Predictors of Hypotension After Angiotensin Receptor-Neprilysin Inhibitor Administration in Patients with Heart Failure.

Angiotensin receptor-neprilysin inhibitors (ARNI) are effective against heart failure (HF) with reduced ejection fraction, but hypotension is a significant complication. Predictors of ARNI-associated hypotension remain unclear. This study aimed to determine predictors of hypotension after administering an ARNI to patients with HF accompanied by ARNI.This retrospective multicenter observational study analyzed data from 138 consecutive patients with HF treated with an ARNI between August 2020 and July 2021. Hypotension attributed to an ARNI after treatment was defined as (A) systolic blood pressure (SBP) below the 1st quartile ≤ 25 mmHg, and as (B) absolute SBP ≤ 103 mmHg. SBP was measured at baseline, after ARNI treatment, at first follow-up as outpatients and on day 7 for inpatients. Presence of atrial fibrillation, and greater BUN/Cr ratio, and SBP at baseline were significant independent predictors for hypotension after ARNI administration on multivariate analyses. Among 43 patients with AF, fine f-waves on electrocardiograms were significantly more prevalent in the hypotensive group.A robust reduction in blood pressure after ARNI administration is associated with AF and elevated BUN/Cr. This highlights the need for caution when administering ARNI to patients with HF.

Renin-angiotensin system inhibitors improve the survival of cholangiocarcinoma: a propensity score-matched cohort study.

BACKGROUND: Hypertension is a risk factor for cholangiocarcinoma (CCA). The effect of anti-hypertensive drugs on the prognosis of CCA is not clear. METHODS: This is a retrospective study of 102 patients (56.9% males, median age 66 years) diagnosed with CCA and hypertension concurrently and received radical surgery (R0), with a median follow-up of 36.7 months. Kaplan-Meier analysis, Cox regressions, and propensity score (PS) matching were applied for statistical analysis. RESULTS: Results of multivariable cox analysis showed that renin-angiotensin system inhibitors (RASis) usage was a protective factor for progression-free survival (PFS) (hazard ratio [HR] = 0.55, 95% confidence interval [95% CI]: 0.32-0.96) and overall survival (OS) (HR = 0.40, 95% CI: 0.20-0.79), respectively. Calcium channel blockers, diuretics, and ß-blockers didn't show significant associations. The association of RASis usage and PFS and OS was derived by PS matching, with a cohort of 28 RASis users and 56 RASis non-users. The median PFS and OS of RASis users (PFS, 17.6 months (9.2-34.4); OS, 24.8 months (16.5-42.3)) were longer than RASis non-users (PFS, 10.5 months (4.1-24.1); OS, 14.6 months (10.6-28.4)). The 1 year, 2 years, and 3 years' survival rates of RASis users (89.1%, 77.0%, and 65.5%) were higher than RASis non-users (70.9%, 54.0%, and 40.0%). CONCLUSIONS: RASis usage improves the survival of patients with CCA and hypertension concurrently.

Effects of olmesartan and amlodipine on blood pressure, endothelial function, and vascular inflammation.

BACKGROUND: Anti-hypertensive drugs can improve vascular endothelial function. However, the mechanism remains to be elucidated. OBJECTIVES: This study sought to investigate mechanisms of anti-hypertensive drugs on improvement of vascular endothelial function in patients with essential hypertension. METHODS: Forty-five patients (mean age 58.5 ± 11.2 years) with uncontrolled essential hypertension were randomly assigned to receive olmesartan, an angiotensin II type 1 receptor blocker (ARB) (N = 23), or amlodipine, a calcium channel blocker (CCB) (N = 22), for 6 months. Endothelial function was evaluated by flow-mediated dilatation (FMD) of the brachial artery. Vascular inflammation was measured by blood-normalized standardized uptake value, known as a target-to-background ratio (TBR) within the carotid arteries using 18F-fluorodeoxyglucose-positron emission tomography combined with computed tomography. RESULTS: There were no significant differences of baseline clinical data between the ARB and CCB groups. Both anti-hypertensive drugs comparably lowered blood pressure and increased %FMD. TBR values were reduced by olmesartan (P < .001), while blood pressure variability was decreased by amlodipine (P = .004). Changes in %FMD from baseline (Δ%FMD) were inversely associated with ΔTBR in the olmesartan group (r = - .606, P = .003) and with Δsystolic blood pressure variability in the amlodipine group (r = - .434, P = .039). CONCLUSION: Our study indicated that olmesartan and amlodipine could improve endothelial function in patients with essential hypertension in different manners, suppression of vascular inflammation, and decrease in blood pressure variability, respectively.

