Integrated Blood Pressure Control[JOURNAL]
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166 papers
Resistant Hypertension: Where are We Now and Where Do We Go from Here?
Pathan MK, Cohen DL
Integr Blood Press Control · 2020 · PMID 32801854 · Full text
Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and Am...
Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and American Heart Association now define resistant hypertension as blood pressure that remains above goal despite use of three maximally titrated anti-hypertensive medications including a diuretic or as a hypertensive patient who requires 4 or more agents for adequate BP control. These agents typically include a calcium-channel blocker, a renin-angiotensin system inhibitor, and a diuretic at maximal or maximally tolerated doses. As recognition of resistant hypertension increases, it is important to distinguish pseudo-resistant or apparent hypertension from true resistant hypertension. Etiologies of apparent resistant hypertension include measurement error and medication non-adherence. The prevalence of true resistant hypertension is likely much lower than reported in the literature when accounting for patients with apparent resistant hypertension. Evaluation of patients with true resistant hypertension includes screening for causes of secondary hypertension and interfering medications. Successful management of resistant hypertension includes lifestyle modification and optimization of medical therapy, often including the use of mineralocorticoid receptor antagonists. Looking ahead at developments in hypertension management, a slew of new device-based therapies are under active development. Of these, renal denervation is the closest to routine clinical application. Further study is needed before these devices can be recommended in the routine treatment of resistant hypertension.
Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management.
Manaktala R, Tafur-Soto JD, White CJ
Integr Blood Press Control · 2020 · PMID 32581575 · Full text
Atherosclerosis is the primary cause of renal artery stenosis. Atherosclerotic renal artery stenosis (ARAS) is associated with three clinical problems: renovascular hypertension, ischemic nephropathy and cardiac destabil...
Atherosclerosis is the primary cause of renal artery stenosis. Atherosclerotic renal artery stenosis (ARAS) is associated with three clinical problems: renovascular hypertension, ischemic nephropathy and cardiac destabilization syndrome which pose huge healthcare implications. There is a significant rate of natural disease progression with worsening severity of renal artery stenosis when renal revascularization is not pursued in a timely manner. Selective sub-groups of individuals with ARAS have had good outcomes after percutaneous renal artery stenting (PTRAS). For example, individuals that underwent PTRAS and had improved renal function were reported to have a 45% survival advantage compared to those without improvement in their renal function. Advances in the imaging tools have allowed for better anatomic and physiologic measurements of ARAS. Measuring translesional hemodynamic gradients has allowed for accurate assessment of ARAS severity. Renal revascularization with PTRAS provides a survival advantage in individuals with significant hemodynamic renal artery stenosis lesions. It is important that we screen, diagnosis, intervene with invasive and medical treatments appropriately in these high-risk patients.
Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?
Tadic M, Cuspidi C, Grassi G … +1 more , Mancia G
Integr Blood Press Control · 2020 · PMID 32368135 · Full text
Nocturnal hypertension has been recognized as a significant risk factor for cardio- and cerebrovascular diseases. Blood pressure (BP) monitoring significantly increased our awareness of nocturnal hypertension and studies...
Nocturnal hypertension has been recognized as a significant risk factor for cardio- and cerebrovascular diseases. Blood pressure (BP) monitoring significantly increased our awareness of nocturnal hypertension and studies revealed its influence on target organ damage. Nocturnal hypertension is associated with nonphysiological 24-h BP patterns, which consider inadequate drop or even increment of nighttime BP in comparison with daytime BP (nondipping and reverse dipping). Nevertheless, investigations showed that nocturnal hypertension was a predictor of adverse outcome independently of circadian BP pattern. There are still many uncertainties regarding diagnosis, mechanisms and treatment of nocturnal hypertension. There is a small difference between American and European guidelines in cutoff values defining nocturnal hypertension. Pathophysiology is also not clear because many conditions such as diabetes, metabolic syndrome, obesity, sleep apnea syndrome, and renal diseases are related to nocturnal hypertension and nonphysiological circadian BP pattern, but mechanisms of nocturnal hypertension still remain speculative. Therapeutic approach is another important issue and chronotherapy provided the best results so far. There are studies which showed that some groups of antihypertensive medications are more effective in regulation of nocturnal BP, but it seems that the timing of drug administration has a crucial role in the reduction of nighttime BP and conversion of circadian patterns from nonphysiologic to physiologic. Follow-up studies are necessary to define clinical benefits of nocturnal BP reduction and restoring unfavorable 24-h BP variations to physiological variant.
Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia.
Fekadu G, Adamu A, Gebre M … +5 more , Gamachu B, Bekele F, Abadiga M, Mosisa G, Oluma A
Integr Blood Press Control · 2020 · PMID 32368134 · Full text
BACKGROUND: Hypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP...
BACKGROUND: Hypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP remain poorly understood globally. Therefore, this study aimed to assess the magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte referral hospital (NRH). METHODS: A hospital-based cross-sectional study was conducted from February to April 2018 at NRH. BP control status was determined by the average consecutive BP recordings across the 3 months. The data was entered and analyzed using SPSS version 20.0 and p-value <0.05 was considered statistically significant. RESULTS: Out of 297 study participants included, the majority were females, 181 (60.9%), and the mean age of the patients was 59.4 ±10.4 years. About half, 137 (46.12%), of the patients had at least one comorbidity and the most common class of anti-hypertensive medication was angiotensin-converting enzyme inhibitors (88.2%). The mean of systolic blood pressure was 132.41± 15.61mmHg, while the mean of diastolic blood pressure was 84.37± 9.32 mmHg. The proportion of participants with optimally controlled BP was 63.6% and 36% were adherent to their medications. Male sex (Adjusted Odd Ratio [AOR]: 1.89, 95% CI: 1.09-4.84), illiteracy (AOR= 1.56, 95% CI: 1.22-6.78), duration of hypertension diagnosis > 10 years (AOR= 2.01, 95% CI: 1.04-16.11), non-adherence (AOR= 3.14, 95% CI: 1.35-10.76) and lack of physical exercise (AOR= 2.8, 95% CI: 1.16-6.74) were positively associated with uncontrolled BP status. Whereas age older than 55 years (AOR= 0.38, 95% CI: 0.11-0.92) was negatively associated with uncontrolled BP. CONCLUSION: BP control was relatively achieved in about two-third of pharmacologically treated patients. We recommend better health education and care of patients to improve the rate of BP control status.
Comparison of Ambulatory Tonometric and Oscillometric Blood Pressure Monitoring in Hypertensive Patients.
Hornstrup BG, Rosenbæk JB, Bech JN
Integr Blood Press Control · 2020 · PMID 32280272 · Full text
AIM: Correct measurement of blood pressure (BP) is important for optimal diagnosis and treatment of patients with hypertension. The aim of this study was to compare a wrist-worn device using tonometric measurements of BP...
AIM: Correct measurement of blood pressure (BP) is important for optimal diagnosis and treatment of patients with hypertension. The aim of this study was to compare a wrist-worn device using tonometric measurements of BP to a conventional device using oscillometric measurements of 24 h BP, diagnosing of hypertension, and non-dipping. METHODS: One-hundred patients in the Renal Outpatient Clinic had 24 h ambulatory BP monitoring performed with a tonometric device, BPro, and an oscillometric device, A&D, simultaneously. RESULTS: Twenty-four-hour and daytime systolic BP was significantly lower using tonometric monitoring compared to oscillometric (7 and 6 mmHg, respectively, < 0.001). In the population of patients diagnosed with hypertension, the tonometric device diagnosed 90% of patients with uncontrolled hypertension correctly (positive predictive value), whereas 49% of patients classified as normotensive were uncontrolled hypertensive (negative predictive value). The mean difference between relative nocturnal BP decrease between tonometric and oscillometric was 2±8% (< 0.01), and 33% of patients classified as dippers were non-dippers (negative predictive value). CONCLUSION: Using the BPro device for tonometric monitoring of BP and classification of hypertension and non-dipping in patients diagnosed with hypertension leads to misclassification of patients. Therefore, the BPro device is not suitable for clinical practice in hypertensive patients from a Renal Outpatient Clinic.
