bluuebunny/crossref_metadata_2025 huggingface dataset:
TIME OF BLOOD PRESSURE IN TARGET RANGE IN ACUTE ISCHEMIC STROKE
Authors: Kakaletsis Nikolaos , Ntaios George , Milionis Haralampos , Protogerou Athanasios , Karagiannaki Anastasia , Chouvarda Ioanna , Dourliou Vasiliki , Ladakis Ioannis , Kaiafa Georgia , Daios Stylianos , Doumas Michael , Savopoulos Christos
Published: June 2022

Objective:

The management and the prognostic role of blood pressure (BP) during the acute phase of acute ischemic stroke (AIS) still remain controversial. Time in target range (TTR) of BP was recently introduced and is suggested that reflects both patient’s mean BP levels and the magnitude of BP variability (BPV). The purpose of this study is to investigate the association of blood pressure TTR derived from 24-hour ambulatory BP monitoring (ABPM), during the acute phase of AIS, with the severity of stroke and its predictive value for the 3 months outcome.

Design and method:

A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 minutes within 48 hours from onset using an automated oscillometric device (TM 2430, A&D Company Ltd). Clinical and laboratory findings were recorded. Mean BP parameters, BPV (standard deviation) and TTR for systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were calculated. Endpoints were death and disability/death at 3 months.

Results:

A total of 14,942 BP measurements were recorded (~66 per AIS patient) within 72 hours of stroke onset. Patient’s 24-hour blood pressure TTR was 34.7 ± 29.9%, 64.3 ± 24.2% and 55.3 ± 29.4% for SBP, DBP and MAP respectively. TTR of DBP and MAP differed according to stroke severity with a “J’’ association in all AIS patents. In patients without prior hypertension, TTR was lower as stroke severity increased for both DBP (p = 0.031) and MAP (p = 0.016). In 175 patients without prior disability, increase in TTR of DBP and MAP associated significantly with a decreased risk of disability/death in the unadjusted and fully adjusted models (HR: 0.96, 95% CI: 0.95–0.98, p = 0.001 and HR: 0.97, 95% CI: 0.95–0.98, p = 0.001). Increase in SBP TTR was associated significantly with an increased risk of disability/death in fully adjusted model with the addition of mean SBP (HR: 1.03, 95% CI: 1.00–1.07, p = 0.047).

Conclusions:

TTR can be included for a more detailed description of BP course, according to stroke severity, and for the evaluation of BP predictive role, in addition to mean BP values, derived from ABPM during the acute phase of AIS.
TRAJECTORY OF PATIENTS AFFECTED BY STROKE IN A UNIVERSITY HOSPITAL CENTER IN THE NORTH WEST OF ALGERIA
Authors: Abdrebbi Samira Benbekhti , Meguenni Kaouel
Published: June 2022

Objective:

Describe the path of patients who have suffered a stroke, and have been cared for at the University Hospital of Tlemcen with the aim of proposing strategies allowing the involvement of the various health bodies in the implementation of these trajectories.

Design and method:

Descriptive observational study over 02 years on stroke patients admitted to TLEMCEN University Hospital. Data collection made using a data collection sheet. Entry and analysis by the EPI info6 software.

Results:

1. The alert and the acute phase: the patients who came to the university hospital center of Tlemcen came from 13 municipalities of the Wilaya of Tlemcen and 5.9% from the other wilayas.

Patient reception structure:

2. The medical emergency service represented the first reception service for 95.60% of our patients and it is at this level that they are initially taken care of by emergency general practitioners. 21 patients were referred by different health establishments in the Wilaya.

3. Hospitalization 82% of stroke patients were hospitalized directed to a specialized and adapted service, preferentially the neurology service (80.50%).

The orientation depends on the cause of the accident and the evolution of the pathology. The practice of brain scan was performed in the public sector in 80.5% of our patients. but 19.5% did so at the private sector level. 93.70% performed this examination the same day of their admission. The mean length of hospitalization was 10.17 ± 7.58 days.

Conclusions:

Stroke is a pathology that involves the entire healthcare chain. This pathology requires multidisciplinary care, it concerns the hospital sector but also liberal medicine with its medical and paramedical actors. Thus, the trajectory of the stroke patient has several phases and involves a wide variety of actors.

Areas for improvement:

-  Improve the organization of care and management of strokes by creating neurovascular units (UNV).

-  Multidisciplinary team coordinated and dedicated to pathology neurovascular both in acute and post-acute phase
DAPAGLIFLOZIN’S EFFECT ON SERUM HOMOCYSTEINE IN PATIENTS WITH HYPERTENSION COMPLIACTED WITH INSULIN RESISTANCE
Authors: Yu Xiaoqian , Xu Rui
Published: June 2022

Objective:

Most patients with hypertension complicate with insulin resistance (IR), which is one of risk factors of hypertension and can increase the level of serum homocysteine (hcy) by affecting hcy metabolic enzyme and insulin. Investigations in recent years have shown that hcy is an independent risk factor of cardiovascular diseases. At present, folic acid is the main drug used to reduce hcy, but its effection for hcy has obvious individual difference, which is closely related to individual genes. Moreover, folic acid (FA) is mostly used in patients with hcy beyond 15 mol/l, but hcy beyond 10 mol/l has had an adverse effect for cardiovascular system. Animal studies have shown that dapagliflozin can improve insulin resistance. Therefore, whether it can reduce hcy has become a new direction.

Design and method:

This study is a retrospective case-control study. Patients with highly serum hcy and hypertension complicated with insulin resistance are divided into two groups: dapagliflozin group and FA group. Before and after 12 weeks of treatment, the changes in serum hcy and IR index are measured and compared.