The comparative effectiveness of fourth-line drugs in resistant hypertension: An application in electronic health record data.

PURPOSE: To examine the utility of electronic health records from a routine care setting in assessing comparative effectiveness of fourth-line anti-hypertensive drugs to treat resistant hypertension. METHODS: We conducted a cohort study using the Clinical Practice Research Datalink: a repository of electronic health records from UK primary care. We identified patients newly prescribed fourth-line anti-hypertensive drugs (aldosterone antagonist , beta-blocker, or alpha-blocker). Using propensity score-adjusted Cox proportional hazards models, we compared the incidence of the primary outcome (composite of all-cause mortality, stroke, and myocardial infarction) between patients on different fourth-line drugs. AA was the reference drug in all comparisons. Secondary outcomes were individual components of the primary outcome, blood pressure changes, and heart failure. We used a negative control outcome, Herpes Zoster, to detect unmeasured confounding. RESULTS: Overall, 8639 patients were included. In propensity score-adjusted analyses, the hazard ratio for the primary outcome was 0.81 (95% CI, 0.55-1.19) for beta-blockers and 0.68 (95% CI, 0.46-0.96) for alpha-blockers versus AA. Findings for individual cardiovascular outcomes trended in a more plausible direction, albeit imprecise. A trend for a protective effect for Herpes Zoster across both comparisons was seen. CONCLUSIONS: A higher rate of all-cause death in the AA group was likely due to unmeasured confounding in our analysis of the composite primary outcome, supported by our negative outcome analysis. Results for cardiovascular outcomes were plausible, but imprecise due to small cohort sizes and a low number of observed outcomes.

From head to toe: Sex and gender differences in the treatment of ischemic cerebral disease.

Stroke is a major cause of mortality and morbidity, particularly in the older ages. Women have a longer life expectancy and are more likely to experience stroke than men. Interestingly, the increased risk of ischemic stroke in women seems to be independent from age or classical cardiovascular risk factors. Notwithstanding the fact that stroke outcomes and survival are usually poorer in women, current evidence suggests that thrombolysis, antiplatelet and anticoagulant therapies are more beneficial in women than in men. A possible explanation of this paradox might be that females are often undertreated and they have fewer chances to be submitted to an effective and timely treatment for stroke than the male counterpart. The first step in the attempt to solve this obvious discrimination is surely to emphasize any reasons for differences in the therapeutic approach in relation to gender and then to denounce the lack of a sustainable motivation for them. In this article, we aimed to review the existing literature about gender-related differences on efficacy, administration and side effects of the most common drugs used for the treatment of ischemic stroke. The most striking result was the evidence that the therapeutic approach for stroke is often different according to patients' gender with a clear detrimental prognostic effect for women. A major effort is necessary to overcome this problem in order to ensure equal right to treatment without any sexual discrimination.

Context-Awareness Based Personalized Recommendation of Anti-Hypertension Drugs.

The World Health Organization estimates that almost one-third of the world's adult population are suffering from hypertension which has gradually become a "silent killer". Due to the varieties of anti-hypertensive drugs, patients are interested in how these drugs can be selected to match their respective conditions. This study provides a personalized recommendation service system of anti-hypertensive drugs based on context-awareness and designs a context ontology framework of the service. In addition, this paper introduces a Semantic Web Rule Language (SWRL)-based rule to provide high-level context reasoning and information recommendation and to overcome the limitation of ontology reasoning. To make the information recommendation of the drugs more personalized, this study also devises three categories of information recommendation rules that match different priority levels and uses a ranking algorithm to optimize the recommendation. The experiment conducted shows that combining the anti-hypertensive drugs personalized recommendation service context ontology (HyRCO) with the optimized rule reasoning can achieve a higher-quality personalized drug recommendation service. Accordingly this exploratory study of the personalized recommendation service for hypertensive drugs and its method can be easily adopted for other diseases.

