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The global burden of hypertension exceeds 1.4 billion people: should a systolic blood pressure target below 130 become the universal standard?

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Abstract

&NA; In 2010, 1.4 billion people globally had hypertension, with 14% controlled to systolic blood pressure (SBP, mmHg) below 140, which contributes to 18 million cardiovascular deaths annually. Recent hypertension guidelines endorsed SBP targets below 130 or lower for all or some hypertensive patients to reduce cardiovascular events (CVEs) more than the prior SBP target less than 140. In 2016, the Australian Guideline strongly recommended target SBP below 120 for adults at very high risk for CVE or aged above 75 years. In 2017 and 2018, the Canadian Guideline recommended automated office SBP (AOSBP) below 120 in adults at high risk and aged above 75 years (grade B). In 2017, the US Guideline recommended SBP below 130 for all adults (moderate-to-high risk class I; lower-risk grade IIb). In 2018, the European Guideline recommended SBP below 140 for all adults, and, if tolerated, a SBP range of 120–129 for adults aged below 65 years and 130–139 for adults aged at least 65 years (class I). The guidelines were variably influenced by Systolic blood PRessure INTervention trial and meta-analyses indicating fewer CVE when mean in-trial SBP was below 130 versus above 130. Clinicians considering lower SBP targets should be aware that: AOSBP preceded by 5-min rest is approximately 10–15 mmHg lower than usual office SBP; hypertensive patients with office SBP consistently versus intermittently below 140 have fewer CVE; benefits of mean office SBP or AOSBP below 120 remain unproven and could increase adverse events. Clinicians worldwide will do well to control SBP to below 140 in most hypertensive patients on most visits, which should lead to mean in-clinic SBP of 120–129.

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... In 2010, HTN was affecting about 1.4 billion patients. 1,2 Taking in consideration the global human ...
... growth and increasing life expectancy, the prevalence is expected to rise. 1 It is estimated to affect about 5 billion patients within the end of this century. 3 Considering 2017 American HTN guidelines that lowered the blood pressure (BP) cutoff for diagnosis, the global burden of HTN will further increase. ...
... 3 Considering 2017 American HTN guidelines that lowered the blood pressure (BP) cutoff for diagnosis, the global burden of HTN will further increase. 1,4,5 More people will be labeled to be hypertensive and thus more medications would be required. Diagnosing and treating the disease could reduce and limit the complications, but it failed to limit its growth. ...
Article
Because of its high prevalence, hypertension (HTN) will continue to exert an increased financial burden on both the individual and the governmental health budgets unless we consider changing our efforts in managing HTN.[1] Since the discovery of the first antihypertensive agent, during the 19th century, we had been focusing on blood pressure (BP) treatment by lowering the systolic and diastolic levels. Over decades, multiple drugs and combinations were introduced to lower the BP and reduce target organ damage, but they were unsuccessful in reducing the incidence or significantly limiting the prevalence. This study focuses on screening teenagers among middle and high schools. Looking for the prevalence and increasing awareness at the same time. It is about time to consider a different approach to stand against HTN. A world without HTN could be optimistic. However, looking into reducing the incidence and limiting the prevalence by early intervening and increasing awareness could be a reasonable first step in that direction. In this study, we screened 2747 students in 14 middle and high schools in Bahrain. The mean systolic BP was 114 mm Hg [standard deviation (SD): 13.9/standard error (SE): 0.27]. The mean diastolic BP was 67 mm Hg (SD 9.6/SE 0.18). Of the screened students, 38% had abnormal elevated BP. Among elevated BP, 68% had isolated systolic high pressure. Younger teenagers were having the higher BP. Age, gender, waist circumference, school, and nationality were among the independent variables associated with elevated BP. Body mass index was not related to elevated BP. Focusing more on prevention and early diagnosis could be a first step toward elimination of HTN, or at least reducing its prevalence.
... High blood pressure (BP) or hypertension is a leading risk factor for cardiovascular (CV) morbidity and mortality [1,2]. It is estimated that over 10 million deaths occur every year due to high BP [1]. ...
... High blood pressure (BP) or hypertension is a leading risk factor for cardiovascular (CV) morbidity and mortality [1,2]. It is estimated that over 10 million deaths occur every year due to high BP [1]. Maintaining an optimal BP (120/80 mmHg) can help reduce the risk of CV, cerebrovascular, and renal complications significantly [3][4][5][6][7][8][9][10][11]. ...
... When we applied the ACC/AHA criteria (<130/80 mmHg) to our population, there was a substantially lower proportion of patients (39.5%) who achieved a consistent BP target compared with the rates reported in the USA (46.6%) [35], Canada (41.1%) [36], and Spain (25.1%) [37]. However, when using the BP targets of the ESC/ESH, NICE, and ISH criteria, the achievement of BP goals was similar or lower than that in Italy (66.5%) [38] and the UK (63%) [39] but higher than the 2010 level of global BP control (13.8%) [1]. ...
Article
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(1) Background: The present study aimed to assess the changes in blood pressure (BP) within the first 6 months of treatment initiation in a newly treated hypertensive cohort and to identify the factors that are associated with achieving the target BP recommended by the American (ACC/AHA, 2017), European (ESC/ESH, 2018), United Kingdom (NICE, 2019), and International Society of Hypertension (ISH, 2020) guidelines. (2) Methods: We analyzed 5308 incident hypertensive outpatients across Abu Dhabi, United Arab Emirates (UAE), in 2017; each patient was followed up for 6 months. Hypertension was defined as a BP of 130/80 mmHg according to the ACC/AHA guidelines and 140/90 mmHg according to the ESC/ESH, NICE, and ISH guidelines. Multiple logistic regression was used to identify factors associated with achieving the guideline-recommended BP targets. (3) Results: At baseline, the mean BP was 133.9 ± 72.9 mmHg and 132.7 ± 72.5 mmHg at 6 months. The guideline-recommended BP targets were 39.5%, 43%, 65.6%, and 40.8%, according to the ACC/AHA, ESC/ESH, NICE, and ISH guidelines, respectively. A BMI of <25 kg/m2 was associated with better BP control according to the ACC/AHA (odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.07–1.49), ESC/ESH (OR = 1.27; 95% CI = 1.08–1.50), and ISH guidelines (OR = 1.22; 95% CI = 1.03–1.44). Hypertension treated in secondary care settings was more likely to achieve the BP targets recommended by the ACC/AHA (1.31 times), ESC/ESH (1.32 times), NICE (1.41 times), and ISH (1.34 times) guidelines. (4) Conclusions: BP goal achievement was suboptimal. BP control efforts should prioritize improving cardiometabolic goals and lifestyle modifications.
... Hypertension is a major risk factor for cardiovascular diseases and stroke, two leading causes of death worldwide. It is currently estimated that 1.4 billion (31.1%) people are affected by high blood pressure (1,2). Based on data-driven projections, more than 50 percent of the world's population will have hypertension within the next 30 years (1)(2)(3)(4)(5). ...
... It is currently estimated that 1.4 billion (31.1%) people are affected by high blood pressure (1,2). Based on data-driven projections, more than 50 percent of the world's population will have hypertension within the next 30 years (1)(2)(3)(4)(5). This highlights the importance of blood pressure management as one of the most important priorities in health care. ...
... Globally, non-communicable diseases (NCDs) account for approximately three-fourths of all deaths (1,2). Hypertension, often known as increased blood pressure, is a worldwide public health concern (1). ...
... Hypertension, often known as increased blood pressure, is a worldwide public health concern (1). Globally, ∼1.4 billion people have hypertension (2). Its burden is also projected to be 1.56 billion worldwide in 2025, two-thirds of which is expected to occur in the developing countries (3,4). ...
Article
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Introduction: Hypertension, often known as increased blood pressure, is a worldwide public health concern. Globally, ∼1 billion people have hypertension and 7.1 million die from this disease. It is disproportionately more prevalent in resource-poor nations, with inadequate health systems like Ethiopia. Moreover, information on the burden of disease from hypertension in the specific area, especially in the newly organized Wolkait Tegedie zone, is essential to develop eective prevention and control strategies. Therefore, this study aimed to assess the prevalence of hypertension and associated factors among adult patients evaluated at the outpatient department of the two district hospitals in the Wolkait Tegedie zone, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from September to October 2021. A systematic random sampling technique was used to select a total of 449 participants. The data were collected and then entered using EPI-INFO version 7 and exported to STATA 14 for analysis. Bivariable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used as a measure of association. Variables having a p-value < 0.05 from the multivariable analysis were considered to have a significant association with the outcome.
... Globally, non-communicable diseases (NCDs) account for approximately three-fourths of all deaths (1,2). Hypertension, often known as increased blood pressure, is a worldwide public health concern (1). ...
... Hypertension, often known as increased blood pressure, is a worldwide public health concern (1). Globally, ∼1.4 billion people have hypertension (2). Its burden is also projected to be 1.56 billion worldwide in 2025, two-thirds of which is expected to occur in the developing countries (3,4). ...
Article
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Introduction Hypertension, often known as increased blood pressure, is a worldwide public health concern. Globally, ~1 billion people have hypertension and 7.1 million die from this disease. It is disproportionately more prevalent in resource-poor nations, with inadequate health systems like Ethiopia. Moreover, information on the burden of disease from hypertension in the specific area, especially in the newly organized Wolkait Tegedie zone, is essential to develop effective prevention and control strategies. Therefore, this study aimed to assess the prevalence of hypertension and associated factors among adult patients evaluated at the outpatient department of the two district hospitals in the Wolkait Tegedie zone, Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from September to October 2021. A systematic random sampling technique was used to select a total of 449 participants. The data were collected and then entered using EPI-INFO version 7 and exported to STATA 14 for analysis. Bivariable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used as a measure of association. Variables having a p -value < 0.05 from the multivariable analysis were considered to have a significant association with the outcome. Results The prevalence of hypertension among adult patients in this study was 44.91% [95% CI: 40.26%, 49.65%], of which 63.92% were new diagnoses. Being >60 years [AOR = 1.81; 95% CI: 1.11, 3.20], having poor physical exercise [AOR = 1.74; 95% CI: 1.01, 3.15], consuming cruddy oil [AOR = 15.22; 95% CI: 3.86, 60.12], having a family history of hypertension [AOR = 13.02; 95% CI: 3.75, 45.16], and having a history of diabetes mellitus (DM) [AOR = 8.05; 95% CI: 1.24, 51.49] had a statistically significant association with having hypertension. Conclusion There is a relatively high prevalence of hypertension among adult patients in the outpatient department of the two primary hospitals, Northwest Ethiopia. Factors such as being of older age, having poor physical exercise behavior, cruddy oil consumption, and family history of DM and hypertension had a positive significant statistical association with being hypertensive. Community-based screening programs for hypertension should be designed and implemented to prevent this silent killer disease. Health education and promotion that focus on healthy nutrition and physical exercise should be delivered.
... Hypertension is a complex disorder, characterized by maintained enhancement in both systolic and diastolic pressures (>130 mm Hg and >90 mm Hg, respectively) [1], and has a high prevalence, being estimated to cause 9.4 million deaths globally every year [2]. This pathology, influenced by both genetic and environmental factors, can be triggered by different pathologies, such as obesity, insulin resistance or hyperthyroidism, Given the above, we hypothesize that the modulation of gut microbioma with the commercial synbiotic formula Prodefen ® might be an interesting non-pharmacological approach to ameliorate vascular disorders in hypertension. ...
... This multifactorial pathology is characterized by maintained enhancement in systemic blood pressure. Alterations in GM composition have been proven to be implicated in the pathogenesis of hypertension [21], and modulation of gut microbiota, by supplying synbiotic agents, can promote recovery of blood pressure levels to normotensive values [1][2][3][4][5]. In line with this, we previously demonstrated, in a metabolic syndrome model, that supplementation with a commercial synbiotic formulation reversed hypertension to normotensive levels [12]. ...
