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Efficacy of individualized homeopathic medicines in intervening with the progression of pre-hypertension to hypertension: A double-blind, randomized, placebo-controlled trial
Abstract
Context
Pre-hypertension remains a significant public health challenge and appropriate intervention is required to stop its progression to hypertension and/or cardiovascular diseases.
Objective
To study the effects of individualized homeopathic medicines (IH) against placebo in intervening with the progression of pre-hypertension to hypertension.
Design
Double-blind, randomized, two parallel arms, placebo-controlled trial.
Setting
Outpatient departments of D. N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India.
Patients
Ninety-two patients suffering from pre-hypertension; randomized to receive either IH (n=46) or identical-looking placebo (n=46).
Interventions
IH or placebo in the mutual context of lifestyle modification (LSM) advices including dietary approaches to stop hypertension (DASH) and brisk exercises.
Main outcome measures
Primary – systolic and diastolic blood pressure (SBP and DBP); secondary – Measure Yourself Medical Outcome Profile version 2.0 (MYMOP-2) scores; all measured at baseline, and every month, up to 3 months.
Results
After 3 months of intervention, the number of patients having progression from pre-hypertension to hypertension between groups were similar without any significant differences in between (all P>0.05). Reduction in BP and MYMOP-2 scores were non-significantly higher (all P>0.05) in the IH group than placebo with small effect sizes. Lycopodium clavatum, Thuja occidentalis and Natrum muriaticum were the most frequently prescribed medicines. No harms or serious adverse events were reported from either group. Thus, there was a small, but non-significant direction of effect favoring homeopathy, which ultimately rendered the trial as inconclusive. [Trial registration: CTRI/2018/10/016026; UTN: U1111-1221-8251]
... Patients aged between 12 and 30 years, suffering from mild (Global Acne Grading System [GAGS], 1-18) to moderate (GAGS, [19][20][21][22][23][24][25][26][27][28][29][30] forms of AV (ICD-10-CM code: L70.0), 20 of either sex, literate in Bengali and consenting to participate, were eligible to be included. Exclusion criteria were patients with severe (GAGS, 31-38) to very severe (GAGS, 39 or higher) forms of AV, any uncontrolled systemic or psychiatric diseases or life-threatening illness (e.g., cancer, diabetes, epilepsy, severe asthma, ischemic heart diseases), a selfreported immuno-compromised state, pregnancy, puerperal and lactating women, subjects on hormonal contraceptives, steroids or non-steroidal anti-inflammatory drugs, those using oil-based cosmetics or undergoing ...
... Similar "dual effects" have also been observed in some other placebo-controlled RCTs in homeopathy. [28][29][30][31] Several single-arm studies have been conducted in homeopathy to evaluate its effects on AV. Neither the sample sizes nor the study designs were adequate to yield any clear conclusions. ...
Introduction Acne is estimated to affect 9.4% of the global population, making it the 8th most prevalent disease worldwide. Acne vulgaris (AV) is among the diseases that directly affect quality of life. This trial evaluated the efficacy of individualized homeopathic medicines (IHM) against placebo in AV.
Methods In this double-blind, randomized, placebo-controlled trial conducted at the National Institute of Homoeopathy, India, 126 patients suffering from AV were randomized in a 1:1 ratio to receive either IHM (verum) in centesimal potencies or identical-looking placebo (control). The primary outcome measure was the Global Acne Grading System score; secondary outcomes were the Cardiff Acne Disability Index and Dermatology Life Quality Index questionnaires — all measured at baseline and 3 months after the intervention. Group differences and effect sizes (Cohen's d) were calculated on the intention-to-treat sample.
Results Overall, improvements were greater in the IHM group than placebo, with small to medium effect sizes after 3 months of intervention; however, the inter-group differences were statistically non-significant. Sulphur (17.5%), Natrum muriaticum (15.1%), Calcarea phosphorica (14.3%), Pulsatilla nigricans (10.3%), and Antimonium crudum (7.1%) were the most frequently prescribed medicines; Pulsatilla nigricans, Tuberculinum bovinum and Natrum muriaticum were the most effective of those used. No harms, unintended effects, homeopathic aggravations or any serious adverse events were reported from either group.
