bluuebunny/crossref_metadata_2025 huggingface dataset:
SURVEY OF AWARENESS AND ATTITUDES TO CLINICAL RESEARCH AND CARDIOVASCULAR HEALTH AMONG ETHNIC MINORITIES IN GLASGOW
Authors: Lip Stefanie , Jain Sahil , McCallum Linsay , Brooksbank Katriona , Padmanabhan Sandosh
Published: April 2021

Objective:

Despite efforts to increase diversity in clinical trials, racial/ethnic minority groups generally remain underrepresented, limiting researchers’ ability to test the efficacy and safety of new interventions across diverse populations. Previous research identified minority patient barriers to participation in clinical trials such as mistrust in medical researchers, fear of experimentation, and other logistical issues (language, transportation and financial barriers). Our aim is to design an observational survey to help understand the barriers or enablers that affect our local ethnic minority population in Glasgow when it comes to their own health and involvement in clinical research.

Design and method:

Surveys were conducted at two events in Glasgow – one South Asian (SA) and the other African (AF) where blood pressure screening was offered along with cardiovascular health advice. Participants completed a survey designed to examine awareness of cardiovascular health and attitudes to health and clinical research. Chi-square test was used to examine the association between races.

Results:

65 SA and 31 AF individuals completed the survey. There were significant differences between the demographics of the groups. The AF participants were younger with 87% between 25 and 54 years of age, while the SA participants were represented across all age groups. The questions which showed significant differences between groups are as follows: “Do you think that the current treatment guidelines for cardiovascular diseases are tailored for different ethnicities?”(Yes-SA: 32%; AF: 16%); “Do you believe treatment of conditions for your ethnic group is likely to be different compared to other ethnic groups?”(Yes-SA: 39%, Yes-AF: 52%); “Friends/family as source of health information” (No-SA: 88%, No-AF: 68%); “I do not know anything about clinical trials – I am not interested in knowing more” (No-SA: 66%, No - AF: 84%); I know what clinical trials are and I am keen to participate (No-SA: 88%, No-AF: 65%); Willingness to take part in clinical trials in the future (Yes -SA: 49%, Yes-AF: 74%); Trials will advance science and help treatment of their condition (No-SA: 83%, No-AF: 61%)

Conclusions:

There are differences in understanding and attitudes to clinical research between the SA and AF individuals. A tailored approach is necessary to overcome the lack of understanding of both health and clinical research in these two groups.
ANTIHYPERTENSIVE EFFECTIVENESS AND TOLERABILITY OF PERINDOPRIL/INDAPAMIDE/AMLODIPINE TRIPLE SINGLE‐PILL COMBINATION IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION (TRICOLOR)
Authors: Logunova Natalya , Khomitskaya Yunona , Karpov Yuriy , Gorbunov Vladimir
Published: April 2021

Objective:

To assess the antihypertensive effectiveness and tolerability of perindopril/indapamide/amlodipine triple single-pill combination (SPC) in hypertensive patients in real-life clinical practice.

Design and method:

TRICOLOR (NCT03722524) was a multicenter, open-label, uncontrolled, 3-month observational Russian study in 1,247 patients (Full analysis set) with uncontrolled hypertension (HTN). The changes in office systolic (SBP) and diastolic blood pressure (DBP) were assessed from baseline visit (V1), at 2 weeks (V2), 1 month (V3) and 3 months (V4) after inclusion in the study and on treatment with SPC.

Results:

At V4, perindopril/indapamide/amlodipine SPC significantly decreased the mean office SBP and DBP compared with baseline (V1), by 34.8/15.2 mm Hg, respectively (P < 0.0001). Mean office SBP and DBP values were significantly reduced at each subsequent visit versus the previous one, with the degree of these differences being reduced by V4: by 19.9/8.9 mm Hg (P < 0.0001) between visits V1 and V2; by 9.1/3.9 mm Hg (P < 0.0001) between visits V2 and V3; by 5.8/2.4 mm Hg (P < 0.0001) between visits V3 and V4. The target office BP (<140/90 mm Hg) was achieved in 39.9% (n = 497) of patients after 2 weeks of treatment with SPC, in 74.6% (n = 921) after 1 month and in 93.3% (n = 1,150) after 3 months. During the study 14 adverse events were registered, including 7 drug-related adverse events (cough – 5, hypotension – 1, worsening of HTN – 1) and 1 case of lack of efficacy.

Conclusions:

The triple SPC of perindopril/indapamide/amlodipine showed antihypertensive effectiveness and good tolerability in patients with uncontrolled HTN during a 3-month treatment.
TREATMENT OF MASKED HYPERTENSION WITH A CHINESE HERBAL FORMULA: A RANDOMIZED, PLACEBO‐CONTROLLED, SINGLE‐BLIND TRIAL
Authors: Zhang Dongyan , Cheng Yibang , Guo Qianhui , Shan Xiaoli , Wei Fangfei , Lu Feng , Sheng Changsheng , Huang Qifang , Yang Chuanhua , Li Yan , Wang Jiguang
Published: April 2021

Objective:

Masked hypertension is associated with adverse cardiovascular outcomes. Nonetheless, no randomized controlled trials exist in the treatment of masked hypertension. The aim of this randomized, placebo-controlled trial was to investigate the efficacy and safety of blood pressure (BP) lowering treatment with a Chinese herbal formula, gastrodia-uncaria granules (GUG), in patients with masked hypertension.

Design and method:

Patients with an office BP of < 140/90 mmHg and daytime ambulatory BP of 135–150 mmHg systolic and/or 85–95 mmHg diastolic were randomized 1:1 to the treatment of GUG or placebo 5–10 grams twice daily for 4 weeks. The primary efficacy variable was the change in daytime ambulatory BP.

