Uncontrolled Hypertensive Patients Research Articles

The Effect of Educational Program on Hypertension Management Toward Knowledge and Attitude Among Uncontrolled Hypertension Patients in Rural Area of Indonesia.

Hypertension is a major public health threat affecting adults worldwide. The low hypertension management knowledge causes uncontrolled high blood pressure and it's a complication. It requires patients with uncontrolled hypertension to increase adherence to either pharmacological therapy or nonpharmacological therapy aimed at achieving normal blood pressure. The purpose of this study was to examine the effectiveness of a short-term educational program on hypertension management related knowledge and attitude among uncontrolled hypertension patients in Malang, Indonesia. The research design used a Quasi-Experimental study with the design of one group pre-post-test. The participants were 41 uncontrolled hypertension patients chosen by purposive sampling at the Ciptomulyo Public Health Center. The questionnaires were used to collect the data. The Hypertension Knowledge-Level Scale (HK-LS) questionnaire was used to determine the knowledge of uncontrolled hypertension patients. KAP questionnaire was used to determine the attitude of the participants. The data were analyzed statistically using the Wilcoxon Signed Rank Test. The majority of respondents were aged 55-65 (54%), female (83%), housewife (76%), graduated elementary school (71%), and long suffered from hypertension >1 year (68%). The result showed that the provision of the educational program increases knowledge (p = 0,000) and attitude (p = 0,008) of patients on the management of hypertension. Health education could improve hypertension management knowledge and attitude among uncontrolled hypertension in the rural area. Furthermore, Health providers should consider giving the education among uncontrolled hypertension.

Usefulness of 24-hour ambulatory blood pressure monitoring in a population with high cardiovascular risk.

High blood pressure is considered a disease and at the same time a cardiovascular risk factor, mainly involved in ischemic heart disease, cerebrovascular disease and kidney failure, causing high mortality worldwide. The objective was to follow up with 24-hour ambulatory blood pressure monitoring in patients with high blood pressure belonging to a population with high cardiovascular risk. Descriptive, observational, retrospective study, which analyzes 24-hour outpatient pressure controls of 1858 patients, in Cartagena, Colombia. 1173 exams were validated and included in the study. The median age was 66 years. 66.8% (783) were women and 33.2% (390) were men. The main changes occurred during the night, when 79.1% of the patients had high systolic pressure loads, 65.6% recorded diastolic pressure averages and 83.7% had abnormal circadian patterns. Only 11% of the studies were normal in all parameters. 24-hour ambulatory blood pressure monitoring proved to be a useful tool to identify uncontrolled hypertensive patients, detect nocturnal hypertension and abnormal circadian patterns, which are risk markers for cardiovascular morbidity and mortality.

PRESHYON: THE PREVALENCE ON THE RISK OF OSA AMONG PATIENTS WITH UNCONTROLLED HYPERTENSION SEEN AT THE OUT-PATIENT DEPARTMENT OF THE UNIVERSITY OF THE PHILIPPINES, PHILIPPINE GENERAL HOSPITAL

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To determine the prevalence of the risk of Obstructive Sleep Apnea among patients with uncontrolled Hypertension (HTN) seen at the Out-Patient Department of the University of the Philippines-Philippine General Hospital METHODS: This is a cross-sectional study that enrolled 325 adult Filipino HTN patients seen at the outpatient department (OPD) of UP-PGH from January 2019 to July 2019. Participants also answered Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS) and the St. Lukes Medical Center-Obstructive Sleep Apnea Clinical Score (SLMC-OSACS) for their OSA risk. Descriptive statistics were used to summarize the clinical characteristics of the patients. A chi-square test was used to analyze categorical data univariately. Logistics regression analysis was used to determine the association of the different independent variables with the outcome (dependent) variable. RESULTS: The risk of OSA was significantly high among uncontrolled HTN patients: 106 (60.7%) based on BQ (p<0.0001) and 68 (69.4%) based on SLMC-OSACS (p<0.0001). OSA risk among uncontrolled HTN was 6x higher (OR=5.69; 95% CI=3.49–9.28;p<0.0001) using the BQ and 4x higher (OR=3.70; 95% CI=2.19 – 6.26;p=<0.0001) using the SLMC-OSACS than those with controlled HTN. Daytime excessive sleepiness was not significantly associated. Other variables significantly associated with high risk OSA were BMI and other comorbidities. CONCLUSIONS: Among patients with hypertension, the risk of OSA based on the Berlin Questionnaire and SLMC-OSACS was significantly high among uncontrolled hypertension patients than those with controlled hypertension. Daytime excessive sleepiness noted with the ESS was not significantly associated with uncontrolled hypertension. Other demographic and clinical profile that were significantly associated with high risk OSA were BMI and other comorbidities (such as bronchial asthma, congestive heart failure) based on the SLMC-OSACS. CLINICAL IMPLICATIONS: Utilizing these sleep questionnaires and determining the risk for OSA among patients with uncontrolled hypertension will lead to early evaluation of OSA and complications. Locally this will aid in improving detection and provide more strategic management of uncontrolled hypertension to decrease associated cardiovascular events. This will guide our clinicians to prioritize patients who would benefit referral to sleep specialists DISCLOSURES: No relevant relationships by Jamie Chua, source=Web Response No relevant relationships by Angelica cruz, source=Web Response No relevant relationships by Maria Lowella De Leon, source=Web Response no disclosure on file for Manuel Jorge; No relevant relationships by Anna Katrina Tojino, source=Web Response

