bluuebunny/crossref_metadata_2025_split huggingface dataset:
PRESCRIBED ANTIHYPERTENSIVE AGENTS IN PATIENTS WITH AND WITHOUT ITS “ESCAPE’’ PHENOMENON
Authors: Mikhailova Oksana , Elfimova Evgenia , Khachatryan Narine , Litvin Alexander , Chazova Irina 
Published: June 2022

Objective:
To identify the percentage of antihypertensive therapy (AHT) groups prescription in patients with and without delayed inefficiency of AHT (“escape’’phenomenon).

Design and method:
The study included 102 hypertensive patients (52 male, age 54.2 ± 9.8 years), whom were assigned 2–3 agents from various AHT group.In 2–3 weeks after therapy initiation (with the single correction if needed), all participants achieved the target blood pressure (BP). The latter was confirmed by office BP measurement (office BP) (<140/90mmHg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory BP monitoring (ABPM) (mean 24-hour BP < 130/80mmHg, oscillometric method, BPLab, Russia). In 1 and 3 months after inclusion, the efficacy of AHT was reassessed by both measurement methods. The “escape’’ phenomenon was verified when BP became higher target by any method in any reassessment time. Adherence was calculated as the ratio of the number of correct medication intake days to the number of follow-up days multiplied by 100%.

Results:
34 patients (33.3%) demonstrated the ‘escape’ phenomenon (Group 1), while BP level in 68 (66.7%) patients remained target (Group 2). There weren’t differences in the cardiovascular (CV) risk factors between groups (Table 1). Both groups received primarily fixed combinations of AHT, which resulted in 1.9 ± 0.7 tablets intake per day. There was comparably high adherence to treatment in groups (89.2 ± 3.8% in group 1, 90.2 ± 5.0% in group 2,p = 0.28). When comparing the percentage of different AHT groups, there was no difference revealed between groups, with the exception of more frequent ARA-II prescription in Group 1 (Table 2). Nevertheless, although in both groups the target BP levels were achieved, the BP in the Group 1 was higher already at the stage of inclusion (Table 2). Moreover, baseline systolic BP was found to be an ‘escape’ phenomenon predictor in univariate logistic regression model (for office BP: systolic BP> 128mmHg (OR 3.43 (95%CI 1.39–8.47,p < 0.00), for ABPM: 24-systolic BP> 124mmHg (OR 25.81 (95%CI 5.61–119.11,p < 0.00).
Further studies on ‘escape’ phenomenon issue in patients with ARA-II intake are required. A higher frequency of ARA-II usage in the ‘escape’ group is likely due to overestimation of the continuing BP decline in 2–3 weeks after ARA-II prescription.
TELMISARTAN/AMLODIPINE SINGLE-PILL COMBINATION THERAPY TO ACHIEVE BLOOD PRESSURE GOAL VALUES IN HYPERTENSIVE PATIENTS IN GPS’ PRACTICE – AN OBSERVATIONAL STUDY
Authors: Járai Zoltán , Ámon Tamás , Baracsi-Botos Viktória , Mészáros Ágota 
Published: June 2022

Objective:
Current ESC/ESH Guidelines suggests a simple therapeutic strategy to increase treatment effectiveness: the application of single pill combination (SPC) of a RAS inhibitor with a calcium channel antagonist or a diuretic as a first step. Our primary goal was to assess the percentage of patients reaching optimal BP goal (130/80 mmHg) after 12 weeks of SPC therapy with telmisartan/amlodipine according to office BP measurements in hypertensive patients treated by general practitioners (GPs) in regular clinical practice. We also examined the percentage of patients achieving primary target BP (<140/90 mmHg).

Design and method:
After given informed consent, 729 patients with primary hypertension from 120 GP’s offices participated in this multicentre, observational, non-interventional, prospective study.

Results:
The average age of the patients was 62 ± 12 years, 357 patients (49.8%) of the population was male. The average office BP at baseline was 150 ± 17/88 ± 10 mmHg, and decreased to 130 ± 8.1/78 ± 6.1 mmHg at 12 week (p < 0.05). Pulse rate has decreased as well (from 80 ± 9.8/min to 75 ± 6.3/min). At baseline, 10.1 % of the patients were at optimal systolic BP goal (<130 mmHg), 15.8% at optimal diastolic BP goal (<80 mmHg) and only 5.5% simultaneously at systolic and diastolic BP goal (<130/80 mmHg). By the end of the observational period the percentage of patients reaching these optimal BP goal values increased to 51.6%, 54.1% and 33.0%, respectively. At baseline 19.2% of patients had BP less than 140/90 mmHg, which increased to 87.1% by the end of the study. Dose adjustments during the study were made in only 3 % of patients (n = 22). Patients tolerated SPC telmisartan/amlodipine well, 95% of the patients continued medication after study conclusion.