Results:

At baseline, office and daytime BP of the 251 participants (mean age 50.4 years, 53.4% men, mean body mass index 24.5 kg/m2, and 2.8%, 1.6%, and 30.7% with cardiovascular disease, diabetes mellitus, and smoking, respectively) averaged 129/82 and 135/89 mmHg, respectively. In the intention-to-treat analysis, daytime systolic/diastolic BP was reduced by 5.44 /3.39 and 2.91/1.60 mmHg in the GUG and placebo groups, respectively. The between-group difference in BP reductions was significant for the daytime (2.52/1.79 mmHg, P?0.025) and 24-h BP (2.33/1.49 mmHg, P?0.012), but not for the clinic and nighttime BPs (P?0.162). The per-protocol analysis in 229 patients produced similar results. Only one adverse event (sleepiness during the day) was reported and no serious adverse event occurred.

Conclusions:

BP lowering treatment with Chinese traditional medicine GUG is efficacious for patients with masked hypertension.
EFFECT OF MINERALOCORTICOID RECEPTOR BLOCKER, ESAXERENONE, ON NOCTURNAL HYPERTENSION: A POST HOC ANALYSIS OF ESAX-HTN STUDY
Authors: Kario Kazuomi , Ito Sadayoshi , Itoh Hiroshi , Rakugi Hiromi , Okuda Yasuyuki , Yamakawa Satoru
Published: April 2021

Objective:

Nocturnal hypertension is an important phenotype of abnormal diurnal blood pressure variability and a known risk marker for target organ damage and cardiovascular events. Esaxerenone is a novel, first non-steroidal mineralocorticoid receptor blocker (MRB) with a dose-dependent antihypertensive effect. We investigated the efficacy of esaxerenone on nocturnal hypertension in Japanese hypertensive patients.

Design and method:

The ‘Esaxerenone compared to Eplerenone in Patients with Essential Hypertension (ESAX-HTN)’ study was a phase 3, multicenter, randomized, controlled, double-blind, and parallel-group clinical study conducted in Japan. Patients were eligible for enrolment in the study if they had trough systolic BP (SBP) > = 140 and < 180 mmHg, trough diastolic BP (DBP) > = 90 and < 110 mmHg, 24-hour mean BP (ABPM) > = 130/80 mmHg. This post hoc analysis used ABPM data to evaluate the effects of esaxerenone and eplerenone on nocturnal blood pressure in patients with essential hypertension.

Results:

Patients (n = 1001) were randomized to esaxerenone 2.5 mg/day (n = 331) or 5 mg/day (n = 338), or eplerenone 50 mg/day (n = 332). Esaxerenone significantly lowered blood pressure from baseline throughout the 24-hour dosing interval; reductions in nighttime systolic blood pressure (95% confidence interval [CI]) were significantly greater with 2.5 and 5 mg/day esaxerenone versus eplerenone (-2.6 mmHg [-5.0, -0.2] and -6.4 mmHg [-8.8, -4.0], respectively). Esaxerenone 2.5 and 5 mg/day significantly reduced nighttime blood pressure from baseline compared with eplerenone in non-dipper patients (-4.4 mmHg [-8.6, -0.2] and -10.8 mmHg [-15.0, -6.7], respectively). In addition, esaxerenone did not markedly alter nighttime blood pressure in extreme dipper patients. In the esaxerenone 5 mg/day group, esaxerenone-induced decreases in nighttime blood pressure were greater than eplerenone-induced decreases in older patients.

Conclusions:

Esaxerenone may be an effective treatment option for nocturnal hypertension, especially in older patients and those with non-dipping patterns of nocturnal blood pressure.
A CROSS SECTIONAL OBSERVATIONAL STUDY EVALATING PERSPECTIVES AND THERAPEUTIC OPTIONS AMONGST CLINICIANS IN YOUNG INDIAN HYPERTENSIVES
Authors: Jadhav Uday , Khan Aziz , Kalmath Bc , Ponde Ck , Sawhney Jps , Tripathy Mp , Hazra Pk , Sahoo Pk , Routray Sn , Chandra Sharad , Alexander Thomas , Chopra Vk , Abhyankar Mahesh , Revankar Santosh
Published: April 2021

Objective:

Hypertension has been reported in 12.1% of young adults in a recent population-based study in India and is a growing concern. There is a paucity in guidelines on the definite therapeutic approach in young hypertensives. This study aimed to understand the clinician's perspective on approach to management of hypertension in young adults in India.

Design and method:

Cross-sectional observational survey conducted between February 6, 2020 and 22 February 22, 2020 using a structured 14-item questionnaire. Total of 2287 clinicians (cardiologists, diabetologists, consultant physicians, and family physicians) across India participated in this survey. Descriptive statistics were first computed. Inferential statistics, namely chi-square test was then run to test the associations among knowledge, awareness and practice among the respondents across India.

Results:

Prevalence of hypertension in young adults was observed in 10–30% by 64.8% participant clinicians. Smoking, mental stress and obesity were considered as the most common risk factors for hypertension in young adults. Parameters of sympathetic overactivity in young hypertensive patients were considered as only increased systolic blood pressure, only increased heart rate and both increased heart rate and increased systolic blood pressure by 15.1%, 24.2% and 57.4% of respondents respectively. Angiotensin II receptor blockers (ARBs) were considered the most appropriate class of drugs to treat hypertension in young by 61.6% respondents. Beta-blockers were preferred by 15.8%, followed by calcium channel blockers, diuretics and ACEI by 10.4%, 7.6% and 4.6% respondents respectively. Beta-blockers were selected as antihypertensive class in young hypertensive adults based on their perception of sympathetic overactivity by 74.5% respondents. Metoprolol was the preferred beta-blocker by 63.1% respondents. Combination therapy of telmisartan & metoprolol was preferred by 15.5%, 40.9%, 43.6% clinicians in young hypertension, uncontrolled hypertension, both young and uncontrolled hypertension patients respectively.