Antihypertensive agent utilization patterns among patients with uncontrolled hypertension in the United States

Hypertension affects approximately one-third of the US adults. This study investigated antihypertensive utilization patterns among hypertensive patients who were prescribed treatment, yet still experienced uncontrolled hypertension. Data from the Decision Resources Group Real World Evidence Data Repository US database (2015-2016) were used to construct a cohort of uncontrolled hypertension patients to observe antihypertensive utilization patterns. Results for 5059 patients, with an average age of 57.8 (SD=13.7), who had, on average 2.4 agents prescribed. Approximately half (51.9%) were female, and most were White (86.8%). More than one-third (N=1877; 37.1%) of patients were diagnosed with diabetes mellitus (DM) or chronic kidney disease (CKD) that could independently contribute to increased cardiovascular complications. Overall, the most common treatments prescribed, as percent of agents and as percent of patients, respectively, were diuretics (24.9%; 59.6%), followed by angiotensin-converting enzyme inhibitors (ACEIs) (23.8%; 56.9%), beta-blockers (BBs) (18.7%; 44.8%), calcium channel blockers (CCBs) (15.4%; 36.8%), and angiotensin II receptor blockers (ARBs) (13.5%; 32.3%). Approximately one-tenth (10.5%) of the prescriptions were written for fixed-dose combination therapies. Among patients diagnosed with DM and CKD (N=200), the order of the most common agents was the same as the overall cohort. Only 5.6% of prescriptions written for these patients were fixed-dose combination therapy. Based on clinical guidelines, which suggest using ACEIs, ARBs, or CCBs as first-line therapy, and fixed-dose combination therapy to increase adherence, this indicates over-prescribing of BBs and under-prescribing of fixed-dose combination therapy. These findings illustrate the need to further investigate challenges faced by patients and providers in treatment decision-making.

Influence of cardiovascular risk factors on arterial hypertension and mild cognitive impairment in 4602 participants of the ELITE study.

In ELITE (Ernährung, Lebensstil und individuelle Information zur Verhinderung von Herzinfarkt, Schlaganfall und Demenz; german for: Nutrition, Lifestyle and Individual Information for the Prevention of Heart Attack, Stroke and Dementia) data on cardiovascular risk factors, cognitive function and quality of life are prospectively collected, which will be improved through targeted individual information. The aim is to improve the health of the participants and identify the reasons for the lack of implementation. Risk factors of 4602 participants were linked to (controlled) hypertension and mild cognitive impairment (MCI). Blood pressure was measured according to the guidelines and the DEMTECT- test was used to detect MCI. The most common risk factor was hypertension (60%). Hypertensive patients were older (56.1 and 44.7 years), had a higher BMI (28 and 24.8 kg/m), frequently physical inactive (26 and 32.4%), diabetes (9.3 and 1.3%), higher LDL (134.7 and 124.1 mg/dl), higher triglycerides (169.6 and 124.8 mg/dl) and lower HDL (57.9 and 65.5 mg/dl) compared with normotensives (P < 0.001). Controlled hypertensive patients are less common men (46.1 and 52.1%, P < 0.001), have a lower BMI (28.3 and 29.1 kg/m, P < 0.001), lower LDL (129.0 and 135.6 mg/dl, P = 0.004) and lower triglycerides (162.5 and 182.3 mg/dl, P = 0.001) compared with treated uncontrolled hypertensive patients. Antihypertensives per person (2.015; 2.017) do not differ. The prevalence of MCI is highly significantly associated with the number of risk factors. in participants without risk factors, the prevalence is 3.9%, in participants with 4 risk factors, 16.3%. In hypertensive patients, the frequency is 11.8% compared with 4.8% for normotensives (P < 0.001). The occurrence of MCI depends significantly from age, blood pressure and diabetes CONCLUSION:: The frequency of MCI is highly significantly associated with the number of cardiovascular risk factors, regardless of age. The prevalence was particularly high among hypertensive patients, which is not often described. The occurrence of MCI depends significantly from age, blood pressure and diabetes. The metabolic syndrome and lack of exercise complicate blood pressure control.

