The Effectiveness of Dietary Approaches to Stop Hypertension Diet Intervention in Persons with Arterial Hypertension and Obesity: A Key Role of the Patients' Personality Profile.

BACKGROUND/AIMS: Benefits resulting from weight loss and dietary approaches to stop hypertension (DASH) diet in the treatment of arterial hypertension led to a search for a better therapy that would include psychological factors. The present study aimed to assess the relationship between the personality traits included in the Big Five personality traits and the effectiveness of treatment for weight loss in patients with essential hypertension and excessive body weight. METHODS: The study involved 84 patients with essential hypertension, overweight or obesity, managed by a hypertensiologist. All patients underwent a 3-month diet treatment as part of the development process of an individualised eating plan that follows the principles of DASH diet and food education. Body mass index and DASH index were calculated before and after the therapy. NEO Five-Factor Inventory was applied to measure psychological variables. RESULTS: The intervention led to a statistically significant increase of DASH index measured before and after treatment. There was a significant correlation between the increase of DASH index and gender. Patients presented higher intensity of openness to experience, extraversion, conscientiousness and lower levels of neuroticism and agreeableness compared to general population. CONCLUSION: The influence of psychological variables on the observed difference between men and women in DASH values and weight loss was not demonstrated.

[Hyperuricemia in obese patients with pharmacologically treated essential hypertension].

INTRODUCTION: Hyperuricemia and gout are a growing health problem worldwide. Their etiology is complex, and usually caused by excessive production of uric acid and/or impaired excretion. Some drugs used in the treatment of high blood pressure furthermore increase the risk of hyperuricemia. An additional risk factor for hyperuricemia is obesity. Thus far, there is no consensus on the treatment of patients with asymptomatic hyperuricemia, despite a large number of studies conducted worldwide. THE AIM: To evaluate the prevalence of hyperuricemia among patients with essential hypertension and obesity, pharmacologically treated with combination therapy. MATERIAL AND METHODS: A total of 109 obese patients (mean BMI=34.6±3.5 kg/m2) were included in this study, selected from the outpatients at the Clinic of Arterial Hypertension, the unit of the Cardinal Stefan Wyszynski Institute of Cardiology in Warsaw. Patients were treated with at least two antihypertensive drugs. Blood pressure, uric acid and insulin levels were measured among patients. RESULTS: The average systolic blood pressure and diastolic blood pressure were of 131±5,9 and 84.6±3.6 mmHg respectively, the average uric acid level of 6.4±1.5 mg/dl, and the average level of insulin 17.6±11.0 mU/L. Hyperuricemia was found in 33 patients (27.5% of subjects). The uric acid level was significantly higher among men. A positive correlation between the serum uric acid concentration of serum insulin (r = 0.27, p <0.001), age (r = 0.21, p <0.002) and BMI patients (r = 0.26, p <0.002) has been shown. There were no significant differences in the concentration of uric acid among patients receiving multiple antihypertensive agents. CONCLUSION: The incidence of hyperuricemia demonstrated in this study confirms the findings of other authors and indicates a fairly common prevalence of this phenomenon among a population of patients with hypertension. Individually adjusted multidrug antihypertensive therapy does not seem to affect significantly the concentration of uric acid, but further research is needed in this respect.

Ferric carboxymaltose in patients with heart failure and iron deficiency.

BACKGROUND: Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection fraction, and iron deficiency, either with or without anemia. METHODS: We enrolled 459 patients with chronic heart failure of New York Heart Association (NYHA) functional class II or III, a left ventricular ejection fraction of 40% or less (for patients with NYHA class II) or 45% or less (for NYHA class III), iron deficiency (ferritin level <100 microg per liter or between 100 and 299 microg per liter, if the transferrin saturation was <20%), and a hemoglobin level of 95 to 135 g per liter. Patients were randomly assigned, in a 2:1 ratio, to receive 200 mg of intravenous iron (ferric carboxymaltose) or saline (placebo). The primary end points were the self-reported Patient Global Assessment and NYHA functional class, both at week 24. Secondary end points included the distance walked in 6 minutes and the health-related quality of life. RESULTS: Among the patients receiving ferric carboxymaltose, 50% reported being much or moderately improved, as compared with 28% of patients receiving placebo, according to the Patient Global Assessment (odds ratio for improvement, 2.51; 95% confidence interval [CI], 1.75 to 3.61). Among the patients assigned to ferric carboxymaltose, 47% had an NYHA functional class I or II at week 24, as compared with 30% of patients assigned to placebo (odds ratio for improvement by one class, 2.40; 95% CI, 1.55 to 3.71). Results were similar in patients with anemia and those without anemia. Significant improvements were seen with ferric carboxymaltose in the distance on the 6-minute walk test and quality-of-life assessments. The rates of death, adverse events, and serious adverse events were similar in the two study groups. CONCLUSIONS: Treatment with intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life; the side-effect profile is acceptable. (ClinicalTrials.gov number, NCT00520780).