Conclusions:

This study adds to the real-world data in management strategies of young Indian hypertensives. Amongst the current class of anti-hypertensive drugs, ARBs and beta -blockers were preferred by the clinicians who participated in the study. Monotherapy and combination therapy with telmisaratan and metoprolol as a prototype of the respective anti-hypertensive class were preferred in the study.
TARGET ACHIEVEMENT IN VERY HIGH RISK PATIENTS IN LIGHT OF THE NEW DYSLIPIDEMIA GUIDELINES
Authors: Vintila Ana Maria , Horumba Mihaela , Cimpu Cristiana , Dumitrescu Diana , Miron Paul , Alucai Andreea , Cristea George , Tudorica Cezar Cornel , Vintila Vlad Damian
Published: April 2021

Objective:

The 2016 ESC Dyslipidemia guidelines established LDL-cholesterol and HbA1c targets at 70 mg/dl and 7% for patients at very-high cardiovascular risk. The 2019 Dyslipidemia guidelines set LDL-cholesterol targets as low as 55 mg/dl for patients with diabetes, hypertension and atherosclerotic cardiovascular disease (ASCVD) or severe chronic kidney disease (CKD), while maintaining 70 mg/dl targets for patients at high cardiovascular risk. The purpose of our study was to establish a baseline of LDL-cholesterol target achievement based on past years’ experience.

Design and method:

We performed a retrospective study on patients admitted to our Internal Medicine and Cardiology Department, from January 2014 to December 2018. All patients had arterial hypertension (HTN) and type 2 diabetes mellitus (T2DM). Data regarding patient demographics, comorbidities and laboratory assay results (including glycemia, glycated hemoglobin and a complete lipid profile) were recorded. Data analysis was performed using SPSS version 20.

Results:

A total of 1239 patients were enrolled with a mean age of 71.3 ± 10.1 years and a slight female predominance (59.4% female). All patients were at very-high risk according to 2016 guidelines, but only 56.3% based on 2019 guidelines: 54.3% had ASCVD and 4.2% had severe CKD. LDL-cholesterol target achievement was 28.6% and 12.4% according to 2016 and 2019 ESC recommendations. The overall mean LDL-cholesterol value was 97.1 ± 39.4 mg/dl, but LDL-cholesterol values were lower after 2016 (93.4 vs. 100.7, p = 0.030) supposedly owing to the publication of the guideline. In terms of HbA1c targets achievement, overall HbA1c was 7.2 ± 1.5% and there was no difference in target achievement before and after 2016: 60.1% vs. 53.8%, p = 0.105.

Conclusions:

Our study shows that very few patients reach the desired treatment goals but lower targets equal better control of risk factors. We also believe that the timing of guideline publication may have an effect on risk factor correction: yearly publications from the American Diabetes Association may help as a reminder about target HbA1c levels, leading to tighter control.
FACTOR ANALYSIS OF UNTREATED HYPERTENSION FROM TARUMIZU STUDY
Authors: Sakoda Takashi , Akasaki Yuichi , Kubozono Takuro , Iked Yoshiyuki , Ohishi Mitsuru
Published: April 2021

Objective:

The percentage of hypertensive patients taking antihypertensive drugs has continued to rise in Japan, it is over 50% in 60 s age group and over 60% in 70 s age group. However, the reason for not receiving treatment for hypertension is not clear. We tried to analyze the factors of untreated hypertension.

Design and method:

We conducted a cross-sectional study of 864 people who participated in health check-up in Tarumizu study in 2018. Untreated hypertension group was defined as participants’ blood pressure was 140 / 90mmHg or higher and not taking antihypertensive medications, and also treated hypertension group was defined as participants were taking antihypertensive drugs regardless of blood pressure control status. Among 864, 221 was in normal blood pressure group (26%; male / female ratio = 75/146, average 73.4 years old), 207 was in untreated hypertension group (24%; male / female ratio = 71/136, average 73.8 years old) and 436 were in treated hypertension group (50%; gender ratio = 170/260, average 76.4 years old).

Results:

Patients with or without antihypertensive therapy were compared by univariate analysis. We selected advanced age (P < 0.0001), living with children (P = 0.0115), angina (p = 0.024), past stroke (p = 0.0004), diabetes mellitus (p < 0.0001), dyslipidemia (p < 0.0001), family history of hypertension (p < 0.0001), family history of no cancer (p = 0.0314), poor health awareness (p = 0.0072), fear of falling (p = 0.0375), awareness of decline in memory (p = 0.0322), interruption of interest (p = 0.0348), lack of vitality (p = 0.0353), decline in motor function (p = 0.0045), brushing after breakfast or lunch (p = 0.0212 / 0.008), lack of exercise (p = 0.0242), few remaining teeth (p = 0.0157), normal walking slowly (p = 0.010), forced walking slowly (p = 0.0002) as related factors for receiving antihypertensive therapy.

Conclusions:

The reasons for not visiting a medical institution include young, energetic and confident in health, not having a major illness such as angina or stroke. If patients had a family history of hypertension, other lifestyle related diseases or lived with their children, the probability of receiving antihypertensive therapy increases.
ANTIHYPERTENSIVE DRUG THERAPY IN NEPAL: FINDINGS FROM MAY MEASUREMENT MONTHS 2019
Authors: Neupane Dinesh , Dhungana Raja Ram , Bhattarai Harikrishna , Adhikari Tara Ballav , Koirala Sweta , Khanal Pratik , Khatiwoda Shiva Ram , Kallestrup Per , Koirala Bhagawan , Matsushita Kunihiro , Olsen Michael Hecht , Poulter Neil , Appel Lawrence J.
Published: April 2021

Objective:

To explore the pattern of the antihypertensive medication use among Nepali patients.

Design and method:

This cross-sectional study in Nepal analysed data from the May Measurement Month 2019 (MMM19). We converted all trade names to generic names and further categorized according to class of medication. Participants who provided the information about the name of their antihypertensive medication at the time of interview were included. Blood pressure (BP) control was defined as a systolic BP < 140 mmHg and diastolic BP < 90.