Article
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In recent years, gut dysbiosis has been related to some peripheral vascular alterations linked to hypertension. In this work, we explore whether gut dysbiosis is related to vascular innervation dysfunction and altered nitric oxide (NO) production in the superior mesenteric artery, one of the main vascular beds involved in peripheral vascular resistance. For this purpose, we used spontaneously hypertensive rats, either treated or not with the commercial synbiotic formulation Prodefen® (108 colony forming units/day, 4 weeks). Prodefen® diminished systolic blood pressure and serum endotoxin, as well as the vasoconstriction elicited by electrical field stimulation (EFS), and enhanced acetic and butyric acid in fecal samples, and the vasodilation induced by the exogenous NO donor DEA-NO. Unspecific nitric oxide synthase (NOS) inhibitor L-NAME increased EFS-induced vasoconstriction more markedly in rats supplemented with Prodefen®. Both neuronal NO release and neuronal NOS activity were enhanced by Prodefen®, through a hyperactivation of protein kinase (PK)A, PKC and phosphatidylinositol 3 kinase-AKT signaling pathways. The superoxide anion scavenger tempol increased both NO release and DEA-NO vasodilation only in control animals. Prodefen® caused an increase in both nuclear erythroid related factor 2 and superoxide dismutase activities, consequently reducing both superoxide anion and peroxynitrite releases. In summary, Prodefen® could be an interesting non-pharmacological approach to ameliorate hypertension.
... Despite important advances in the understanding of the prevention, diagnosis and treatment of cardiovascular diseases (CVD), CVD remain the major cause of mortality worldwide [1]. One of the most severe, prevalent, and manageable risk factor for CVD and adverse complications is arterial hypertension (AH) [2], a chronic degenerative condition that induces renal, endothelial, metabolic and brain alterations [3,4]. Its etiology is multifactorial and is characterized by sustained elevation of blood pressure greater than 140/90 mmHg for systolic and diastolic pressures, respectively [2]. ...
... Tyrode's solution ( [1,2,4] oxadiazolo -[4,3-a]quinoxalin-1-one (ODQ), 2-phenyl-4,4,5,5,-tetramethylimidazoline-1-oxyl 3-oxide (PTIO), tetraethylammonium (TEA), febuxostat and proadifen hydrochloride were obtained from Sigma-Aldrich (São Paulo-SP, Brazil) or Sigma Chemical Co. (St Louis, MO, USA). ...
Article
Organic nitrates are widely used to restore endogenous nitric oxide (NO) levels reduced by endothelial nitric oxide synthase dysfunction. However, these drugs are associated with undesirable side effects, including tolerance. This study aims to investigate the cardiovascular effects of the new organic nitrate 1,3-diisobutoxypropan-2-yl nitrate (NDIBP). Specifically, we assessed its effects on blood pressure, vascular reactivity, acute toxicity, and the ability to induce tolerance. In vitro and ex vivo techniques showed that NDIBP released NO both in a cell-free system and in isolated mesenteric arteries preparations through a process catalyzed by xanthine oxidoreductase. NDIBP also evoked endothelium-independent vasorelaxation, which was significantly attenuated by 2-phenyl-4,4,5,5,-tetramethylimidazoline-1-oxyl 3-oxide (PTIO, 300 μM), a nitric oxide scavenger; 1-H-[1,2,4] oxadiazolo–[4,3-a]quinoxalin-1-one (ODQ, 10 μM), a soluble guanylyl cyclase inhibitor; tetraethylammonium (TEA, 3 mM), a potassium channel blocker; febuxostat (500 nM), a xanthine oxidase inhibitor; and proadifen (10 μM), an inhibitor of cytochrome P450 enzyme. Furthermore, this organic nitrate did not induce tolerance in isolated vessels and presented low toxicity following acute oral administration. In vivo changes on cardiovascular parameters were assessed using normotensive and renovascular hypertensive rats. NDIBP evoked a reduction of blood pressure that was significantly higher in hypertensive animals. Our results suggest that NDIBP acts as a NO donor, inducing blood pressure reduction without having the undesirable effects of tolerance. Those effects seem to be mediated by activation of NO-sGC-cGMP pathway and positive modulation of K⁺ channels in vascular smooth muscle.
... Hypertension affects around 1.4 billion people globally [3,4] and represents the principal risk factor for ischemic heart disease and cerebrovascular disease (stroke). Ischemic heart disease and stroke accounted for more than 85% of cardiovascular disease deaths. ...
... ACE acts converting angiotensin I into angiotensin II (a potent vasoconstrictor) by removing the C-terminal dipeptide HL [5]. The inhibition of renin and ACE in the RAS pathway is considered an important therapeutic strategy in treating hypertension [3,6] which is a controllable risk factor for cardiovascular diseases. ACE is the molecular target of antihypertensive drugs such as Captopril, Lisinopril, Benazepril, and Zofenopril [7][8][9]. ...
Article
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This study aimed at determining the effect of cocoa proteins (CP) on the blood pressure, using in silico, in vitro and in vivo approaches. The in silico assay showed 26 Criollo cocoa peptides with alignment in the Blast® analysis. Peptide sequences ranged from 6 to 16 amino acids, with molecular weight ranging from 560.31 to 1548.76 Da. The peptide sequences LSPGGAAV, TSVSGAGGPGAGR, and TLGNPAAAGPF showed the highest theoretical affinity with −8.6, −5.0, and −10.2 kcal/mol, for the angiotensin-converting enzyme (ACE), renin, and angiotensin II type 1 receptor (AT1-R), respectively. The Criollo CP hydrolysates (CPH) presented in vitro ACE inhibitory activity with an IC50 value of 0.49 mg/mL. Furthermore, the orogastric administration of 150 mg CP/kg/day in rats fed a high-fat (HF) diet (HF + CP group) showed a significant decrease in systolic blood pressure (SBP) by 5% (p < 0.001) and diastolic blood pressure (DBP) by 7% (p < 0.001) compared with the HF group. The human equivalent dose (HED) of CP for an adult (60 kg) is 1.45 g per day. These results suggest that the consumption of CP could reduce blood pressure by blocking ACE, and could be used as an ingredient in the elaboration of antihypertensive functional foods.
... Importantly, a delay or advance of just one hour is associated with increased adverse cardiovascular events as well as increased traffic accidents 4,5 , underscoring the critical role of precise timing in maintaining health. Understanding the molecular mechanisms of how these rhythms are regulated and its implications for health is needed as hypertension is the leading modifiable risk factor for all-cause mortality 6,7 . With human and mice having comparable rhythms, albeit inverted due to diurnal and nocturnal behaviors, respectively 8 ...
Article
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Brain and muscle ARNT-like 1 (BMAL1) is a core circadian clock protein and transcription factor that regulates many physiological functions, including blood pressure (BP). Male global Bmal1 knockout (KO) mice exhibit ∼10 mmHg reduction in BP, as well as a blunting of BP rhythm. The mechanisms of how BMAL1 regulates BP remains unclear. The adrenal gland synthesizes hormones, including glucocorticoids and mineralocorticoids, that influence BP rhythm. To determine the role of adrenal BMAL1 on BP regulation, adrenal-specific Bmal1 (ASCre/+::Bmal1) KO mice were generated using aldosterone synthase Cre recombinase to KO Bmal1 in the adrenal gland zona glomerulosa. We confirmed the localization and efficacy of the KO of BMAL1 to the zona glomerulosa. Male ASCre/+::Bmal1 KO mice displayed a shortened BP and activity period/circadian cycle (typically 24 hours) by ∼1 hour and delayed peak of BP and activity by ∼2 and 3 hours, respectively, compared with littermate Cre- control mice. This difference was only evident when KO mice were in metabolic cages, which acted as a stressor, as serum corticosterone was increased in metabolic cages compared with home cages. ASCre/+::Bmal1 KO mice also displayed altered diurnal variation in serum corticosterone. Furthermore, these mice have altered eating behaviors where they have a blunted night/day ratio of food intake, but no change in overall food consumed compared with controls. Overall, these data suggest that adrenal BMAL1 has a role in the regulation of BP rhythm and eating behaviors.
... Furthermore, hypertension affects 26.6% of Iran's population. It should be highlighted that managing hypertension individuals is a greater challenge for healthcare systems in the developing world due to inadequate treatment and misinformation [1], [2]. ...
Article
Hypertension is the primary worldwide cause of cardiovascular disease and early death. Because of the extensive use of anti-hypertensive treatments during the past 40 years, the mean blood pressure (BP) over the world has either decreased dramatically or remained constant. Contrastingly, hypertension has increased in prevalence, especially in low- and middle-income countries. There is evidence of decreasing the incidence rate of hypertension however, it has been noted that there are more and more side effects that are being discovered associated with high-cost chemical treatments. Therefore, Phyto-based traditional medicine is now being investigated for its safety and lowcost characteristics. One of the main phyto-based treatments for hypertension is Hibiscus sabdariffa, which has been used by different countries. However, a comprehensive approach for evaluating the efficacy of this plant, its extracts, and beverages is still lacking. Therefore, this study aims to provide a review and compilation of the clinical trials and animal studies documenting and evaluating the effectiveness of H. sabdariffa for the effective management of hypertension in individuals with low to severe hypertension issues. Thus, this study can pave the pathway for future research to focus on the limitations that are confronting harnessing the full potential of Hibiscus sabdariffa.
... HBP affected approximately 1.13 billion people in 2015, accounting for 19% of all fatalities (NCD Risk Factor Collaboration (NCD-RisC) 2017; Forouzanfar et al. 2017). Uncontrolled blood pressure affects up to 80% of people with HBP, putting them at a higher risk of morbidity and death (Egan et al. 2019). Thirty percent of people have HBP or have an increase in BMI and age. ...
Chapter
Blood pressure (BP) is an important physiological parameter used in the diagnosis of many life-threatening diseases such as heart attack, ischemic stroke, hypertension, vascular disease, hypotension, and many others. It is directly connected to human life, it plays an important role in the diagnosis and monitoring of various health ailments. Accurate and precise BP measurement is always a priority for both researchers and medical practitioners. With recent technological advancements, the issue of accurate measurements, standardization of techniques, and efforts toward adopting some uniform methods remain debatable, particularly traceability in dynamic mode. There are numerous types of BP measuring devices in the market. The accuracy of these devices is always an unresolved issue for researchers, medical practitioners, and metrologists. Several national and international standards recommend methods for calibrating these devices, but very few devices/systems/instruments are available to calibrate these devices convincingly in SI traceable units. This chapter provides an in-depth explanation of various noninvasive BP measuring techniques as well as available national and international standards. Some recent advances in BP measurement, as well as challenges addressed and challenges ahead in their calibration, are also discussed.
... Заболевание ведет к огромным экономическим потерям, а также является серьезным социальным бременем, так как напрямую увеличивает количество лет жизни с инвалидностью [2]. Парадоксальным образом только в среднем 20 % пациентов с АГ достигают целевого артериального давления (АД) [3]. ...
Article
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Refractory arterial hypertension (RefHTN) is an extreme phenotype of resistant hypertension (RHTN), is associated with utmost poor clinical sequelae. True RHTN occurs in 10-15 % of treated patients. Up to half of them meet the definition of RefHTN, but another ~50 % are eventually diagnosed with ‘pseudo’-RHTN. Partial or complete non-adherence are among its the main causes. To date, there is no ‘gold’ standard to assess adherence. Directly observed therapy (DOT) is a promising non-invasive method to assess patient compliance. The wellknown abroad, DOT is not widely used in Russian clinical practice. In this short report we demonstrate a case of DOT in a patient with apparent RefHTN.
... Affecting approximately 1.4 billion people in 2010 and with a drastic increase to over 1.6 billion people expected by 2025 [1], hypertension remains the leading cause of cardiovascular disease and premature death worldwide [2]. Despite the growing incidence of hypertension, especially in low-and middle-income countries (LMIC), the global mean blood pressure (BP) has remained constant, which is mainly attributed to the widespread application of antihypertensive medication [2,3]. ...
Article
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Purpose: The aim of this study was to analyze the association between antihypertensive drugs and the incidence of acute lower respiratory infections in patients treated in general practices in Germany. Methods: After propensity score matching of five antihypertensive drug classes, a total of 377,470 patients aged ≥18 years were available for analysis. The association between each antihypertensive drug class and ALRI incidence as compared to all other antihypertensive drug classes (as a group) was studied using conditional Cox regression analyses. Because of multiple comparisons and large patient samples, findings were clinically considered relevant when the hazard ratio was <0.85 or >1.15. Results: The regression analyses applied found no clinically relevant associations between antihypertensive drugs and the incidence of acute lower respiratory infections, as all hazard ratios were between 0.85 and 1.15. Conclusion: In the present study, only slight and not clinically relevant increases or decreases in the ALRI incidence were observed. Additional studies are necessary to further explore the risks associated with antihypertensive agents that are widely embedded in today's clinical practice.
... Hypertension is a long-term medical condition that increases the risk of serious problems including heart attacks and strokes. Globally, hypertension is estimated to affect 1.4 billion people (Egan et al., 2019) and its prevalence increases with age. Among Westerners aged over 40 years, systolic blood pressure (SBP) increases by about 7 mmHg per decade (Wolf-Maier et al., 2003), and over 65% of midlife/older (aged ≥50 years) adults in the United States present with above-normal SBP (Virani et al., 2020;Craighead et al., 2021). ...