Conclusions:
The introduction of a SPC therapy of telmisartan/amlodipine increases the success rate of treatment during a relative short period. High proportion of patients were able to lower within 3 months their BP levels under 140/90 mmHg, however, only one third of the patients reached optimal target BP. Main possible reasons for this was the low rate of dose adjustment during the study.
The study was sponsored by KRKA Hungary Ltd.
CLINICAL EFFICACY AND SAFETY OF AMLODIPINE/BISOPROLOL/PERINDOPRIL SINGLE-PILL AND FREE COMBINATION THERAPY IN PATIENTS WITH UNCONTROLLED ESSENTIAL HYPERTENSION
Authors: Konradi Alexandra , Hassan Hasnaa , Lefay Didier , Isachenko Elena , Jamois Aude 
Published: June 2022

Objective:
Efficacy and safety of the triple therapy amlodipine 5 mg, bisoprolol 5 mg and perindopril 5 mg in single pill combination (SPC) and in free combination, over a 12-week period.

Design and method:
Multicenter, randomized, open-label, controlled, phase III study. Patients with uncontrolled hypertension (Systolic Blood Pressure (SBP) > = 140 and < 160mmHg and Diastolic Blood Pressure (DBP) > = 90 and < 100 mmHg) treated either by monotherapy at maximal dose or bitherapy at initial dose were randomized to the SPC (group A), or to the free combination (group B). Previous antihypertensive treatment was discontinued. Efficacy assessments: SBP, DBP, response to treatment (rate of patients with BP normalized and/or decrease of SBP > = 20 mmHg and/or decrease of DBP > = 10 mmHg from baseline) and BP control rate (SBP < 140 mmHg and DBP < 90 mmHg). Patient-reported outcomes were evaluated using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) to assess treatment effectiveness, convenience and global satisfaction at the end of the study.

Results:
150 patients were randomized (mean age 55.2 ± 10.1 years). At baseline, mean SBP/DBP in the included population were 149.71 ± 5.09/94.92 ± 2.78 mmHg. After 12 weeks of treatment, important SBP/DBP decrease was observed in both groups (-22.01 ± 10.04/-13.79 ± 7.47 mmHg in group A and -21.81 ± 9.41/-15.06 ± 8.31 mmHg in group B). High response to treatment was observed in both groups (90.91% in group A, 93.06% in group B) but higher proportion of patients were controlled with SPC (91.89% in group A, 87.5% in group B). Treatments were well tolerated. Less treatment-related adverse events were reported in group A (1.3%) versus in group B (6.9%). Most of the patients were satisfied with treatment in both groups, with a better convenience for the group A.

Conclusions:
In case of uncontrolled BP despite monotherapy at maximal dose or bitherapy at initial dose, switching to triple therapy of amlodipine 5mg+bisoprolol 5mg+perindopril 5 mg leads to a significant decrease of BP (p < 0.001), an improvement of response to treatment and better BP control rate. For similar efficacy, treatment by SPC showed lower rate of treatment-related adverse events and was assessed as more convenient by patients as compared to free combination.
PHARMACOLOGICAL TREATMENT OF ARTERIAL HYPERTENSION GUIDED BY PERIPHERAL OR CENTRAL BLOOD PRESSURE: COMPARISON OF THE TWO STRATEGIES IN THE INCIDENCE OF INTERMEDIATE OUTCOMES
Authors: Filho Gilberto Guimaraes , Inuzuka Sayuri , Vitorino Priscila , Sousa Ana Luiza Lima , Coca Antonio , Barroso Weimar Sebba 
Published: June 2022

Objective:
To compare the parameters of central and peripheral blood pressure measurements, arterial stiffness, target organ damage (TOD), biochemical and renal profiles among participants who had the therapeutic strategy guided by central (CG) and peripheral (PG) blood pressure values.