Conclusion There was non-significant direction of effect favoring homeopathy against placebo in the treatment of AV.
Trial Registration: CTRI/2018/11/016248; UTN: U1111–1221–8164.
Background: Hypertension is a growing health concern and is a major risk factor for cardiovascular diseases and stroke. Homeopathy is one of the most frequently used complementary medicines for various clinical conditions, but the state of current evidence for hypertension is not well characterized. This scoping review aims to map the current state of evidence and explore the range of prescription methods used in homeopathy for this condition. Methods: Three electronic databases (PubMed, Cam-Quest, Core-Hom) were systematically searched for published studies evaluating the effects of homeopathic medicines on hypertension. Studies that assessed the impact of homeopathy on hypertension, published in the English 1422language, from 1950 till December 2023, were included. Data were extracted and organized in a spreadsheet, capturing study population characteristics, prescription methods, outcomes, and specific homeopathic medicines used. Results:A total of 18 studies met the inclusion criteria. The primary outcome assessed in most studies was blood pressure, including systolic and diastolic measurements. Eleven studies reported a statistically significant reduction in blood pressure with homeopathic treatment. Both individualized homeopathy (n=11) and prescription based on specific remedies or complex homeopathy (n=7) demonstrated improvements in hypertension. Lifestyle modifications were consistently incorporated into the management plans in all the studies. However, most of the included studies had short treatment durations. The review provides a list of potentially helpful homeopathic medicines for future research. Conclusion:This scoping review reveals a limited number of studies that have examined the effect of homeopathic medicines in managing hypertension. In addition, determining the optimal prescription method for homeopathy in hypertension management remains challenging. Further research, including well-designed randomized controlled trials with larger sample sizes and long-term follow-up, is warranted to strengthen the evidence base.
Objectives
Hypertension (HTN) or elevated blood pressure is a serious medical condition that significantly increases the risk of heart, brain, kidney, and other diseases. HTN in an adult is said to be present when clinical systolic and diastolic blood pressure exceed 140 mm and 90 mm of hg, respectively. An estimated 1.28 billion people aged 30–79 years have HTN worldwide, most (two-thirds) living in low- and middle-income countries (World Health Organization). Homoeopathy can be useful in managing HTN and its complications, for which a proper knowledge of treatment modalities available in homoeopathy is essential.
Materials and Methods
An intensive search of articles, publications, and writings, both online and offline, dealing with the management of essential HTN through homoeopathy was conducted between November 2021 to January 2022. Databases such as Google Scholar, PubMed, ScienceDirect, and various other published books, literature, and anecdotes in homoeopathy were explored, collecting data on the role of homoeopathy in essential HTN. Emphasis was on words such as homoeopathy, HTN, and blood pressure.
Results
Management of essential HTN through homoeopathy can be broadly divided into two categories. First, drugs or medicines given in homoeopathic literature, such as Materia Medicas and Repertories, whose choice of administration in HTN depends on the classical methods of prescription, and secondly, drugs or medicines obtained from research outcomes on HTN.
Conclusion
In homoeopathic therapeutics, many medicines are available and used in cases of essential HTN. Recently, research activities targeted toward managing HTN through homoeopathy have increased, and data have been generated. Even then, the available data till now are not sufficient in bringing homoeopathy equivalent or near to the conventional system of medicine in managing HTN demands; in turn, more research works in homoeopathy with statistical rigour.
Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebo-controlled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM) =116 or placebo + LSM = 101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F = 12.12, df = 213,P = 0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mm Hg, 95% confidence interval [CI] 4.72–9.53,P = 0.0001) and DBP (mean difference 5.76 mm Hg, 95% CI: 4.18–7.23,P = 0.0001) favouring Homoeopathy plus LSM group. Sulphur (n = 24), Natrum muriaticum (n = 21), Lycopodium (n = 16), Nux vomica (n = 12) and Phosphorus (n = 10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted.
Importance
Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level.
Objective
To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population.
Data Sources
PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension (hypertension OR high blood pressure OR elevated blood pressure), children (children OR adolescents), and prevalence (prevalence OR epidemiology).