Management of Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis.
Almaaitah S, Highland KB, Tonelli AR
Integr Blood Press Control · 2020 · PMID 32280271 · Full text
Systemic sclerosis (SSc) is a rare and complex immune-mediated connective tissue disease characterized by multi-organ fibrosis and dysfunction. Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a...
Systemic sclerosis (SSc) is a rare and complex immune-mediated connective tissue disease characterized by multi-organ fibrosis and dysfunction. Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a leading cause of death in this population. Pulmonary arterial hypertension (PAH) can coexist with other forms of pulmonary hypertension in SSc, including pulmonary hypertension related to left heart disease, interstitial lung disease, chronic thromboembolism and pulmonary venous occlusive disease, which further complicates diagnosis and management. Available pulmonary arterial hypertension therapies target the nitric oxide, endothelin and prostacyclin pathways. These therapies have been studied in SSc-PAH in addition to idiopathic PAH, often with different treatment responses. In this article, we discuss the management as well as the treatment options for patients with SSc-PAH.
Magnitude and Associated Factors of Depression Among Hypertensive Patients Attending Treatment Follow Up in Chronic OPD at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia.
Gebre BB, Deribe B, Abeto M
Integr Blood Press Control · 2020 · PMID 32273751 · Full text
BACKGROUND: Hypertension and depression are among the most common public health issues affecting the population around the world. Like patients with other chronic medical conditions, hypertensive patients experience many...
BACKGROUND: Hypertension and depression are among the most common public health issues affecting the population around the world. Like patients with other chronic medical conditions, hypertensive patients experience many intense emotions which increase their risk for the development of depression. Globally, depression is the leading cause of disability and 382 million people suffer worldwide. OBJECTIVE: The aim of this study was to assess the magnitude and factors associated with depression among hypertensive patients attending treatment follow up in the chronic OPD at Hawassa University Comprehensive Specialized Hospital (HUCSH) from March to May, 2019. METHODS: An institutional-based cross-sectional study was conducted with 310 hypertensive patients attending treatment follow up at the chronic Out-Patient Department of HUCSH at Hawassa from March to May, 2019. A validated patient health questionnaire (PHQ-9) was used to assess depression. The data were entered using EPI-data version 3.1 and analyzed in SPSS version 22. Binary logistic regression was used to determine the association of independent variables with dependent variables. RESULTS: The magnitude of depression among hypertension (HPN) patients was found to be 73 (24.7%). The independent predictors were sex 2.6 (1.16, 5.83), age 11.2 (2.98, 42), educational status, social support 2.55 (1.09, 5.94), family history of depression 7.12 (1.48, 34.26), hypertension 7.57 (2.67, 21.44), and medication adherence 11.6 (4.23, 31.78). CONCLUSION: The magnitude of depression among HPN patients was high. So, continuous health information dissemination at a different level regarding factors affecting them should be given. Strengthening a referral linkage with a psychiatric unit for psycho-behavioral therapy will bring good clinical outcome. Besides, controlling hypertension was crucial to bring good clinical outcome.
Knowledge and Attitude of Self-Monitoring of Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Selected Public Hospitals in Arsi Zone, Oromia Regional State, Ethiopia: A Cross-Sectional Study.
Wake AD, Bekele DM, Tuji TS
Integr Blood Press Control · 2020 · PMID 32189970 · Full text
BACKGROUND: Self-monitoring of blood pressure (BP) among hypertensive patients is an important aspect of the management and prevention of complication related to hypertension. However, self-monitoring of BP among hyperte...