[Results of hypertensive treatment in outpatient hypertension clinics with different payment status]. / Wyniki leczenia nadcisnienia tetniczego pierwotnego w poradniach specjalistycznych o róznym statusie odplatnosci.

BACKGROUND: Arterial hypertension concerns about 40% of adult population in Poland. WOBASZ study shows that vast majority of hypertonics in Poland are treated unsuccessfully. The aim of study was to compare the effectiveness of hypertension treatment by specialist in different payment status outpatient clinics in 2 periods: 1996-2000 (A) and 2001-2006 (B). MATERIAL AND METHODS: The received data is based on documentation of 1772 patients with essential hypertension (ntp) in three outpatient hypertension clinics: one public-PP and two private outpatient hypertension clinics (NP). Duration of treatment: 2-10 years (average 54 months). Two periods were compared: period A: 1996-2000 (679 patient) and period B: 2001-2006 (1093 patients). Every patient had blood pressure measured twice within approximately 1-2 minute interval in siting position after 15 minute rest. We used mean blood pressure from both measurements in our analysis. RESULTS: Blood pressure lowering < 140/90 mmHg was reached in location PP with 79% patients in A and with 84.5% patients in period B. Blood pressure lowering < 140/90 mmHg was reached in location NP correspondingly with 99.5% patients and with 99.7% patients. Levels of hypertension were as follows: in P- no patients with hypertension 1.level in period A, 7% in period B while in NP 2.1% and 3.5% correspondingly. There was similar percentage of patients with hypertension 2.level in all clinics. Differences were observed in proportion of treated patients with hypertension 3.level. In NP.- more patients were treated in period B (24.7%) than in period A (10.8%) and more than in P (A: 4.2% B: 1.2%). Patients over 64 years old were mainly treated in PP. Young patients, especially during last five years, were treated in NP. CONCLUSIONS: 1. In public type of clinic the majority of treated patients with essential hypertension were over 64 years of age, in private clinics were in different age. 2. Treatment in private clinics was better than in public in patients with essential hypertension regardless of aging, gender and coexisting diabetes type 2 or complications of hypertension. 3. In public clinic hypertensive treatment during 2001-2006 was more effective than 5 year before but only in group of patients without complica tion hypertensive or coexisting diabetes type 2.

Effectiveness of Individual Nutrition Education Compared to Group Education, in Improving Anthropometric and Biochemical Indices among Hypertensive Adults with Excessive Body Weight: A Randomized Controlled Trial.

OBJECTIVE: The study aims to compare the effectiveness of individual and group nutrition education methods in improving key anthropometric and biochemical markers in drug-treated, overweight-obese hypertensive adults. METHODS: The randomized trial included 170 patients with pharmacologically well-controlled primary hypertension and body mass index (BMI) ≥ 25 kg/m2. For six months, the patients received six sessions, either one-to-one individual nutrition education (IE, n = 89) or group education (GE, n = 81), developed by dietitians. Anthropometric measurements, body composition, and fasting measures of biochemical parameters were obtained at baseline and after six months of intervention. RESULTS: 150 patients completed the nutrition education program. The IE group significantly improved in many parameters compared to the GE group, including weight (p < 0.001), waist circumference (p < 0.001), BMI (p < 0.001), systolic and diastolic blood pressure (BP) (p < 0.001), fasting plasma glucose (p = 0.011), oral glucose tolerance test (OGGT) (p = 0.030), and insulin resistance (homeostatic model assessment of insulin resistance, HOMA-IR) (p < 0.001). The groups did not differ in terms of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. CONCLUSION: Individual nutrition education is more effective than group education in terms of improving anthropometric and biochemical indices in overweight-obese hypertensive adults.