Study Selection
Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions.
Data Extraction and Synthesis
Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend.
Main Outcomes and Measures
Prevalence of childhood hypertension overall and by subgroup.
Results
A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years.
Conclusions and Relevance
This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.
The clinical and experimental data on seasonal variation in blood pressure is mainly from office and home blood pressure (BP) monitoring studies. There are few studies from temperate climates on seasonal changes with ambulatory blood pressure (ABP) monitoring and none from India. This is a prospective, observational study among healthy adults. ABP was measured in four different seasons in 28 subjects. Mean arterial pressure (MAP), ambulatory systolic blood pressure (SBP), and ambulatory diastolic blood pressure (DBP) were significantly higher in winter compared to summer season. 24-hour MAP was lowest in summer while highest MAP was recorded in winter (97.04 ± 8.30 and 103.89 ± 8.54, respectively). The mean difference was −6.86 mm Hg (95% CI: −10.74 to −2.97, p = 0.001). This difference was mainly due to increase in day time MAP. There was no difference in 24 h systolic and diastolic blood pressure between summer and winter. There was significant difference between summer and winter in the SBP (day time) [125.61 ± 11.44 and 131.93 ± 9.46, mean difference −6.32 (95% CI: −10.69 to −1.95, p = 0.005)] and DBP (day time) [79.57 ± 9.95 and 87.07 ± 9.9, mean difference −7.50 (95% CI: −12.49 to −2.51, p = 0.003)]. The night time systolic and diastolic BP was similar during winter and summer. Thus, BP increases significantly during winter compared to summer season. This change is primarily in the day time systolic, diastolic and mean blood pressures. Larger studies are required to further validate our findings.
Hypertension is one of the major causes of morbidity and mortality. Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. This led WHO to set a target of 25% reduction in prevalence by 2025. To reach that, WHO has adopted non-conventional methods for the management of hypertension? Despite worldwide popularity of such non-conventional therapies, only small volume of evidence exists that supports its effectiveness. This review attempted to make a critical appraisal of the evidence, with the aim to (1) describe the therapeutic modalities frequently used, and (2) review the current level of evidence attributable to each modality. Databases from Cochrane Library, MEDLINE, PUBMED, and EMBASE were searched from 2005-2015. A total of 23 publications have been identified and selected. Out of these, 15 systematic reviews and/or meta-Analysis of RCTs, 5 RCTs, 1 non-RCT, and 2 observational studies without control. Among those 23 publications, therapeutic modalities identified are: fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, Vitamin D, Vitamin C, monounsaturated fatty acids, dietary aminoacids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-Arginine. The followings were found to have weak or no evidence: fish oil, yoga, Vitamin D, monounsaturated fatty acid, dietary amino-Acids, and osteopathy. Those found to have significant reduction in blood pressure are: magnesium, qigong, melatonin, meditation, Vitamin C, chiropractic, folate, inorganic nitrate, beetroot juice and L-Arginine. Coenzyme Q10on the other hand, showed contradicting results were some studies found weak or no effect on blood pressure while others showed significant blood pressure reduction effect. By virtue of the research designs and methodologies, the evidence contributed from these studies is at level 1. Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidencebased approach.
The article discussed the immanent problems of meta-analyses selecting a number of independent trials in homeopathy, within which, the purpose was to examine the effectiveness of homeopathic treatment. Our focus lied in clarifying that the complex effects of homeopathic treatment known from history and day-to-day practice have not been respected so far.
The examination of most of the homeopathic trials showed that studies rarely account for homeopathic principles, in order to assess the effectiveness of the treatment. The main flaw was that trials reflect the point of view that the treatment with a specific remedy could be administered in a particular disease. However, homeopathy aims to treat the whole person, rather than the diseases and each case has to be treated individually with an individualized remedy. Furthermore, the commonly known events during the course of homeopathic treatment, such as “initial aggravation” and “symptom-shift” were not considered in almost all the studies. Thus, only few trials were eligible for meta-analyses, if at all. These and other factors were discussed and certain homeopathic principles were suggested to be respected in further trials. It is expected, that a better understanding of homeopathic principles would provide guidelines for homeopathic research, which are more acceptable to both homeopathy and conventional medicine.
