bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
ACCESS TO AFFORDABLE ANTI-HYPERTENSIVE MEDICINES AND ITS ASSOCIATION WITH ADHERENCE AND BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS AT A TEACHING HOSPITAL IN GHANA
Authors: Harrison Mark Amankwa , Marfo Afia Frimpomaa A. , Buabeng Kwame Ohene , Nelson Frempomaa , Acheampong Franklin , Ankrah Daniel Nii Amoo 
Published: April 2021

Objective:
To determine multiple anti-hypertensive medicines affordability and accessibility and their association with adherence and blood pressure control among hypertensive patients attending the Korle Bu Teaching Hospital.

Design and method:
It was a cross-sectional study of hypertensive patients attending the Korle Bu Teaching Hospital Polyclinic in Ghana. Systematic sampling was used to administer a questionnaire to 310 patients treated for hypertension. Data on ten generic anti-hypertensive medicine prices at the hospital and two private pharmacies were collected to determine out-of-pocket affordability. Availability of the medicines at the hospital and percentage available at patients’ home or acquired by them was collected to determine accessibility. Adherence was measured using a validated 8-item scale.

Results:
Questionnaires retrieved were 304. Some health insurance patients (19.4%) made out-of-pocket payments. One hundred and twenty three (40.5%) and 77 patients (25.3%) could not afford 4 anti-hypertensive medicines at the private pharmacy and the hospital respectively. Availability at the hospital was 60%. Continuous access at the hospital was 14.8%. Overall access (medicine acquisition or percentage available at patients’ home) was 74.9% (SD ± 41.3). Only 18.1% were highly medication adherent. Blood pressure control was 41.8%. Out-of-pocket affordability was not significantly associated with adherence (regression beta coefficient = 0.005; p-value = 0.281) but it was positively associated with blood pressure control with statistical significance (R = 0.12, p = 0.037). Obtaining medicines with health insurance only was more likely to result in blood pressure control than with health insurance plus out-of-pocket payments (OR = 2.185; 95% CI, 1.215 – 3.927). Access was positively associated with adherence, and this was statistically significant (R = 0.17; p = 0.03). Access at the hospital was more likely to result in blood pressure control (OR = 1.642; 95% C.I, 0.843 – 3.201). Patients who had controlled blood pressure had a higher adherence score than those who had uncontrolled blood pressure [6.048 (1.701) versus 5.847 (1.744); p = 0.319].

Conclusions:
Accessibility was lower than the WHO target. A significant proportion of patients didn’t have out-of-pocket affordability. Obtaining drugs free was more likely to result in blood pressure control. Access to affordable anti-hypertensive medicines is associated with adherence and blood pressure control.
HIGH PREVALENCE OF HIGH BLOOD PRESSURE AND EXCESSIVE BLOOD PRESSURE REDUCTION IN PATIENTS WITH “CONTROLLED” ARTERIAL HYPERTENSION AFTER MYOCARDIAL INFARCTION AND STROKE
Authors: Pavelko Mykhailo , Oshtuk Yaroslav , Yagensky Andriy 
Published: April 2021

Objective:
Arterial hypertension (AH) is important risk factor and its control is a cornerstone of primary and secondary prevention. On the other hand, excessive blood pressure (BP) reduction may be harmful, especially in patients with the history of ischemic events. To assess AH control we performed 24-hours ambulatory blood pressure monitoring (ABPM) in patients with AH in remote period after myocardial infarction (MI) or ischemic stroke (IS) in whom AH was believed to be controlled accordingly BP office measurements.

Design and method:
64 patients with AH and previous (at least 6 months after) MI (39 patients, 64.1% men) and IS (25 patients, 36.0% men) with normal office BP (120–139 mm Hg/60–89 mm Hg) during two consecutive visits were involved into the study. ABPM was performed and mean values of systolic BP (SBP) and diastolic BP (DBP) were assessed. Excessive BP reduction (EBPR) was considered as SBP below 100 mm Hg at daytime. Prolonged EBPR was considered as EBPR more than 1 hour of consecutive measurements.