Results:

(1) The IR index and serum hcy levels are clearly lower in the dapagliflozin group after therapy, and the changement of IR index and the level of serum hcy has a significant relativity. (2) The IR index reduction is more noticeable in the dapagliflozin group than in FA group. (3) In dapagliflozin group, the standard deviation (SD) of serum hcy is lower than in the FA group.

Conclusions:

Dapagliflozin can reduce the serum hcy level of patients with hypertension and insulin resistance in a certain extent, also having an important effection in reducing IR. The lowering of serum hcy in the dapagliflozin group is more balanced than in the FA group. Dapagliflozin could be a viable option for these patients.
TRIPLE ANTIHYPERTENSIVE THERAPY TYPE AND USE IN FRENCH GENERAL PRACTICE AND CARDIOLOGY IN 2021
Authors: Mourad Jean Jacques , Jamet Philippine , Huguet Michael , Loubiere Manon , Lorc’h Erwan Le , Azria Philippe , Ferreira Emmanuel , Antakly Yara
Published: June 2022

Objective:

Blood pressure control in France leaves room for improvement. Analysis of the data from the 2015 ESTEBAN study found treatment to be insufficient, with disproportionate use of monotherapies. The 2016 French National Authority for Health (HAS) guidelines emphasise the importance of logical treatment titration giving preference in primary prevention to a triple therapy combining a renin-angiotensin system blocker, a thiazide diuretic and a dihydropyridine. The impact of these guidelines on the prescription of triple therapies has not been studied in France.

Design and method:

Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including general practitioners (GPs) (n = 1200) and community cardiologists (n = 100) – contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France.

Results:

In 2021, a total of 2 455 065 patients had received a triple therapy. A figure that accounted for 17.4% of the patients seen by a GP (n = 2 016 689) and 19.0% of the hypertensive patients followed by a cardiologist (n = 438 376). The most common (>5%) triple therapy combinations are given in the table. The ‘standard’ triple therapy recommended by the guidelines accounted for only 24.7% of the prescriptions in general practice. The prescriptions made in the cardiology and general practice settings have more similarities than differences.

Conclusions:

These findings confirm not just the insufficient use of triple therapies, but also their misuse, with the overrepresentation of the beta-blockers class not always justified by preferential indications. These observations should call into question both the quality of the guidelines’ dissemination and the continuing education of the primary care practitioners for this disease.
ACUTE AEROBIC EXERCISE-INDUCED DECREASE IN BLOOD PRESSURE IS ASSOCIATED WITH CHRONIC BLOOD PRESSURE CHANGES IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Lopes Susana , Mesquita-Bastos José , Garcia Catarina , Oliveira José , Polónia Jorge , Alves Alberto , Ribeiro Fernando
Published: June 2022

Objective:

The acute blood pressure (BP) decrease after an exercise training session seems to correlate with the chronic BP reductions following exercise training programs in participants with pre-hypertension; yet, among patients with resistant hypertension (RH) it is unknown. This study aims to investigate the association between the magnitude of BP decrease after acute exercise and the change in 24-hr ambulatory blood pressure (ABP) after an aerobic exercise intervention in patients with RH.

Design and method:

EnRicH trial was a randomized clinical trial assessing the effects of a 12-week moderate-intensity aerobic exercise program in participants with RH. In the present study, twenty-six patients (mean age 59.3 ± 8.2 years, 58.3% male) with RH that participated in the intervention arm of the EnRicH trial were included. Office and ABP measurements were obtained before and after the 12-week aerobic exercise training program. To assess the acute effect, resting BP measures were assessed before and 10 minutes after each exercise session of the third week of the exercise program. Exercise sessions were supervised, occurred three times per week, and included 40 min of aerobic exercise at 50% to 70% of VO2max and a 10-minute cooldown.

Results:

Resting systolic (-9.4 ± 7.0, p < 0.001) and diastolic BP (-1.9 ± 3.4, p = 0.10) were significantly reduced after acute exercise. 24hr systolic (-6.2 ± 12.1, p = 0.015) and diastolic BP (-4.42 ± 6.1, p = 0.001) an office systolic (-10.9 ± 15.2, p = 0.001) and diastolic BP (-5.9 ± 11.1, p = 0.013) were significantly decreased after the exercise program. The acute changes were correlated with the chronic decrease in 24hr ambulatory systolic (r = 0.556, p = 0.003) and diastolic (r = 0.484, p = 0.012) BP, and office systolic (r = 0.478, p = 0.014) and diastolic BP (r = 0.452, p = 0.020). Multiple regression analysis revealed that the acute effect of exercise was an independent predictor of the chronic effect on systolic BP (ß = 0.556, adjusted r2 = 0.280, p = 0.003) BP.

Conclusions:

The magnitude of the acute effect of exercise in BP correlates with the chronic decrease in both office and 24hr BP effects. These results suggest that it is possible to predict those patients that are less likely to improve BP with an exercise training program without the burden of a period of several months of intervention.
CARDIOVASCULAR OUTCOMES OF INITIAL BETA-BLOCKER + CALCIUM CHANNEL BLOCKER THERAPY VS OTHER DUAL THERAPIES IN CHINESE PATIENTS WITH NEWLY DIAGNOSED HYPERTENSION: A REAL-WORLD STUDY
Authors: Guo Qinghui , Lin Junxiong , Peng Feng , Chai Dajun , Lin Jinxiu
Published: June 2022

Objective:

This study aimed to compare cardiovascular (CV) outcomes associated with initial beta-blocker (BB) + calcium channel blocker (CCB) dual therapy and other initial dual therapies in Chinese patients with newly diagnosed hypertension.