Results:

Out of 72,320 who participated in the MMM19, three BP readings were available for 66,955 (93%). Among them, 15,872 (24%) had hypertension and 7,507 (47%) were taking antihypertensive medication. Out of them, 1,434 (19%) provided the information about the antihypertensive medication. The mean (SD) of systolic and diastolic blood pressure were 135 mmHg (17 mmHg) and 86 mmHg (11 mmHg). Among those treated for BP, 85%,14% and 1% used 1, 2 and > 2 drugs respectively and 63% were controlled. The proportion of patient taking calcium channel blockers (CCB), angiotensin II receptor blockers (ARBs), and CCB plus ARB were 56%, 24% and 10%, respectively. Amlodipine was the most widely used medicine (55 %) followed by losartan (15%). Blood pressure control rate among participants using telmisartan, losartan plus hydrochlorothiazide, amlodipine plus losartan, losartan and amlodipine were 75%, 68%, 64%, 62% and 62%, respectively.

Conclusions:

Among individuals taking antihypertensive medications in Nepal, 85% of patients were taking monotherapy, mostly amlodipine. Improvements in BP control will likely require intensification of therapy, potentially through greater use of fixed dose combination therapy.
STATIN ADHERENCE IN REAL CLINICAL PRACTICE
Authors: Grintsevich Julia , Vasilyeva Lyubov , Bragina Anna , Podzolkov Valeriy
Published: April 2021

Objective:

To study statin adherence and factors associated with in real clinical practice.

Design and method:

53 statin taking patients with multimorbidity during their hospitalization were included. Mean age was 68,1 ± 10,2 years. All participants completed general questionnaires containing questions about their comorbidity and knowledge about statins, HADS (Hospital Anxiety and Depression Scale) and MoCa (The Montreal Cognitive Assessment) scale. Adherence was assessed by original questionare. Statistica 10.0 software was used for data management and statistical analysis.

Results:

50,9% of patients were non-adherent, 22,6% were adherent, and 26,4% had insufficient adherence. 67,9% of respondents had some knowledge about statins, 32% had lack of information. Among informed patients answers of 91,7%, were correct, 8,3% had wrong information. 34,0% of patients took prescribed therapy for less than a year, 9,4% - from 1 year to two years, 22,6% - from 2 to 5 years, 17,0% - more than 5 years, the longest period of statin intake was 13 years. Long-standing course of statin administration (r = -0,30), level of total cholesterol (r = -0,30) and body mass index (BMI) (r = 0,28) were correlated with the score of adherence questionare. Patient awareness about statins were associated with gender (r = -0,33), smoking (r = -0,35), family history of cardiovascular diseases (r = 0,43), anxiety (r = 0,35), comorbidity (r = 0,41), initial insomnia (r = 0,38), sleeping quality disorder (r = 0,33), grade of hypertension (r = 0,39). There was correlation between correct patient knowledge and scores on the Moca scale (r = 0,46).

Conclusions:

About a half of all respondents were non-adherent to statin therapy and adherence of one-third was insufficient. Adherence to therapy was associated with the duration of taking statins, levels of total cholesterol and BMI. Due to the received correlations it was possible to identify male gender and smoking as markers of low awareness. Presence of family history of cardiovascular diseases, anxiety, comorbidity, initial insomnia and sleeping quality disorder, grade of hypertension were positively correlated with awareness about statins. Correct information about statins were also associated with the cognitive functions level.
STATIN TREATMENT REDUCES THE RISK OF DEATH AMONG ELDERLY FRAIL PATIENTS. EVIDENCE FROM A LARGE POPULATION-BASED COHORT
Authors: Rea Federico , Corrao Giovanni , Mancia Giuseppe
Published: April 2021

Objective:

Randomized controlled trials show that statin treatment is associated with a reduction of cardiovascular outcomes and mortality. Evidence is limited, however, on whether these drugs are protective in frail patients. Aim of our study was to assess the protective effect of these drugs in a large and unselected cohort of frail elderly subjects. Protection was inferred from the reduction of mortality associated with adherence to treatment because of the evidence that adherence to statin is closely related with outcomes.

Design and method:

The target population included Lombardy residents (Italy), aged 65 years or older, who received at least three consecutive prescriptions of a statin during 2011–2012. A case-control study was performed, the cases being the cohort members who died until 2018. Logistic regression was used to model the outcome risk associated with statin adherence. Adherence was measured by the proportion of the follow-up covered by prescriptions. The analysis was stratified according to four clinical categories (good, medium, poor, and very poor clinical status), based on different life expectancies, as assessed by a prognostic score (i.e., the Multisource Comorbidity Score) which had been found to sensitively predict the risk of death. From the good to the very poor clinical status, the 7-year death probability increased from 11% to 52%.

Results:

In each clinical status, there was a significant reduction of all-cause mortality as adherence to statin treatment increased. The reduction in the adjusted risk of mortality from the lowest to the highest adherence level was greatest among patients with a good clinical status (-56%) and less among other cohort members (i.e., -48%, -44% and -47% in medium, poor and very poor groups, respectively). Similar findings were obtained for the risk of cardiovascular mortality.

Conclusions:

In a real-life setting, adherence to statin treatment reduced the risk of death in elderly patients regardless their clinical conditions. The reduction extended to patients with a high risk of mortality, suggesting that also frail patients are protected by lipid-lowering treatment. However, in these patients the benefit from the treatment seems lower than those in good clinical conditions.
POTENTIAL ADHERENCE TO TREATMENT OF PATIENTS, HOSPITALIZED WITH THE HYPERTENSIVE CRISIS
Authors: Pereverzeva Kristina , Iakushin Sergey
Published: April 2021

Objective:

To analyze potential adherence to treatment of patients, hospitalized with the hypertensive crisis using the quantitative questionnaire of adherence. The level of potential adherence (PA) in the interval to 50% is interpreted as “low”, within the range of 51% to 75% is interpreted as “medium” and in the interval of more than 75% as “high”.

