patients with uncontrolled hypertension subjected to cardiopulmonary bypass have altered coronary vasomotor responses to serotonin

BackgroundWe previously found that cardioplegic arrest and cardiopulmonary bypass are associated with altered coronary arteriolar response to serotonin in patients undergoing cardiac surgery. In this study, we investigated the effects of hypertension on coronary microvascular vasomotor tone in response to serotonin and alterations in serotonin receptor protein expression in the setting of cardioplegic arrest and cardiopulmonary bypass. MethodsCoronary arterioles were dissected from harvested pre– and post–cardioplegic arrest and cardiopulmonary bypass right atrial tissue samples of patients undergoing cardiac surgery with normotension, well-controlled hypertension, and uncontrolled hypertension. Vasomotor tone was assessed by video-myography, and protein expression was measured with immunoblotting. ResultsPre–cardioplegic arrest and cardiopulmonary bypass, serotonin induced moderate relaxation responses of coronary arterioles in normotension and well-controlled hypertension patients, whereas serotonin caused moderate contractile responses in uncontrolled hypertension patients. Post–cardioplegic arrest and cardiopulmonary bypass, serotonin caused contractile responses of coronary arterioles in all 3 groups. The post–cardioplegic arrest and cardiopulmonary bypass contractile response to serotonin was significantly higher in the uncontrolled hypertension group compared with the normotension or well-controlled hypertension groups (P < .05). Pre–cardioplegic arrest and cardiopulmonary bypass, expression of the serotonin 1A receptor was significantly lower in the uncontrolled hypertension group compared with the well-controlled hypertension and normotension groups (P = .01 and P < .001). Serotonin 1B receptor expression was higher in the uncontrolled hypertension group compared with the normotension or well-controlled hypertension groups post–cardioplegic arrest and cardiopulmonary bypass (P = .03 and P = .046). ConclusionUncontrolled hypertension is associated with an increased coronary contractile response of coronary microvessels to serotonin and altered serotonin receptor protein expression after cardioplegic arrest and cardiopulmonary bypass. These findings may contribute to a worse postoperative coronary spasm and worsened recovery of coronary perfusion in patients with uncontrolled hypertension after cardioplegic arrest and cardiopulmonary bypass and cardiac surgery.

SYNERGIA-MOROCCO: EFFECTIVENESS OF HYPERTENSION MANAGEMENT WITH AN AMLODIPINE AND PERINDOPRIL ARGININE-BASED STRATEGY IN MOROCCO: STUDY DESIGN AND PRELIMINARY DATA

Objective: In Morocco, 1 in 3 adults currently live with hypertension; over 70%1 are not aware or not effectively treated. Among treated hypertensive patients, many receive monotherapy and remain uncontrolled. WHO recommends the addition of an angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker or a diuretic in patients who are uncontrolled on a calcium-channel blocker and a monthly follow-up after initiation until patients reach targets. However, there is limited evidence from real-world observational studies in Morocco on the effectiveness of this approach on blood pressure control. This study aims to evaluate the effectiveness of an amlodipine and perindopril arginine-based strategy for 90 days in hypertensive patients previously uncontrolled on monotherapy of amlodipine. Design and method: This is a multicenter prospective observational study. Eighty (80) primary care physicians across Morocco will recruit about 1 600 uncontrolled hypertensive adult patients who start perindopril-arginine on top of previous amlodipine monotherapy. During the study, physicians will be free to adapt treatment per their judgement, including dose adaptations, the addition of a third drug or the use of a single pill combination (SPC) as a substitute for the free combination of amlodipine/perindopril at the same dose when patients become controlled. The primary outcome will be the change in sitting office blood pressure between baseline and day 90. Secondary outcomes will include; the change in the blood pressure between baseline and the initiation of the SPC and between the initiation of the SPC and the end of the study, and the difference in the proportion of participants with side effects between the free combination and SPC. Results: The first patient was enrolled in the study on October 30, 2023. On January 10, 2024, 1 400 patients were recruited, and 760 had the 30-day follow-up visit. Conclusions: In Morocco, hypertension is a significant public health issue but current treatment optimisation strategies lack evidence from real-world data. The recruitments started as planned, and this will be the first real-world study from Morocco on the short-term effectiveness of treating hypertension with an amlodipine and perindopril arginine-based combination strategy on blood pressure control.

Approaches in Managing Resistant Hypertension: A Review.

In India, around 234 million adults (one in three) suffer from hypertension (HTN). An average of 10% of these cases are likely to be resistant hypertension (RH). This load of 23 million patients is expected to expand further with revisions in diagnostic criteria. The treatment and control rates of hypertension in India average around 30% and 15%, respectively. Pharmacological management involves a stepwise approach starting with optimizing the A-C-D (angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide-like diuretics) triple-drug combination, followed by substitution with a thiazide-like diuretic and use of spironolactone as a next step (fourthdrug). The subsequent steps are suggestions based on expert input and must be individualized. These include using a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when target blood pressure (BP) values are not achieved. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are likely to be helpful in managing RH due to their renal and cardiovascular protection as well as mortality benefits. SGLT2i lowers BP independent of the dosage and concomitant anti-hypertensive medications. Patient education and tools to monitor BP and treatment compliance will improve outcomes with these medications. In addition to therapeutic intervention, a preventive approach for RH mandates a need to identify patients at risk and use appropriate preventive and optimal therapy to prevent uncontrolled hypertension in patients with cardiovascular disorders.