Design and method:

In this retrospective study, all patients in a regional electronic database with newly diagnosed hypertension from January 01, 2012 to December 31, 2016 who received initial dual therapy recommended by the 2018 Chinese Guidelines for Prevention and Treatment of Hypertension were included. The recommended dual therapies included BB+CCB (B+C), ARB/ACEI+C (A+C), A+Diuretic (A+D) and C+D. 1:2 PSM was used to balance baseline characteristics between patients receiving B+C and patients receiving other initial dual therapies (Others). Primary outcome was major adverse cardiovascular events (MACE) consisting of non-fatal stroke, non-fatal myocardial infarction (MI), non-fatal chronic heart failure (CHF) and all-cause death during a median follow-up of 2.02 years (IQR: 1.07–3.36 years). Cox proportional hazard models were used to compare these CV outcomes in the 2 matched cohorts.

Results:

After the PSM, 6,227 patients in the B+C group and 12,454 patients in the Others group were included. The B+C group and the Others group had comparable age (59.5 ± 12.7 years vs. 59.8 ± 12.3 years) and diastolic blood pressure (91.2 ± 6.7 mmHg vs. 91.2 ± 6.9 mmHg), although their heart rate (88.0 ± 6.8 vs. 88.4 ± 7.1) and systolic blood pressure (156.2 ± 7.0 mmHg vs. 155.9 ± 7.1 mmHg) still had differences. Compared to the Others group, the B+C group had significantly lower risks of MACE (HR 0.85; 95%CI 0.78–0.92; P < 0.001), non-fatal stroke (HR 0.89; 95% CI 0.81–0.98; P = 0.018) and non-fatal CHF (HR 0.74; 95% CI 0.63–0.86; P < 0.0001) (Figure 1). Differences in risks of non-fatal MI and all-cause death in the 2 groups were statistically insignificant. Additionally, A+D (HR 1.71; 95% CI 1.52–1.92) and C+D (HR 1.77; 95% CI 1.45–2.15) were associated with significantly higher risk of MACE than B+C, and the difference between A+C (HR 1.04; 95% CI 0.96–1.14) and B+C was small.

Conclusions:

BB+CCB initial dual therapy was associated with lower risks of MACE, stroke and CHF than other recommended initial dual therapies in Chinese patients with newly diagnosed hypertension.
BIOIMPEDANCE - BASED CLINICAL DECISION MAKING IN HEMODIALYSIS PATIENTS DECREASES EPISODES OF HYPOTENSION
Authors: Katzir Zeev , Petrohno Oksana , Leiba Adi , Sharipov Tatiana , Rubin Olga , Gaber Yahya , Hausman Michel
Published: June 2022

Objective:

Intradialytic hypotension and exaggerated fluid removal during hemodialysis (HD) are related to organ ischemia and resultant increased morbidity and mortality. Fluid overload and congestion due to less than optimal fluid removal, are associated with adverse outcomes. Previous studies performed did not assess clinical decision making that is based mainly on hemodynamics. Thus, our aim was to recruit only new HD patients, and to examine the effect of bioimpedance based management within the first 90 days, a critical timeframe in dry weight determination and HD prescription.

Design and method:

The study incorporated 20 new HD patients in an established HD unit. Patients were randomized into standard clinical approach versus hemodynamic monitoring using a whole body bioimpedance device (NICaS, NI Medical, Petah Tikva, Israel). Intradialytic cardiac output, cardiac power, total body water and peripheral resistance were measured during the 1st dialysis session. Each measured session consisted of start, mid and end of dialysis recordings. Hemodynamic measurements during the pilot study interval (three months) were done also at the investigator discretion, whenever decisions on dry weight, diuretic or anti-hypertensive medications were needed. Control group patients were treated conservatively, without bioimpedance or any noninvasive hemodynamic monitoring. We recorded hypotensive episodes (<90/60 mmHg, while pre-dialysis blood pressure > = 90/60 mmHg) cardiovascular hospitalizations and cardiovascular related death.

Results:

Twenty patients completed the study (12 study, 8 control) thus far. Within a period of three months, there were 81 hypotensive episodes (6.75 episodes per patient per period) in the study group VS 93 (11.625 episodes per patient per period) in the control group (p < 0.05).

There were 3 hospitalizations due to cardiovascular events in the control group and one case of cardiovascular death, while study group had no deaths and one hospitalization due to CV complication.

Conclusions:

These preliminary results suggest that clinical decision making based on bio-impedance monitoring, when applied to new HD patients from the very beginning of their HD treatments, might confer a benefit in reducing hypotensive episodes and resultant hospitalizations. Our study is ongoing in order to further clarify these promising results.
EFFICACY OF SGLT2I IN ACUTE DECOMPENSATED HEART FAILURE WITH TYPE 2 DIABETES MELLITUS
Authors: Doan Long
Published: June 2022

Objective:

We hypothesized that Sodium Glucose cotransporter 2 inhibitors (SGLT2i) exerts positive effects in patients admitted with ADHF and type 2 diabetes mellitus (T2DM).

Design and method:

Prospective case control study with 1-month follow up. All the patients who admitted to Cardiology center, Hue Central Hospital between 01/12/2020 and 01/06/2021. Inclusion criteria: Adults diagnosed with T2DM with hypervolemic ADHF reduce LVEF and planned treatment with IV loop diuretic therapy. Exclusion criterias: fasting blood glucose (FBG) < 4.4 mmol/L, Systolic blood pressure < 90mmHg, requires inotrope therapy, eGFR < 30 ml/min/1.73m2, severe anemia, breastfeeding or pregnant, severe AS or MS without repair, severe hepatic impairment, acute coronary syndrome or history of coronary artery stenting. The study primary end-point: Length of hospitalization, in-hospital death, death within 30 days after discharge and re-hospitalized within 30 days. The study safety end-point: Urinary tract infection, worsening renal function, ketonacidosis or hypovolemic shock.