Results:
Groups did not differ significantly in age, body mass index, glomerular filtration rate, number of antihypertensive drugs, prevalence of diabetes. Mean 24-hour SBP was higher in IS group (131.9/76.4 ± 11.7/7.3 mm Hg) comparing to 118.5/71.3 ± 11.0/9.0 mm Hg in MI group (p < 0,00001 for both SBP and DBP). Mean 24-hour SBP higher than 140/90 mm Hg was found in 28.0% patients in IS and only in 2.6% patients in MI group (p = 0.002). Much more episodes of EBPR were detected in MI than in IS group (10.2 ± 10.8 vs 4.0 ± 3.9, p = 0.008) and number of patients with at least one prolonged EBPR was also higher in MI group (23.1% vs 8.0%). Patients with prolonged EBPR did not differ significantly in age, body mass index, glomerular filtration rate, prevalence of diabetes and number of antihypertensive drugs.

Conclusions:
Around a quarter of patients in remote period after IS had high BP levels whereas similar proportion of patients after MI had prolonged episodes of excessive hypotension during ABPM. Office BP measurements may be not sufficient to detect inadequacy of AH control in secondary prevention.
A PERSPECTIVE OF PRIVATE HEALTH CARE PROVIDERS IN THE STATE OF MADHYA PRADESH ON ADOPTING KEY STRATEGIES OF INDIA HYPERTENSION CONTROL INITIATIVE
Authors: Krishna Ashish , Pathni Anupam Khungar , Sharma Bhawna , Shivashankar Roopa , Shrivastava Suyesh , Hering Dagmara 
Published: April 2021

Objective:
The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities of three districts of Madhya Pradesh (MP). In India, more than 70% of outpatient visits take place in the private health sector. To achieve the Government of India's goal of a 25% relative reduction in the prevalence of raised blood pressure (BP) by 2025, it is critical to expand the implementation of quality hypertension treatment. This study aimed to assess the perspective of private practitioners (PPs) on adopting the core strategies of the IHCI in Bhopal district of MP

Design and method:
A semi-structured detailed interview was purposely applied to 30 PPs who were familiar with IHCI to obtain their opinions on standardised hypertension treatment protocols, patient-centred services and easy-to-use information system in their private practice. Verbatim data were recorded and analysed thematically using the Microsoft 2010.

Results:
Only 11 PPs followed the State approved hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs (13 PPs), (2) preferences for single fixed combinations drug (10 PPs) and (3) fear of losing patients due to a lack of immediate BP control or drug-related adverse effects (7 PPs). None of the interviewed doctors had resources to provide patient-centred care and use the information system. Overall, the interviewed doctors identified that free supply of standard treatment protocols (12 PPs), inclusion of single-pill combinations in treatment protocol (10 PPs), increasing number of staff for follow-up visits and patient education (19 PPs), IT-based solutions for patient records (17 PPs), employee incentives (5 PPs) and preparation of national data sharing policies (5 PPs) are the key actions to accelerate the adoption of IHCI strategies in the private sector.

Conclusions:
This exploratory study suggests that engagement of the private sector in IHCI is feasible. Future studies should focus on ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user-friendly digital platform for patient monitoring.
FIXED COMBINATIONS IN ACHIEVEMENT TARGET LEVEL OF BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Rekovets Oksana , Sirenko Yuriy , Torbas Olena , Kushnir Svitlana , Primak Galina , Sirenko Olexandr , Krushynska Nina , Ponomareva Galina 
Published: April 2021

Objective:
Aim. Evaluate the therapeutic efficacy of fixed triple combination of valsartan / amlodipine / hydrochlorothiazide compared a double fixed combination of valsartan / amlodipine in patients with arterial hypertension.

Design and method:
The study included 50 patients with moderate and severe arterial hypertension. Patients were divided into 2 groups. The first group (n = 25) received fixed triple combination of 160 mg valsartan / 5 mg amlodipine / 12.5 mg hydrochlorothiazide once daily, in the morning for 1 month. Patients in the second group (n = 25) received a double fixed combination of 160 mg valsartan / 5 mg amlodipine once a day, in the morning for 1 month. If necessary, dose was titrated to 320/10 / 12.5 mg (valsartan / amlodipine / hydrochlorothiazide) or 320/10 mg (valsartan / amlodipine). After 3 months of treatment was control of therapy.