Article
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Objective: To explore the effect of a low-dose hydrogen–oxygen (H 2 -O 2 ) mixture inhalation in midlife/older adults with hypertension. Methods: This randomized, placebo-controlled trial included 60 participants with hypertension aged 50–70 years who were randomly divided into Air group (inhaled placebo air) or H 2 -O 2 group [inhaled H 2 -O 2 mixture (66% H 2 /33% O 2 )]. Participants in both groups were treated 4 h per day for 2 weeks. Four-limb blood pressure and 24-h ambulatory blood pressure were monitored before and after the intervention, and levels of plasma hormones related to hypertension were determined. Results: A total of 56 patients completed the study (27 in the Air group and 29 in the H 2 -O 2 group). The right and left arm systolic blood pressure (SBP) were significantly decreased in H 2 -O 2 group compared with the baseline levels (151.9 ± 12.7 mmHg to 147.1 ± 12.0 mmHg, and 150.7 ± 13.3 mmHg to 145.7 ± 13.0 mmHg, respectively; all p < 0.05). Meanwhile, the H 2 -O 2 intervention significantly decreased diastolic nighttime ambulatory blood pressure by 2.7 ± 6.5 mmHg ( p < 0.05). All blood pressures were unaffected in placebo group (all p > 0.05). When stratified by age (aged 50–59 years versus aged 60–70 years), participants in the older H 2 -O 2 group showed a larger reduction in right arm SBP compared with that in the younger group ( p < 0.05). In addition, the angiotensin II, aldosterone, and cortisol levels as well as the aldosterone-to-renin ratio in plasma were significantly lower in H 2 -O 2 group compared with baseline ( p < 0.05). No significant differences were observed in the Air group before and after the intervention. Conclusion: Inhalation of a low-dose H 2 -O 2 mixture exerts a favorable effect on blood pressure, and reduces the plasma levels of hormones associated with hypertension on renin-angiotensin-aldosterone system and stress in midlife/older adults with hypertension.
... Hypertension is a major public health problem that affects more than 1 billion people worldwide, of which 75 % are estimated to live in developing countries including Africa. (10)(11)(12)(13). Over the last few years, the prevalence and the health impact of hypertension have been increasing in Tigray, Ethiopia. ...
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Background: A tragic and brutal war has been ongoing in Tigray, northern Ethiopia since November 2020. More than 70 % of health facilities had been dysfunctional. The condition of the hypertensive patients follow up/care and other non-communicable diseases is not studied since the war started. Methods: This study was conducted in six zones of Tigrai from July 03-to August 5, 2021. Health facilities were randomly selected and data on patient’s follow-up of pre-war period (September 2020-October 2020) as well as the subsequent 8 months war period (November 2020-June 2021). Data were collected using a check list. The number of patients who had visits during pre-war and the 8-month war period were compared to assess the impact of the war. Results: Pre-war and post war data from 46 health facilities in Tigray region (31 health centers, 9 primary hospitals and 6 general hospitals) was collected and analysed. There were 2565 average monthly hypertension visits to health facilities before war period which dropped to 1211 during the war period, a 52.7% reduction. There was reduction of hypertension visits across all health facilities; with health centres 51.2% and hospitals a 53.5% reduction. Eastern and north west zone health facilities had worst impact of the war as both showed >85% reduction in clinic visits. The impact of the war was highest in rural areas especially remote areas than urban areas. There was no available data from western Tigray zone and some other zones’ health centres and hospitals due to war destructions. The impact of the war on hypertensive patients could even be higher in these areas. Conclusion: Due to the war, the care of hypertension had significantly decreased in Tigray. Reduction in the number of hypertensive patients follow up visits and hence care would lead to an increase in short and long-term morbidity/mortality from stroke, acute coronary syndrome, heart failure and sudden cardiac death among other consequences. We recommend humanitarian/development agencies and other organizations to consider morbidity from hypertension and all other chronic non-communicable diseases when planning.
... Hypertension is a health problem that affects approximately 1 billion individuals worldwide [1]. During the course of hypertension, increased pressure overload causes changes in heart morphology, notably in the left ventricle (LV), resulting in left ventricular hypertrophy [2]. ...
Article
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Bioactive peptides are physiologically active peptides produced from proteins by gastrointestinal digestion, fermentation, or hydrolysis by proteolytic enzymes. Bioactive peptides are resorbed in their whole form and have a preventive effect against various disease conditions, including hypertension, dyslipidemia, inflammation, and oxidative stress. In recent years, there has been a growing body of evidence showing that physiologically active peptides may have a function in sports nutrition. The present study aimed to evaluate the synergistic effect of dipeptide (IF) from alcalase potato protein hydrolysates and exercise training in hypertensive (SHR) rats. Animals were divided into five groups. Bioactive peptide IF and swimming exercise training normalized the blood pressure and decreased the heart weight. Cardiac, hepatic, and renal functional markers also normalized in SHR rats. The combined administration of IF peptide and exercise offer better protection in SHR rats by downregulating proteins associated with myocardial fibrosis, hypertrophy, and inflammation. Remarkably, peptide treatment alongside exercise activates the PI3K/AKT cell survival pathway in the myocardial tissue of SHR animals. Further, the mitochondrial biogenesis pathway (AMPKα1, SIRT1, and PGC1α) was synergistically activated by the combinatorial treatment of IF and exercise. Exercise training along with IF administration could be a possible approach to alleviating hypertension.
... 16,18 Arterial hypertension (aHT) is a leading risk factor for cardiovascular morbidity and mortality. 20 aHT is defined as a blood pressure (BP) above 130/80 mmHg according to the ACC/AHA guidelines and 140/90 mmHg according to the ESC/ESH, NICE, and ISH guidelines. 21 Given that psoriasis patients have an inherently increased risk of developing aHT, dermatologists need to give special consideration to this comorbidity when following up and treating psoriasis patients. ...
Article
Purpose: To review the literature on guidance on the follow-up of psoriasis and its comorbidities and to provide practical recommendations. Patients and methods: A PubMed search was conducted using MeSH terms and free text keywords related to "psoriasis", "obesity", "hypertension", "diabetes", "dyslipidemia", "metabolic syndrome" and "Psoriatic arthritis". The search was conducted between September 2021 and January 2022. References of selected articles were scanned to identify additional articles. Results: Recommendations on the follow-up of hypertension, obesity, dyslipidemia, type 2 diabetes, metabolic syndrome, psoriatic arthritis, non-alcoholic fatty liver disease and inflammatory bowel disease in psoriasis patients were extracted from the included articles. These data are presented in summary tables for both adults and children. A practical and feasible approach for each comorbidity is discussed. Conclusion: Awareness among dermatologists for relevant psoriasis-associated comorbidities is crucial. The dermatologist should function as gatekeeper and screen for comorbidities, in order to make timely referrals when indicated.
... Hypertension is the most common chronic disease in developed societies and is responsible for approximately 7.1 million deaths per year worldwide, affecting 6 to 25 percent of the world's adult population (17). In 2010, global hypertension was estimated at approximately 1.4 billion people and is likely to significantly exceed 1.6 billion by 2025 (18). The prevalence of hypertension in different parts of the world is estimated at 30 to 40% (19). ...
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Background and Aim: Hypertension is one of the chronic diseases that has been introduced as a silent killer and public health crisis in the world. Due to the increase in this dangerous disease, education about blood and blood pressure control can help reduce it. This study aimed to investigate the effect of virtual education on the knowledge of patients with hypertension. Materials and Methods: The present study is an intervention that was performed on 70 people over 35 years of age with hypertension in Varamin. Sampling in this study was random. In this study, individuals were divided into two groups of 35 intervention and control. First, the level of knowledge of both groups was determined using a researcher-made electronic questionnaire. Then, the intervention group was given virtual training through the Skype platform. After two months, the knowledge of both groups was measured again using an electronic questionnaire, and statistical data were analyzed using SPSS 26 software and the necessary tests. All necessary measures were taken in compliance with ethical standards in research and health protocols. Results: The results of this study showed that there was no significant difference between the two groups before the intervention (P> 0.05).
... 1,2 Among those diagnosed with high BP, more than 80% have uncontrolled BP leading to increased morbidity and mortality. 3 A recent global survey on .1.5 million adults reported that among those on treatment for high BP, .71% had uncontrolled BP (.130/80 mmHg). ...
Article
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Background High blood pressure (BP) is the commonest modifiable cardiovascular risk factor, yet its monitoring remains problematic. Wearable cuffless BP devices offer potential solutions; however, little is known about their validity and utility. We aimed to systematically review the validity, features and clinical use of wearable cuffless BP devices. Methods We searched MEDLINE, Embase, IEEE Xplore and the Cochrane Database till December 2019 for studies that reported validating cuffless BP devices. We extracted information about study characteristics, device features, validation processes, and clinical applications. Devices were classified according to their functions and features. We defined devices with a mean systolic BP (SBP) and diastolic BP (DBP) biases of <5 mmHg as valid as a consensus. Our definition of validity did not include assessment of device measurement precision, which is assessed by standard deviation of the mean difference- a critical component of ISO protocol validation criteria. Study quality was assessed using the QUADAS-2 tool. A random-effects model meta-analysis was performed to summarise the mean biases for systolic and diastolic BP across studies. Results Of the 430 studies identified, 16 studies (15 devices, 974 participants) were selected. The majority of devices (81.3%) used photoplethysmography to estimate BP against a reference device; other technologies included tonometry, auscultation and electrocardiogram. In addition to BP and heart rate, some devices also measured night-time BP (n=5), sleep monitoring (n=3), oxygen saturation (n=3), temperature (n=2) and electrocardiogram (n=3). Eight devices showed mean biases of <5 mmHg for SBP and DBP compared to a reference device and three devices were commercially available. The meta-analysis showed no statistically significant differences between the wearable and reference devices for SBP (pooled mean difference=3.42 mmHg, 95%CI -2.17, 9.01, I2 95.4%) and DBP (pooled mean=1.16 mmHg, 95%CI -1.26, 3.58, I2 87.1%). Conclusion Several cuffless BP devices are currently available using different technologies, offering the potential for continuous BP monitoring. The variation in standards and validation protocols limited the comparability of findings across studies and the identification of the most accurate device. Challenges such as validation using standard protocols and in real-life settings must be overcome before they can be recommended for uptake into clinical practice.
... 8 Globally, with new guidelines, there is an increase in the prevalence of hypertension (exceeding 1.4 billion), including untreated hypertension. 12,13 In South Korea and China, hypertension and its impact on mortality are greater in lower-income groups. The combined impact of hypertension and lower income level on cardiovascular outcomes is male predominant in China 10 and India, 14 whereas this difference is not reported in South Korea. ...
Article
It has long been recognized that there are significant differences between the sexes affecting prevalence, incidence, and severity over a broad range of diseases. Until the early 1990s, the limited research conducted on women’s health focused primarily on diseases affecting fertility and reproduction, and women were excluded from most clinical trials. For these reasons, the prevention, diagnosis, and treatment of serious chronic diseases such as cardiovascular disease in women continue to be based primarily on findings in men, and sex-specific clinical guidelines are mostly lacking. Hypertension, obesity, and diabetes, interrelated risk factors for cardiovascular disease, differ by sex in terms of prevalence and adverse effects as well as by genetics and biology. Research is needed to understand sex differences in hypertension, obesity, and diabetes to optimally inform sex-specific prevention, diagnosis, and treatment strategies for women and men. In this way, sex-specific clinical guidelines can be developed where warranted.
... All countries around the world spend significant financial resources on diagnosing, treating, and rehabbing the effects of high blood pressure as one of the most common NCDs. [22] Due to the conditions of the disaster-affected communities, trauma and infectious diseases are usually given priority, and NCDs such as HTN are usually ignored in the early stages. [17] However, according to the patients with unknown HTN in the affected population before flood, epidemiological information should be interpreted with more caution. ...