Design and method:
Randomized study in two groups: CG and PG. Five visits were carried out, the first (V1) being selection and randomization followed by intermediate visits, every 3 months, to assess blood pressure and adjust antihypertensive drugs. The procedures performed in the initial and final visit (V5) were: measurement of central arterial pressure and pulse wave velocity (PWV) (mobil-o-graph) and peripheral (OMRON HEM1100), carotid ultrasound, echodopplercardiogram and laboratory tests. Paired and unpaired t and chi-square tests were used. Adopted significance level of 5% and a confidence interval of 95%.

Results:
A total of 59 participants were evaluated (30 from the CG and 29 from the PG). Age, BMI, central and peripheral blood pressure measurements, PWV, left ventricular mass index (LVMI), carotid intimal mean thickness, biochemical profile and glomerular filtration rate did not differ between the two groups (p > 0.05) in randomization. The augmentation index (AIx) was higher in the CG than in the PG at randomization (27.3% ± 12.2% vs 20.3% ± 13.3% p 0.041). After 1 year of follow-up, in the analysis between the groups, the central diastolic pressure was lower in the CG (78.9mmHg ± 9.7mmHg vs 84.3 ± 10.4mmHg, p 0.024) and the difference in AIx between the groups ceased to exist. When intra-group comparisons were made before and after the intervention, a reduction in the PWV (p < 0.001) and LVMI (p = 0.018) was observed in the CG. In PG there was an increase in PWV (p < 0.001) and LVMI (p = 0.003).

Conclusions:
The intervention guided by central pressure, after 1 year of follow-up, was able to reduce the central diastolic pressure and correct the AIx parameter and, in the intra-group analysis, it promoted a reduction in PWV and LVMI. There was no difference between the two groups regarding the improvement of outcomes related to central and peripheral blood pressure, cardiac and vascular TOD, biochemical and renal profile.
ANTIHYPERTENSIVE TREATMENT IN MASKED HYPERTENSION FOR TARGET ORGAN PROTECTION (ANTI-MASK): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Huang Jian-Feng , Zhang Dong-Yan , An De-Wei , Li Ming-Xuan , Chen Xin , Feng Ying-Qing , Zheng Qi-Dong , Li Yan , Wang Ji-Guang 
Published: June 2022

Objective:
Masked hypertension is associated with target organ damage and adverse outcomes. However, up to now there is no interventional evidence that antihypertensive therapy will be beneficial to the patients.

Design and method:
The ANTIhypertensive treatment in MASKed hypertension for target organ protection (ANTI-MASK) trial is a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT02893358). Eligible patients were 30 to 70 years old, had untreated masked hypertension and at least one sign of target organ damage (TOD). Masked hypertension was defined as a normal office blood pressure (BP, < 140/90 mmHg) and an elevated 24-hour (> = 130/80 mmHg), daytime (> = 135/85 mmHg) or nighttime BP (> = 120/70 mmHg) at both screening visits. TOD included electrocardiogram diagnosed left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (ba-PWV) > = 1400 cm/s, or a random urinary albumin-to-creatinine ratio (ACR) > = 2.5 mg/mmol in men and > = 3.5 mg/mmol in women. Randomized patients were treated with alisartan 80 mg per day or placebo. If ambulatory BP was uncontrolled, drug dosage was doubled at the 2-month visit, and amlodipine 2.5 mg or matching placebo was added at the 4-month visit. The primary endpoint was the improvement rate of TOD after 12 months treatment, defined as the reverse (yes to no) of TOD or a significant decrease of ba-PWV or ACR by > = 20% of the baseline level.

Results:
From Feb 2017 to Oct 2020, 317 patients with masked hypertension (43.2% women, mean age 54 years) were randomized in 13 hospitals in China. Overall, baseline office, 24-h, daytime and nighttime BPs averaged 130/81, 137/85, 141/87, and 126/77 mmHg, respectively. At baseline, 98% had an elevated ba-PWV, 12% microalbuminuria, and 8% LVH. 252 patients completed the 12-month treatment and 65 (20.5%) withdrew from the trial. In the intention-to-treat analyses, the improvement rate of TOD was significantly higher in the antihypertensive treatment group than the placebo group (47.4% vs 26.1%, P < 0.0001), as well as the decrease of the 24-h systolic/diastolic BPs (-9.1/-5.7 vs -1.5/-1.0 mmHg, P < 0.0001).