Results:

The proportion of in-hospital mortality, 30-days mortality and the length of hospitalization by day tended to be higher in the group of patients not using SGLT2i but not significant. The proportion of re-hospitalized for 30 days was higher in group not using SGLT2i (p = 0.014). The patient group of non-SGLT2i using re-hospitalized sooner than the patient using SGLT2i (p = 0.029). The eGFR of the patient use the SGLT2i show significantly improvement after 30 days (p = 0.024) but in day 4, it’s shown no improvement. In patient who don’t use the agent, the eGFR get worst in day 4 with p = 0.01 then it improve in day 30 but not significant. The group of using SGLT2i seems much more effective in reduce NT-proBNP and FBG (p values: NT-proBNP:0.026 to 0.044; FBG: 0.021 to 0.038, respectively). Complications that should be considered in patients using SGLT2i were UTIs and discontinuation of treatment due to feeling lose weight too fast.

Conclusions:

The using of SGLT2i reduce the numbers of re-hospitalization in first 30-day after discharged, prolong the duration between re-hospitalization period and only the patient groups using SGLT2i could improve the eGFR after 30-days with no significant adverse effects.
EFFECT OF SINGLE PILL COMBINATIONS ON CENTRAL SYSTOLIC BLOOD PRESSURE
Authors: Brguljan Jana , Chazova Irina , Gaciong Zbigniew , Simic Dragan , Vajer Peter , Zelveian Parounak , Jelakovic Bojan
Published: June 2022

Objective:

Central systolic blood pressure (cSBP) is considered an important haemodynamic parameter, and a relevant prognostic risk factor. Data about control of cSBP with single-pill combination (SPC) treatment are lacking. Therefore we assessed the effect of perindopril/amlodipine (P/A; dual SPC arm) and perindopril/amlodipine/indapamide (P/A/I; triple SPC arm) in naïve and uncontrolled hypertensive patients on 24-hour cSBP compared to office BP.

Design and method:

440 adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial PRECIOUS. ABPM was performed at the baseline and end of the trial (Mobilograph PWA). At inclusion, naïve or patients uncontrolled on previous mono or dual therapy other than P/A were assigned to dual SPC arm with initial dose of 4/5 mg P/A. Patients uncontrolled on previous dual or triple therapy were assigned to triple SPC arm with initial dose of 4/5/1.25 mg P/A/I. If not reaching office BP control, initial dose was up titrated in 4-week intervals to 8/5 mg, 8/10 mg P/A or 8/10/2.5 mg P/A/I in dual SPC arm and to 8/5/2.5 mg or 8/10/2.5 mg P/A/I in triple SPC arm.

Results:

In 16 weeks mean office BP decreased from 156.3 ± 10.9/98.6 ± 8 mmHg to 128.4 ± 9.4/81.7 ± 7.2 mmHg in dual SPC arm and from 157.9 ± 12.6/97.5 ± 9.5 mmHg to 127.7 ± 11.4/80.3 ± 7.5 mmHg in triple SPC arm. The average cSBP decreased from 132.1 ± 9.4 mmHg to 115.4 ± 8.9 mmHg in dual SPC and from 135.8 ± 11.1 mmHg to 114.7 ± 9.8 mmHg in triple SPC arm. All BP reductions were statistically significant (p < 0.001). 77.7% of patients achieved normal office BP values in dual SPC arm and 82.5% in triple SPC arm. A reduction of cSBP below 120 mmHg was reached by 68.9% of patients in dual SPC and by 71.5% in triple SPC arm.

Conclusions:

In triple SPC arm, higher proportion of patients reached target office BP which was reflected also in lower cSBP compared to dual SPC arm. This is important information showing the advantageous effect of triple SPC on cSBP. Usefulness of putting cSBP as additive information, reflecting effect of SPC treatment in clinical practice, will need to be proven with longer patients’ follow up.
DEPENDENCY RELATIONSHIP OF EXERCISE AND MEDICATION ADHERENCE IN HYPERTENSIVE PATIENTS
Authors: Fragoulis Christos , Prentakis Andreas G. , Kontogianni Evangelia , Polyzos Dimitrios , Leontsinis Ioannis , Mantzouranis Emmanouil , Kalos Theodoros , Politis Antonios , Tsioufis Konstantinos
Published: June 2022

Objective:

Few studies have examined the relationship between exercise and adherence to antihypertensive medication, examining all possible factors contributing to blood pressure control. The purpose of our study was to access the possible dependence relationship among hypertensive patients visiting the Behavioral Cardiology Unit in a Tertiary Hospital.

Design and method:

The study population consisted of patients reporting to the Behavioral Cardiology Unit in a Tertiary Hospital during a period of 6 months in 2021. In terms of holistic approach, all patients underwent a thorough clinical in-depth interview, using the Morisky Medication Adherence Scale (MMAS8), the Frail Questionnaire Screening Tool (Frailty Score) and the Patient Health Questionnaire-4 (PHQ-4). All patients also provided full history of exercise (at least 150 minutes of physical activity or 75 minutes of intense activity per week), while completing the Duke Activity Status Index (DASI).