Article
Background: Several studies have been conducted on the effects of floods on the health of the affected community. We aimed to determine the effects of floods as the most common disaster on hypertension (HTN) as one of the most common noncommunicable diseases (NCDs). Materials and Methods: Four databases including Medline, Scopus, Google Scholar, and ScienceDirect were searched with the search strategy protocol up to the end of June 2021 and with the keywords of flood and high blood pressure or hypertension. Grey literature database and websites of WHO, UNDRR, and PreventionWeb were also searched. After removing duplicate articles, abstracts of the relevant titles were reviewed, and eligible articles were included for full-text review. Finally, the study variables were extracted from selected articles. Results: The search strategy resulted in eight final relevant articles from 48,980 articles. All final articles noted meaningful effect of flood on high blood pressure. There was a positive correlation between anxiety level, property loss, financial loss, physical activity, use of alcoholic beverages, interruption of medication, and medical cares with HTN. Different studies have also reported long-term effects of flooding on blood pressure. Conclusions: The flood has significant effect on high blood pressure in affected population. However, cases of unknown HTN in the affected population should also be considered, so screening is recommended in the affected community.
... Furthermore, those who remained in the study may be more adherent to blood pressure lowering medications than those lost to follow-up. We observed diminished attendance to the club meetings over time, which may be due to reasons such as: i) improvement in BP control with a subsequent attenuation of perceived need to attend the club meetings, ii)non-specific symptoms or asymptomatic nature of hypertension [38]. In addition, some sociodemographic characteristics, such as older age, male sex and lower education, might be associated with poorer engagement with the intervention. ...
Article
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Background: Hypertension control remains a significant challenge in reducing the cardiovascular disease burden worldwide. Community peer-support groups have been identified as a promising strategy to improve medication adherence and blood pressure (BP) control. Objectives: The study aimed to evaluate the feasibility and impact of adherence clubs to improve BP control in Southeast Nigeria. Methods: This was a mixed-methods research involving a formative (pre-implementation) research, pilot study and process evaluation. Hypertensive patients in two communities were recruited into peer-support adherence clubs under the leadership of role-model patients to motivate and facilitate medication adherence, BP monitoring, and monthly medication delivery for six months. The primary outcome was medication adherence measured using visual analogue scale (VAS), with BP level at six months as a key secondary outcome. Results: We recruited a total of 104 participants. The mean age was 56.8 (SD-10.7) years, 72 (69.2%) were women, mean BP was 146.7 (SD-20.1)/86.9 (SD-11.2) mmHg, and the mean percentage of medication adherence on the VAS was 41.4% (SD-11.9%). At six months, 67 patients were assessed; self-reported adherence on the VAS increased to 57.3% (SD-25.3%) (mean difference between baseline and follow-up of 15.5%, p < 0.0001), while the mean BP decreased to 132.3 (SD-22.0)/82.9 (SD-12.2) mmHg (mean difference of 13.0 mmHg in systolic BP, p < 0.0001 and of 3.6 mmHg in diastolic BP, p = 0.02). Five in-depth interviews and four focus groups discussions were conducted as part of the qualitative analyses of the study. The participants saw hypertension as a big issue, with many unaware of the diagnosis, and they accepted the CLUBMEDS differential service delivery (DSD) model concept in hypertension. Conclusions: The study demonstrates that the implementation of adherence clubs for hypertension control is feasible and led to a statistically significant and clinically meaningful improvement in self-reported medication adherence, resulting in BP reduction. Upscaling the intervention may be needed to confirm these findings.
... Hypertension is one of the strongest modifiable risk factors for cardiovascular disease (CVD) with its prevalence increasing especially in low-and middle-income countries [1,2]. Reports indicate that a quarter of men and a fifth of women have hypertension, and hypertension is responsible for approximately 45% of deaths from CVDs [3,4]. Results of systematic review and meta-analysis on 42 Iranian studies showed that hypertension affects 22% of 402,282 subjects included in this analysis [5]. ...
Article
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Background Although obesity increases the risk of hypertension, the effect of obesity based on metabolic status on the incidence of hypertension is not known. This study aimed to determine the association between obesity phenotypes including metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) and the risk of hypertension incidence. Methods We conducted a prospective cohort study on 6747 adults aged 35–65 from Ravansar non-communicable diseases (RaNCD) study. Obesity was defined as body mass index above 30 kg/m² and metabolically unhealthy was considered at least two metabolic disorders based on the International Diabetes Federation criteria. Obesity phenotypes were categorized into four groups including MUO, MHO, metabolically unhealthy non obesity (MUNO), and metabolically healthy non obesity (MHNO). Cox proportional hazards regression models were applied to analyze associations with hypertension incidence. Results The MHO (HR: 1.37; 95% CI: 1.03–1.86) and MUO phenotypes (HR: 2.44; 95% CI: 1.81–3.29) were associated with higher hypertension risk compared to MHNO. In addition, MUNO phenotype was significantly associated with risk of hypertension incidence (HR: 1.65; 95% CI: 1.29–2.14). Conclusions Both metabolically healthy and unhealthy obesity increased the risk of hypertension incidence. However, the increase in metabolically unhealthy phenotype was higher.
... Transisi epidemiologi telah mengakibat-kan beban ganda penyakit menular dan tidak menular di semua negara maju dan berkembang . Penyakit tidak menular seperti hipertensi menjadi masalah kesehatan global dan mengalami peningkatan tiap tahun (Egan et al., 2019). Studi populasi memperkirakan 1 dari 8 orang dewasa dibawah usia 40 tahun menderita hipertensi (Hinton et al., 2020). ...
Article
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AbstrakPenyakit hipertensi pada usia dewasa muda tiap tahun mengalami peningkatan. Selain itu, banyak permasalahan yang ditemui seperti penurunan kontrol pengobatan, defisit perawatan diri dan buruknya kualitas hidup yang disebabkan oleh rendahnya well-being. Meningkatkan well-being dibutuhkan intervensi yang tepat. Peer support group dipilih karena berfokus pada hubungan individu, adanya pertukaran informasi serta pengalaman. Tujuan penelitian untuk menjelaskan pengaruh peer support group terhadap well-being pasien hipertensi usia dewasa muda. Jenis penelitian menggunakan quasi-experiment dengan rancangan pre post test control group design. Populasi dalam penelitian ini  berjumlah 176 orang. Sampling yang digunakan purposive sampling. Besar sampel sebanyak 80 orang dan dibagi ke dalam 2 kelompok (masing-masing kelompok sebanyak 40 orang). Penelitian dilaksanakan pada bulan Oktober-November 2021 di Puskesmas Koting Propinsi Nusa Tenggara Timur. Instrumen untuk mengukur well-being menggunakan Indonesian Well-being Scale (IWS). Analisis data menggunakan paired t test dan independent sample t-test. Hasil penelitian menunjukkan ada pengaruh peer support group terhadap well-being (p=0,000). Sebelum diberikan peer support group, kedua kelompok tidak menunjukkan perbedaan (p = 0,631). Namun, setelah diberikan peer support group, kedua kelompok menunjukkan perbedaan (p = 0,000). Peer support group terbukti dapat meningkatkan well-being, untuk itu Puskesmas dapat membuat program promosi kesehatan dengan mengintegrasikan peer support group dalam layanan kesehatan.  Kata kunci: peer support group, well-being, hipertensi, dewasa muda Abstract Hypertension in young adults is increasing every year. In addition, many problems were encountered such as decreased medication control, self-care deficits and poor quality of life caused by low well-being. Improving well-being requires appropriate intervention. The peer support group was chosen because it focuses on individual relationships, the exchange of information and experiences. The purpose of the study was to explain the effect of peer support groups on the well-being of hypertensive patients in young adults. This type of research uses a quasi-experimental design with a pre-post-test control group design. The population in this study were 176 people. Sampling used purposive sampling. The sample size is 80 people and divided into 2 groups (each group is 40 people). The research was carried out in October-November 2021 at the Koting Public Health Center. The instrument for measuring well-being uses the Indonesian Well-being Scale (IWS). Data analysis using paired t-test and independent sample t-test. The results showed that there was an effect of a peer support group on well-being (p=0,000). Data analysis using paired t-test and independent sample t-test. The results showed that there was an effect of a peer support group on well-being (p=0,000). Before being given a peer support group, the two groups showed no difference (p = 0,631). However, after being given a peer support group, the two groups showed a difference (p = 0,000). Peer support groups are proven to be able to improve well-being, for that public health centres can create health promotion programs by integrating peer support groups in health services. Keywords: peer support group, well-being, hypertension, young adults
... Elevated blood pressure is one of the most important preventable causes of CVD mortality and disease burden and is a persistent health issue in many countries around the world (Collaboration, 2017; Global Burden of Metabolic Risk Factors for Chronic Dis-easesC, 2014). The global burden of hypertension in 2010 was approximately 1.4 billion people, which is estimated to reach more than 1.6 billion by 2025 (Egan et al., 2019). A comprehensive strategy, including the use of non-pharmacological interventions, should be entailed for the successful control of hypertension . ...
Article
Ethnopharmacological relevance Berberis integerrima commonly known as “barberry” belongs to the Berberidaceae family and has been used as a medicinal plant in Iranian traditional medicine. Aim of the study Our aim in this study was to investigate the effects of barberry consumption on blood pressure (BP). Materials and methods Eighty-four medicated hypertensive patients were selected and randomly allocated to barberry and placebo groups. The barberry group received 10 g/day dried purple-black barberry powder, once daily, for 2-months. Systolic, diastolic, and mean arterial BP was assessed through 24-hours ambulatory BP monitoring before and after 2-month treatment. The estimation of sodium and potassium intake was done through measurement of sodium and potassium in 24-hours urinary samples. Plasma and urinary nitrite, and nitrate (NOx) levels, as well as plasma angiotensin-converting enzyme (ACE) activity, were also determined. Results Seventy-eight participants with an average age of 54.12 ± 10.32 years and BMI of 27.93 ± 2.22 kg/m2 completed the study. There was no significant difference in body weight, physical activity, and the 24-hours urinary sodium and potassium excretion between the two groups before and after the study. After adjusting for baseline values and changes in sodium intake, systolic, and mean arterial BP decreased significantly in the barberry group compared to the placebo group (p = 0.015 and p = 0.008, respectively). Plasma NOx levels and ACE activity were not different between the two groups, but urinary NOx was increased significantly in the barberry group compared to the placebo group (p = 0.008). Conclusions In patients treated with antihypertensive drugs, daily consumption of purple-black barberry can be effective in improving systolic BP control.
... Hypertension affects more than 1 billion people worldwide, and that number is growing [1], mainly as a result of an aging population [2]. In 2016, 17.9 million or 44% of noncommunicable disease-related deaths were due to cardiovascular disease (CVD) with hypertension the leading risk factor [3]. Hypertension is also the leading preventable risk factor for premature death and disability. ...
Article
Full-text available
It is documented that regular exercise is beneficial for improving the antioxidant system, metabolic system, cardiac autonomic function, and blood pressure in those with hypertension. In this regard, low-intensity exercise is recommended for older adults, particularly those with chronic diseases. This study aimed to compare the effects of long-term regular continuous walking with intermittent walking on oxidative stress, metabolic profile, heart rate variability, and blood pressure in older adults with hypertension. Forty-three participants with hypertension aged 60–80 years were randomly divided into the continuous or intermittent walking (CON or INT) groups. Participants in the CON group walked for 30 min, 3 days/week for 12 weeks. Participants in the INT group split 30 min walking into 3 identical sessions punctuated by a 1 min rest after each session, 3 days/week for 12 weeks. Antioxidant and oxidative stress markers, metabolic markers, heart rate variability, and blood pressure were evaluated before and after the exercise program. Glutathione (GSH), GSH to GSH disulfide (GSSG) ratio, and total GSH increased significantly, and GSSG and malondialdehyde decreased significantly in both groups (p
... India is no longer an exception for this as the current epidemiological study established the epidemiological transition from communicable diseases to NCDs in various states of India (Dandona et al., 2017). Hypertension is the most metastasizing NCD, which has affected more than 1.4 billion people, worldwide (Egan et al., 2019). India alone has approximately 100-110 million people of hypertension. ...
Article
Hypertension is the most metastasizing non-communicable disease, which has affected more than 1.4 billion people,worldwide. Exercise is the core management strategy for hypertensive individuals. Extensive literature is available for each kind of exercise that is isometric hand grip training (IHGT), resistance training (RT), and aerobic training (AT). However, the comparison between these exercise regimens has not been done in a single trial. The trial was conducted on 126 subjects in Hisar, an urban area of Haryana (INDIA), from July 2017 to December 2018. Subjects were randomly assigned to four groups: control (n=33), IHGT (n=32), RT (n=31), and AT (n=30). Study variables were measured at baseline, 2nd week, 4th week, 6th week, and also after the 8th week of intervention. Experimental groups showed significant reduction in all the components of blood pressure in comparison to control group. The RT group showed maximum reduction in blood pressure in comparison to other regimens (systolic blood pressure: RT > IHGT > AT; diastolic blood pressure: RT> AT > IHGT). However, the difference between the groups is not statistically significant (P>0.05). The study findings reveal that different kind of exercise regimens are equally effective in lowering blood pressure among pre hypertensive and stage 1 hypertension adults. Keywords: blood pressure, hypertension, aerobic training, resistance training, randomised controlled trial
... Hypertension, or high blood pressure (BP), affects more than 20% of the population and is a major public health problem due to its contribution to stroke, heart failure, and kidney failure [1]. Although sodium (Na + )-rich diets are major contributors to the onset of hypertension, a low potassium (K + ) intake often accompanies this high Na + intake, and dietary K + intake can have an inverse correlation with BP [2,3]. ...