Conclusions:
Antihypertensive treatment was beneficial for patients with masked hypertension in terms of TOD protection.
MULTIPLE DRUG INTOLERANCE IN PATIENTS WITH ARTERIAL HYPERTENSION: PREVALENCE AND DETERMINING FACTORS
Authors: Polaczyk Magdalena , Olszanecka Agnieszka , Wojciechowska Wiktoria , Rajzer Marek , Stolarz-Skrzypek Katarzyna 
Published: June 2022

Objective:
One of the reasons for patients’ poor medication compliance is the occurrence of drug-induced adverse events. The aim of this study was to determine the prevalence of Multiple Drug Intolerance Syndrome (MDIS), defined as adverse events after 3 or more drug classes, in a group of patients with arterial hypertension and to assess the predisposing factors.

Design and method:
The study population comprised hospitalized patients diagnosed with arterial hypertension as well as patients undergoing chronic treatment in an outpatient hypertension clinic. A structured proprietary questionnaire was used, which focused on demographic and clinical data, including current or past incidences of adverse drug reactions.

Results:
The study population comprised a total of 1000 patients, including 560 women. The mean age was 62.84 ± 14.96 years. Eighty patients (8%) suffered from MDIS. A significantly higher percentage of patients with MDIS were women (71% vs. 55%, p = 0.006) and patients with longer-lasting hypertension (median 15 vs. 10 years, p = 0.008). Moreover, among patients with MDIS, the following disorders were more frequent: respiratory (21% vs. 11%, p = 0.013), gastrointestinal (25% vs. 13%, p = 0.003), rheumatic (24% vs. 9%, p < 0.001) and endocrine (29% vs. 16%, p = 0.007). The risk of MDIS was highest in the case of concomitant use of analgesics, OR = 65.59, p < 0.001, followed by beta-blockers, OR = 48.42, p < 0.001, antiplatelet drugs, OR = 47.26, p < 0.001 and antibiotics OR = 30.04, p < 0.001.

Conclusions:
MDIS in patients with hypertension is common and affects more frequently women and patients with a longer disease duration. Comorbidities increase risk of MDIS. The risk of MDIS is most strongly associated with the use of analgesics, beta-blockers, antiplatelet drugs and antibiotics.
RESISTANT HYPERTENSION IMPROVED AFTER 3 AND 6 MONTHS BY MEASURING DRUG LEVELS TO IDENTIFY NON-ADHERENCE
Authors: Peeters Laura , Kappers M.H.W. , Hesselink D.A. , Net J.B. Van Der , Hartong S.C.C. , Bahmany S. , Massay E. , Dijk L. Van , Gelder T. Van , Koch B.C.P. , Versmissen J. ,   Rhyme-Rct Research Group
Published: June 2022

Objective:
Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this measuring drug levels is the most reliable method.
The primary objective of this analysis is to determine whether drug levels measured with a dried blood spot (DBS) sampling method combined with personalized feedback leads to a decrease in prevalence of RH after 3 and 6 months due to an increase in adherence.

Design and method:
This is a multi-center single-blinded randomized controlled trial (RHYME-RCT, NL6736). Patients went to an eligibility visit, where DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) was performed simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg were randomized to standard treatment (control) or intervention. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 months after the eligibility visit. At each visit an ABPM and DBS were performed.

Results:
A total of 78 patients (mean age of 59 ± 11 years, 75.6% male) with at least six months of follow-up were included. The prevalence of RH decreased from 100% in both arms to 60.0% in the intervention arm (p < 0.001, n = 35) and 58.1% in the control arm (p < 0.001, n = 43) after 6 months of follow-up. Adherence rates also improved over time, but only significantly improved in the intervention group after 3 months (p = 0.020). Furthermore, no statistically significant differences were found after six months between the two groups in the degree of RH (p = 0.868), SBP (p = 0.759) or adherence (p = 0.841).

Conclusions:
Measuring blood pressure and drug levels led to a decrease in the prevalence of RH. However, this improvement could not be linked to the actual intervention or improvement of adherence.
Note: In June 2022 data from the 12 months follow-up will also be complete and presented.
BELIEFS IN HEALTH AND ADHERENCE TO TREATMENT IN HYPERTENSIVE PATIENTS IN BARRANQUILLA- COLOMBIA
Authors: Montealegre Leslie , Navarro Gema , Amador Eulalia , Arteta Martha , De Oro Carlos 
Published: June 2022

Objective:
The objective was to establish health beliefs and adherence to treatment in patients with hypertension in a health service in the District of Barranquilla, Colombia