Results:

The population consisted of 42 hypertensive patients, 54.8% of them were females, with a mean age of all patients at 55.8 ± 15.2 years. Body Mass Index was averaging at 27.6 kg/m2. Salt consumption above the daily suggested amount (>5gr/day) was reported by 60% of patients, binge drinking by 43% of them, while 43% had a history of active smoking. High adherence was reported by 17 patients (46%), medium adherence by 14 (37.8%) and low adherence by 6 (16.2%). Results indicate a relationship between exercise and adherence to medication. More specifically, Chi-Square test showed statistical significance between exercise and medium medication adherence in MMAS8 (MMAS8: 6–7, p = 0.033). Moreover, statistical analysis showed significant relationship between exercise, frailty and PHQ-4 score. Particularly, patients with absence of exercise showed higher level of PHQ-4 score (F = 7.07, p = 0.011).

Conclusions:

Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.
THE PHARMACISTS’ AND MOBILE APPLICATIONS’ ROLE IN THE TREATMENT OF HYPERTENSION
Authors: Tarnovski Lorka , Frkanec Stjepan , Frkanec Stjepan , Katic Luka , Strbac Tea , Lovakovic Josip , Susnjara Petar , Rasic Fran , Sekulic Mislav , Josipovic Josipa , Begic Zvonimir , Barisic Klara , Prelevic Vladimir , Radunovic Danilo , Jelakovic Ana , Gellineo Lana , Domislovic Marija , Velkovski Olgica , Dapic Kresimir , Jelakovic Bojan
Published: June 2022

Objective:

Poor adherence is the main reason for inadequate blood pressure control. Pharmacists are highly accessible healthcare professionals, and it has been reported that community pharmacist-led interventions improved patients’ BP control and outcomes. Some authors reported on the beneficial effects of mobile applications on better drug adherence. The aim of this study was to identify subjects in the general population who may benefit from such interventions.

Design and method:

A total of 1228 subjects enrolled in the EHUH 2 study (a random sample, nationwide survey) and 424 participants of the Hunt on the Silent Killer (HSK) (opportunistic screening on islands) were included in this analyses. The same questionnaire was applied containing questions about health issues, therapy, habits, and opinion on pharmacists’ and mobile applications’ (MA) role in hypertension treatment.

Results:

The binomial logistic regression analysis showed a significant model when comparing positive and negative answers for the following: the participants were more likely to be in favour of pharmacists’ role if they had a positive history of angina pectoris ( = 1.333, p = 0.016), diabetes mellitus ( = 1.125, p < 0.001), dyslipidemia ( = 1.326, p < 0.001), or being treated for hypertension ( = 1.326, p < 0.001) in the HSK, and in the EHUH 2 study if they suffered a stroke (100%). Socio-demographic factors had no impact on the pharmacists’ role in the general population. However, at islands significantly enhanced negative responses in case of lower household income (35%), married state (29%) and employed subjects (17%) were observed. The participants were more likely to be in favour of MA if they had a positive history of hypertension, have higher income and were married. Interestingly, the history of cardiovascular diseases indicated more negative responses.

Conclusions:

The participants were generally in favour of MA, which may confirm the need to digitalise the healthcare system, but it was more enhanced in participants with a higher socio-demographic status. Pharmacists-led interventions (lifestyle support and adherence increasing programs) have to be individualized.
ATHERO: AN OBSERVATIONAL CROSS-SECTIONAL EVALUATION OF ATHEROSCLEROTIC RISK CONTROL IN THE BELGIAN POPULATION TREATED WITH AT LEAST ONE ANTIHYPERTENSIVE AND ONE LIPID-LOWERING DRUG
Authors: Rietzschel Ernst , Descamps Olivier , De Sutter Johan , Philips Jean-Christophe , van de Borne Philippe , Mertens Ann , Verhaegen Ann , Wallemacq Caroline , Demeure Fabian , De Buyzere Marc
Published: June 2022

Objective:

To evaluate real-life lipid and blood pressure (BP) control in a contemporary Belgian population sample treated with at least one lipid-lowering and one antihypertensive drug.

Design and method:

Data was collected through GP questionnaires on 2337 subjects (ATHERO STUDY).

Results:

A complete set of relevant clinical variables was available for 1706 subjects (61.5% men; mean age 67.9 ± 10.9 years; mean BMI 28.4 ± 4.9 kg/m2), in which CVD, CAD, DM and renal insufficiency were reported respectively in 34.0%; 22.2%, 37.5% and 6.6% of cases. Based on the 2016 EAS/ESC guidelines for the management of dyslipidemias, 68.8% of subjects were classified as very high risk (VHR) and 10.9% as high-risk (HR). Despite the majority (almost 70%) taking > 1 antihypertensive drug, BP was uncontrolled in 44.0% (using the 140/90 mmHg threshold), without clear differences in control across risk strata. Treatment targets from the 2016 LDL-cholesterol guidelines were met in only 24.4% of VHR and 45.7% of HR subjects. For the new LDL-cholesterol targets 2019 ESC/EAS guidelines for the management of dyslipidemias (which came after the data collection) this would be 10.1% and 11.7%% respectively. GP’s estimated adequate BP control in 69.2% and LDL-cholesterol control in 63.4% of cases. Combined BP and LDL-cholesterol control was achieved in 16.1% of VHR and 26.9% of HR subjects. In the VHR group there was a clear gender disparity (11.7% of women compared to 18.6% of men) in achieving adequate combined control. More striking, combined control in those VHR subjects with a clinical condition (1040/1174 subjects) was 17.9% whilst in those with VHR due to risk factor combinations this was only 2.2%. Use of combination lipid-lowering and antihypertensive drug combinations was low (1.8%) whilst 66.5% of subjects were potential candidates.