Characterizing Patients with Uncontrolled Blood Pressure at an Urban Hospital in Hanoi, Vietnam.

Great efforts to advance the diagnosis and treatment of hypertension for controlling hypertension have been made; however, the rates of uncontrolled blood pressure are still high. This study explored the rate of uncontrolled hypertension in patients with hypertension managed in an urban hospital of Vietnam and identified associated factors. A cross-sectional survey was performed from August to October 2019 among hypertensive patients at an urban hospital in Hanoi, Vietnam. Blood pressure was evaluated at the time of medical examination. Demographic, clinical, and behavioral characteristics were also collected. Multivariate logistic regression was used to identify the factors related to uncontrolled hypertension. Among 220 patients, the rate of uncontrolled hypertension was 40.5%. Females had a lower likelihood of having uncontrolled hypertension compared to males (adjusted OR = 0.33; 95% CI = 0.11–0.98). Higher duration of diseases (adjusted OR = 1.07; 95% CI = 1.01–1.14) and higher body mass index (adjusted OR = 1.23; 95% CI = 1.05–1.45) were positively associated with uncontrolled hypertension. Patients who carried supplies needed for self-care, cut down on stress, exercised regularly, and stopped/cut down on smoking were also less likely to develop uncontrolled hypertension. This study reveals that uncontrolled hypertension was common among hypertensive patients in Vietnam. Improving self-care capacity and encouraging healthy behaviors are critically important to control blood pressure, particularly among patients who were males and had high disease duration and body mass index.

Assessment of suitable antihypertensive therapies: Combination with high-dose amlodipine/irbesartan vs triple combination with amlodipine/irbesartan/indapamide (ASAHI-AI study).

Angiotensin receptor blockers (ARBs) plus calcium channel blockers (CCBs) are a widely used combination therapy for hypertensive patients. In order to determine which combination was better as the next-step therapy for standard-dose combination of ARBs and CCBs, a combination with high-dose CCBs or a triple combination with diuretics, the authors conducted a prospective, randomized, open-label trial to determine which of the following combination is better as the next-step treatment: a combination with high-dose CCBs or a triple combination with diuretics. Hypertensive outpatients who did not achieve their target blood pressure (BP) with usual dosages of ARBs and amlodipine 5mg were randomly assigned to treatment with irbesartan 100mg/amlodipine 10mg (Group 1: n=48) or indapamide 1mg in addition to ARBs plus amlodipine 5mg (Group 2: n=46). The primary end point was changes in the systolic BP (SBP) and diastolic BP (DBP) after the 12-week treatment period, while secondary end points were changes in BP after the 24-week treatment period and laboratory values. At 12weeks, the SBP/DBP significantly decreased from 152.1/83.4mmHg to 131.5/76.1mmHg in Group 1 and 153.9/82.1mmHg to 132.7/75.9mmHg in Group 2. Although both groups produced a similar efficacy in reducing the SBP/DBP (-19.2/-9.2mmHg in Group 1 and -21.6/-8.8mmHg in Group 2; SBP P=.378, DBP P=.825), high-dose CCBs combined with ARBs controlled hypertension without elevation of serum uric acid. These results will provide new evidence for selecting optimal combination therapies for uncontrolled hypertensive patients.

Treatment-resistant hypertension in the hemodialysis population: a 44-h ambulatory blood pressure monitoring-based study.

Uncontrolled hypertension notwithstanding the use of at least three drugs or hypertension controlled with at least four drugs, the widely accepted definition of treatment-resistant hypertension (TRH), is considered as a common problem in the hemodialysis population. However, to date there is no estimate of the prevalence of this condition in hemodialysis patients. We estimated the prevalence of TRH by 44-h ambulatory BP monitoring (ABPM) in 506 hemodialysis patients in 10 renal units in Europe included in the registry of the European Renal and Cardiovascular Medicine (EURECAm,), a working group of the European Association, European Dialysis and Transplantation Association (ERA EDTA). In a sub-group of 114 patients, we tested the relationship between fluid overload (Body Composition monitor) and TRH. The prevalence of hypertension with 44-h ABPM criteria was estimated at 85.6% (434 out of 506 patients). Of these, 296 (58%) patients were classified as uncontrolled hypertensive patients by 44-h ABPM criteria (≥130/80 mmHg). Two hundred and thirteen patients had uncontrolled hypertension while on treatment with less than three drugs and 210 patients were normotensive while on drug therapy (n = 138) or off drug treatment (n = 72). The prevalence of TRH was 24% (93 among 386 treated hypertensive patients). The prevalence of predialysis fluid overload was 33% among TRH patients, 34% in uncontrolled hypertensive patients and 26% in normotensive patients. The vast majority (67%) of hemodialysis patients with TRH had no fluid overload. TRH occurs in about one in four treated hypertensive patients on hemodialysis. Fluid overload per se only in part explains TRH and the 67% of these patients show no fluid overload.