Design and method:
Bonilla Ibáñez’s questionnaire version 3 with a Cronbach alpha of 0.851 was used to determine the adherence index and health beliefs of a sample of 400 patients from the cardiovascular risk program subprogram Hypertension attended in a health service of the subsidized regime of Barranquilla/Colombia

Results:
The mean age of the participants was 63.52(SD:12.70), 76% female, average evolution time of hypertension was 9.6 years (SD: 8.29). El 54.75% was found in adherence advantage (VADH),32.5% in risk of non-adherence (RNoADH) and 12.75% in nor adherence (NoADH). VaDH and RNoADH patients considered that their treatment did not create dependence and should be taken in 94% and 86.9% respectively, in contrast to 56.9% of NonADH who do not consider it, P(<0.001). To the belief of whether the treatment is beneficial and that is why it continues, the VADH and RNoADH always consider it in 97.7% and 87.7%, compared to 88.2% who sometimes consider it from the NoADHgroup, P(<0.001). When informed by the family’s beliefs about treatment and changes in customs if they were contrary to their faith and values, the VADH and RNoADH never consider it 97.3% and 87.7%, compared to 60.8% who sometimes consider it from the NoADHgroup, P(<0.001). Beliefabout hard-to-change habits about food and exercise is sometimes considered by patients VADH (61.6%), in RNoADH (56.2%) and in NoADH (56.9%), P(<0.001). VADH patients (95.9%), in RNoADH (78.5%) and NoADH (76.5%) believe it is convenient for their health to control weight, through diet and exercise, P(<0.001). VADHpatients (97.7%), NonADH (94.6%) and NoADH (54.9%) believe it is important to continue their treatment to improve their health, P(<0.001)

Conclusions:
Health beliefs may influence the rate of adherence to pharmacological and non-pharmacological treatment of patients with hypertension. The understanding and management of these variables by health personnel can help strengthen follow-up programs, addressing early the doubts and concerns that treatments may generate.
ESTIMATE OF ANTI-HYPERTENSIVE DRUG ADHERENCE THROUGH SERIAL MEASUREMENTS OF ALDOSTERONE-TO-RENIN RATIO
Authors: Buffolo Fabrizio , Sconfienza Elisa , Burrello Jacopo , Losano Isabel , Mengozzi Giulio , Priolo Gabriella , Avataneo Valeria , D’Avolio Antonio , Veglio Franco , Rabbia Franco , Mulatero Paolo , Monticone Silvia 
Published: June 2022

Objective:
Inadequate adherence to anti-hypertensive prescription is one of the major obstacles for blood pressure control in patients with arterial hypertension. It is estimated that 40% of patients with hypertension have partial or absent compliance, with more than 80% of non-adherence when blood pressure targets are not achieved. However, in clinical practice the assessment of therapeutic adherence is still challenging. The available methods for the assessment of anti-hypertensive compliance are costly, low accurate or time consuming.

Design and method:
We designed a prospective observational study to evaluate the therapeutic adherence to inhibitors of renin-angiotensin-aldosterone system (RAAS) in patients with hypertension through serial measurement of aldosterone-to-direct renin ratio (ARR), before and after treatment.
We enrolled 80 patients, including 40 patients with arterial hypertension and 40 healthy controls. Patients with arterial hypertension underwent three visits: at baseline and 2 and 8 weeks after initiation of RAAS inhibitors. Patients of the control group underwent two visits: at baseline and after 2 weeks. At each visit we collected blood specimens for hormonal assays and therapeutic drug monitoring, used as gold standard for therapeutic adherence. We used delta ARR (ARR), defined as the relative change in ARR before and after treatment, for assessment of therapeutic compliance.

Results:
After initiation of RAAS inhibitor, aldosterone significantly decreased and renin levels significantly increased, with consequent ARR reduction. The use ARR provided high accuracy for determination of therapeutic compliance, with an area under the curve (AUC) of 0.900 and 0.886, at 2 and 8 weeks respectively. A cut-off of -48% of ARR was adopted, providing 90% sensitivity and 75% specificity, both at 2 and 8 weeks.

Conclusions:
The ARR measurement, is an innovative, cheap and highly sensitive method to predict compliance to RAAS inhibitors in patients with hypertension. We hence propose the implementation of ARR as screening test for identification of patients suspected to be non-adherent, reserving therapeutic drug monitoring for non-adherence confirmation.