BACKGROUND: Self-monitoring of blood pressure (BP) among hypertensive patients is an important aspect of the management and prevention of complication related to hypertension. However, self-monitoring of BP among hypertensive patients on scheduled follow-up in hospitals in Ethiopia is unknown. The aim of the study was to assess knowledge and attitude of self-monitoring of BP among adult hypertensive patients. METHODS: A cross-sectional survey was conducted on 400 adult hypertensive patients attending follow-up clinics at four public hospitals of Arsi Zone, Oromia Regional State, Ethiopia. The data were collected from patients from March 10, 2019 to April 8, 2019 by face-to-face interview using a pretested questionnaire and augmented by a retrospective patients' medical records review. The data were analyzed using the SPSS version 21.0 software. RESULTS: A total of 400 patients were enrolled into the study with the response rate of 97.6%. The median age of the participants was 49 years (range 23-90 years). More than half (225 [56.3%]) were male. The majority (160 [40%]) were married and more than two-thirds (282 [70.5%]) were Oromo by ethnic background. About 206 (51.5%) had attended primary education. The proportion of patient's knowledge toward self-monitoring of BP and the practice of self-monitoring of BP among hypertensive patients was 31.5% (n=126 [95% CI; 26.5, 36.5]) and 7.75% (n=31 [95% CI; 5.3, 10.5]) respectively. The multivariable logistic regression analysis revealed; higher education (AOR=2.73, 95% CI [1.33, 13.88)], governmental employed (AOR=1.52, 95% CI [1.06, 6.48]), having an income of >3500 Ethiopian Birr (AOR=2.16, 95% CI [1.56, 7.39]), duration of hypertension >6 years (AOR=1.87, 95% CI [1.21, 6.37]), having health insurance (AOR=3.56, 95% CI [1.39, 10.53]), having co-morbidities (AOR=3.93, 95% CI [1.35, 10.32]), receiving a health professional recommendation toward self-monitoring of BP (AOR=6.08, 95% CI [2.45, 15.06]), and having an awareness of hypertension-related complication (AOR=3.94, 95% CI [1.34, 11.44]) were factors significantly associated with self-monitoring of BP. CONCLUSION: In this study, the proportion of knowledge of self-monitoring of BP and the practice of self-monitoring of BP among hypertensive patients on follow-up were low. Educational programs on self-monitoring of BP including teaching through demonstration may be needed to be in place.
Hyperuricemia and Hypertension: Links and Risks.
Stewart DJ, Langlois V, Noone D
Integr Blood Press Control · 2019 · PMID 31920373 · Full text
Hyperuricemia has long been recognized to be associated with increased cardiovascular risk, including risk of developing hypertension. Epidemiological findings suggest that the link with hypertension is stronger in child...
Hyperuricemia has long been recognized to be associated with increased cardiovascular risk, including risk of developing hypertension. Epidemiological findings suggest that the link with hypertension is stronger in children and adolescents. Uric acid acts as a strong antioxidant compound in the extracellular environment but has pro-inflammatory effects within the intracellular setting. A chronic phase of microvascular injury is known to occur after prolonged periods of hyperuricemia. This is proposed to contribute to afferent arteriolopathy and elevation of blood pressure that may become unresponsive to uric acid-lowering therapies over time. Studies have struggled to infer direct causality of hyperuricemia due to a vast number of confounders including body mass index. The aim of this review is to present the available data and highlight the need for large scale prospective randomized controlled trials in this area. At present, there is limited evidence to support a role for uric acid-lowering therapies in helping mitigate the risk of hypertension.
Association of Chronic Khat Chewing with Blood Pressure and Predictors of Hypertension Among Adults in Gurage Zone, Southern Ethiopia: A Comparative Study.
Geta TG, Woldeamanuel GG, Hailemariam BZ … +1 more , Bedada DT
Integr Blood Press Control · 2019 · PMID 31908523 · Full text
PURPOSE: The leaves of the Khat plant contain amphetamine-like compounds which are implicated in the development of hypertension. The increase in blood pressure coincides with the plasma cathinone level. Other factors as...