The impact of individualised nutritional therapy according to DASH diet on blood pressure, body mass, and selected biochemical parameters in overweight/obese patients with primary arterial hypertension: a prospective randomised study.

BACKGROUND AND AIM: The aim of the study was to assess the impact of individualised nutritional intervention based on the DASH diet (Dietary Approaches to Stop Hypertension) on the nutritional status, blood pressure, and selected biochemical parameters of obese/overweight patients with primary arterial hypertension. METHODS: A total of 131 participants were randomised to the DASH intervention group (DIG; n = 69, 33 males) or the control group (CG; n = 62, 32 males). A three-month nutritional intervention was carried out in the DIG group, while the control group received only standard recommendations. Body weight, height, waist and hip circumference, body composition, blood pressure, serum glucose, and insulin and leptin concentrations were measured at the baseline and after the intervention. RESULTS: Sixty-four (92.8%) participants in the intervention and 62 (100%) in the control group completed the study. In the DIG group a significant decrease in body mass, systolic and diastolic blood pressure, body fat content, fasting glucose, insulin, and leptin concentrations were observed in comparison to the control group (p < 0.05). CONCLUSIONS: The DASH dietary intervention provides significant benefits to overweight/obese patients with primary hypertension.

[Difficult questions for family physicians concerning hypertension--questionnaire results]. / Trudne pytania dla lekarzy rodzinnych dotyczace nadcisnienia tetniczego.

UNLABELLED: Epidemiological studies shows high percent of hypertension cases are not covered as well as level of hypertension control is not satisfactory. The aim of this study was assessment of basic level of knowledge concerning hypertension in group of basic health care physicians. MATERIAL AND METHODS: 846 practice family physicians were included in this study. The questionnaire (own creation) was used for investigation. Before training course, four questions were asked to physicians about: 1/ Hypertension diagnosis in different age groups of people, 2/ Frequency of essential hypertension among of adult population, 3/ Blood pressure in first half period of normal pregnancy comparison to pre-pregnancy blood pressure, 4/ Groups of antihypertensive drugs certainly non administered in pregnancy period. RESULTS: 14% responders correctly answered for first question, 19%for second question, 10%-for third and 6% for fourth question. CONCLUSIONS: 1. Investigated physicians presented low level of knowledge about hypertension. 2. It is necessary to elaborate more effective strategy for education of family physicians.

Efficacy of eplerenone versus enalapril as monotherapy in systemic hypertension.

This study compared the efficacy and tolerability of eplerenone and enalapril in 499 patients with stage 1 or 2 hypertension who were randomized to receive eplerenone or enalapril for 6 months in a 3-step titration-to-effect study. After 6 months, patients whose diastolic blood pressure (BP) was <90 mm Hg had their dosages down-titrated were followed for an additional 6 months. Diastolic BP was the primary end point. Eplerenone was as effective as enalapril in reducing both systolic BP (eplerenone, -14.5 mm Hg; enalapril, -12.7 mm Hg; p = 0.199) and diastolic BP (eplerenone, -11.2 mm Hg; enalapril, -11.3 mm Hg; p = 0.910) at 6 months. BP reductions at 12 months were also similar between groups (-16.5/-13.3 mm Hg for eplerenone, -14.8/-14.1 mm Hg for enalapril; p = 0.251 and 0.331, respectively). Withdrawal rates for adverse events (eplerenone 7.9%, enalapril 9.3% at 6 months) and treatment failures (eplerenone 23.3%, enalapril 22.8% at 6 months) were also equivalent. Approximately 2/3 of each group had normal BP with monotherapy treatment at 6 months. BP response was independent of renin levels in the eplerenone group, but not in the enalapril group. Both agents reduced albuminuria in patients who had an elevated value at baseline, with significantly greater improvement in patients treated with eplerenone versus enalapril (-61.5% vs -25.7%; p = 0.01). Both agents were similarly well tolerated, and there was no increased incidence of any sexual adverse events in the eplerenone group. Patients taking enalapril had a higher rate of cough. Both agents increased serum potassium levels, but <1% in each group reported adverse events from hyperkalemia. Eplerenone was as effective as enalapril as monotherapy in patients with stage 1 or 2 hypertension, was more effective in reducing albuminuria, and was well tolerated for 12 months.