The effects of anti-hypertensives and type 2 diabetes on salivary flow and total antioxidant capacity.

OBJECTIVE: The present cross-sectional study aimed to determine the effect of first-line anti-hypertensive drugs (enalapril, metoprolol, and combinations of enalapril with metoprolol and/or hydrochlorothiazide) on salivary gland function and salivary total antioxidant capacity (TAC) in hypertensive patients with/without diabetes mellitus (DM) type 2. MATERIALS AND METHODS: Salivary gland function was measured as xerostomia (interview) and unstimulated whole saliva flow rate (UWSFR) in 447 subjects (387 hypertensive and 60 healthy). Salivary TAC was evaluated by spectrophotometric assay. RESULTS: Enalapril is not xerogenic, while metoprolol and drug combinations are. In the presence of DM type 2, all drugs, except metoprolol, had pronounced xerogenic effect. Binary logistic regression analysis found enalapril to be significantly associated with decreased risk of xerogenic effect development, while DM type 2 with increased risk. In the presence of enalapril in hypertensive patients with/without DM type 2 salivary TAC was similar to that in healthy subjects, while for metoprolol was reduced. CONCLUSIONS: Enalapril is not xerogenic but is antioxidant, which moderately reduces the risk of xerogenic effect development even in the presence of DM type 2. However, metoprolol and drug combinations exhibit xerogenic effect. In DM type 2, xerogenic effect of all drugs was pronounced except of metoprolol.

A Real-World Study on the Short-Term Efficacy of Amlodipine in Treating Hypertension Among Inpatients.

Purpose: Hospitalized hypertensive patients rely on blood pressure medication, yet there is limited research on the sole use of amlodipine, despite its proven efficacy in protecting target organs and reducing mortality. This study aims to identify key indicators influencing the efficacy of amlodipine, thereby enhancing treatment outcomes. Patients and Methods: In this multicenter retrospective study, 870 hospitalized patients with primary hypertension exclusively received amlodipine for the first 5 days after admission, and their medical records contained comprehensive blood pressure records. They were categorized into success (n=479) and failure (n=391) groups based on average blood pressure control efficacy. Predictive models were constructed using six machine learning algorithms. Evaluation metrics encompassed the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). SHapley Additive exPlanations (SHAP) analysis assessed feature contributions to efficacy. Results: All six machine learning models demonstrated superior predictive performance. Following variable reduction, the model predicting amlodipine efficacy was reconstructed using these algorithms, with the light gradient boosting machine (LightGBM) model achieving the highest overall performance (AUC = 0.803). Notably, amlodipine showed enhanced efficacy in patients with low platelet distribution width (PDW) values, as well as high hematocrit (HCT) and thrombin time (TT) values. Conclusion: This study utilized machine learning to predict amlodipine's effectiveness in hypertension treatment, pinpointing key factors: HCT, PDW, and TT levels. Lower PDW, along with higher HCT and TT, correlated with enhanced treatment outcomes. This facilitates personalized treatment, particularly for hospitalized hypertensive patients undergoing amlodipine monotherapy.

Pulse pressure level after acute ischemic stroke is associated with early neurological deterioration.