Article
Full-text available
The thiazide-sensitive sodium chloride cotransporter (NCC) plays a vital role in maintaining sodium (Na+) and potassium (K+) homeostasis. NCC activity is modulated by with-no-lysine kinases 1 and 4 (WNK1 and WNK4), the abundance of which is controlled by the RING-type E3 ligase Cullin 3 (Cul3) and its substrate adapter Kelch-like protein 3. Dietary K+ intake has an inverse correlation with NCC activity, but the mechanism underlying this phenomenon remains to be fully elucidated. Here, we investigated the involvement of other members of the cullin family in mediating K+ effects on NCC phosphorylation (active form) and abundance. In kidneys from mice fed diets varying in K+ content, there were negative correlations between NCC (phosphorylated and total) and active (neddylated) forms of cullins (Cul1, 3, 4, and 5). High dietary K+ effects on phosphorylated NCC were attenuated in Cul3 mutant mice (CUL3-Het/Δ9). Short-term (30 min) and long-term (24 h) alterations in the extracellular K+ concentration did not affect cullin neddylation levels in ex vivo renal tubules. In the short term, the ability of high extracellular K+ to decrease NCC phosphorylation was preserved in the presence of MLN4924 (pan-cullin inhibitor), but the response to low extracellular K+ was absent. In the long term, MLN4924 attenuated the effects of high extracellular K+ on NCC phosphorylation, and responses to low extracellular K+ were absent. Our data suggest that in addition to Cul3, other cullins are involved in mediating the effects of K+ on NCC phosphorylation and abundance.
... India is no longer an exception for this as the current epidemiological study established the epidemiological transition from communicable diseases to NCDs in various states of India (Dandona et al., 2017). Hypertension is the most metastasizing NCD, which has affected more than 1.4 billion people, worldwide (Egan et al., 2019). India alone has approximately 100-110 million people of hypertension. ...
Article
Hypertension is the most metastasizing non-communicable disease, which has affected more than 1.4 billion people, worldwide. Exercise is the core management strategy for hypertensive individuals. Extensive literature is available for each kind of exercise that is isometric hand grip training (IHGT), resistance training (RT), and aerobic training (AT). However, the comparison between these exercise regimens has not been done in a single trial. The trial was conducted on 126 subjects in Hisar, an urban area of Haryana (INDIA), from July 2017 to December 2018. Subjects were randomly assigned to four groups: control (n=33), IHGT (n=32), RT (n=31), and AT (n=30). Study variables were measured at baseline, 2 nd week, 4 th week, 6 th week, and also after the 8 th week of intervention. Experimental groups showed significant reduction in all the components of blood pressure in comparison to control group. The RT group showed maximum reduction in blood pressure in comparison to other regimens (systolic blood pressure: RT > IHGT > AT; diastolic blood pressure: RT > AT > IHGT). However, the difference between the groups is not statistically significant (P>0.05). The study findings reveal that different kind of exercise regimens are equally effective in lowering blood pressure among pre hypertensive and stage 1 hypertension adults.
... Hypertension or high blood pressure (BP), affects more than 20% of the population and is a major public health problem due to its contribution to stroke, heart failure and kidney failure [1]. ...
Preprint
Full-text available
The thiazide sensitive sodium-chloride co-transporter (NCC) plays a vital role in maintaining sodium (Na+) and potassium (K+) homeostasis. NCC activity is modulated by the with-no-lysine kinases 1 and 4 (WNK1 and WNK4), the abundance of which are controlled by the RING-type E3 ligase Cullin 3 (Cul3) and its substrate adapter Kelch-like protein 3. Dietary K+ intake has an inverse correlation with NCC activity, but the mechanism underlying this phenomenon remains to be fully elucidated. Here, we investigated the involvement of other members of the Cullin family in mediating K+ effects on NCC phosphorylation (active form) and abundance. In kidneys from mice fed diets varying in K+ content, there were negative correlations between NCC (phosphorylated and total) and active (neddylated) forms of Cullins (Cul1, 3, 4 and 5). High dietary K+ effects on phosphorylated NCC were attenuated in Cul3 mutant mice (CUL3-Het/Δ9). Short-term (30 min) and long-term (24 h) alterations in the extracellular K+ concentration did not affect Cullin neddylation levels in ex vivo renal tubules. Short-term, the ability of high extracellular K+ to decrease NCC phosphorylation was preserved in the presence of MLN4924 (pan Cullin inhibitor), but the response to low extracellular K+ was absent. Long-term, MLN4924 attenuated the effects of high extracellular K+ on NCC phosphorylation and responses to low extracellular K+ were absent. Our data suggest that in addition to Cul3, other Cullins are involved in mediating the effects of K+ on NCC phosphorylation and abundance.
... Hypertension constitutes a major global health issue. In 2010, approximately 1.4 billion people were living with hypertension [1]. A more recent report indicates that the global burden of this blood pressure-related medical condition is likely to substantially exceed 1.6 billion by 2025 [2]. ...
Article
Full-text available
Hypertension is a medical condition that affects millions of people worldwide. Despite the high efficacy of the current antihypertensive drugs, they are associated with serious side effects. Peptides constitute attractive options for chemical therapy against hypertension, and computational models can accelerate the design of antihypertensive peptides. Yet, to the best of our knowledge, all the in silico models predict only the antihypertensive activity of peptides while neglecting their inherent toxic potential to red blood cells. In this work, we report the first sequence-based model that combines perturbation theory and machine learning through multilayer perceptron networks (SB-PTML-MLP) to enable the simultaneous screening of antihypertensive activity and hemotoxicity of peptides. We have interpreted the molecular descriptors present in the model from a physicochemical and structural point of view. By strictly following such interpretations as guidelines, we performed two tasks. First, we selected amino acids with favorable contributions to both the increase of the antihypertensive activity and the diminution of hemotoxicity. Then, we assembled those suitable amino acids, virtually designing peptides that were predicted by the SB-PTML-MLP model as antihypertensive agents exhibiting low hemotoxicity. The potentiality of the SB-PTML-MLP model as a tool for designing potent and safe antihypertensive peptides was confirmed by predictions performed by online computational tools reported in the scientific literature. The methodology presented here can be extended to other pharmacological applications of peptides. Graphical abstract
... [18] Classically, this placental finding has been associated with a clinical diagnosis of pre-eclampsia [19] and other hypertensive disorders of pregnancy. [20] Globally, 1.4 billion people had hypertension in 2010 [21] and more than 30% of adults were estimated to have hypertension in SA. [22] The prevalence of hypertensive disorders of pregnancy is 12.5 -38% in SA mothers [23][24] and it causes significant maternal morbidity and mortality, accounting for 18% of maternal deaths. [25] This is in keeping with the high percentage of MVM in submitted placentas from both public and private hospitals. ...
... According to the records and as far as we know, the present study is the only systematic review research that has been done exclusively on the effects of flood on blood pressure with the wide range of searched databases. All countries around the world spend significant financial resources on diagnosing, treating and rehabbing the effects of high blood pressure as one of the most common NCDs (16). Due to the conditions of the disaster-stricken community, trauma and infectious diseases are usually given priority, and non-communicable diseases such as hypertension are usually ignored in the early stages (17). ...
Preprint
Full-text available
Background: Several studies have been conducted on the effects of floods on the health of the affected community. We aimed to determine the effects of floods as the most common disaster on hypertension as one of the most common non-communicable diseases (NCDs). Material and Methods: The 4 databases, including Medline, Scopus, Google Scholar, and Science Direct were searched with the search strategy protocol up to the end of 2020. Grey literature database and websites of WHO, UNDRR, and Prevention Web also searched. After removing duplicate articles, abstracts of the relevant titles were reviewed and eligible articles were included for full text review. Finally, the study variables were extracted from selected articles. Results: The search strategy resulted in 8 final relevant articles from total number of 48980 articles. All final articles noted meaningful effect of flood on hypertension. There were founded positive correlation between anxiety level, property loss, financial loss, physical activity, use of alcoholic beverages, interruption of medication and medical cares with hypertension. Different studies have reported also long-term effects of flooding on blood pressure. Conclusions: The flood has effect on blood pressure in affected population. According to the importance of hypertension and its burden, screening are recommended in the affected community. Keywords: Hypertension, Disaster, Flood, Blood pressure
... Hypertension is the leading risk factor for mortality and disability [9, 10]. In 2010, more than one billion hypertensive adults were living in low-and middle-income countries where the rate of achieving blood pressure goals was 7.7% [8,10]. ...
Article
Full-text available
Background Hypertension and its consequent end-organ damage including Hypertensive Heart Disease (HHD) are a major concern that impact health, resulting into impairment and reduced quality of life (QOL). The purpose of this study was to describe the burden of HHD in Iran and comparing it with the World Bank upper middle-income countries (UMICs) in terms of disability-adjusted life years (DALY), mortality and prevalence. Methods Using data from the Global Burden of Disease study 2017, we compared the number of DALYs, deaths and prevalence trends for HHD from 1990 to 2017 in all age groups for both sex in Iran, and compared the epidemiology and trends with UMICs and globally. Results The age-standardized DALY rate for HHD increased by 51.6% for men (95% uncertainty interval [UI] 305.8 to 436.7 per 100,000) and 4.4% for women (95% UI 429.4 to 448.7 per 100,000) in Iran. The age-standardized prevalence of HHD in Iran was almost twice times higher than globally and 1.5-times more than the World Bank UMICs. The age-standardized death rate for HDD increased by 60.1% (95% UI 17.3 to 27.7% per 100,000) for men and by 21.7% (95% UI 25.85 to 31.48 per 100,000) for women from 1990 to 2017. Age-standardized death rate in Iran was 2.4 and 1.9 times higher than globally and UMICs, respectively. Conclusions The higher prevalence and death rate in Iran in comparison with UMICs and globally should encourage health care provider to perform intensive screening activities in at risk population to prevent HHD and mitigate its mortality.
... A célérték meghatározásában már jelentős közeledés van a hypertonia kezelésével foglalkozó hat legjelentősebb irányelv között (a 11 amerikai tudományos társaság közös irányelve, a továbbiakban: amerikai irányelv; a kanadai, az ausztrál, a European Society of Cardiology és a European Society of Hypertension közös irányelve, a továbbiakban: ESC/ESH irányelv; a brit National Institute for Health and Care Excellence irányelve, a továbbiakban: NICE-irányelv; az International Society of Hypertension irányelve, a továbbiakban: ISH-irányelv), hiszen a 65 év alatti egyéneknél a <130/80 Hgmm célérték kezd általánosan elfogadottá válni [7,8]. Ezt az előrelépést az azóta sokat kritizált SPRINT tanulmány indította el, amelynek eredményei arra utalnak, hogy a kezelés korai indítása és a <120 Hgmm systolés célérték elérése javítja a betegek életkilátásait, és szignifikánsan csökkenti a cardiovasularis halálozást és a szívelégtelenség előfordulási gyakoriságát [9]. ...