Mineralocorticoid Receptor Antagonists for Hypertension Management in Advanced Chronic Kidney Disease

Spironolactone, a steroidal mineralocorticoid receptor antagonist, is recommended as add-on therapy for treatment-resistant/uncontrolled hypertension. However, caution is advised in patients with advanced chronic kidney disease (CKD) due to an increased risk for hyperkalemia. KBP-5074 is a nonsteroidal mineralocorticoid receptor antagonist under investigation for the treatment of treatment-resistant and uncontrolled hypertension in patients with moderate-to-severe CKD. BLOCK-CKD is a phase 2, international, multicenter, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of KBP-5074, on top of current therapy, in patients with stage 3B/4 CKD (estimated glomerular filtration rate ≥15 and ≤44 mL/[min·1.73 m2]) and resistant hypertension (trough cuff seated systolic blood pressure ≥140 mm Hg, despite treatment with maximally tolerated doses of 2 or more antihypertensive medicines with complementary mechanisms). Patients (n=240) will be randomized 1:1:1 to once-daily treatment with KBP-5074 0.25 mg, KBP-5074 0.5 mg, or placebo, stratified by estimated glomerular filtration rate (≥30 versus <30 mL/[min·1.73 m2]) and systolic blood pressure (≥160 versus <160 mm Hg). Approximately 30% of enrolled patients should have an estimated glomerular filtration rate of 15 to 29 mL/(min·1.73 m2). The primary efficacy analysis is the change in trough cuff seated systolic blood pressure from baseline to day 84 for the KBP-5074 doses compared with placebo. Changes in urinary albumin-creatinine ratio will be assessed along with changes in serum potassium/incidence of hyperkalemia and changes in estimated glomerular filtration rate and serum creatinine. BLOCK-CKD will determine whether the addition of KBP-5074 will effectively lower blood pressure without an increased risk of hyperkalemia in patients who are not candidates for steroidal mineralocorticoid receptor antagonists due to advanced CKD. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT03574363.

Subclinical left ventricular systolic dysfunction by two-dimensional speckle-tracking echocardiography and its relation to ambulatory arterial stiffness index in hypertensive patients.

Increased arterial stiffness is associated with cardiovascular morbidity and mortality among hypertensive patients. To assess the relationship between ambulatory arterial stiffness index (AASI) and subclinical left ventricular (LV) systolic dysfunction assessed by 2-D speckle-tracking echocardiography (STE). We enrolled 70 consecutive patients with hypertension. All patients were evaluated for parameters of ambulatory blood pressure monitoring (ABPM) including AASI. From those patients, 51 underwent conventional echocardiography as well as 2-D STE to assess for subclinical LV systolic dysfunction defined by global longitudinal strain (GLS) and global circumferential strain (GCS). The mean age of the patients (n = 51) was 46.3 ± 12.3 years, women represented 59%. Study population were divided into two groups according to blood pressure control as defined by ABPM; controlled (n = 23), and uncontrolled (n = 28). Baseline characteristics were comparable between both groups. There were significant differences in both daytime and night-time mean ABPM (P < 0.05). Posterior wall thickness, as well as LV relative wall thickness were significantly higher in uncontrolled patients (P < 0.05 for each). AASI was significantly, but moderately correlated to GLS. Most ABPM parameters were elevated with the higher AASI values (AASI ≥0.5). Significantly more uncontrolled hypertensive patients were encountered as well. Interestingly, sex and AASI were predictors of impaired GLS by univariate linear regression analysis; however, AASI was the only independent predictor of impaired GLS on multivariate analysis (Beta = 0.3, CI = 0.2--12, and P = 0.04). AASI might predict subclinical LV systolic dysfunction as assessed by global longitudinal strain. Further wide-scale studies should further explore this intriguing hypothesis.

Epithelial Na+ Channel (ENaC) in Human Arteries – An Emerging Player in Hypertension