Design and method:

112 patients took part in this research, 71.4 % of them were women. The median age is 58 [49;70] years old.

Results:

The median of overall PA to treatment of patients was 47.2% [42.6; 60.1]. The median of PA to lifestyle modification was 48.7% [32.4; 54.8] to medical support - 40.6% [30.9; 57.8] and to therapy with drugs – 41.4% [36.4; 63.2].

The duration of the anamnesis of hypertensive disease was 3 [2; 10] years in a group with a medium level of PA to lifestyle modifications and was less durable than the duration of the disease in groups of patients with lower levels of adherence 8 [4; 12] years, p < 0.05. Big number of patients, who had a disease duration of more than 5 years had a low level of PA to lifestyle modification (78.3% against 62.2%, p < 0.05), alone patients had a low level of PA to medical support (80.4% against 40.7%, p < 0.05), male patients had a low level of PA to therapy with drugs (71.8% against 42.4%, p < 0.05). Patients, hospitalized more than once during this year had a low level of potential adherence to treatment more frequently (83.6% against 60.2%, p < 0.05).

Conclusions:

1. Among the indexes of PA the highest quantity had the adherence to lifestyle modification – 48.7% [32.4; 54.8] and the lowest quantity had the adherence to medical support – 40.6% [30.9; 57.8] (p > 0.05). 2. Statistically significant factors that affect patients’ potential adherence were gender differences, the duration of a disease, presence or absence of family and number of hospitalizations during the year.
PHONE CALLS FOR IMPROVING BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS ATTENDING PRIVATE MEDICAL PRACTITIONERS IN INDIA: FINDINGS FROM MUMBAI HYPERTENSION PROJECT
Authors: Kannure Mandar , Sharma Bhawna , Pathni Anupam Khungar , Negi Sagri , Vijayan Shibu , Hegde Asha , Gandhi Ravdeep , Scuteri Angelo , Hering Dagmara
Published: April 2021

Objective:

Despite the availability of effective medication, blood pressure control rate is low, particularly in low- and middle-income countries. Adherence to medication and follow-up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow-up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives (RTSL) from January 2019 to February 2020. The study included hypertensive patients attending 164 private practitioners in Mumbai, India; practitioners screened all adults visiting clinic during the project period. Among 13184 hypertensive patients registered, the mean age was 53 years (SD = 12.38), 52% were female and 96% provided phone number. 9528 (72%) patients responded to a telephone call at least once during the study period. 82% of patients visited the clinic for follow-up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 21.0% to 44.3% (P < 0.001) and 22.8% to 48.8% (P < 0.001), respectively. The blood pressure control rate at follow-up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 - 1.71). The study demonstrates that follow up visits and telephone call intervention can improve patient retention in care and subsequently, blood pressure control among hypertensive patients attending urban private-sector clinics in India.
SERUM CONC. OF ANTIHYPERTENSIVE DRUGS MAY REVEAL NON-ADHERENCE IN PATIENTS CONSIDERED TO HAVE TRUE TREATMENT RESISTANT HYPERTENSION ASSESSED BY DIRECTLY OBSERVED THERAPY
Authors: Halvorsen Lene Vernås , Bergland Ola Undrum , Søraas Camilla Lund , Larstorp Anne Cecilie Kje , Hjørnholm Ulla , Kjær Vibeke Norheim , Mula Fadl El Mula Fadl El , Opdal Mimmi Stokke , Høieggen Aud
Published: April 2021

Objective:

Detecting non-adherence is challenging. Both directly observed intake of antihypertensive medication (DOT) followed by 24 hour-ambulatory blood pressure monitoring and serum conc. measurements of antihypertensive drugs are objective methods considered reliable in revealing drug non-adherence. We aimed to investigate whether serum conc. offers additional information regarding drug adherence compared to DOT in patients with assumed true treatment resistant hypertension.

Design and method:

Patients referred for renal denervation (RDN) were thoroughly investigated and tested for adherence. 19 patients were defined as true treatment resistant when their daytime systolic BP remained high (> 135 mmHg) after DOT. Blood samples were collected at baseline, 6 months and 3 years after RDN and analyzed using ultra high pressure liquid chromatography-tandem mass spectrometry. Partial non-adherence was defined as at least one undetectable drug (but not all)and non-adherence as no detectable drugs in serum.

Results:

Ten out of 56 blood samples (17.9%) showed too low levels of one or more drug to be compatible with drug adherence. Six patients were redefined as either non-adherent or partially non-adherent based on their serum conc. results. Their systolic BPs are shown in the Figure.

Three of these six patients went through a renal denervation procedure, while the remaining three were randomized to control. One of two patients considered to be RDN responders, became adherent to medication after six months which may have contributed to the fall in BP. At the 3 years visit none of the five antihypertensive agents prescribed were detected, and the patient́s BP was again elevated.

Conclusions:

Non-adherence was revealed in more patients when serum conc. measurements of antihypertensive drugs were added to directly observed therapy. Serum conc. measurement is objective and quantitative, and since some antihypertensive drugs require regular intake over a certain period of time to have maximal effect, they may offer important additional information.
DEVELOPMENT OF A MOBILE HEALTH APP FOR THE MANAGEMENT OF HYPERTENSION, INCLUDING TREATMENT ADHERENCE ASSESSMENT, USING IMAGE DETECTION TECHNOLOGY – INSPIRERS-HTN
Authors: Nogueira-Silva Luis , Vieira-Marques Pedro , Valente José , Holtkötter Jannis , Amaral Rita , Jácome Cristina , Ferreira Ana , Almeida Rute , Fonseca João Almeida
Published: April 2021

Objective:

We aim to develop a mHealth smartphone app with a novel strategy to support the management of hypertension, including the measurement of adherence to treatment, taking advantage of the widespread use of smartphones and using only their embedded sensors.