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Összefoglaló. Az irodalmi adatok arra utalnak, hogy a systolés vérnyomás értékének emelkedése már 110-115 Hgmm-től együtt jár az atherosclerosissal összefüggő elváltozások kialakulásával is és ezzel együtt a cardiovascularis és a renalis funkció romlásával. Az összefüggés exponenciális, de mértékét az életkor jelentősen befolyásolja. A kezelés során az elérendő vérnyomás célértéke a jelenlegi adatok alapján 120-130 Hgmm között helyezkedik el a 18-65 év közötti populációban; idősebb korban - különösen 80 év felett - ennél magasabb, a 130 Hgmm alatti érték elérése nem reális, de talán nem is szükséges. A leghelyesebb az egyéni vérnyomásprofil meghatározása, és számos befolyásoló tényezőt is figyelembe kell venni a páciens legmegfelelőbb kezeléséhez. A populáció egészségének javításához és megőrzéséhez az egyik legfontosabb és leggyakoribb cardiovascularis kockázati tényezőt, a magas vérnyomást időben fel kell fedezni, amihez a vérnyomást rendszeresen szükséges ellenőrizni, és ezzel párhuzamosan kell végezni a prevenciót célzó tevékenységeket (nevelés, oktatás, szűrés, egészségtudatos életmód) is. Orv Hetil. 2021; 162(34): 1351-1361. Summary. The data in the literature suggest that the increase in the value of systolic blood pressure from 110-115 mmHg leads to the development of atherosclerotic process and to the deterioration of cardiovascular and renal function. The correlation is initially linear, then above 140-150 mmHg it is already exponential, but it is also related to the progression of the age. The systolic target for therapy is between 120-130 mmHg in the population aged 18-65; in older ages - especially over 80 years - it is higher and reaching the value below 130 mmHg is unrealistic, and may even be not necessary. It is the best to determine the individual treatment, taking into account the individual blood pressure profile and the factors influencing the patient. In order to improve and maintain the health of the population - in addition to unknown hypertension - it is necessary to regularly monitor blood pressure and apply the known preventive methods (education, training, screening, etc). Orv Hetil. 2021; 162(34): 1351-1361.
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Hypertension is most common life style disease in the world nowadays and becomes a challenge to medical field, as it cannot be cured although it can be controlled with continuous medications. Ayurveda, the richest and oldest Indian medical science mentioned certain principles of life style and food regimen which can effectively help to prevent this hazard, if followed promptly. However Hypertension has been not mentioned as a separate disease in Ayurveda, as it is a symptom seen due to multifactorial causative involvement. Still many efforts were made to understand the pathology of Hypertension in Ayurveda in relation to contemporary medical science understanding and certain terms like Dhamani pratichaya, Dhamani Upalepa, Rakta gata vata, Siragatha vata, Prana vata, Vyan vata, and Aavrut vata were explained. As Hypertension is not a disease, rather a sequel of underlying pathological entity or complication of certain disorders or outcome of lifestyle derangement, it is quite difficult to establish the exact clinical entity in Ayurveda, and hence it has to be understood on the basis of symptomatology of the patient. The present article is an attempt to throw some light on clinical understanding of Essential Hypertension (EHT) in terms of Ayurveda based clinical symptomatology of the patient along with insight on pathology as per Ayurveda
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The study of hemodynamic mechanisms in children and young people with primary hypertension has been neglected historically. An understanding of the abnormalities in the function of the large arteries, the left ventricle, and their interaction may be important to elucidate the development and observed effects of hypertension. In this chapter, we discuss cardiovascular influences that determine blood pressure; highlighting the static and pulsatile components of blood pressure and review the published literature evaluating hemodynamics in children with hypertension. We compare findings in hypertensive children with those with normotension. Increasing data support a cardiac and large artery component in early hypertension in children and young people. Increase in cardiac output appears to be the earliest identifiable abnormality in children and young people (CYP) with increased systemic vascular resistance (SVR) in hypertensive young adults. Given the tracking of hypertension from children to adults, the finding of a cardiac/aortic rather than peripheral vascular changes associated with primary hypertension has implications for the etiology of hypertension both in children and adults. It also has implications for the best treatment in children.
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Puerarin (Pue) has been widely used in the treatment of hypertension and cardiovascular diseases, but the basic mechanism of Pue on myocardial remodeling (MR) of hypertension is not clear. The purpose of this study was to investigate the effect and mechanism of Pue on MR and provide the basis for the clinical application. Thirty male spontaneously hypertensive rats (SHR) and six male Wistar Kyoto rats (WKY) aged 3 months were used in this study, SHR rats were randomly divided into 5 groups, Pue (40 or 80 mg/kg/d, ip) and telmisartan (TELMI) (30 mg/kg/d, ig) were administrated for 12 weeks. We used Echocardiography to detect the cardiac function. Morphology and structure of myocardium were observed. H9C2 cells were subjected to 1 μM Ang Ⅱ in vitro, 100 μM Pue, 0.5 μM Calmodulin-dependent calcineurin (CaN) inhibitor Cyclosporin A (CsA) and 1 μM specific transient receptor potential channel 6 (TRPC6) inhibitor SAR7334 were used in H9C2 cells. Long-term administration of Pue could significantly improve cardiac function, improve morphology and structure of myocardium in vivo. Pue could reduce MR related proteins expression (ACTC1, TGF-β1, CTGF, β-MHC and BNP), attenuate ROS, restore MMP and decrease Ca²⁺-overload in vitro. Further study indicated that Pue could decrease TRPC6 expression and inhibit nuclear factor of activated T cells 3 (NFATc3) nuclear translocation in vitro. These results suggested that puerarin could ameliorate myocardial remodeling through inhibiting TRPC6-CaN-NFATc3 in spontaneously hypertensive rats.
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Background Prehypertension is a pre-disease state wherein an individual has a blood pressure (BP) measurement above normal (≥120/80 mmHg) but below the hypertensive range (<140/90 mmHg). Large population-based studies have shown that individuals with a BP in the prehypertensive range have an increased risk of developing hypertension and cardiovascular events. Despite these risks and high mortality rates associated with pre-hypertension, there are currently no reviews that define the prevalence of pre-hypertension in the Saudi population. Objective To determine the magnitude of the pre-hypertension problem among Saudi adults and identify areas for future research based on the current gaps in the literature. Methods This narrative review considers studies addressing the prevalence of pre-hypertension among Saudi adults; 8 studies were identified for this review. Results In total, 14,782 men and women participated in these studies. The overall prevalence of pre-hypertension in both sexes ranged from 18.5-54.9%. Men had higher rates of pre-hypertension (24.7-66.1%) than women (7-48.1%).A modifiable risk factor reported in the majority of the studies was increased adiposity. Conclusion Lifestyle changes to reduce weight may be effective in preventing or at least delaying the progression to hypertension and its associated cardiovascular events. Large, prospective, epidemiological studies are needed to estimate the risk of incident hypertension and cardiovascular events in pre-hypertension patients. Randomized clinical trials are also needed to evaluate the effectiveness of lifestyle modification and/or pharmacotherapy in reducing the risk of incident hypertension.
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Despite extensive studies on blood pressure, its genetic risk factors remain uncertain. Even one of the most researched blood pressure-related traits - renin - is not fully understood genetically. Here, we determine the genetic relationship and associated predisposition between blood pressure and baseline renin. In 8840 Korean individuals, we observed a strong negative genome-wide genetic correlation (rg = −0.484) between systolic blood pressure (SBP) and plasma renin activity (PRA), suggesting that antagonistic genetic signals explain the variance in the two traits. We found 51 significant pleiotropic SNPs affecting the two traits, which could contribute to the Renin-Angiotensin-Aldosterone System (RAAS). Our findings provide insight into studies on RAAS by identifying the genome-wide relationship and susceptibility loci of SBP and PRA.
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Peppermint (Mentha piperita) is one of the most important EO(essential oil crops) and is cultivated worldwide. It is composed primarilyof monoterpenes, whose medicinal properties are mainly due to their EO composition, accumulated in glandular trichomes. Nowadays, agriculturerelies heavily on the use of synthetic chemicals, such as fertilizers andpesticides, to achieve high yields but without taking into account theirdeleterious effects on the environment. However, there is an interestingbiotechnological alternative using microorganisms to increase theavailability and intake of nutrients by crops and to control phytopathogenicorganisms and herbivorous insects. The group of bacteria termed plantgrowth-promoting rhizobacteria (PGPR) colonizes the rhizosphere andstimulates plant growth and development by direct or indirect mechanisms.Thus, in the search for new strategies of plant production to optimizeessential oil (EO) yield, inoculation with PGPR is an interesting candidate.We present here an integrated summary of our experimental findings froman analysis of the community of fluorescent Pseudomonas strains in therhizosphere of commercially grown Mentha piperita, including the effectsof inoculation and co-inoculation with different PGPR strains (native andwild type) on total EO yield and glandular trichome density. Thequalitative and quantitative compositions of the main monoterpenes(menthol, menthone, pulegone, limonene and linalool) were alsodetermined to analyze the effects of the volatiles emitted byPGPR rhizobacteria on EO production. The various PGPR strains(Bacillus amyloliquefaciens GB03, Pseudomonas fluorescens WCS417r,Azospirillum brasilense SP7, Pseudomonas putida SJ04-SJ25-SJ48) andco-inoculations evaluated produced significant increases in the productionof EO in peppermint plants, but at different magnitudes. Bacterialinoculants are thus an effective biotechnological tool for stimulating thesecondary metabolism in plants. Application of these techniques maycontribute to environmental conservation, increased crop productivity andsustainable agricultural practices.
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Background The burden of uncontrolled hypertension in sub-Saharan Africa (SSA) is high and hypertension is known to coexist with other chronic diseases such as kidney disease, diabetes among others. This is the first systematic review and meta-analysis to determine the burden of uncontrolled hypertension among patients with comorbidities in SSA. Methods A comprehensive search was conducted on MEDLINE, Excerpta Medica Database (Embase) and Web of Science to identify all relevant articles published between 1 January 2000 and 17 June 2021. We included studies that reported on the prevalence of uncontrolled hypertension among people in SSA who report taking antihypertensive treatment and have another chronic condition. A random-effects meta-analysis was performed to obtain the pooled estimate of the prevalence of uncontrolled hypertension among patients with comorbid conditions while on treatment across studies in SSA. Results In all, 20 articles were included for meta-analyses. Eleven articles were among diabetic patients, five articles were among patients with HIV, two were among patients with stroke while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with comorbidities was 78.6% (95% CI 71.1% to 85.3%); I² 95.9%, varying from 73.1% in patients with stroke to 100.0% in patients with atrial fibrillation. Subgroup analysis showed differences in uncontrolled hypertension prevalence by various study-level characteristics Conclusion This study suggests a high burden of uncontrolled hypertension in people with comorbidities in SSA. Strategies to improve the control of hypertension among people with comorbidities are needed. PROSPERO registration number CRD42019108218.
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This paper discusses the clinical and pathogenetic aspects of hypertension comorbid with type 2 diabetes mellitus. The role of sympathetic hyperactivation in the mechanisms of this comorbidity and the damage to target organ are reviewed. Authors analyze the capabilities of endovascular renal artery denervation and discuss the mechanisms of therapeutic effect of this procedure. The article is intended for cardiologists, therapists, endocrinologists, and endovascular surgeons.
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Accumulating evidence suggests that the molecular circadian clock is crucial in blood pressure (BP) control. Circadian rhythms are controlled by the central clock, which resides in the suprachiasmatic nucleus of the hypothalamus and peripheral clocks throughout the body. Both light and food cues entrain these clocks but whether these cues are important for the circadian rhythm of BP is a growing area of interest. The peripheral clocks in the smooth muscle, perivascular adipose tissue, liver, adrenal gland, and kidney have been recently implicated in the regulation of BP rhythm. Dysregulation of the circadian rhythm of BP is associated with adverse cardiorenal outcomes and increased risk of cardiovascular mortality. In this review, we summarize the most recent advances in peripheral clocks as BP regulators, highlight the adverse outcomes of disrupted circadian BP rhythm in hypertension, and provide insight into potential future work in areas exploring the circadian clock in BP control and chronotherapy. A better understanding of peripheral clock function in regulating the circadian rhythm of BP will help pave the way for targeted therapeutics in the treatment of circadian BP dysregulation and hypertension.
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Hypertension has become an increasing health concern given that it is a major risk for cardiovascular disease. Synthetic antihypertensive drugs, including angiotensin-converting enzyme (ACE) inhibitors, effectively control high blood pressure but are associated with unpleasant side effects. Milk fermented by certain lactic acid bacteria (LAB) provides energetic contributions to the management of hypertension, especially the regulation of ACE. LAB are important food-grade microbial organisms that release ACE inhibitory peptides through their unique proteolysis system, which consists of cell-envelope proteinases (CEPs), transporter systems, and intracellular peptidases. Thus, the description of LAB proteolysis system genes and their contributions to ACE inhibitory peptide production is a challenging but promising study. This review provides a survey of LABs with potential ACE inhibitory activity and investigates the research progress of LAB proteolytic systems with an emphasis on the correlation of their components and ACE inhibitory activity. Subsequently, a depiction of the ACE inhibitory peptide action mechanism, structure-activity relationship and bioavailability is presented. The improved functional annotation of LAB proteolytic system genes will provide an excellent framework for future experimental validations of predicted ACE inhibitory activity in fermented milk.