PURPOSE: The leaves of the Khat plant contain amphetamine-like compounds which are implicated in the development of hypertension. The increase in blood pressure coincides with the plasma cathinone level. Other factors associated with hypertension are being overweight, obesity, cigarette smoking, alcohol use, physical inactivity, unhealthy diet, and stress. Thus, this study assessed the association of chronic khat chewing with hypertension and other factors associated with hypertension. PATIENTS AND METHODS: Acommunity based comparative cross-sectional study was undertaken from October 5, 2018 to February 15, 2019 in Gurage zone, southern Ethiopia. A total of 1200 adults (600 chewers and 600 non-chewers) aged 18 - 65 years were selected using a convenience sampling method. The data was collected by an interviewer-administered questionnaire plus physical measurements and were carried out at a fixed time of the day in the morning (7: 00 am-10:00 am). Linear regression and binary logistic regression analysis were performed to identify the determinant factors of blood pressure. The test of statistically significant association was declared by using 95% CI and p-value less than 0.05. RESULTS: A total of 1198 adults participated in the study giving a response rate of 99.8%. The mean age of Khat chewers were 34 (± 11.27) and non-chewers were 34.73 (± 11.48) years. The mean values of systolic blood pressure and diastolic blood pressure were higher in chewers than in non-chewers (p < 0.001). The prevalence of diastolic blood pressure > 80mmHg was significantly higher among Khat chewers than in non-chewers (17.4% versus 8.7%, p < 0.001). The duration of Khat chewing was significantly associated with systolic blood pressure (Beta coefficient = 0.83, p < 0.001) and diastolic blood pressure (Beta coefficient = 0.51, p < 0.001). The sex, age, BMI and alcohol were significantly associated with both systolic and diastolic blood pressure. CONCLUSION: Chronic Khat chewing, male sex, BMI and alcohol were associated with increased systolic and diastolic blood pressure. To assess the cause and effect relationship between chronic Khat chewing and hypertension further studies with better defined cohorts and basic science studies need to be undertaken.
Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia.
Shukuri A, Tewelde T, Shaweno T
Integr Blood Press Control · 2019 · PMID 31564965 · Full text
BACKGROUND: Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, little information is available with regard to old age hypert...
BACKGROUND: Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, little information is available with regard to old age hypertension in Ethiopia. Thus, this study assessed old age hypertension and associated factors among older adults in rural Ethiopia. METHODS: A community-based cross-sectional study design was employed among 418 selected permanent residents of Chiro town aged 50 years and older using simple random sampling technique. Data were collected face to face using a structured questionnaire which is adapted from the WHO Stepwise approach to surveillance of non communicable disease instrument, and was used to collect data on risk factors. Physical measurements were taken as per WHO STEP guidelines. The data were entered into Epi Data version 3.1 and exported to SPSS Version 20 for analysis. Bivariate and multivariable logistic regression analysis were conducted and statistical significance was declared at a -value ≤0.05. RESULTS: The overall prevalence of old age hypertension was 41.9% (95% CI: 37.2-46.6). Age ≥70 years (AOR: 1.91; 95% CI: 1.12-3.27), low intake of fruits (AOR: 2.45; 95% CI: 1.55-3.86), overweight/obese (AOR: 4.29; 95% CI: 2.48-7.42) and family history of hypertension (AOR: 2.95; 95% CI: 1.70-5.12) were significantly associated risk factors of hypertension. CONCLUSION: The prevalence of hypertension among older adults was high. Older age ≥70 years, low intake of fruits, overweight/obese and having a family history of hypertension were significantly associated with hypertension. Consideration should be given for community-based screening of hypertension among older adults. In addition, fruit consumption habits and maintaining normal weight should be encouraged.
Liddle's syndrome mechanisms, diagnosis and management.
Enslow BT, Stockand JD, Berman JM
Integr Blood Press Control · 2019 · PMID 31564964 · Full text
Liddle's syndrome is a genetic disorder characterized by hypertension with hypokalemic metabolic alkalosis, hyporeninemia and suppressed aldosterone secretion that often appears early in life. It results from inappropria...