Accounting for subject nonadherence and eliminating inappropriate subjects in clinical trials are critical elements of a successful study. Nonadherence can increase variance, lower study power and reduce the magnitude of treatment effects. Inappropriate subjects (including those who do not have the illness under study, fail to report exclusionary conditions, falsely report medication adherence, or participate in concurrent trials) confound safety and efficacy signals. This paper, a product of the International Society for CNS Clinical Trial Methodology (ISCTM) Working Group on Nonadherence in Clinical Trials, will explore and model nonadherence in clinical trials, and put forth specific recommendations to identify and mitigate its negative effects. These include statistical analyses of nonadherence data, novel protocol design, and the use of biomarkers, subject registries and/or medication adherence technologies. This article is protected by copyright. All rights reserved.
We conducted the present study to assess the prevalence of hypertension, prehypertension, normotension and the associated factors along with awareness, treatment and control of hypertension among police personnel in Bankura, West Bengal, India.
We collected information on individual, lifestyle, service-related and anthropometric characteristics of 1817 police personnel. We also measured blood pressure (BP) and plasma glucose level of the participants. Individuals were classified as hypertensive (BP ≥ 140/ 90 mmHg), prehypertensive (BP 120-139/ 80-89 mmHg) and normotensive (BP < 120/ 80 mmHg) on the basis of BP and their prevalence were expressed in percentages. Relation of individual, lifestyle, service-related and anthropometric characteristics with hypertension and/or prehypertension was examined with binary logistic regression.
Prevalence of hypertension, prehypertension and normotension are 41.9%, 42.9% and 15.2% respectively. Even one-quarter of below 40 years subjects have hypertension. Mean BP remains in the prehypertensive range. Prevalence of hypertension and mean BP increases with age. Cardiovascular risk factors show clustering in higher age and with hypertension. Older age group, male gender, abdominal obesity, diabetes and service length are positively associated with hypertension and/or prehypertension. Around 40% of hypertensive knew their status, three-quarter of aware subjects received treatment and only one-third of treated subjects have controlled BP (< 140/ 90 mmHg).
High prevalence of hypertension and prehypertension, high mean BP, mean age above 40 years and clustering of other risk factors pose a greater risk of cardiovascular morbidity in the current study population.
Background: Hypertension is the most common cardiovascular disorder posing a major public health challenge to the population. Homoeopathy, although widely used in hypertension, is assumed to have nothing but placebo effects and its specific clinical effects are frequently ascribed as implausible. Aims: To evaluate whether individualized homoeopathy can produce any significant effect different from placebo in essential hypertension by comparing the lowering of blood pressure between groups. Settings and Design: A prospective, double-blind, randomized, placebo-controlled, parallel-arm clinical trial was conducted at the Outpatient Clinic of the Mahesh Bhattacharyya Homoeopathy Medical College and Hospital, West Bengal. Material and Methods: Out of 233 hypertensives assessed for eligibility, 150 were enrolled and randomized (verum/homoeopathy 70, control/placebo 80). A total of 18 dropped out and 132 were regular (verum 64, control 68). The outcome measures were assessed after three months and six months. Statistical Analysis: The intention-to-treat population was subjected to statistical analysis. Group differences were tested using the χ 2 test and independent t test. Repeated measure (ANOVA) was performed to compare the data of two groups obtained longitudinally at baseline, three months and six months. Results: The baseline data were not significantly different between the groups. After six months, mean Systolic Blood Pressure (SBP) reduction was 26.6 mm Hg (95% CI 21.5, 31.7) in the homoeopathy group and SBP increased by 3.6 mm Hg (95% CI -8.7, 1.5) in the placebo group. Similarly, the mean Diastolic Blood Pressure (SBP) in the homoeopathy group reduced by 11.8 mm Hg (95% CI 9.2, 14.4) and increased by 1.6 mm Hg (95% CI -3.6, 0.4) in the placebo group. Repeated measures ANOVA also showed significant difference ( P =0.0001) between the groups. Natrum muriaticum , Calcarea carbonica , Sulphur , Thuja occidentalis , Nitric acid and Medorrhinum were frequently prescribed. Conclusion: Individualized homoeopathy produced a significantly different hypotensive effect than placebo.