Conclusions:

In GP practices, target achievement was very low for BP and even more so for LDL-cholesterol prevention targets amongst VHR patients, especially in those associated to risk factor combinations rather than more easily recognizable clinical conditions. There was a clear disparity between GPs’ estimates of risk factor control/target achievement and real-life figures in GP practices.
MAIN FACTORS THAT DETERMINE ADHERENCE TO PHARMACOLOGICAL TREATMENT IN HYPERTENSIVE PATIENTS. SYSTEMATIC REVIEW
Authors: Montealegre Leslie , Amador Eulalia , Pulido Tammy , Cabrera Carlos , Rivera Alma , Rebolledo Roberto
Published: June 2022

Objective:

To determine through the systematic review which are the factors that determine adherence to pharmacological treatment in hypertensive patients.

Design and method:

Systematic review with the terms DeCS and MeSH: Medication adherence, treatment adherence, medication compliance, hypertension, hypertensive patients, factors associated, in different databases. We included cohort studies and systematic review studies. Articles were assessed at risk of bias, with the help of critical and methodological guidelines STROBE and Prism, and level of evidence (CEBM)

Results:

The factors associated with pharmacological adherence were: age greater than 45 years, greater knowledge of the disease, treatment and therapeutic adherence, high levels of self-efficacy and / or recognize low level of barriers, the factors associated with pharmacological non-adherence were: lower economic income, age less than 35 years, difficulty accessing health care, not having adequate follow-up of the disease, prescription of more than two types of antihypertensive drugs, diagnosis of hypertension less than 5 years, deficiency of knowledge of the disease, treatment and adherence, not trusting in the treatment or using alternative, complementary or traditional medicine.

Conclusions:

High blood pressure is a global public health problem associated with an increased risk of developing cardiovascular disease, which requires lifelong treatment. The main consequence of suffering from hypertension is the development of complications that deteriorate the patient’s quality of life and inevitably cause death. Therefore, adherence to pharmacological treatment is essential in the treatment of chronic diseases, particularly hypertension, the identification and understanding of the factors that modify adherence to treatment is key to adapt a better control of hypertensive patients. The findings of existing studies should be interpreted with caution due to their methodological limitations. The results of this study confirm that pharmacological adherence to the treatment of hypertension is due to a multiplicity of factors, such as: socioeconomic factors, related to access to health systems, therapy, related to the condition and the patient. Since some of these factors are modifiable, they may be the focus of interventions to increase medication adherence.
RESISTANT HYPERTENSION PATIENTS’ PERSPECTIVES ABOUT AN AEROBIC EXERCISE PROGRAM: INSIGHTS FROM THE ENRICH TRIAL
Authors: Lopes Susana , Diniz Filipa , Oliveira José , Mesquita-Bastos José , Polónia Jorge , Alves Alberto J. , Ribeiro Fernando , Figueiredo Daniela
Published: June 2022

Objective:

Aerobic exercise training programs decrease blood pressure in patients with resistant hypertension. However, patients’ experiences regarding exercise training participation are often undervalued. The aim of this study is to explore the lived experiences of patients with resistant hypertension who participated in a 12-week moderate intensity aerobic exercise training program.

Design and method:

An exploratory qualitative study was conducted with twenty patients (11 males and 9 females) with resistant hypertension, after the exercise program. Participants’ mean age was 58.9 ± 8.9 years and were taking an average of 4.7 ± 0.9 antihypertensive medications. Focus group interviews were performed to explore participants’ perspectives. The interviews were video-recorded, transcribed verbatim, and submitted to thematic analysis.

Results:

Five main themes have emerged from interviews’ analyses: 1) impacts of participating in the exercise program; 2) facilitators of adherence to exercise; 3) perceived barriers; 4) perception of the program structure; and 5) global satisfaction with the exercise training program.

Overall positive benefits were reported regarding emotional and physical well-being, associated with a decrease in daily life stress and irritability alongside a decrease in blood pressure. Adherence to the physical activity program was facilitated by the commitment to attend the training sessions, different schedule options and the professional and individualized supervision. Participants referred to lack of motivation, absence of company, physical health limitations and difficulty in conciliating schedules as barriers to the maintenance of exercise training.

Conclusions:

The perceived benefits by the participants are important indicators of adherence and maintenance of exercise training, despite the perceived barriers. This study has an innovative approach by focusing on the participants’ perception analysis, going beyond quantitative clinical data, and providing important insights to increase future participants’ adherence to exercise training programs.
GLOBAL BURDEN, REGIONAL DIFFERENCES, TRENDS, AND HEALTH CONSEQUENCES OF MEDICATION NON-ADHERENCE IN PATIENTS WITH HYPERTENSION DURING 2010-2020: A SYSTEMATIC REVIEW AND META-ANALYS
Authors: Lee Eric Kam-Pui , Poon Paul , Bo Yacong , Zhu Meng-Ting , Yu Chun-Pong , Ngai Alfonse Ch , Wong Martin Cs , Wong Samuel Ys
Published: June 2022

Objective:

Non-adherence to anti-hypertensive medications (anti-HT non-adherence) is the leading cause of poor blood pressure (BP) control, and thereby cardiovascular diseases and mortality worldwide. This study aims to investigate the global epidemiology of anti-HT non-adherence.

Design and method:

This study comprises a systematic review and meta-analysis investigating global prevalence, regional differences, and trends of anti-HT non-adherence in 2010–2020. Multiple medical databases and clinicaltrial.gov were searched for articles with a cut-off of December 2020. Observational studies reporting the proportion of patients with anti-HT non-adherence were included. The proportion of non-adherence, publication year, year of first recruitment (for trend analysis), country, and health outcomes due to anti-HT non-adherence were extracted. Two independent reviewers conducted abstract and full text screening, classified countries according to levels of income and locations and extracted data. Meta-analyses were conducted using a random effect model and trends of prevalence were analysed using meta-regression.