Masked uncontrolled hypertension in patients with impaired carbohydrate metabolism

Aim. To establish the prevalence of masked uncontrolled hypertension (HTN) (MUH) in patients with diabetes or impaired glucose tolerance (IGT) and determine its clinical and hemodynamic characteristics.Material and methods. The study involved 87 patients who received regular antihypertensive therapy for hypertension and had established diabetes or IGT. The mean age of patients was 62,6±9,9 years, of which 51,7% were women, 48,3% — men. Type 2 diabetes was revealed in 77,7%, IGT — 22,8% of patients. For 24-hour blood pressure monitoring, BpLAB system (OOO Petr Telegin) was used; blood pressure (BP) was determined in the brachial artery, central blood pressure — in the aorta. We analyzed risk factors and target organ damage. The results were processed using the Excel Microsoft Office 2007 package and the Statistica 6.0 and 10.0 package from StatSoft, Inc (USA).Results. Uncontrolled hypertension was revealed in 59,8%, MUH — in 18,4%, controlled HTN — 21,8% of patients. Mean daytime and mean nighttime systolic BP in patients with MUH and uncontrolled HTN were comparable. Patients with controlled hypertension compared with MUH had lower mean day- and nighttime aortic BP by 27,1% (p&lt;0,01) and 16,8% (p&lt;0,01), respectively. Aortic BP was comparable in individuals with MUH and uncontrolled HTN. Asymptomatic hyperuricemia was more common in patients with uncontrolled HTN compared with MUH and controlled hypertension by 29,3% and 41,8%, respectively. With MUH, compared with controlled HTN, we revealed a higher incidence of stroke by 18,8%, a decrease in glomerular filtration rate &lt;60 ml/min by 17,5%, albuminuria by 18,8%, left ventricular hypertrophy by 2,6 times.Conclusion. Only 41,2% of patients with diabetes and prediabetes achieve the target office BP level, while every second of these patients has MUH. MUH, compared with controlled HTN, is characterized by a higher incidence of stroke, kidney (decrease in glomerular filtration rate &lt;60 ml/min and albuminuria) and heart damage (left ventricular hypertrophy).

Lorundrostat may cause a clinically significant decline in renal function; a letter to the editor

Lorundrostat is an aldosterone synthase inhibitor that can be used in patients with uncontrolled hypertension. It effectively lowers blood pressure, but there are concerns about the limited renal safety data available for lorundrostat. In order to address this issue, it is recommended that future research should incorporate more detailed kidney assessments, which would include monitoring for conditions such as proteinuria and acute kidney injury (AKI). This paper discusses the effects of lorundrostat on the estimated glomerular filtration rate (eGFR) and highlights the significant variability in these effects among individuals. The research shows that lorundrostat may cause a decline in eGFR exceeding one standard deviation above the mean change in approximately 16% of patients. In severe cases, 0.2% of patients may experience eGFR declines of ≥42 mL/min/1.73 m². These declines in eGFR could increase chronic kidney disease (CKD) stages, even in those with baseline eGFR &gt;60 or 90 mL/min/1.73 m². In conclusion, while most lorundrostat patients do not experience severe eGFR declines, there is still a risk of clinically meaningful declines and CKD progression, particularly among susceptible individuals. Further research is needed to confirm these findings and identify renal risk factors in uncontrolled hypertension patients who receive aldosterone synthase inhibition.

The impact of communication training on the clinical care of hypertension in general practice: a cluster randomized controlled trial in China

BackgroundHypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management.MethodsA cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs’ communication skills after one month, patients’ knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes.ResultsAfter the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP’s communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients’ knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP’s communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient’s knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up.ConclusionCommunication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs.Trial registrationThe trial was registered on Chinese Clinical Trials Registry on 2019–04-03. (ChiCTR1900022278).