Prehypertension (PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease (CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system (RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the potential pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the "Polypill" in prehypertensive subjects to ascertain its potential in delaying (or preventing) CVD associated with raised blood pressure in the presence of other risk factors.
Viscum album, an infrequently used antihypertensive in homeopathy, is evaluated by 1-group pretest-posttest model in primary hypertension. The drug was administered for 12 weeks at a dosage of 10 drops 3 times a day. Using paired t test, a significant drop in blood pressure (P < .0001) and serum triglyceride (P < .0001) was observed in the treatment group. This dual effect of Viscum album shows promise in optimizing therapy for primary hypertension.
Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India.
No standardized homeopathic drug use indicators are available. The researchers used indicators for health care setting (drug availability)-modified prescribing indicators and patient care indicators, based on World Health Organization's core drug use indicators. A cross-sectional, prospective, institutional, observational study of 2-month duration with record analysis was conducted on 600 patients visiting seven different outpatient departments (OPDs) for the first time at Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Howrah, West Bengal, India, using the developed indicators.
Overall availability of prescribed drugs was quite satisfactory (92.28%). Centesimal potencies accounted for the majority of prescriptions (74.76%). There was a poor record of diagnosis (39.17%) except in the OPDs of Gynecology and Obstetrics (68.48%, P < 0.01) and Dermatology (64.58%, P < 0.01). Records of investigational findings and ongoing therapies, if any, were also poor except OPDs of Gynecology and Obstetrics, and Pediatrics. Structure of prescriptions was maintained satisfactorily in all the OPDs. Though tendency of using 'individualized homeopathy' predominated, there also existed the use of 'polypharmacy'. Mean consultation time was 5.9 min. Labeling was extremely poor and is an area needing improvement. The prescriptions were highly legible.
This was a preliminary study, conducted for the first time in homeopathy using newly developed indicators that yield meaningful results. Further studies are necessary in order to evaluate the different factors involved and to plan future interventions to improve the quality of care in healthcare settings.
Prehypertension remains an important public health challenge all over the world and appropriate treatments should be adopted to prehypertensive group in different degree effectively. This review aimed to assess the prevalence of Prehypertension and provide effective evidence of the benefits of treating prehypertensive patients. The reasonable evaluation and appropriate intervention of prehypertensive remain need further study.
Randomized controlled trials often suffer from two major complications, i.e., noncompliance and missing outcomes. One potential solution to this problem is a statistical concept called intention-to-treat (ITT) analysis. ITT analysis includes every subject who is randomized according to randomized treatment assignment. It ignores noncompliance, protocol deviations, withdrawal, and anything that happens after randomization. ITT analysis maintains prognostic balance generated from the original random treatment allocation. In ITT analysis, estimate of treatment effect is generally conservative. A better application of the ITT approach is possible if complete outcome data are available for all randomized subjects. Per-protocol population is defined as a subset of the ITT population who completed the study without any major protocol violations.
Objective:
The present study assessed the feasibility of a definitive placebo-controlled trial for evaluating individualized homeopathy (IH) in stage I hypertension (HTN).
Design:
Double-blind, randomized (IH: 34, placebo: 34), placebo-controlled, parallel arms, pilot trial.
Settings/Location:
National Institute of Homoeopathy, India.
Subjects:
Patients suffering from stage I HTN.
Interventions:
IH and identical-looking placebo.
Outcome measures:
Feasibility issues, blood pressure (BP) and Measure Yourself Medical Outcome Profile-2 (MYMOP-2) were assessed for 6 months.
Results:
The recruitment and retention rates were 44.4% and 85.3%, respectively. Group differences were seemingly higher in the IH group than in the placebo group.
Conclusions:
Despite challenges in recruitment, an adequately powered efficacy trial appears feasible in the future.
KEY POINTS
1) Cardiovascular disease is traditionally treated through medications and lifestyle modifications, yet adherence to these treatments is often poor.