Results:

A total of 161 studies, including more than 27 million participants were included. The global prevalence of anti-HT non-adherence was 43% (95%CI: 40–45%, I2: 99·98%, p < 0·001). Non-adherence was more prevalent in low-to-middle-income countries than in high-income countries (47% vs. 38%, meta-regression p = 0·002), and in non-Western countries than in Western countries (46% vs. 36%, p = 0·002). No significant trend in prevalence was detected during 2010–2020. Patients with anti-HT non-adherence had suboptimal BP control (OR 2·15, 95%CI: 1·84–2·5, I2: 97·4%, p < 0·001), complications from HT (OR 2·08, 95%CI: 0·99–4.35, I2: 94·2%, p < 0.001), all-cause hospitalisation (OR 1·38, 95%CI: 1·35–1·41, I2: 0, p = 0·64), and all-cause mortality (OR 1·38, 95%CI: 1·35–1·41, I2: 0, p = 0·509).

Conclusions:

While a high prevalence of anti-HT non-adherence was detected worldwide, a higher prevalence was detected in low-to-middle-income and non-Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity.
IMPLICATIONS OF CYP2D6 POLYMORPHISMS FOR THERAPEUTIC DRUG MONITORING IN PATIENTS WITH HYPERTENSION
Authors: Halvorsen Lene Vernås , Gognstad Stine , Søraas Camilla Lund , Ågnes Camilla , Hjørnholm Ulla , Kjær Vibeke Norheim , Svarstad Anja Camilla , Bergland Ola Undrum , Brobak Karl Marius , Aune Arleen , Olsen Eirik , Solbu Marit D. , Gerdts Eva , Mo Rune , Fadl Elmula Fadl Elmula M. , Rostrup Morten , Kjeldsen Sverre E. , Tuv Silja Skogstad , Høieggen Aud , Larstorp Anne Cecilie K. , Opdal Mimi Stokke
Published: June 2022

Objective:

When using therapeutic drug monitoring for evaluating non-adherence, serum concentrations of drugs are related to the actual intake, but also to pharmacokinetic variability. We aimed to map CYP2D6 polymorphisms in treated hypertensive patients and assess implications for a previous classification of adherence.

Metoprolol is predominantly metabolized by CYP2D6, and is the most commonly prescribed beta-blocker in our population. Reduced metabolism can lead to increased concentrations of this drug, potentially causing more side effects and erroneous evaluation of adherence.

Design and method:

In a multicenter study we mapped CYP2D6 polymorphisms retrospectively in 331 patients being prescribed at least 2 antihypertensive agents, already reported as adherent or non-adherent based on serum concentrations of antihypertensive drugs by mass-spectrometry (UPLC-MS/MS).

The CYP2D6 panel included the non-functional variants (null) 2D6*3, 2D6*4, 2D6*5, 2D6*6, 2D6*13 and 2D6*68, and the reduced-functional variants (red) 2D6*9, 2D6*10 and 2D6*41. 2D6*2 or absence of the assayed variant alleles was interpreted as 2D6*1 (wild-type).

Patients with *null/*null and absent enzyme activity were classified as poor metabolizers, and patients with *null/*wild-type or *null/*red and varied degree of reduced enzyme activity as intermediate metabolizers. Normal metabolizers included homozygote wildtype and *wildtype/*red. Patients with duplications of functional alleles, leading to increased enzyme activity, were classified as ultra-rapid metabolizers.

Results:

Based on genotype, 117 patients (35.3%) were intermediate-, 21 (6.3%) were poor- and 3 (0.9%) were ultra-rapid metabolizers, comparable to the European reference population. The low frequency of ultra-rapid metabolizers did not affect the classification of non-adherence. Serum concentrations of metoprolol were related to the CYP2D6 genotype. Some (perhaps 5–10%) non-adherent patients with absent or severely reduced enzyme activity may have been misclassified as adherent; with a higher serum concentration of metoprolol due to poor metabolism rather than excellent adherence.

Conclusions: In 331 hypertensive patients with a normal distribution of CYP2D6 polymorphisms, the genotype seemed to influence the serum concentration of metoprolol, but did not affect the classification of non-adherence. However, perhaps 5–10% of the non-adherent patients with reduced metabolism may have been misclassified as adherent.
SYSTOLIC BLOOD PRESSURE, FRAILTY, AND ALL-CAUSE MORTALITY IN COMMUNITY-DWELLING OLDER ADULTS: FINDINGS FROM THE CHINESE LONGITUDINAL HEALTHY LONGEVITY SURVEY 2002-2014
Authors: Chaolei Chen , Liu Lin , Huang Yuqing , Feng Yingqing
Published: June 2022

Objective:

Although convincing evidence on blood pressure (BP) targets in older adults is increasing, data of individual BP management in this group is lacking, especially in frail subjects. We aimed to investigate whether frailty modifies the association between systolic blood pressure (SBP) and all-cause mortality in community-dwelling older adults.

Design and method:

This study included participants aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey 2002–2014 and followed up to 2018. They were divided into two groups according to a frailty index based on the accumulation of 44-items deficits. The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, marital status, education, residence, economic income, current smoking, current alcohol consumption, BMI, DBP, cognitive impairment, hypertension, diabetes, cardiovascular disease, stroke and other cerebrovascular diseases, respiratory disease, and cancer.