Liddle's syndrome is a genetic disorder characterized by hypertension with hypokalemic metabolic alkalosis, hyporeninemia and suppressed aldosterone secretion that often appears early in life. It results from inappropriately elevated sodium reabsorption in the distal nephron. Liddle's syndrome is caused by mutations to subunits of the Epithelial Sodium Channel (ENaC). Among other mechanisms, such mutations typically prevent ubiquitination of these subunits, slowing the rate at which they are internalized from the membrane, resulting in an elevation of channel activity. A minority of Liddle's syndrome mutations, though, result in a complementary effect that also elevates activity by increasing the probability that ENaC channels within the membrane are open. Potassium-sparing diuretics such as amiloride and triamterene reduce ENaC activity, and in combination with a reduced sodium diet can restore normotension and electrolyte imbalance in Liddle's syndrome patients and animal models. Liddle's syndrome can be diagnosed clinically by phenotype and confirmed through genetic testing. This review examines the clinical features of Liddle's syndrome, the differential diagnosis of Liddle's syndrome and differentiation from other genetic diseases with similar phenotype, and what is currently known about the population-level prevalence of Liddle's syndrome. This review gives special focus to the molecular mechanisms of Liddle's syndrome.
Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis.
Cipriano GF, Cipriano G, Santos FV … +4 more , Güntzel Chiappa AM, Pires L, Cahalin LP, Chiappa GR
Integr Blood Press Control · 2019 · PMID 31190975 · Full text
Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective c...
Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. We identified 10 RCTs involving 267 subjects (mean age range 51-71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (=6) and moderate to high intensity (=4) protocols, but the protocols varied considerably (duration: 1-12 weeks, frequency: 3-14 times/week, time: 10-30 mins). An overall increase of the MIP (cmHO) was observed (-27.57 95% CI -18.48, -37.45, =64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (-0.72 95% CI-1.40, -0.05, =50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (-7.59 95% CI -13.96, -1.22 bpm, =0%) and diastolic blood pressure (DBP) (-8.29 [-11.64, -4.94 mmHg], =0%), respectively. IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.
Potential use of a "Blood Pressure Action Sheet" for Indonesian patients with hypertension living in rural villages: a qualitative study.
Rahmawati R, Bajorek B
Integr Blood Press Control · 2018 · PMID 30573990 · Full text
PURPOSE: The aim of the study was to obtain feedback on the layout, content, and potential use of a blood pressure (BP) action sheet, a purpose-designed written resource for Indonesian patients with hypertension. METHODS...
PURPOSE: The aim of the study was to obtain feedback on the layout, content, and potential use of a blood pressure (BP) action sheet, a purpose-designed written resource for Indonesian patients with hypertension. METHODS: Telephone interviews were conducted with 13 health professionals, 12 community health workers, and 12 patients in rural Yogyakarta, Indonesia, to explore their impressions of the BP action sheet, how the sheet might affect management of hypertension, and suggestions for improvement. RESULTS: Participants felt that the sheet presented useful information about achieving the target BP and managing hypertension. The use of the sheet could be optimized by engaging community health workers to help explain the information and to provide assistance around the stated actions for hypertension management. A more attractive design and inclusion of more details were suggested. Both patients and health care workers expressed interest in using the sheet. CONCLUSION: The BP action sheet has potential as a useful resource for patients with hypertension by providing information, recording target BP, and facilitating patient-centered communication. Use of the BP action sheet might provide an effective low-cost way for health professionals and community health workers to encourage patients to achieve their target BP.
Hypertension and transcatheter aortic valve replacement: parallel or series?
Tiwari N, Madan N
Integr Blood Press Control · 2018 · PMID 30538539 · Full text
Aortic stenosis (AS) is the most common valvular heart disease in the elderly and it causes significant morbidity and mortality. Hypertension is also highly prevalent in elderly patients with AS, and AS patients with hyp...