The epithelial sodium channel (ENaC) in the kidney plays a key role in blood pressure regulation. Recent evidence from animal models indicates the expression of ENaC in vascular cells and suggests a role in the regulation of vascular tone and hypertension. However, it is unknown if ENaC is expressed in human arteries and if ENaC contributes to hypertension. The role of vascular ENaC in human hypertension may be further complicated by the existence of a fourth ENaC subunit δ, which is not expressed in rodents.In this study we aimed to characterise the expression of ENaC subunits in human arteries and to compare the expression of ENaC subunits in arteries from both normotensive and hypertensive patients. Human internal mammary arteries (HIMA) and human aortic punches from patients undergoing coronary artery bypass graft (CABG) surgery were collected through the HeartOtago network. The patients were divided into 3 groups on the basis of their medical history and recent blood pressure measurement: 1) Normotensive 2) Uncontrolled hypertensive and 3) Controlled hypertensive. The mRNA and protein expression of ENaC (α, β, γ and δ) were analysed with qPCR and western blot techniques respectively.We report for the first time that all four ENaC subunits are expressed at mRNA and protein levels in human arteries. In HIMA of the controlled hypertensive patients δ‐ENaC mRNA and protein expression were significantly decreased compared to normotensive patients and uncontrolled hypertensive patients (P&lt;0.05), whereas, there was no significant difference observed between the normotensive and uncontrolled hypertensive groups. However, there were no changes in α‐, β‐ and γ‐ENaC between all 3 groups. In human aortic punches, there was a significant decrease in both β‐ (p&lt;0.05) and γ‐ENaC (p&lt;0.01) protein expression in controlled hypertensive patients compared to uncontrolled hypertensive and normotensive patients respectively.In summary, we observed downregulation of vascular ENaC subunits in controlled hypertensive patients compared to normotensive patients and uncontrolled hypertensive patients. Overall, our data provide new links between vascular ENaC expression and hypertension in human arteries.Support or Funding InformationDepartment of Physiology Doctoral Scholarship, University of Otago

New Nutraceutical Combination Reduces Blood Pressure and Improves Exercise Capacity in Hypertensive Patients Via a Nitric Oxide-Dependent Mechanism.

BackgroundHigh blood pressure (BP) has long been recognized as a major health threat and, particularly, a major risk factor for stroke, cardiovascular disease, and end‐organ damage. However, the identification of a novel, alternative, integrative approach for the control of BP and cardiovascular protection is still needed.Methods and ResultsSixty‐nine uncontrolled hypertension patients, aged 40 to 68 years, on antihypertensive medication were enrolled in 2 double‐blind studies. Forty‐five were randomized to placebo or a new nutraceutical combination named AkP05, and BP, endothelial function, and circulating nitric oxide were assessed before and at the end of 4 weeks of treatment. Twenty‐four patients were randomized to diuretic or AkP05 for 4 weeks and underwent a cardiopulmonary exercise test to evaluate the effects of AkP05 on functional capacity of the cardiovascular, pulmonary, and muscular systems. Vascular and molecular studies were undertaken on mice to characterize the action of the single compounds contained in the AkP05 nutraceutical combination. AkP05 supplementation reduced BP, improved endothelial function, and increased nitric oxide release; cardiopulmonary exercise test revealed that AkP05 increased maximum O2 uptake, stress tolerance, and maximal power output. In mice, AkP05 reduced BP and improved endothelial function, evoking increased nitric oxide release through the PKCα/Akt/endothelial nitric oxide synthase pathway and reducing reactive oxygen species production via NADPH‐oxidase inhibition. These effects were mediated by synergism of the single compounds of AkP05.ConclusionsThis is the first study reporting positive effects of a nutraceutical combination on the vasculature and exercise tolerance in treated hypertensive patients. Our findings suggest that AkP05 may be used as an adjunct for the improvement of cardiovascular protection and to better control BP in uncontrolled hypertension.

Blood Pressure Targets Achievement According to 2018 ESC/ESH Guidelines in Three European Excellence Centers for Hypertension.

The most recent European guidelines on hypertension redefined office blood pressure (BP) treatment targets according to age strata and cardiovascular (CV) risk profile. To evaluate proportions of adult outpatients achieving office BP treatment targets recommended by current compared to previous hypertension guidelines. We extracted data from medical databases of adult outpatients followed in three excellence centers in hypertension (Rome, Italy; L'Aquila, Italy; Valencia, Spain). Office BP treatment targets were defined according to either 2013 ESH/ESC guidelines (< 140/90mmHg in non-diabetic individuals aged 18-80years, < 150/90mmHg in those aged ≥ 80years, and < 140/85mmHg in diabetic individuals), or 2018 ESC/ESH guidelines: (< 130/80mmHg in individuals aged 18-65years, < 140/80mmHg in those aged 65-79 and ≥ 80years). SCORE risk was assessed in all patients. From an overall sample of 14,229 adult subjects, 4049 (28.5%) resulted normotensive individuals, 3088 (21.7%) were untreated and 7092 (49.8%) treated hypertensive outpatients. Treated hypertensives showed significantly higher ESC score risk (8.3 ± 13.0% vs. 3.9 ± 8.4%; P < 0.001) and lower systolic/diastolic BP (140.6 ± 18.8/83.9 ± 11.5 vs. 148.3 ± 14.2/94.7 ± 10.1mmHg; P < 0.001) than untreated hypertensives. Compared to previous guidelines, BP control significantly lowered in non-diabetic outpatients (n = 5847) of all age groups [18-65years: (13.1% vs. 42.9%), 65-79years (25.8% vs. 42.5%) and ≥ 80years (29.1% vs. 66.0%); P < 0.001 for all comparisons]; similar reductions were observed in diabetic outpatients (n = 1245) [18-65years (32.7% vs. 14.8%), 65-79years (37.3% vs. 24.7%) and ≥ 80years (47.1% vs. 27.9%); P < 0.001]. According to the recommended new office BP treatment targets, the proportions of treated uncontrolled hypertensive patients substantially increased. These findings should prompt a tighter application of therapeutic recommendations and, thus, highlight the need for improving hypertension management and control strategies.