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Background: Automated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the "white coat effect" and shows a strong association with ambulatory blood pressure. Methods and results: We conducted a cross-sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland-Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (-5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, -6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and -2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician). Conclusions: Our findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting.
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Hypertension Canada provides annually-updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines were introduced, and one existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke was revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
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Hypertension Canada provides annually-updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic blood pressure readings ≥140 mmHg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic pressure ≤60 mmHg, especially in the presence of left ventricular hypertrophy. Following a hemorrhagic stroke, in the first 24 hours, systolic blood pressure lowering to <140 mmHg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of <120 mm Hg, when compared with <140 mm Hg, resulted in lower nighttime, daytime, and 24-hour systolic BP, but did not change the night/day systolic BP ratio. Ambulatory BP monitoring may be required to assess the effect of targeted hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835249.
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Background: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. Methods: We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Results: At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group. Conclusions: Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.).
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Aims The SCORE project was initiated to develop a risk scoring system for use in the clinical management of cardiovascular risk in European clinical practice. Methods and results The project assembled a pool of datasets from 12 European cohort studies, mainly carried out in general population settings. There were 205 178 persons (88 080 women and 117 098 men) representing 2.7 million person years of follow-up. There were 7934 cardiovascular deaths, of which 5652 were deaths from coronary heart disease. Ten-year risk of fatal cardiovascular disease was calculated using a Weibull model in which age was used as a measure of exposure time to risk rather than as a risk factor. Separate estimation equations were calculated for coronary heart disease and for non-coronary cardiovascular disease. These were calculated for high-risk and low-risk regions of Europe. Two parallel estimation models were developed, one based on total cholesterol and the other on total cholesterol/HDL cholesterol ratio. The risk estimations are displayed graphically in simple risk charts. Predictive value of the risk charts was examined by applying them to persons aged 45–64; areas under ROC curves ranged from 0.71 to 0.84. Conclusions The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.
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: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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The debate on the generalizability of the SPRINT (Systolic Blood Pressure Intervention Trial) findings raised considerable interest in the technique of unattended office blood pressure (BP) measurement. It remains elusive, however, whether unattended BP measurement yields lower values than conventional measurements in a real world setting with subjects consulting their personal general practitioner in a familiar office. We performed a cross-sectional study in 158 patients in 4 general practitioners' offices and compared conventional auscultatory office BP to unattended automated office BP in 107 subjects (group 1) and unattended to attended automated office BP in another 51 subjects (group 2). Unattended BP was calculated as the mean of 3 automated measurements performed in a separate room after 5 minutes of rest. Additionally, patients documented home BP for 7 days after the consultation. Mean auscultatory office, unattended office and home BP were 144.6/81.0, 144.1/79.9, and 135.5/78.3 mm Hg in group 1; unattended and attended automated office BP were 134.2/80.6 and 135.7/80.6 mm Hg in group 2. Systolic attended and unattended office BP values were significantly higher than home BP (P<0.001, P<0.01, respectively). Attended and unattended office BP, however, did neither show a significant difference in group 1 nor in group 2 (P>0.05 each). Bland-Altman analysis revealed a bias of 0.5 mm Hg systolic and 1.1 mm Hg diastolic in group 1 and -1.5 mm Hg systolic and 0 mm Hg diastolic in group 2. In conclusion, the present findings show that unattended and attended office BP measurements achieve comparable results, if measurements take place at a familiar general practitioner's office.
Article
Importance Clinical trials have documented that lowering blood pressure reduces cardiovascular disease and premature deaths. However, the optimal target for reduction of systolic blood pressure (SBP) is uncertain. Objective To assess the association of mean achieved SBP levels with the risk of cardiovascular disease and all-cause mortality in adults with hypertension treated with antihypertensive therapy. Data Sources MEDLINE and EMBASE were searched from inception to December 15, 2015, supplemented by manual searches of the bibliographies of retrieved articles. Study Selection Studies included were clinical trials with random allocation to an antihypertensive medication, control, or treatment target. Studies had to have reported a difference in mean achieved SBP of 5 mm Hg or more between comparison groups. Data Extraction and Synthesis Data were extracted from each study independently and in duplicate by at least 2 investigators according to a standardized protocol. Network meta-analysis was used to obtain pooled randomized results comparing the association of each 5–mm Hg SBP category with clinical outcomes after adjusting for baseline risk. Main Outcomes and Measures Cardiovascular disease and all-cause mortality. Results Forty-two trials, including 144 220 patients, met the eligibility criteria. In general, there were linear associations between mean achieved SBP and risk of cardiovascular disease and mortality, with the lowest risk at 120 to 124 mm Hg. Randomized groups with a mean achieved SBP of 120 to 124 mm Hg had a hazard ratio (HR) for major cardiovascular disease of 0.71 (95% CI, 0.60-0.83) compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, an HR of 0.58 (95% CI, 0.48-0.72) compared with those with a mean achieved SBP of 140 to 144 mm Hg, an HR of 0.46 (95% CI, 0.34-0.63) compared with those with a mean achieved SBP of 150 to 154 mm Hg, and an HR of 0.36 (95% CI, 0.26-0.51) compared with those with a mean achieved SBP of 160 mm Hg or more. Likewise, randomized groups with a mean achieved SBP of 120 to 124 mm Hg had an HR for all-cause mortality of 0.73 (95% CI, 0.58-0.93) compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, an HR of 0.59 (95% CI, 0.45-0.77) compared with those with a mean achieved SBP of 140 to 144 mm Hg, an HR of 0.51 (95% CI, 0.36-0.71) compared with those with a mean achieved SBP of 150 to 154 mm Hg, and an HR of 0.47 (95% CI, 0.32-0.67) compared with those with a mean achieved SBP of 160 mm Hg or more. Conclusions and Relevance This study suggests that reducing SBP to levels below currently recommended targets significantly reduces the risk of cardiovascular disease and all-cause mortality. These findings support more intensive control of SBP among adults with hypertension.
Article
Although high blood pressure (BP) is the leading risk factors for cardiovascular (CV) disease, the optimal BP treatment target in order to reduce CV risk is unclear in the aftermath of the SPRINT study. The aim of this review is to assess large, randomized, and controlled trials on BP targets, as well as review selected observational analyses from other large randomized BP trials in order to evaluate the benefit of intense vs. standard BP control. None of the studies, except SPRINT, favored intense BP treatment. Some of the studies suggested favorable effects of lowering treatment target in patients with diabetes or high risk of stroke. In SPRINT, a new BP measurement method was introduced, and the results must be interpreted in light of this. The results of the observational analyses indicated the best preventive effect when achieving early and sustained BP control rather than low targets. In conclusion, today's guidelines' recommended treatment target of <140/90mmHg seems sufficient for most patients. Early and sustained BP control should be the main focus.
Article
Background: Hypertension is the leading preventable cause of premature death worldwide. We examined global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compared secular changes from 2000 to 2010. Methods: We searched MEDLINE from 1995 through 2014 and supplemented with manual searches of retrieved article references. We included 135 population-based studies of 968 419 adults from 90 countries. Sex- and age-specific hypertension prevalences from each country were applied to population data to calculate regional and global numbers of hypertensive adults. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates. Results: In 2010, 31.1% (95% confidence interval, 30.0%-32.2%) of the world's adults had hypertension; 28.5% (27.3%-29.7%) in high-income countries and 31.5% (30.2%-32.9%) in low- and middle-income countries. An estimated 1.39 (1.34-1.44) billion people had hypertension in 2010: 349 (337-361) million in high-income countries and 1.04 (0.99-1.09) billion in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension decreased by 2.6% in high-income countries, but increased by 7.7% in low- and middle-income countries. During the same period, the proportions of awareness (58.2% versus 67.0%), treatment (44.5% versus 55.6%), and control (17.9% versus 28.4%) increased substantially in high-income countries, whereas awareness (32.3% versus 37.9%) and treatment (24.9% versus 29.0%) increased less, and control (8.4% versus 7.7%) even slightly decreased in low- and middle-income countries. Conclusions: Global hypertension disparities are large and increasing. Collaborative efforts are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.
Article
The Systolic Blood Pressure (SBP, mm Hg) Intervention Trial (SPRINT) showed that targeting SBP <120 mm Hg (intensive treatment, mean SBP: 121.5 mm Hg) versus <140 (standard treatment, mean SBP: 134.6 mm Hg) reduced cardiovascular events 25%. SPRINT has 2 implicit assumptions that could impact future US hypertension guidelines: (1) standard therapy controlled SBP similarly to that in adults with treated hypertension and (2) intensive therapy produced a lower mean SBP than in adults with treated hypertension and SBP <140 mm Hg. To examine these assumptions, US National Health and Nutrition Examination Survey 2009 to 2012 data were analyzed on 3 groups of adults with treated hypertension: group 1 consisted of SPRINT-like participants aged ≥50 years; group 2 consisted of participants all aged ≥18 years; and group 3 consisted of participants aged ≥18 years excluding group 1 but otherwise similar to SPRINT-like participants except high cardiovascular risk. Mean SBPs in groups 1, 2, and 3 were 133.0, 130.1, and 124.6, with 66.2%, 72.2%, and 81.9%, respectively, controlled to SBP <140; 68.3%, 74.8%, and 83.4% of the controlled subset had SBP <130. Mean SBPs in those controlled to <140 were 123.3, 120.9, and 118.9, respectively. Among US adults with treated hypertension, (1) the SPRINT-like group had higher mean SBP than comparison groups, yet lower than SPRINT standard treatment group and (2) among groups 1 to 3 with SBP <140, SBP values were within <3 mm Hg of SPRINT intensive treatment. SPRINT results suggest that treatment should be continued and not reduced when treated SBP is <130, especially for the SPRINT-like subset. Furthermore, increasing the percentage of treated adults with SBP <140 could approximate SPRINT intensive treatment SBP without lowering treatment goals.
Article
Hypertension control may offer less protection from incident cardiovascular disease (CVDi ) in adults with than without apparent treatment-resistant hypertension (aTRH), ie, blood pressure uncontrolled while taking three or more antihypertensive medications or controlled to <140/<90 mm Hg while taking four or more antihypertensive medications. Electronic health data were matched to health claims for 2006-2012. Patients with CVDi in 2006-2007 or with untreated hypertension were excluded, leaving 118,356 treated hypertensives, including 40,690 with aTRH, and 460,599 observation years. Blood pressure and medication number were determined by all clinic visit means from 2008 to CVDi or end of study. Primary outcome was first CVDi (stroke, coronary heart disease, heart failure) from hospital and emergency department claims. Controlling for age, race, sex, diabetes, chronic kidney disease, and statin use, hypertension control afforded less CVDi protection in patients with aTRH (hazard ratio, 0.87; 95% confidence interval, 0.82-0.93) than without aTRH (hazard ratio, 0.69; 95% confidence interval, 0.65-0.74; P<.001). Strategies beyond hypertension control may prevent more CVDi in patients with aTRH.
Article
Background and objectives: Previous meta-analyses of our group have investigated the cardiovascular effects of more vs. less intense blood pressure (BP) treatment and the BP levels to be achieved by treatment. A few additional trials have been completed recently, particularly the large SPRINT study. Updating of the previous meta-analyses has been done with the objective of further clarifying the practical question of BP targets of antihypertensive treatment. Methods: Among randomized-controlled trials (RCTs) of BP lowering treatment between 1966 and 2015, 16 (52 235 patients) compared more vs. less intense treatment and fulfilled other preset criteria, and in 34 (138 127 patients) SBP in the active (vs. placebo) or the more (vs. less) intense treatment was below (vs., respectively, above) three predetermined cutoffs. For their meta-analyses risk ratios (RR) and 95% confidence intervals, standardized to -10/-5 mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. Results: More intense BP lowering significantly reduced risk of stroke [RR 0.71 (0.60-0.84)], coronary events [0.80 (0.68-0.95)], major cardiovascular events [0.75 (0.68-0.85)] and cardiovascular mortality [0.79 (0.63-0.97)], but not heart failure and all-cause death. When the 16 RCTs were stratified according to cardiovascular death risk, relative risk reduction did not differ between strata, but absolute risk reduction increased with cardiovascular risk, though the residual risk also increased. Stratification of the 34 RCTs according to the three different SBP cutoffs (150, 140 and 130 mmHg) showed that a SBP/DBP difference of -10/-5 mmHg across each cutoff significantly reduced risk of all outcomes to the same proportion (relative risk reduction), but absolute risk reduction of most outcomes had a significant trend to decrease at lower cutoffs. Conclusion: Updating of previous meta-analyses indicates that more vs. less intense BP lowering can reduce not only stroke and coronary events, but also cardiovascular mortality. Including data from recent RCTs also shows that all major outcomes can be reduced by lowering SBP a few mmHg below vs. above 130 mmHg, but absolute risk reduction becomes smaller, suggesting patients at lower initial SBP were at a lower level of cardiovascular risk.