Aortic stenosis (AS) is the most common valvular heart disease in the elderly and it causes significant morbidity and mortality. Hypertension is also highly prevalent in elderly patients with AS, and AS patients with hypertension have worse outcomes. Accurate assessment of AS severity and understanding its relationship with arterial compliance has become increasingly important as the options for valve management, particularly transcatheter interventions, have grown. The parameters used for quantifying stenosis severity have traditionally mainly focused on the valve itself. However, AS is now recognized as a systemic disease involving aging ventricles and stiff arteries rather than one limited solely to the valve. Over the last decade, valvuloarterial impedance, a measure of global ventricular load, has contributed to our understanding of the pathophysiology and course of AS in heterogeneous patients, even when segregated by symptoms and severity. This review summarizes our growing understanding of the interplay between ventricle, valve, and vessel, with a particular emphasis on downstream vascular changes after transcatheter aortic valve replacement and the role of valvuloarterial impedance in predicting left ventricular changes and prognosis in patients with various transvalvular flow patterns.
White coat syndrome and its variations: differences and clinical impact.
Pioli MR, Ritter AM, de Faria AP … +1 more , Modolo R
Integr Blood Press Control · 2018 · PMID 30519088 · Full text
Hypertension is closely linked to increased cardiovascular risk and development of target organ damage (TOD). Therefore, proper clinical follow-up and treatment of hypertensive subjects are mandatory. A great number of i...
Hypertension is closely linked to increased cardiovascular risk and development of target organ damage (TOD). Therefore, proper clinical follow-up and treatment of hypertensive subjects are mandatory. A great number of individuals present a variation on blood pressure (BP) levels when they are assessed either in the office or in the out-of-office settings. This phenomenon is defined as white coat syndrome - a change in BP levels due to the presence of a physician or other health professional. In this context, the term "white coat syndrome" may refer to three important and different clinical conditions: 1) white coat hypertension, 2) white coat effect, and 3) masked hypertension. The development of TOD and the increased cardiovascular risk play different roles in these specific subgroups of white coat syndrome. Correct diagnose and clinical guidance are essential to improve the prognosis of these patients. The aim of this review was to elucidate contemporary aspects of these types of white coat syndrome on general and hypertensive population.
Exercise as a tool for hypertension and resistant hypertension management: current insights.
Lopes S, Mesquita-Bastos J, Alves AJ … +1 more , Ribeiro F
Integr Blood Press Control · 2018 · PMID 30288097 · Full text
Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge...
Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension. The present review draws attention to the importance of exercise training in the management of blood pressure in both hypertension and resistant hypertension individuals.
The effect of passive leg-raising maneuver on hemodynamic stability during anesthesia induction for adult cardiac surgery.
Fakhari S, Bilehjani E, Farzin H … +2 more , Pourfathi H, Chalabianlou M
Integr Blood Press Control · 2018 · PMID 29922085 · Full text
INTRODUCTION: Some cardiac patients do not tolerate the intravenous fluid load commonly administered before anesthesia induction. This study investigated preinduction passive leg-raising maneuver (PLRM) as an alternative...
INTRODUCTION: Some cardiac patients do not tolerate the intravenous fluid load commonly administered before anesthesia induction. This study investigated preinduction passive leg-raising maneuver (PLRM) as an alternative method to fluid loading before cardiac anesthesia. METHODS AND MATERIALS: During a 6-month period, 120 adult elective heart surgery patients were enrolled in this study and allocated into 2 groups: PLRM group vs control group (n=60). Anesthesia was induced using midazolam, fentanyl, and cisatracurium. Initially, 250 mL of fluid was administrated intravenously in all of patients before anesthesia induction. Then in the PLRM group, PLRM was performed starting 2 minutes before anesthesia induction and continued for 20 minutes after tracheal intubation. In the control group, anesthesia was induced in a simple supine position. Heart rate, invasive mean arterial blood pressure (MAP), and central venous pressure (CVP) were recorded before PLRM, before anesthetic induction, before laryngoscopy, and at 5, 10, and 20 minutes after tracheal intubation. The hypotension episode rate (MAP <70 mmHg) and CVP changes were compared between the 2 groups. The predictive value of the ≥3 mmHg increase in CVP value in response to PLRM for hypotension prevention was defined. RESULTS: Hypotension rates were lower in the PLRM group (63.3% vs 81.6%; -value 0.04), and MAP was higher among PLRM patients immediately before anesthetic injection, before laryngoscopy, and 20 minutes after intubation, compared to the control group. PLRM increased CVP by 3.57±4.9 mmHg (from 7.50±2.94 to 11.05±3.55 mmHg), which required several minutes to reach peak value, returning to baseline after 15 minutes. This change did not correlate to subsequent MAP changes; an increase in the CVP value ≥3 mmHg decreased the postinduction hypotension rate by 62.50%. CONCLUSION: Preinduction PLRM can provide a more stable hemodynamic status in adult cardiac surgery patients and decreases anesthesia-induced hypotension rates by 62.50%. Rate of the changes in the CVP value caused by PLRM is not predictive of subsequent MAP changes.
Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects.
Bilo G, Grillo A, Guida V … +1 more , Parati G
Integr Blood Press Control · 2018 · PMID 29872338 · Full text
Morning hours are the period of the day characterized by the highest incidence of major cardiovascular events including myocardial infarction, sudden death or stroke. They are also characterized by important neurohormona...
Morning hours are the period of the day characterized by the highest incidence of major cardiovascular events including myocardial infarction, sudden death or stroke. They are also characterized by important neurohormonal changes, in particular, the activation of sympathetic nervous system which usually leads to a rapid increase in blood pressure (BP), known as morning blood pressure surge (MBPS). It was hypothesized that excessive MBPS may be causally involved in the pathogenesis of cardiovascular events occurring in the morning by inducing hemodynamic stress. A number of studies support an independent relationship of MBPS with organ damage, cerebrovascular complications and mortality, although some heterogeneity exists in the available evidence. This may be due to ethnic differences, methodological issues and the confounding relationship of MBPS with other features of 24-hour BP profile, such as nocturnal dipping or BP variability. Several studies are also available dealing with treatment effects on MBPS and indicating the importance of long-acting antihypertensive drugs in this regard. This paper provides an overview of pathophysiologic, methodological, prognostic and therapeutic aspects related to MBPS.
Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study.
Animut Y, Assefa AT, Lemma DG
Integr Blood Press Control · 2018 · PMID 29720880 · Full text
BACKGROUND: Large segments of the hypertensive population in the world are either untreated or inadequately treated. The incidence of heart failure and mortality from cardiovascular complications of hypertension is high...
BACKGROUND: Large segments of the hypertensive population in the world are either untreated or inadequately treated. The incidence of heart failure and mortality from cardiovascular complications of hypertension is high among patients with uncontrolled blood pressure (BP). But BP control status of hypertensive patients has not been investigated in the study area. The study aimed to assess BP control status and determinant factors among adult hypertensive patients on antihypertensive medication attending outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia. METHODS: An institution-based retrospective follow-up study was conducted from September 2015 to April 2016. Data were collected using a structured and pretested questionnaire adopted from the World Health Organization STEPwise approach. BP records of 6 months were used, and patients were classified as having controlled BP if their BP readings were <140/90 mmHg for all adults ≥18 years of age and <150/90 mmHg for adults aged ≥60 years. A generalized estimating equation was fitted, and the odds ratio with a 95% confidence level was used to determine the effect of covariates on BP control status. RESULTS: Among 395 participants, 50.4% (95% CI: 45-55) of them controlled their BP in the last 6 months of the survey. Physical activity (adjusted odds ratio [AOR]=1.95, 95% CI: 1.41-2.68), duration on antihypertensive drugs of 2-4 years (AOR=1.70, 95% CI: 1.13-2.56) and 5 years or more (AOR=1.96, 95% CI: 1.32-2.92), and high adherence (AOR=2.18, 95% CI: 1.14-4.15) to antihypertensive drugs were positively associated with BP control, while salt intake (AOR=0.67, 95% CI: 0.49-0.93), overweight (AOR=0.50, 95% CI: 0.36-0.68), and obesity (AOR=0.56, 95% CI: 0.36-0.87) were inversely associated with BP control. CONCLUSION: In this study, only half of the hypertensive patients controlled their BP. Thus, health care providers need to be made aware about the importance of counseling hypertensive patients on drug adherence, moderate physical activity, and salt restriction to improve BP control.
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