2) The use of complementary therapies, such as nonprescription vitamins and herbs, is increasing, and patients are seeking information from their physicians about the safety and effectiveness of these therapies.
3) When considering integrative therapies for cardiovascular disease, it is important to understand the underlying pathogenesis of the disease, which may be linked to chronic stress, inflammation, and altered gut microbiota.
4) There is evidence for several promising integrative therapies for the treatment and prevention of cardiovascular disease, including specific nutritional approaches, meditation, yoga, acupuncture, and select supplements and herbal therapies.
5) Physicians should be diligent in asking patients about any alternative therapies for cardiovascular disease that they may be using, and be capable of discussing the risk/benefit ratio of these options.
Prehypertension is associated with increased risk for hypertension and cardiovascular disease. Data are limited on the temporal changes in the prevalence of prehypertension and risk factors for hypertension and cardiovascular disease among US adults with prehypertension. We analyzed data from 30 958 US adults ≥20 years of age who participated in the National Health and Nutrition Examination Surveys between 1999 and 2012. Using the mean of 3 blood pressure (BP) measurements from a study examination, prehypertension was defined as systolic BP of 120 to 139 mm Hg and diastolic BP <90 mm Hg or diastolic BP of 80 to 89 mm Hg and systolic BP <140 mm Hg among participants not taking antihypertensive medication. Between 1999-2000 and 2011-2012, the percentage of US adults with prehypertension decreased from 31.2% to 28.2% (P-trend=0.007). During this time period, the prevalence of several risk factors for cardiovascular disease and incident hypertension increased among US adults with prehypertension, including prediabetes (9.6% to 21.6%), diabetes mellitus (6.0% to 8.5%), overweight (33.5% to 37.3%), and obesity (30.6% to 35.2%). There was a nonstatistically significant increase in no weekly leisure-time physical activity (40.0% to 43.9%). Also, the prevalence of adhering to the Dietary Approaches to Stop Hypertension eating pattern decreased (18.4% to 11.9%). In contrast, there was a nonstatistically significant decline in current smoking (25.9% to 23.2%). In conclusion, the prevalence of prehypertension has decreased modestly since 1999-2000. Population-level approaches directed at adults with prehypertension are needed to improve risk factors to prevent hypertension and cardiovascular disease.
This study investigated the relationship between seasonal variations in blood pressure (BP) and the corresponding changes in meteorological parameters and weather-induced patients' discomfort. Hypertensives on stable treatment were assessed in winter-1, summer and winter-2 with clinic (CBP), home (HBP) and 24-hour ambulatory BP (ABP). Discomfort indices derived from temperature, humidity and atmospheric pressure that reflected subjects' discomfort were evaluated. Symptomatic orthostatic hypotension was assessed with a questionnaire. Sixty subjects (mean age 65.1±8.8 [s.d.], 39 men) were analyzed. CBP, HBP and daytime ABP were lower in summer than in winter (P<0.01). Nighttime ABP was unchanged, which resulted in a 55% higher proportion of non-dippers (P<0.001). All the discomfort indices that reflected weather-induced subjects' discomfort were higher in summer (P<0.05) and systolic daytime ABP was <110 mm Hg in 15 subjects (25%). Seasonal changes in temperature and the discomfort indices were correlated with BP changes (P<0.05). Multivariate analyses revealed that winter BP levels, seasonal differences in temperature, female gender and the use of diuretics predicted the summer BP decline. In conclusion, all aspects of the BP profile, except nighttime ABP, are reduced in summer, resulting in an increased prevalence of non-dippers in summer with unknown consequences. Seasonal BP changes are influenced by changes in meteorological parameters, anthropometric and treatment characteristics. Trials are urgently needed to evaluate the clinical relevance of excessive BP decline in summer and management guidelines for practicing physicians should be developed.Hypertension Research advance online publication, 3 September 2015; doi:10.1038/hr.2015.96.
Chapter 185. Human Papillomavirus Infections.
To explore the frequency of CAM use among hypertensive patients in Palestine, determine demographic characteristics that may increase the likelihood of CAM use and to find out how benefits were perceived by patients.
Across-sectional survey of patients attending outpatient hypertension clinics. The method was based on a semi-structured questionnaire.