Design and method:

We have designed and developed a cross-platform, multi-language app which allows to register a pharmacological treatment and to customize alerts for the patient to take his/her medication and to measure his/her blood pressure (BP). Moreover, the app will be able to identify the number of pills in a blister and to capture the BP values from the screen of BP measuring devices, using the smartphone's camera. Thus, the app will quantify adherence to therapy and generate automatic BP reports.

Blister photos and BP values collected by the users are enhanced using standard image processing methods for contrast increase, gap filling and relevant elements location. Classification strategies allow to count the pills present in the blisters, while the Google MLKit text mining API is employed for BP values recognition. Health Level Seven International (HL7) Fast Health Interoperability Resources (FHIR) standard is used for health care data modeling and exchange, promoting interoperability while guaranteeing data quality and security.

Evaluation of the app's performance by real users will be presented, regarding its usability and the offline validity of the data acquisition.

Results:

The user interface concept of the app has been defined and the mockups have been produced.

Regarding pill counting, blisters with diverse materials and textures were considered. Different processing strategies are used depending on blisters’ characteristics, which has allowed an accuracy above 95% for most of the tested blisters. Extracting the BP measures from smartphone acquired images using the MLKIT app seems to be feasible. Further improvements and evaluations are ongoing. We will show preliminary results regarding usability and offline validity.

Conclusions:

We propose a new smartphone app that will support the management of hypertension, including an innovative image detection tool that will allow to objectively measure adherence to therapy and will facilitate the capture of BP values.
TARGET DIASTOLIC BLOOD PRESSURE RANGE ACCORDING TO THE AGE CATEGORY AND PRESENCE OF PRIOR CARDIOVASCULAR DISEASE DURING ANTIHYPERTENSIVE TREATMENT
Authors: Sobieraj Piotr , Sinski Maciej , Lewandowski Jacek
Published: April 2021

Objective:

The evidence supporting European Society of Cardiology (ESC) recommended target diastolic blood pressure (DBP) in range 70–79 mm Hg is scarce. The study was aimed to evaluate optimal DBP according to age category (< 65 years, 65–80 years, > 80 years) and presence of cardiovascular disease (CVD).

Design and method:

Analysis was performed using Systolic Blood Pressure Intervention Trial (SPRINT) data shared by National Heart, Lung and Blood Institute. On-treatment DBP was computed as a mean of DBP measurements made in period from 6th month of participation to the end of the study, when BP was stable. Composite outcome event (CE) included myocardial infarction and other acute coronary syndrome, stroke, heart failure decompensation and cardiovascular death. Adjusted Cox proportional models were used to establish association between DBP and hazard ratio according to age category and presence of CVD.

Results:

Data of 8890 SPRINT participants (aged 67.8 ± 9.4 years) with available data were analysed. 3139 (35.3%) were female and 1773 (19.9%) were diagnosed with prior CVD. There was 3049 (42.8%) participants younger than 65 years, 3288 (46.2%) in age 65–80 years and 780 (11%) older than 80 years in group without prior CVD. There was 583 (32.9%) participants younger than 65 years, 891 (50.3%) in age 65–80 years and 299 (16.9%) older than 80 years in group with prior CVD. There was 293 (4.1%) CE events in group without prior CVD and 168 (9.5%) CE events in participants with prior CVD.

Figure 1 presents the relationship between DBP and hazard ratio according to age category and presence of CVD.

Conclusions:

Optimal DBP range for patients with hypertension and CVD younger than 80 years is similar to the recommended interval 70–79 mm Hg. Similar DBP target should be recommended for younger than 65 years adults with hypertension but without prior CVD. DBP range 70–79 mm Hg should be reconsidered as a treatment target in subjects without prior CVD older than 65 years and in subjects with prior CVD older than 80 years.
INFLUENCE OF RESTING HEART RATE ON BLOOD PRESSURE LOWERING EFFECT
Authors: Sobieraj Piotr , Lewandowski Jacek , Sinski Maciej
Published: April 2021

Objective:

Elevated resting heart rate (RHR) identifies hypertensive subjects at higher cardiovascular risk. The study was aimed to compare benefit of intensive blood pressure (BP) lowering in subjects with higher and lower RHR.

Design and method:

The analysis was performed using Systolic Blood Pressure Intervention Trial (SPRINT) data shared by National Heart, Lung and Blood Institute. SPRINT trial assessed intensive lowering of systolic BP to a target < 120 mm Hg in comparison to standard goal (< 140 mm Hg).

Baseline RHR was estimated as a pulse rate obtained during automated office BP measurements at first study visit.

RHR higher than 80 b.p.m. was defined as increased according to current European Society of Cardiology guidelines.

Composite outcome event (CE) included myocardial infarction and other acute coronary syndrome, stroke, heart failure decompensation and cardiovascular death.

Cox proportional model was used to assess impact of BP lowering in subjects with RHR higher and lower than 80 bpm. P-value for interaction between study BP intervention and baseline RHR.

Results:

Data of 9361 SPRINT participants, aged 67.9 ± 9.4 years, were analyzed. 3332 (35.6%) were female an 1877 (20.1%) were diagnosed with prior cardiovascular disease.

Mean baseline RHR was 66.3 ± 11.6 b.p.m. Baseline HR in both treatment arms was similar (standard arm 66.3 ± 11.7 b.p.m. vs intensive arm 66.2 ± 11.5 b.p.m., p = 0.762)

1198 (12.8%) participants had baseline RHR higher than 80 b.p.m. and experienced 78 (6.8%) CE events. There were 484 (5.9%) events among subjects with RHR lower than 80 b.p.m.