[Telmisartan in monotherapy of essential hypertension in young men--time of drug administration and 24-hours blood pressure and heart rate]. / Telmisartan w monoterapii nadcisnienia téticzego pierwotnego mlodych mezczyzn--pora dnia zazycia leku a rozklad dobowy wartosci cisnienia tetniczego i czynnosci serca.

UNLABELLED: 42 men, aged 19-35 years (mean 26.3), with mild or moderate essential hypertension (DBP 95-110 mmHg), were treated with telmisartan (40 mg or 80 mg ) once daily in the morning (6 and 7 a.m.) for at least 6 weeks and for next 6 weeks and after that administration time was changed to evening dose (6-7 p.m.) 24-hours ABPM (SpaceLabs) was performed in all patients on last day of each period. Obtained recordings were compared in different periods of time: 6.00 a.m. -10.59 p.m., 11.00 p.m-5.59 a.m., 2.00-5.59 a.m., 6.00-12.00 a.m, 3.00-7.00 p.m. The SBP values in all time intervals were comparable (differences statistically not significant). A statistically significant reduction of the DBP in the time interval 6:00-12:00 a.m. was found in patients treated with telmisartan in the morning. The heart rate of the patients who received telmisartan has not been affected by the treatment schedule and remained comparable. CONCLUSIONS: 1.) The time of the day administration does not affect the diurnal and night hypotensive efficacy of telmisartan. 2.) According to the results of this study, patients with the essential hypertension should receive telmisartan as monotherapy in the morning.

[Blood pressure in healthy women with positive and negative family history of hypertension during pregnancy]. / Cisnienie tetnicze krwi u zdrowych kobiet z obciazonym i bez obciazonego wywiadu rodzinnego w kierunku nadcisnienia tetniczego w okresie ciazy.

UNLABELLED: I studied levels of blood pressure on 120 healthy primigravides aged between 22-40 years during physiological pregnancy. Blood pressure had been taken by standard methods (mercury sphygmomanometer). 60 of these women had a positive family history of hypertension and 60 pregnancies were with no family history of hypertension. Phase I of Korotkoff sound was used as the ausculatory criterion of systolic blood pressure and phase V was used as the criterion of diastolic blood pressure. The group of healthy pregnant women with a positive family history of hypertension presented statistically significantly higher values of systolic as well as diastolic blood pressure than the group of pregnancies with no family history of hypertension. The lowest systolic value has shown in the 6th month, diastolic in the 5th month of pregnancy and the highest values of both-were determined in the 9th month of pregnancy CONCLUSION: Hypertension during pregnancy of healthy women is strongly influenced by their positive family history of hypertension.

[Blood pressure in women with essential hypertension during pregnancy]. / Cisnienie tetnicze krwi u kobiet z nadcisnieniem tetniczym pierwotnym w przebiegu ciazy.

I studied 84 pregnant women with mild to moderate essential hypertension, aged 22-40 (average of 29.5 + 5.4 years). After determination of pregnancy the existing hypertensive treatment has been stopped. Blood pressure measurements were performed twice every 3 minutes, with a mercury sphygmomanometer, at least 2 weeks after withdrawing hypertensive treatment, in a sitting position, on a left arm after 1 hour break. Among 84 women, the blood pressure of 36% ranged below 140/90 mm Hg at the end of 1 trimester. At the end of II trimester the percentage reached 54% and during the last trimester of pregnancy it has not changed significantly (52%). In the III trimester about 43% of all studied women showed the tendency of normalizing the blood pressure values to 135/85 mm Hg. Approximately 82% of women did not require pharmacological hypertensive treatment.

[Renin aldosterone profile in essential hypertension during pregnancy and after delivery]. / Profil reninowo-aldosteronowy u kobiet z nadcisnieniem tetniczym pierwotnym w okresie ciazy i po porodzie.