The Effect of Intravitreal Ranibizumab Injection on Systemic Blood Pressure: A Prospective Study

Introduction: Hypertension is a common disease, which may be induced or precipitated by antivascular endothelial growth factor therapy with many studies reporting this complication of this therapy. Methods: This is a prospective study to evaluate blood pressure changes in normotensive, controlled and uncontrolled hypertensive patients on regular medical treatment after a 0.05 ml (0.5 mg) intravitreal Ranibizumab injection. It was held in Ibn-alhaitham eye teaching hospital in Baghdad between May 2019 and December 2019. It included patients with variable retinal diseases receiving either unilateral or bilateral intravitreal Ranibizumab injections, their blood pressure was measured before the treatment as a baseline, and then 2 hours, 1 month, and at 3 months from the first injection(s). These were allocated to three groups; Group A included normotensive patients without history of hypertension; Group B included controlled hypertensives and those with grade 1 hypertension with antihypertensive treatment. Group C included those with Grade 2 hypertension or more with antihypertensive treatment. Blood pressure was measured in all patients using the manual sphygmomanometer in sitting position. Paired t-test was used to analyze blood pressure measurements and compare mean arterial, systolic and diastolic pressure. A P-value of ≤ 0.05 was considered significant, and a P-value of ≤ 0.001 was considered highly significant. Results: Seventy-five patients (n=75) were included in the study with a mean age of 59.1 ± 11.4 years 58.7% males and 41.3% females, 44% were controlled-hypertensives, 26.7% were uncontrolled-hypertensives, 29.3% were normotensives. Group C showed highly significant reduction in the mean arterial, and systolic pressures in all three measurements after baseline (P ≤ 0.001), and significant reduction of diastolic blood pressure at one and three months after baseline (P ≤ 0.05). Both groups A and B showed a reduction in most measurements, but most were statistically insignificant (P ≥ 0.05). Unilateral and bilateral injection groups showed similar reduction in the mean arterial pressure at 2 hours and 3 months (P ≤ 0.05), mean systolic blood pressure was reduced in unilateral group in all 3 measurements (P ≤ 0.05, P ≤ 0.05, P ≤ 0.001, respectively) and also in the bilateral group at 2 hours and 3 months (P ≤ 0.001, P ≤ 0.05 respectively), and mean diastolic blood pressure was reduced at 2 hours in the unilateral group (P ≤ 0.05), and at 3 months in the bilateral injection group (P ≤ 0.05). Conclusion: There is an overall reduction of blood pressure with Ranibizumab Intravitreal injections especially in the moderate to severely uncontrolled hypertensive patients, while controlled-hypertensive, mildly uncontrolled hypertensive showed statistically insignificant changes which indicates that, it is acceptable to continue using Ranibizumab in both normotensive and hypertensive patients in the short term.

Uncontrolled arterial hypertension in patients with breast cancer and the risk of developing cardiotoxicity with anthracycline-containing chemotherapy

Aim. To study of the role of the effectiveness of blood pressure control according to the daily monitoring of blood pressure in patients with triple negative breast cancer with arterial hypertension at risk of developing cardiotoxicity with anthracycline-containing chemotherapy. Materials and methods. The study included 99 breast cancer patients (mean age 48 years [36; 63]) who received chemotherapy including anthracyclines, taxanes and platinum -based agent. Before chemotherapy, patients underwent 24-hour blood pressure monitoring, which revealed masked uncontrolled hypertension. Before and after chemotherapy, echocardiography was performed, including speckle tracking echocardiography in a two-dimensional mode, and the concentration of biomarkers (highly sensitive troponin T and NT-proBNP) was also determined. Patients with breast cancer with masked uncontrolled hypertension (n=12) were the main group of the study, and patients with controlled hypertension (n=17) and patients with normotension (n=70) were the comparison group. Results. After chemotherapy in patients with uncontrolled hypertension, a large degree of decrease in global longitudinal strain (GLS) was recorded, a high incidence of subclinical cardiotoxicity, assessed by the diagnostic criterion of GLS; a larger increase in the volume of the drug and a higher degree of increase in highly sensitive troponin T. In patients with uncontrolled hypertension who received a higher total dose of doxorubicin, the degree of decrease in GLS was statistically significantly greater than in patients with controlled hypertension. Conclusion. Uncontrolled hypertension in patients with breast cancer is unfavorable in terms of the risk of developing subclinical and clinical cardiotoxicity, especially when using high doses of anthracycline. The method of daily monitoring of blood pressure should be used in patients with breast cancer both to detect masked hypertension and to assess the achievement of the target level of blood pressure before anthracycline-containing chemotherapy.