Intensive lowering of systolic BP was beneficial both in subjects with elevated RHR (hazard ratio 0.79 with 95% confidence interval 0.51–1.24, p = 0.311) and non-elevated RHR (hazard ratio 0.75 with 95% CI 0.62–0.89, p = 0.002). The intervention between study BP intervention and baseline RHR was not significant (p for interaction 0.819).

Conclusions:

Elevated RHR does not influence effect of BP reduction on cardiovascular events risk.
FIXED HIGH-DOSE TRIPLE COMBINATION ANTIHYPERTENSIVE MEDICATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION
Authors: Matova Olena , Mishchenko Larysa , Serbeniyk Katerina
Published: April 2021

Objective:

to evaluate efficacy and safety use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system and a thiazide diuretic with a maximal dose for 3 months in patients with long uncontrolled hypertension.

Design and method:

We studied 117 patients with uncontrolled hypertension which was confirmed by the office and 24-h ambulatory blood pressure monitoring (ABPM). All patients used 3.6 ± 0.1 antihypertensive drugs in free combinations. The adherence was moderate or low in 80 % of patients by the Morisky-Green test. After baseline examination patients have started treatment with the 3-component fixed-dose combination (FDC) of valsartan 320 mg/ hydrochlorothiazide 25 mg/ amlodipine 10 mg daily. The mean baseline systolic/diastolic BP was 170.2 ± 1.6/98.8 ± 1.2 mmHg and 24-h ambulatory BP was 160.3 ± 1.3/93.3 ± 1.1 mmHg.

Results:

After 3 months of treatment with triple combination pill, BP target was achieved in 57.3 % of patients according to the results of office and ABPM. In controlled hypertension (HTN) patients there was attenuated prevalence of non-dipping at the final evaluation (37 % vs 19 %, P < 0.01). The other 50 patients were classified as patients with resistant hypertension (RH). Patients with RH had a longer duration of hypertension, higher plasma aldosterone and 24-h urinary metanephrines, higher 24–h urinary sodium and were included more subjects with obesity, diabetes mellitus, chronic kidney disease (CKD), coronary artery disease than HTN patients (all P < 0.05). During the study, there were no adverse events such as dizziness, presyncope, or syncope, and headache. At the end of treatment, in HTN patients without initial CKD, creatinine level increased by 12.8% (P = 0.003), and GFR decreased by 10.0% (P = 0.004).

Conclusions:

The use of the fixed high-dose triple combination of antihypertensive drugs normalizes office and 24-hour BP in 57 % patients and differentiates the patients with true RH among the patients with low adherence to treatment and ineffective previous multicomponent therapy. BP lowering in patients without CKD has shown an increase in creatinine level and possibly refers to hemodynamic changes rather than renal damage; it requires observation.
EFFECT OF BRACHIAL ANKLE-PULSE WAVE VELOCITY COMBINED WITH WAIST-HIP RATIO ON CARDIA AND CEREBRAL VASCULAR EVENTS
Authors: Li Yao , Wang Chi , Xue Hao , Wu Shouling
Published: April 2021

Objective:

Abdominal obesity is one of the risk factors of cardia and cerebral vascular events (CCVEs), waist-hip ratio (WHR) could conveniently reflect the degree of abdominal obesity. Brachial ankle-pulse wave velocity (ba-PWV) is one of the indicators of the degree of atherosclerosis. This study intends to determine the influence of ba-PWV combined with WHR on the occurrence and risk of CCVEs.

Design and method:

Kailuan study (n = 19054) was a prospective community cohort study. Baseline data were collected from all the participants in this community and 3 times follow-up were conducted over 4.75 years. According to the increase of ba-PWV and WHR in baseline clinical characteristic, we divided all the participants into 4 groups: Q1 (ba-PWV normal, WHR normal), Q2 (ba-PWV normal, WHR increased), Q3 (ba-PWV increased, WHR normal) and Q4 (ba-PWV increased, WHR increased). The incidence and risk of CCVEs were analyzed.

Results:

During the mean follow-up period of 4.75 years, 394 cases of total CCVEs occurred in the observed subjects, with the cumulative incidence of 2.1%. Among them, the incidence of total CCVEs in Q1-Q4 group was 0.5%, 0.5%, 3.2% and 3.7%, respectively. According to the LogRank test, the cumulative incidence of CCVEs among each group was statistically significant (P < 0.05). CCVEs were taken as the dependent variable, ba-PWV combined with WHR as the independent variable, and group Q1 as control. Factors such as age, gender, BMI, SBP, DBP, HR, FBG, TG, LDL-C, HDL-C UA, eGFR and smoking were adjusted. The results showed that the risk of CCVEs in group Q3 was higher than that in group Q1 and Q2, and lower than that in group Q4.

Conclusions:

Both ba-PWV and WHR are important risk factors for cardia and cerebral vascular events, and synergistic effects would be showed when ba-PWV and WHR are increased simultaneously.
HEMODYNAMIC EVALUATION OF TREATED HYPERTENSIVE PATIENTS WITH IMPEDANCE CARDIOGRAPHY: RESULTS OF IMPEDDANS STUDY
Authors: Leão Rodrigo , Janeiro Claudia , Silva Pedro
Published: April 2021

Objective:

The prevalence of arterial hypertension (AHT) in Portuguese adult population is higher than 40%. Historically defined by sustained elevation of blood pressure (BP), AHT results from hemodynamic changes characterized by cardiac output, systemic vascular resistance and/or arterial compliance abnormalities, with significant implications for diagnosis, risk stratification and treatment. Impedance cardiography (ICG) is a noninvasive method for hemodynamic profile evaluation. It allows to access risk and optimize therapy. In this study we analyzed the resistant hypertensive patients with controlled blood pressure values in order to evaluate and characterize their hemodynamic profile by ICG.