BACKGROUND: The pathogenesis of essential hypertension (EH) is a complex multifactorial process. Little is known about the association between pregnancy and blood pressure fluctuation in women with EH. In this study we wanted to evaluate the relationship between the blood pressure (BP) and plasma renin activity (PRA) as well as serum and urine aldosterone (ALDO) levels in pregnant women with essential hypertension. MATERIALS AND METHODS: We analyzed 84 pregnant women (97% primigravida) with EH aged 22-40 (mean 29.5 +/- 5.4) years and 60 healthy pregnant women aged 22-40 (mean 28.5 +/- 4.9) years. In women with EH, antihypertensive therapy was stopped immediately after pregnancy was confirmed. Patients with EH were divided to two groups: 1) with BP > or = 140/90 and 2) with BP > or = 140/90. PRA and ALDO as well as sodium and potassium excretion were measured three times in different periods of pregnancy: 8-12 weeks, 24-28 weeks, 34-38 weeks. In addition, both PRA and ALDO were analyzed in 4th month after delivery i.e. in the time, in which woman is reached hormonal and hemodynamic stability. PRA and ALDO were determined by RIA methods. BP was monitored by standardized method using mercury manometer. RESULTS: PRA and ALDO concentrations in both: serum and urine were increased during pregnancy in all studied groups. No difference in kinetics of PRA and ALDO was stated between healthy pregnant women with EH. Increased was observed in women and during pregnancy. Statistically significant, the highest level of PRA was noted in fourth month after delivery in women with BP > 140/90. In this period, however, concentrations of ALDO in both serum and urine were the same in all examined women. CONCLUSION: 1. In women with EH and BP < 160/100 mm Hg during pregnancy PRA and concentration of ALDO in serum as well as ALDO excretion were the same as in healthy pregnancy women. 2. Reduction of blood pressure was observed in the group of women with the lowest PRA in fourth month after delivery. 3. PRA measured in women with EH may be a predictive parameter of BP during pregnancy.

[Placebo: its hypotensive effect and influence on certain psychological parameters and dependency on dosage prescribed to patients]. / Placebo--jego dzialanie hipotensyjne oraz wplyw na wybrane parametry psychologiczne w zaleznosci od podawanej pacjentowi liczby tabletek.

The main purpose of this study is to estimate the influence of taking a number of placebo tablets to obtain hypotensive effects and some psychological parameters with essential hypertension. 197 patients (102F/95M) aged between 18-80 years (average age 52.3) with essential hypertension were included in the research in two outpatients clinics. The patients who participated in research, stayed for at least seven days without any pharmacological treatment. They had a diastolic pressure (DBP) between 95-114 mm Hg and systolic pressure (SBP) up to 200 mm Hg. 92 patients had taken one tablet a day and 105 patients had taken two tablets in the morning. This was before the placebo was included and two weeks after their blood pressure had been taken by standard methods (sphygmomanometer). They were monitored daily throughout the period using traditional methods and ABPM (SpaceLabs 90121). The patients completed two psychological tests. 97 records (52F/45M) qualified for statistical analysis (80% of measurements were undertaken properly, and the time between measurements was less than two hours). Psychological questionnaires were correctly completed by 92 patients. The visible results of decreasing systolic and diastolic value of blood pressure were obtained after using one (group 1) and two (group 2) placebo tablets. They were monitored by a standard method and recorded by ABPM. In group 1 SBP decreased from 164 +/- 11.4 mm Hg to 158 +/- 8.8 mm Hg (p < 0.01, on standard method) and from 149.5 +/- 17.8 to 144.5 +/- 8.3 mm Hg daily (p < 0.05, ABPM). DBP in this examined group decreased from 106.2 +/- 2.8 to 102 +/- 3.9 mm Hg (p < 0.01, stand. method), and from 103.2 +/- 2.6 to 98.6 +/- 1.2 mm Hg daily (p < 0.05, ABPM). In the second group SBP decreased from 169 +/- 12.8 to 157.6 +/- 17.9 mm Hg (p < 0.001, stand. method), and in ABPM from 148.5 +/- 15.8 to 139.6 +/- 16.2 mm Hg (p < 0.01). In this same group, DBP decreased from 104.4 +/- 2.6 to 98 +/- 3.4 mm hG (p < 0.001, stand. method), and from 107.4 +/- 5.8 mm Hg to 95.5 +/- 4.2 mm Hg-daily (p < 0.001, ABPM). There were no differences between heart rate in all groups of patients. In both groups there were significant statistical differences in negative symptoms, physical symptoms and anexity, but a more optimistic mood was observed by group 2. More effective hypertensive treatment was observed within the group which was treated with two placebo tablets. This group was characterized by more optimistic mood compared to the group which was treated with one placebo tablet a day.