Of the 4575 hypertensive patients interviewed, 85.7% respondents used at least one type of CAM. Of the 3921 CAM users, 62.13% reported taking herbs. Most of these users were >50 years old, of low educational level, and had a family history of HTN, 62.9% claimed to have obtained the desired effect from taking these herbs; however, 68.1% did not disclose this fact to their health care providers, 83 plant taxa were reported by these patients, Allium sativum was the most commonly used herb.
The use of CAM, particularly herbal therapies for hypertension treatment, is highly prevalent in Palestine.
Prehypertension as an entity has been given Importance after JNC VII report. The magnitude of this problem in India and the importance of recognising prehypertension is slowly growing and getting established. Under these circumstances it was decided to study the prevalence of prehypertension in the city of Belgaum in Karnataka and the literature was reviewed. The objective of this study was to find out the prevalence of prehypertension in the urban population of Belgaum above thirty years of age. The urban population of Belgaum city was screened for prehypertension and hypertension by measuring blood pressure of all individuals aged 30 years and above. Blood pressure of 52196 persons was checked and the data was analysed. JNC VII criteria was used for defining hypertension, prehypertension and normal blood pressure. Among 52196 persons prehypertension was present in 41.1%, 67.1% were in the age group of 30-50 years. The prevalence was similar in both male and female population. Thirty-three percent of diabetic population had prehypertension. About 22.8% of prehypertensives were obese. Prehypertension is highly prevalent in urban population of India, more often seen in persons below 50 years of age. This study recognises the importance of detection of prehypertension and emphasises the need for mass education on life style modification to prevent the development of hypertension and its complications.
Taking into account the toxicology of soluble barium salts, the authors treated 32 hypertensive subjects who were confirned to bed in two old people's homes with Baryta carbonica 15 CH versus placebo in a randomized double-blind study. Seventeen patients were given Baryta carbonica and 15 placebo. Taking the groups as a whole, no statistically significant differences were found between the effects of placebo and active drug on the blood pressure. But the four subjects who had been prospectively considered sensitive and were treated with Baryta carbonica gave strongly positive results. Some interesting conclusions were arrived at both from the general medical and the homœopathic point of view.
To ascertain the ability of a patient-generated outcome measure, the 'Measure Yourself Medical Outcome Profile' (MYMOP), to reflect the outcomes of consultations which patients consider are most important, as derived from qualitative interviews.
A qualitative study using a constant comparative method to analyse semistructured interviews which were then compared with the results of MYMOP questionnaires. A variable-orientated analysis was used to develop themes and a case-orientated analysis was used to develop narrative summaries called vignettes from the interviews. The MYMOP questionnaire was completed by the interviewees (n = 20), a minimum to twice and a maximum of nine times over a four-month period. The scores were displayed on individual MYMOP charts. For each individual, the outcome as measured by MYMOP was compared with the outcome data from the qualitative interviews. The interviewees were attending a variety of complementary practitioners in primary care.
The treatment effects which people described were encompassed by five themes: reduction in symptoms; reduction in disability; reduction in, or avoidance of, medication; gaining control and improving coping skills; and securing support and hope through the patient-practitioner relationship. The vignettes demonstrated how individuals identified and valued these various effects and weighed them up in evaluating the overall benefit of the treatment. Their MYMOP charts were able to measure some effects better than others.
The treatment effects, as quantified using MYMOP, accorded with those described by most patients at interview, but some important limitations were identified with MYMOP, particularly an underplaying of the importance of medication avoidance or medication reduction in this patient group. This dimension is lacking in most outcome questionnaires and has been included in a new version of MYMOP. This study also showed that qualitative interview data can help in evaluating the ability of outcome questionnaires to measure the treatment effects that particular patient groups consider most important.
Pumpan in a dosage of 3 x 10 drops daily over 6 weeks does not differ in its effect on systolic and diastolic blood pressure significantly from placebo. The tolerance was excellent: not one single patient had to be withdrawn from the study due to side effects. Blood lipids (cholesterol, HDL-, LDL-cholesterol and triglyzerides) did not change, neither in the placebo nor in the verum group.
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