Pengaruh Faktor Determinan terhadap Hasil Terapi Hipertensi Pasien pada Tiga Puskesmas di Jakarta Pusat

Prevalensi pasien hipertensi yang tidak terkendali meningkat setiap tahunnya. Penelitian ini bertujuan untuk mengidentifikasi faktor determinan hipertensi terhadap keterkendalian hipertensi. Penelitian dilakukan secara prospektif observasional selama lima bulan melalui wawancara pasien hipertensi di 3 Puskesmas di Jakarta Pusat (Puskesmas Kecamatan Menteng, Tanah Abang, dan Johar Baru). Hasil wawancara dicocokkan dengan riwayat rujukan pasien selama setahun terakhir. Untuk analisis faktor determinan digunakan 26 faktor yang diuji, meliputi: faktor sosiodemografi, biofisiologis, pola konsumsi, penggunaan kontrasepsi hormonal, aktivitas fisik, dan stres. Pada analisis regresi logistik multivariat menunjukan ada 2 faktor yang berpengaruh signifikan dan saling berkorelasi terhadap kondisi tekanan darah pasien yaitu faktor riwayat penyakit jantung dan rutinitas dalam melakukan aktivitas fisik. Pasien dengan riwayat penyakit jantung berpotensi 10,99 kali lipat untuk dirujuk ke rumah sakit karena tekanan darahnya tidak terkendali dibandingkan dengan pasien yang tidak memiliki riwayat penyakit jantung. Pasien yang rutin melakukan aktivitas fisik minimal 5 hari dengan durasi 150 menit/minggu, memiliki potensi 10,647 kali lipat tekanan darahnya terkendali dibandingkan dengan pasien yang tidak rutin melakukannya.

Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection

Purpose: To report a single-center experience with thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (cATBAD) comparing patients with vs without end-organ ischemia. Materials and Methods: Between November 2010 and December 2017, 64 patients (mean age 64.8±12.5 years; 49 men) underwent TEVAR for cATBAD. Patients were grouped into 2 cohorts: nonischemic (39, 61%) patients with unrelenting pain, early progressive aortic dilatation, uncontrolled hypertension, or rupture, and ischemic (25, 39%) patients with visceral, renal, lower extremity, or spinal cord hypoperfusion. Results: Mean time from diagnosis to treatment was 7.5 days (range 1–32) in the nonischemic group vs 2.3 days (range 1–14) days in the ischemic group (p=0.007). Fourteen (56%) of 25 ischemic cATBAD patients had stents implanted in the renovascular branch vessels, while 4 (16%) patients had stents implanted in the iliac arteries. When branch vessel cannulation failed, fenestrations were made in the intimal flap to improve perfusion of the involved branch (n=5). In the nonischemic group, 3 arteries were stented owing to atherosclerotic stenosis. Technical success was achieved in 62 (97%) of 64 patients; despite stenting, 2 patients had low renal artery perfusion on final angiography. There were no statistically significant differences in early or late outcomes between the nonischemic vs ischemic cATBAD patients. Six (9%) patients died within 30 days: 2 (5%) in the nonischemic group vs 4 (16%) in the ischemic group. Major complications (1 stroke, 2 cases of paraplegia, 1 retrograde type A dissection, and 1 case of bowel ischemia) occurred only in the nonischemic group. The mean follow-up was 28 months. Late endoleaks were observed in 3 (8%) nonischemic patients and 1 (4%) ischemic patient. Reinterventions were required in 7 (18%) nonischemic patients and 4 (16%) ischemic patients. Conclusion: TEVAR is an effective and safe method of treating cATBAD. Early intervention in ischemic cATBAD may have played a significant role in the lack of significant difference between ischemic and nonischemic cATBAD outcomes. Direct visceral reperfusion through branch vessel stenting during TEVAR may be crucial in achieving good outcomes in ischemic cATBAD.

Feasibility of 24-h central blood pressure monitoring: experience from multinational clinical trial assessing the efficacy of perindopril/indapamide/amlodipine.