Results:
The average age of patients 54.9 ± 1.8 (25–75) years, BMI 31.2 ± 0.7 kg / m2. Office SBP/DBP at the beginning 161.7 ± 1.8/98.5 ± 1.4 mmHg, HR 70.7 ± 1.4 beats / min. 24 SBP/DBP 143.8 ± 1.1/92.4 ± 1.2 mm Hg. 24HR 71.5 ± 1.5 beats / min. The decrease 24SBP/DBP was 18.0 / 16.1 mm Hg (p < 0,05) on (val/aml) and 23,8 / 20,7 mm Hg (p < 0,05) on (val/aml/HTZ). The decrease day time SBP/DBP - 19.4 / 17.8 mm Hg (p < 0,05) on (val/aml) and 17,8 / 22,6 mm Hg (p < 0,05) on (val/aml/HTZ). Decrease mean nocturnal SBP/DBP 17.0 / 12.1 mm Hg (p < 0,05) on (val/aml) and 20,5 / 18,2 mm Hg (p < 0,05) on (val/aml/HTZ) combination. Achievement of target BP at ABPM was 77.3% - in the double (val/aml) combination and 95.2% in the triple (val/aml/HTZ) combination.

Conclusions:
The triple fixed combination (val/aml/HTZ) was more effective in reducing blood pressure with daily monitoring compared to a double fixed (val/aml) combination which was not increase in side effects.
CARDIOVASCULAR RISK FACTORS IN HYPERTENSION PATIENTS: VIEW IN 15–20 YEARS
Authors: Zelenenka Liliia 
Published: April 2021

Objective:
Introduction. According to the latest clinical research great attention to provide a study of the clinical conditions that contribute to increase the risk for cardiovascular complications. The combinations essential hypertension (EH) and mellitus diabetes (MD) causes the development of fatal and nonfatal cardiovascular events.
Purpose. The aim of the study was to identify possible factors of MD in patients with EH the I-II stage with normoglycemia in a 15–20 year follow up.

Design and method:
Methods. We examined 54 patients with EH I-II st. Reexamined were conduct in the same conditions in 15–20 years. All patient divided in two groups: 1-st gr. (n = 39) – pts with only EH, 2-nd gr. (n = 15) – pts with comorbidy status (EH and diabetes). The frequency of development MD in our research consisted 27,8%.

Results:
Results. At the basing examine groups were same by age, gender, hemodynamics parameters and the structural data of the EhoCG. But initial body mass index (BMI) (kg/m2) were more higher (p < 0,013) in pts of 2-nd gr. (30,41 ± 0,44) than in pts of 1-st gr. (27,94 ± 0,44) and glycemia - (p < 0,002) in pts of 2-nd gr. - 5,93 ± 0,35 mmol/l and 4,61 ± 0,15 mmol/l in pts of 1-st gr.
The results of re-examination (in 15–20 years) demonstrated reliable increase indicators between the 1-st and the 2-nd groups of BMI (0,21 ± 0,06 and 0,47 ± 0,11, p < 0,05), hemodynamics parameters: systolic blood pressure (BP) (−0,97 ± 4,06 and 33,46 ± 5,43, p < 0,0001), diastolic BP (−6,23 ± 2,67 and 6,77 ± 3,00, p < 0,027), and pulse BP (5,26 ± 2,33 and 26,69 ± 4,87, p < 0,0001).

Conclusions:
Conclusion. The results of this study showed that the following risk factors: the presence of initial obesity (BMI = 30,41 ± 0.44 kg/m2) with increasing normal blood glucose (5,93 ± 0.35 mmol/l), uncontrolled arterial (systolic, diastolic and pulse) hypertension associated with the risk of development of diabetes mellitus in patients with EH during a long period of time (in 15–20 years).