Design and method:

Resistant hypertensive patients without heart failure, ischemic heart disease, valvular heart disease or dysrhythmia were prospectively selected. After ICG were classified as: vasoconstrictor (systemic vascular resistance (SVR) > 2500dyn.s.cm-5.m2), hyperdynamic (cardiac index (CI) > 4.2l/min/m2 and/or heart rate (HR) > 80 cycles/min), hypervolemic (thoracic fluid (TFC) > 341/kOhm) or balanced (hemodynamic parameters below the established limit values). All patients underwent transthoracic echocardiography to exclude major changes. In this sub-analysis of patients from the IMPEDDANS study we included only those who, according to international recommendations, had office and outpatient blood pressure values within the therapeutic goals.

Results:

From 178 initial patients, 52 were included, 57.7% male, with 63 ± 9 years old, under 4 ± 1 antihypertensive agents. The mean hemodynamic values were: systolic blood pressure (BP) 125 ± 12, diastolic BP 75 ± 6, HR 69 ± 11, SVR 2756 ± 527, CI 2.8 ± 0.5, TFC 32 ± 4. According to the hemodynamic profile 63.7% appear to be vasoconstrictors, 13.5% hyperdynamic, 28.7% hypervolemic and 22.9% balanced.

Conclusions:

These results suggest that, despite polymedicated and with arterial pressure within the recommended values, the majority of patients were not hemodynamically stabilized, confirming that BP is an hemodynamic variable supported by several processes, tendentially redundant, in which inhibition of one element tends to favor the activation of another. ICG is, therefore, an useful method in the evaluation of hypertensive individuals, capable of contributing to adequate therapeutic optimization.
ANALYZING ESC GUIDELINES (GL) OF ARTERIAL HYPERTENSION, MYOCARDIAL REVASCULARIZATION, SYNCOPE AND PREGNANCY FOR DECISION MAKING EFFICACY: THE WINNER IS ARTERIAL HYPERTENSION GL
Authors: Koller Akos , Takács Johanna
Published: April 2021

Objective:

Guidelines (GLs) for medical practice are essential collection of knowledge, helping the daily clinical decision making in specific health conditions. Accordingly, the European Society of Cardiology (ESC) also develops and publishes GLs. We hypothesized that not every GL of ESC is equally efficient in decision making due to the lack of sufficient evidence.

Design and method:

Design: Exploratory data analysis. Methods: A total of 636 levels of evidence (LEVEL) of and classes of recommendations (CLASS) data were processed on four ESC GLs – Arterial Hypertension (AH), Myocardial Revascularization (MR), Syncope (S) and Pregnancy (P).

Results:

Results: The frequency distributions of LEVEL by CLASS showed that AH had the highest rate of Evidence A in each class of recommendations. However, the percent of Evidence A was under 50% on ‘to do’ and ‘not to do’ classes. MR showed a similar frequency distribution than AH, but the frequency of Evidence A was only 36.4% on ‘to do’ and 25.0% on ‘not to do’ classes. In S and P, the percent of Evidence B and/or C was the highest in each class of recommendations. Percent of uncertainty was between 24.3% (AH) and 75.5% (P). The deviation of LEVEL from an optimal decision making revealed that the observed percentages were significantly lower in Evidence A than the expected percentages in the studied GLs. Thus Arterial Hypertension GL provided the highest level of Certainty, whereas Pregnancy GL the highest level of Uncertainty.

Conclusions:

Conclusions: There is a great disparity of certainty among the four ESC GLs. To ensure the relevant level of Certainty, our findings recommend to reveal the ratio of certainty and uncertainty in the GLs, and to increase the level of strong evidence by conducting new basic science experimental studies and clinical investigations, such as multiple randomized clinical trials or meta-analyses.
ANTIHYPERTENSIVE EFFECTIVENESS OF SWITCHING TO SINGLE PILL COMBINATION OF PERINDOPRIL/AMLODIPINE IN PATIENTS INEFFECTIVELY TREATED BY ARB-CONTAINING FREE COMBINATIONS (AVANGARD STUDY)
Authors: Burtsev Yuriy , Logunova Natalya , Glezer Mariya
Published: April 2021

Objective:

Objectives. To evaluate the effectiveness of perindopril arginine/ amlodipine single-pill combination (SPC) in patients with grade 1–2 hypertension uncontrolled on previous therapy with ARB-containing free combinations.

Design and method:

AVANGARD was a multicenter, open-label, 3-month Russian observational study, in 658 patients with suboptimal efficacy (SBP/DBP 140–179/90–109 mm Hg) of previous antihypertensive therapy with two drugs in free combination (one of which was an ARB), who were switched to perindopril arginine/amlodipine SPC. Data were collected at four visits: V1 (inclusion visit and treatment initiation), V2 (2 weeks), V3 (1 month), V4 (3 months).

Results:

The SBP/DBP values gradually and significantly decreased with Perindopril/amlodipine SPC from 159.9 ± 8.5/ 92.1 ± 7.4 mmHg to 141.3 ± 11.0/83.7 ± 7.5 mmHg after 2 weeks, 131.7 ± 9.2/79.5 ± 6.0 mmHg after 1 month and finally 125.8 ± 7.1 /77.4 ± 5.5 mm Hg; all p < 0.001). The controlled BP was achieved in 36.2%, 73.4 and 93.5% of patients at V2, V3 and V4, respectively.

The mean HR followed the same patern (V1: 73.9 ± 7.3 beats per minute (bpm); V4: 68.9 ± 5.0 bpm; p < 0.001). Daytime 24-hour BP variability decreased from V2 to V4, from 4.4 ± 2.9/3.0 ± 2.0 to 3.0 ± 2.2/2.2 ± 1.7 mm Hg (p < 0.001). Treatment acceptability was very high considering couple related adverse events (0,21%) in accordance with the well-known side effects of the drugs (oedema and cough)

Conclusions:

This study showed the antihypertensive effectiveness of perindopril/amlodipine SPC in hypertensive patients previously uncontrolled on two-drug free combinations containing an ARB.