Brachial blood pressure (BP) is a predictor of cardiovascular events. Evidence suggests that central BP (CBP) provides additional information for cardiovascular risk assessment. Methods to assess 24-h CBP are now available. Our objective was to assess the feasibility of 24-h CBP monitoring in clinical trials and its ability for drug evaluation. Data are issued from an international phase 3 randomized clinical trial comparing the efficacy of perindopril/indapamide/amlodipine vs. perindopril/indapamide (Per/Ind), in uncontrolled hypertensive patients treated with Per/Ind. 24-h ambulatory BP monitoring (ABPM) was performed at baseline and after 1-month treatment using the Mobil-O-Graph device which provide brachial BP and CBP and arterial parameters. From the 345 patients included in the ABPM substudy, 276 had two valid ABPM (M0 and M1) for brachial BP assessment (80%). After applying device/software built-in and expert quality control criteria on these recordings, 210 (76%) had valid data at M0 and M1 for the assessment of CBP. After 1 month, superior ambulatory central SBP reductions were observed in the perindopril/indapamide/amlodipine (n = 101) vs. Per/Ind group (n = 109) for 24-h/daytime/night-time periods (-4.5 mmHg, P = 0.002/-5.0, P < 0001/-4.1 mmHg, P = 0.016, respectively). Similar trends were observed for pulse wave velocity and other central parameters. Recording 24-h central ABPM and its derived arterial parameters needs a strict expert quality control and must consider a loss of up to 39% of the population included in the ABPM substudy. This method can be used to assess drug effect.

Efficiency and safety of renal denervation via cryoablation (Cryo-RDN) in Chinese patients with uncontrolled hypertension: study protocol for a randomized controlled trial

BackgroundClinical data show that due to the limited effects of lifestyle regulation and unsatisfactory drug adherence, only half of the hypertensive population have their blood pressure (BP) under control. In recent years, catheter-based renal denervation (RDN) has been used as a novel approach for treating uncontrolled hypertension. The safety and efficacy of catheter-based RDN have been confirmed by a number of studies and trials in which the participants were all non-Chinese and RDN was conducted via radiofrequency or ultrasound.Methods/designThis study is a prospective multicenter randomized sham-controlled trial that aims to investigate the safety and efficacy of cryoablation RDN (cryo-RDN) using a novel dedicated cryoablation balloon catheter (Cryofocus, China). A total of 200 Chinese patients who have uncontrolled hypertension despite standard medical treatment will be enrolled. With drug standardization, eligible participants will be randomized in a 1:1 ratio to undergo cryo-RDN treatment or renal angiography alone as a sham treatment.The primary endpoint is defined as the change in 24-h ambulatory systolic blood pressure from baseline to 6 months. Office BP and other 24-h ambulatory BP are included as secondary endpoints. Safety endpoints primarily include any adverse effects.DiscussionThis study was designed to verify the safety and efficacy of cryo-RDN with Cryofocus balloon catheters in uncontrolled hypertensive patients on polypharmacy. The aim is to provide a new way to improve the control of hypertension in China as a complement to drug therapy.Trial registrationChiCTR, ChiCTR1800017707. Registered on 10 August 2018.

Efficacy and Safety of Renal Denervation for Patients with Uncontrolled Hypertension in Taiwan: 3-Year Results From the Global SYMPLICITY Registry-Taiwan (GSR-Taiwan).

It is unclear whether renal denervation (RDN) can safely result in blood pressure (BP) reductions in Asian hypertensive patients and whether such reductions would be sustainable. The study is to assess the safety and efficacy of RDN achieved by either main renal artery ablation using the Symplicity FlexTM catheter or main plus branch renal artery ablations using the Symplicity SpyralTM catheter in Taiwanese uncontrolled hypertensive patients enrolled in the Global SYMPLICITY Registry (GSR) with 3 years of follow-up. The GSR is a prospective, open-label, and all-comer registry to evaluate the safety and effectiveness of RDN in patients with uncontrolled hypertension worldwide. Among 26 patients enrolled (mean age, 59.1 ± 13.8 years), 8 were treated with the Symplicity FlexTM catheter, and 18 were treated with the Symplicity SpyralTM catheter. Baseline office systolic BP was 168.2 ± 19.8 mmHg and diastolic BP was 89.0 ± 14.3 mmHg. Office BP reductions following RDN were sustained throughout the follow-up periods of up to 3 years in the Symplicity FlexTM group and 2 years in the Symplicity SpyralTM group. In the Symplicity FlexTM group, the office systolic BP reductions were 14.9 ± 14.7 mmHg and 29.7 ± 25.9 mmHg at 3 months and 3 years, respectively (both p < 0.05 from baseline). In the Symplicity SpyralTM group, the office systolic BP reductions were 21.2 ± 28.7 mmHg and 42.4 ± 10.7 mmHg at 3 months and 2 years, respectively (both p < 0.05 from baseline). There were no significant changes in heart rate or antihypertensive medication classes. Three protocol-defined adverse events occurred in 2 patients, including new-onset end-stage renal disease, stroke, and hospitalization for new-onset heart failure. Given the susceptibility of Asian populations to hypertension, RDN, as a safe antihypertensive procedure with long-lasting BP-lowering effects, could reliably serve as an alternative or complementary BP-lowering strategy for patients with uncontrolled hypertension in Taiwan and other Asian countries.