Article
Systolic Blood Pressure Intervention Trial (SPRINT) is a parallel group antihypertensive efficacy study, with randomized allocation to 2 groups: intensive treatment (target clinic systolic blood pressure [BP], 120 mm Hg) and standard treatment (target 140 mm Hg systolic BP), and with blinded outcome adjudication.1 Patient selection aimed to assemble a test hypertension population enriched for existing cardiovascular disease, chronic kidney disease, and patients aged >75 years, but with exclusion of diabetics. For the total population tested, in the intensively treated group a reduction in a composite cardiovascular disease end point (the primary outcome), and in all-cause mortality was demonstrated, compared with standard treatment. SPRINT promises to transform the clinical practice of antihypertensive drug prescribing! In SPRINT, there is a convergence of BP target (here 120 mm Hg systolic) toward the epidemiology linking untreated BP to risk, where incremental cardiovascular risk emerges above a systolic pressure of 100 mm Hg.2 This has of late, subsequent to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial3 been held to be not attainable; those …
Article
Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH.
Article
Background: High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure-related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial. Purpose: To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of trial participants. Methods: The Systolic Blood Pressure Intervention Trial is a multicenter, randomized, controlled trial that compares two strategies for treating systolic blood pressure: one targets the standard target of <140 mm Hg, and the other targets a more intensive target of <120 mm Hg. Enrollment focused on volunteers of age ≥50 years (no upper limit) with an average baseline systolic blood pressure ≥130 mm Hg and evidence of cardiovascular disease, chronic kidney disease, 10-year Framingham cardiovascular disease risk score ≥15%, or age ≥75 years. The Systolic Blood Pressure Intervention Trial recruitment also targeted three pre-specified subgroups: participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), participants with a history of cardiovascular disease, and participants 75 years of age or older. The primary outcome is first the occurrence of a myocardial infarction (MI), acute coronary syndrome, stroke, heart failure, or cardiovascular disease death. Secondary outcomes include all-cause mortality, decline in kidney function or development of end-stage renal disease, incident dementia, decline in cognitive function, and small-vessel cerebral ischemic disease. Results: Between 8 November 2010 and 15 March 2013, Systolic Blood Pressure Intervention Trial recruited and randomized 9361 people at 102 clinics, including 3331 women, 2648 with chronic kidney disease, 1877 with a history of cardiovascular disease, 3962 minorities, and 2636 ≥75 years of age. Limitations: Although the overall recruitment target was met, the numbers recruited in the high-risk subgroups were lower than planned. Conclusions: The Systolic Blood Pressure Intervention Trial will provide important information on the risks and benefits of intensive blood pressure treatment targets in a diverse sample of high-risk participants, including those with prior cardiovascular disease, chronic kidney disease, and those aged ≥75 years.
Article
Background Apparent treatment resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥ 3 antihypertensive medication classes or controlled hypertension while treated with ≥ 4 antihypertensive medication classes. We evaluated the association of aTRH with incident stroke, coronary heart disease (CHD) and all-cause mortality. Methods Participants from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) Study treated for hypertension with aTRH (n=2,043) and without aTRH (n=12,479) were included. aTRH was further categorized as controlled aTRH (≥ 4 medication classes and controlled hypertension) and uncontrolled aTRH (≥ 3 medication classes and uncontrolled hypertension). Results Over a median of 5.9, 4.4, and 6.0 years of follow-up the multivariable adjusted hazard ratio for stroke, CHD, and all-cause mortality associated with aTRH versus no aTRH was 1.25 (0.94 – 1.65), 1.69 (1.27 – 2.24), and 1.29 (1.14 – 1.46), respectively. Compared to controlled aTRH, uncontrolled aTRH was associated with CHD (HR=2.33; 95% CI 1.21 – 4.48), but not stroke or mortality. Comparing controlled aTRH to no aTRH, risk of stroke, CHD and all-cause mortality was not elevated. Conclusion aTRH was associated with an increased risk for coronary heart disease and all-cause mortality.
Article
Background Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease. Methods We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥140 mm Hg despite 3 antihypertensive agents or <140 mm Hg with ≥4 antihypertensive agents. The primary outcome was major cardiovascular events (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, and stroke). Results Among the 10,001 patients in the trial, 1112 (11.1%) had apparent treatment-resistant hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P < .001), driven by a 69% increase in coronary heart disease death (HR, 1.69; 95% CI, 1.22, 2.34; P = .001) and 73% increase in nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.39-2.16, P < .0001) when compared with the no apparent treatment-resistant hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P < .0001), 45% increase in death (P = .001), 33% increase in heart failure (P = .05), 53% increase in any cardiovascular event (P < .0001), 60% increase in any coronary event (P < .0001), 68% increase in angina (P < .0001), and 51% increase in coronary revascularization (P < .0001) when compared with the no apparent treatment-resistant hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥140 mm Hg despite 3 agents or a blood pressure <140 mm Hg with ≥4 agents. Conclusions In patients with coronary artery disease, apparent treatment-resistant hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death.
Article
Manual blood pressure (BP) is gradually disappearing from clinical practice with the mercury sphygmomanometer now considered to be an environmental hazard. Manual BP is also subject to measurement error on the part of the physician/nurse and patient-related anxiety which can result in poor quality BP measurements and office-induced (white coat) hypertension. Automated office (AO) BP with devices such as the BpTRU (BpTRU Medical Devices, Coquitlam, BC) has already replaced conventional manual BP in many primary care practices in Canada and has also attracted interest in other countries where research studies using AOBP have been undertaken. The basic principles of AOBP include multiple readings taken with a fully automated recorder with the patient resting alone in a quiet room. When these principles are followed, office-induced hypertension is eliminated and AOBP exhibits a much stronger correlation with the awake ambulatory BP as compared with routine manual BP measurements. Unlike routine manual BP, AOBP correlates as well with left ventricular mass as does the awake ambulatory BP. AOBP also simplifies the definition of hypertension in that the cut point for a normal AOBP (< 135/85 mm Hg) is the same as for the awake ambulatory BP and home BP. This article summarizes the currently available evidence supporting the use of AOBP in routine clinical practice and proposes an algorithm in which AOBP replaces manual BP for the diagnosis and management of hypertension.
Article
Discordance between blood pressure (BP) measurement methods can occur and create ambiguity. New automated office BP monitors (AOBPs) are widely available, but their role is presently unclear. The objectives of this study are to quantify concordance among BP measurement methods and to define the diagnostic sensitivity, specificity, and predictive value of AOBPs in a population of hypertensive patients. The office mercury sphygmomanometer, the AOBP, an ambulatory BP monitor (ABPM), and home self-measurement with an automatic device were compared in a randomized, crossover study. BP averages and achievement of therapeutic goals were defined. Comparisons and agreement tests were performed. Diagnostic indices were calculated for the AOBP. A total of 101 patients were enrolled. Average BP results were similar between measurement methods with the exception of daytime ABPM, which was significantly higher; figures are mean ± standard deviation (SD): sphygmomanometer, 129.9 ± 13.7/80.9 ± 9.3 mm Hg; AOBP, 128.4 ± 13.9/80.0 ± 9.4 mm Hg; 24-hour ABPM, 131.4 ± 11.7/78.7 ± 9.7 mm Hg; day ABPM, 135.5 ± 11.4/82.0 ± 11.9 mm Hg; home self-measurement, 131.0 ± 14.3/82.5 ± 8.2 mm Hg. Discordance in the achievement of therapeutic goals was observed in 58 patients, with only 26 cases being explained by masked hypertension or "white coat syndrome" according to all measurements. Disagreement was greater when office methods were compared with ambulatory methods. This study shows that the 4 measurement strategies provide similar average BP estimates but generate many discordant results. The AOBP device can be very valuable as a replacement for the sphygmomanometer.
Article
The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure. We aimed to reliably establish the prognostic significance of visit-to-visit variability in blood pressure, maximum blood pressure reached, untreated episodic hypertension, and residual variability in treated patients. We determined the risk of stroke in relation to visit-to-visit variability in blood pressure (expressed as standard deviation [SD] and parameters independent of mean blood pressure) and maximum blood pressure in patients with previous transient ischaemic attack (TIA; UK-TIA trial and three validation cohorts) and in patients with treated hypertension (Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm [ASCOT-BPLA]). In ASCOT-BPLA, 24-h ambulatory blood-pressure monitoring (ABPM) was also studied. In each TIA cohort, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SD SBP over seven visits in UK-TIA trial: 6.22, 95% CI 4.16-9.29, p<0.0001), independent of mean SBP, but dependent on precision of measurement (top-decile HR over ten visits: 12.08, 7.40-19.72, p<0.0001). Maximum SBP reached was also a strong predictor of stroke (HR for top-decile over seven visits: 15.01, 6.56-34.38, p<0.0001, after adjustment for mean SBP). In ASCOT-BPLA, residual visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (eg, top-decile HR for stroke: 3.25, 2.32-4.54, p<0.0001), independent of mean SBP in clinic or on ABPM. Variability on ABPM was a weaker predictor, but all measures of variability were most predictive in younger patients and at lower (<median) values of mean SBP in every cohort. Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events. None.
Article
Considering the reproducibility of blood pressure readings the epidemiologist and the physician in his clinical work take two different points of view. Studying drug effects the epidemiologist is interested in significant differences of blood pressures in a study population. The physician however, who estimates the effect of his prescription given to an individual patient has to compare single blood pressure readings in single individuals. In a pharmacological study we accept without any doubt the need of certain numbers of investigations to define a difference of 10 mm Hg as significant. In clinical routine however we behave quite differently and judge single readings intuitively as equal or different, independent of any statistical considerations. Not only the doctor but also the scientific societies with the highest reputation share the same point of view. In their recommendations they accept an arithmetic mean of two blood pressure readings as sufficient to judge blood pressures in individuals. In order to discuss this topic primarily from the doctors point, we analysed repeated blood pressure readings of 21 volunteers who tested 20 different blood pressure devices. We conclude, that the ongoing practice of judging the blood pressures of the patients meets only the needs of the epidemiologist. Reproducibility of single readings or mean values of two readings however are insufficient to draw satisfactory conclusions from the distributions of blood pressure in single individuals. Due to the short and long term blood pressure variability increasing the numbers of readings within a single day does not improve reproducibility sufficiently. It seems that the amount of blood pressure readings which are necessary to improve reproducibility of "the patients blood pressures" should be increased and taken over several days. If this is true, daily self-recordings should be the most promising approach.
Article
Once considered an inconsequential part of the aging process, an age-associated rise in systolic blood pressure (SBP) occurs as a consequence of increased arterial stiffness and contributes to a high prevalence of systolic hypertension after middle-age. Elevated SBP imparts a predilection toward the onset of vascular events, highlighting the importance of its control. Current philosophy ranks systolic pressure as the most relevant component of blood pressure (BP) for determining risk for cardiovascular and other events in hypertensive patients, particularly those >50 years of age. Despite its prognostic role, SBP remains more difficult to control than diastolic BP (DBP), and most middle-age and older hypertensive patients fail to achieve recommended targets. In part, the lack of strict control of SBP in the more aged population lies in the physiology of hypertension. Younger persons tend toward isolated diastolic hypertension or combined systolic-diastolic hypertension, primarily driven by increased peripheral resistance and more effectively treated by antihypertensive medications; whereas older persons develop isolated systolic hypertension (ISH) associated with increased arterial stiffness that appears to be less amenable to current therapies. Thus, diastolic pressure in hypertensive patients often plateaus as patients reach middle-age and subsequently declines, whereas systolic pressure consistently rises through the ensuing decades. Treatment approaches favoring control of DBP frequently result in residual high SBP, putting patients at greater risk for vascular complications. Improving patient outcomes relies on antihypertensive therapy that appropriately addresses control of SBP and pulse pressure, underscoring the importance of therapeutic options that effectively reduce arterial stiffness.
Article
Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.
Unattended blood pressure measurement in the Systolic Blood Pressure Intervention Trial: implications for entry and achieved blood pressure values compared to other trials
  • Kjeldsen
Generalizability of SPRINT results to the U.S. adult population
  • Bress