Results:

Among 18,503 participants included, 75.2% of them were 80y or older, and 42.2% were frail. The median follow-up time was 42.7 months, detecting 15,901 (85.9%) deaths. We identified 7808 (42.2%, 7533 deaths) frail participants (mean frailty index = 0.33). Effect modification by frailty was detected. Among frail participants, a U-shaped association was found with hazard ratios of 1.16 (95% CI, 1.02–1.32) for SBP < 100 mmHg, and 1.11 (95% CI, 1.00–1.24) for SBP 150 mmHg or higher compared with SBP 120–130 mmHg. For non-frail older adults, a tendency toward higher risk among those with SBP 130 mmHg or higher was observed.

Conclusions:

Our results suggest the presence of effect modification by frailty indicating a possible negative effect for elevated SBP in non-frail older adults and a U-shaped relationship of SBP in frail older adults with respect to all-cause mortality even after adjusting for diastolic blood pressure.
EFFECTIVENESS AND TOLERABILITY OF BISOPROLOL/PERINDOPRIL SINGLE-PILL COMBINATION IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND CONCOMITANT HYPERTENSION WHO HAD A HISTORY OF MIOCARDIAL INFARCTION
Authors: Burtsev Yuriy , Boytsov Sergey , Karpov Yuriy , Khomitskaya Yunona
Published: June 2022

Objective:

To evaluate effectiveness and tolerability of bisoprolol/perindopril single-pill combination (Bis/Per SPC) in the subgroup with stable coronary artery disease (CAD) and concomitant hypertension (HTN) and a history of myocardial infarction (MI)

Design and method:

STYLE (NCT03730116) was a 3-month, multicenter, open-label, uncontrolled observational study conducted in Russia. Stable CAD patients (n = 1892) comorbid with HTN and treated with Bis/Per SPC were included from November 2018 to January 2019. Data were collected at 3 visits: V1 (inclusion visit), V2, V3 (1, 3 months). In this post-hoc analysis, the antihypertensive effectiveness of Bis/ Per SPC in the subgroup with a history of MI was assessed by mean change in systolic (SBP) and diastolic blood pressure (DBP) and antianginal effectiveness - by mean changes in number of angina attacks and short acting nitrates (SAN) intake. Treatment tolerability was assessed by investigators as excellent, good, or acceptable.

Results:

Subanalisis included 495 patients (26.2%) with a history of MI. At baseline (BL), mean age was 62.9 ± 8.5 years, 39.0% (n = 193) were women, mean SBP and DBP were 155.5 ± 16.2 mmHg and 92.1 ± 10.3 mmHg, respectively and mean heart rate (HR) was 80.2 ± 10.3 bpm.

By V3, mean SBP/DBP significantly decreased by 29.6 ± 15.2/15.5 ± 10.0 mmHg respectively (p < 0.0001 for both) and 86.9% (n = 430) of patients achieved target BP < 140/90 mmHg. Mean HR decreased by 12.1 ± 8.5 bpm after 1 month and by 16.1 ± 9.6 bpm after 3 months (p < 0.0001 for both) and 27.3% (n = 135) of patients reached target level of HR (55–60 bpm). The proportion of patients who achieved target BP (<140/90 mmHg) with HR < 60 bpm at V3 was 27,5 % (131 of 476). The number of angina attacks per week and intake of SAN decreased from 5.2 ± 14.5 and 5.0 ± 4.9 (at V1) to 0.8 ± 1.7 and 1.3 ± 1.7 (at V3), respectively (p < 0.0001 for both). 97% of investigators rated tolerability of SPC as excellent or good at V3.

Conclusions:

In stable CAD patients with HTN and a history of MI treated with Bis/Per SPC for 3 months, significant improvement in BP and HR control, reduced angina attacks and SAN intake were observed, and treatment was well tolerated.
Exploring Surgeons’, Nurses’, and Patients’ Information Seeking Behavior on Medical Innovations
Authors: Whyte Stephen , Bray Laura , Chan Ho Fai , Chan Raymond J. , Hunt Jeremy , Peltz Tim S. , Dulleck Uwe , Hutmacher Dietmar W.
Published: June 2022

Objectives:

To explore information seeking behavior on medical innovations.

Background:

While autologous and alloplastic options for breast reconstruction are well established, it is the advent of the combination of 3D printing technology and the biocompatible nature of a highly porous biodegradable implants that offers new treatment options for the future. While this type of prosthesis is not yet clinically available understanding how patients, surgeons, and nurses take up new medical innovations is of critical importance for efficient healthcare provision.

Materials and Methods:

Using the largest ever combined sample of breast cancer patients (n = 689), specialist surgeons (n = 53), and breast care nurses (n = 101), we explore participants preference for a new surgical treatment concept rooted in 3D printed and biodegradable implant technologies in the context of breast reconstruction.

Results:

We find that patients overwhelmingly favor information from a successful patient of the proposed new technology when considering transitioning. Surgeons and nurses instead favor regulatory body advice, peer-reviewed journals, and witnessing the procedure performed (either in person or online). But while 1 in 4 nurses nominated talking to a successful patient as an information source, not a single surgeon chose the same. Our multinomial logit analysis exploring patient preference (controlling for individual differences) showed statistically significant results for both the type of surgical treatment and choice to undergo reconstruction. Women who underwent a type of mastectomy procedure (compared with lumpectomy patients) were more likely to choose a former patient than a surgeon for seeking information relating to a new breast implant technology. Further, women who chose to undergo a reconstruction procedure, compared with those who did not, where more likely to prefer a surgeon for information relating to a new breast implant technology, rather than a successful patient. For medical professionals, we find no statistically significant relationship between medical professionals’ preference and their age, nor the number of other medical professionals they work with daily, nor the average number of breast procedures performed in their practice on a weekly basis.

Conclusions:

As our findings show large variation exists (both within our patient group and compared with medical professionals) in where individuals favor information on new medical innovations, future behavioral research is warranted.