Clinical Decision Support for Hypertension Management in Chronic Kidney Disease

Chronic kidney disease (CKD) affects 37 million adults in the United States, and for patients with CKD, hypertension is a key risk factor for adverse outcomes, such as kidney failure, cardiovascular events, and death. To evaluate a computerized clinical decision support (CDS) system for the management of uncontrolled hypertension in patients with CKD. This multiclinic, randomized clinical trial randomized primary care practitioners (PCPs) at a primary care network, including 15 hospital-based, ambulatory, and community health center-based clinics, through a stratified, matched-pair randomization approach February 2021 to February 2022. All adult patients with a visit to a PCP in the last 2 years were eligible and those with evidence of CKD and hypertension were included. The intervention consisted of a CDS system based on behavioral economic principles and human-centered design methods that delivered tailored, evidence-based recommendations, including initiation or titration of renin-angiotensin-aldosterone system inhibitors. The patients in the control group received usual care from PCPs with the CDS system operating in silent mode. The primary outcome was the change in mean systolic blood pressure (SBP) between baseline and 180 days compared between groups. The primary analysis was a repeated measures linear mixed model, using SBP at baseline, 90 days, and 180 days in an intention-to-treat repeated measures model to account for missing data. Secondary outcomes included blood pressure (BP) control and outcomes such as percentage of patients who received an action that aligned with the CDS recommendations. The study included 174 PCPs and 2026 patients (mean [SD] age, 75.3 [0.3] years; 1223 [60.4%] female; mean [SD] SBP at baseline, 154.0 [14.3] mm Hg), with 87 PCPs and 1029 patients randomized to the intervention and 87 PCPs and 997 patients randomized to usual care. Overall, 1714 patients (84.6%) were treated for hypertension at baseline. There were 1623 patients (80.1%) with an SBP measurement at 180 days. From the linear mixed model, there was a statistically significant difference in mean SBP change in the intervention group compared with the usual care group (change, -14.6 [95% CI, -13.1 to -16.0] mm Hg vs -11.7 [-10.2 to -13.1] mm Hg; P = .005). There was no difference in the percentage of patients who achieved BP control in the intervention group compared with the control group (50.4% [95% CI, 46.5% to 54.3%] vs 47.1% [95% CI, 43.3% to 51.0%]). More patients received an action aligned with the CDS recommendations in the intervention group than in the usual care group (49.9% [95% CI, 45.1% to 54.8%] vs 34.6% [95% CI, 29.8% to 39.4%]; P < .001). These findings suggest that implementing this computerized CDS system could lead to improved management of uncontrolled hypertension and potentially improved clinical outcomes at the population level for patients with CKD. ClinicalTrials.gov Identifier: NCT03679247.

Assessment of diastolic dysfunction in controlled and uncontrolled hypertensive patients: A prospective observational study

Introduction and Aim: Hypertension is a significant risk factors for CVS events on its own, and resulting DD. The aim of the study is to demonstrate the effect of hypertension on the LV diastolic dysfunction in controlled and uncontrolled hypertensive patients which helps to predict the CVS mortality. Materials and Methods: The present study included 210 Hypertensive patients in which 105 controlled HTN &amp; 105 uncontrolled HTN (age ranged from 30-70 years) with their evidence of Blood Pressure. By using Tissue Doppler imaging E/A, E/E’ and E’ are measured and TTE, the following parameters are assessed: IVRT, IVCT, Pulmonary venous flow and hepatic vein flow. Results: Diastolic dysfunction and blood pressure were positively correlated, with degree of diastolic dysfunction increasing along with blood pressure levels. Diastolic dysfunction and controlled hypertension were not correlated, although moderate and severe hypertension and diastolic dysfunction had a direct association. Conclusion: In the uncontrolled hypertensive groups compared to the controlled hypertensive groups, the diastolic dysfunction was considerably and progressively higher, according to this study. To obtain population-based data on diastolic dysfunction and other confounding factors in our environment, irrespective of blood pressure levels, more research with a greater number of patients is advised.

Chitosan‐Based Hemostatic Pad Reduced Vascular Complications After Transradial Coronary Intervention in Uncontrolled Hypertensive Patients: Application of Chitosan‐Based Hemostatic Pad on CAG or PCI

Background: Vascular complications after coronary angiography (CAG) or percutaneous coronary intervention (PCI) are a major concern for revascularization therapies. In this study, we investigated whether the application of a chitosan‐based hemostatic pad (HP) could ameliorate vascular complications after CAG or PCI procedures.Methods: We retrospectively analyzed patients undergoing CAG or PCI in our cardiovascular center from January 2019 to December 2021. The incidence of total vascular complications including errhysis, large hematoma, pseudoaneurysm, radial artery occlusion (RAO), blister, and pain was recorded. Subgroup analyses of patients with a history of hypertension, patients with uncontrolled hypertension, and patients with controlled hypertension were performed.Results: Our results demonstrated that the application of chitosan‐based HP had no effect on vascular complications after CAG or PCI procedures (odds ratio [OR]: 1.03 (0.84–1.26), p = 0.80). Nevertheless, chitosan‐based HP treatment markedly decreased the incidence of vascular complications in uncontrolled hypertensive patients (OR: 0.32 (0.11–0.95), p = 0.04), but not in hypertensive patients with controlled blood pressure (BP) (OR: 1.09 (0.88–1.35), p = 0.42).Conclusions: Chitosan‐based HP treatment could reduce the incidence of vascular complications in patients with uncontrolled hypertension. Nonetheless, applying chitosan‐based HP treatment after CAG or PCI procedures is not recommendable for controlled hypertensive patients.