Early neurological deterioration (END) is an unfavorable outcome of acute ischemic stroke and is associated with poor prognosis. Blood pressure variability has been suggested to be involved in the development of END. Therefore, the present study investigated the association between blood pressure variability and the development of END. In the present prospective observational study, 286 patients who developed acute ischemic stroke and then hospitalized within 24 h of stroke onset were recruited. Blood pressure parameters (systolic blood pressure, diastolic blood pressure and pulse pressure) were monitored using a 24 h ambulatory sphygmomanometer within 72 h of ischemic onset. Clinical characteristics were also recorded. Multivariate logistic regression analysis was used to analyze the possible relationship between blood pressure parameters and END after adjustment for confounders. Of the 286 patients in the present study, 64 (22.3%) developed END. Pulse pressure variables, including the mean of 24-h pulse pressure (24-h PPMEAN) and the mean of daytime pulse pressure (Day PPMEAN), were found to be higher in the END group compared with those in the non-END group (P<0.05). Multivariate logistic regression analysis revealed that the blood pressure parameters 24-h PPMEAN [odds ratio (OR), 1.08; 95% CI, 1.01-1.16; P=0.02) and Day PPMEAN (OR, 1.20; 95% CI, 1.011-1.45; P=0.04) were significantly associated with END. These findings suggest that the pulse pressure level fluctuations during the acute stage of ischemic stroke can serve important roles in the development of END, which worsens outcomes after stroke.

Unveiling intricate transformation pathways of emerging contaminants during wastewater treatment processes through simplified network analysis.

As the key stage for purifying wastewater, elimination of emerging contaminants (ECs) is found to be fairly low in wastewater treatment plants (WWTPs). However, less knowledge is obtained regarding the transformation pathways between various chemical structures of ECs under different treatment processes. This study unveiled the transformation pathways of ECs with different structures in 15 WWTPs distributed across China by simplified network analysis (SNA) we proposed. After treatment, the molecular weight of the whole component of wastewater decreased and the hydrophilicity increased. There are significant differences in the structure of eliminated, consistent and formed pollutants. Amino acids, peptides, and analogues (AAPAs) were detected most frequently and most removable. Benzenoids were refractory. Triazoles were often produced. The high-frequency reactions in different WWTPs were similar, (de)methylation and dehydration occurred most frequently. Different biological treatment processes performed similarly, while some advanced treatment processes differed, such as a significant increase of -13.976 (2HO reaction) paired mass distances (PMDs) in the chlorine alone process. Further, the common structural transformation was uncovered. 4 anti-hypertensive drugs, including irbesartan, valsartan, olmesartan, and losartan, were identified, along with 22 transformation products (TPs) of them. OH2 and H2O PMDs occurred most frequently and in 80.81 % of the parent-transformation product pairs, the intensity of the product was higher than parent in effluents, whose risk should be considered in future assessment activity. Together our results provide a macrography perspective on the transformation processes of ECs in WWTPs. In the future, selectively adopting wastewater treatment technology according to structures is conductive for eliminating recalcitrant ECs in WWTPs.

Association between antihypertensive drugs and the elderly's oral health- related quality of life: Results of Amirkola cohort study.

Background: Hypertension is one of the most common chronic diseases in the world. The prevalence of hypertension in the elderly is increasing. Patients with high blood pressure have to take medication throughout their lives. In this study, the relationship between antihypertensive drugs and oral health-related quality of life in the elderly was evaluated. Methods: This modified cross-sectional study, which is the part of the second phase of the Amirkola Health and Ageing Project (AHAP), was performed on 900 elderly people. Participants included 300 people with hypertension under medical treatment, 300 people with hypertension without medication and 300 people with normal blood pressure. All patients' blood pressure was recorded, and the standard xerostomia questionnaire and GOHAI questionnaire (Geriatric Oral Health Assessment Index) was completed for all participants. Then, the obtained data were analyzed by SPSS 17, whereby student's t-test, ANOVA and chi square, Pearson correlation coefficient and logistic regression model were used. A p<0.05 was considered statistically significant. Results: The mean GOHAI score in the three studied groups: hypertensive under medication treatment, hypertensive without medication treatment and normal blood pressure (51.1±7.4, 51.7±7.3, 51.1±7.5, respectively) did not differ significantly (P=0.533).The frequency of xerostomia was significantly different in the three groups (P=0.008). Among the antihypertensive drugs, the highest rate of xerostomia was due to the use of calcium channel blockers (31.1%) and diuretics (26.8%). Conclusion: In our study, although antihypertensive medications were associated with xerostomia, they did not decrease the oral health-related quality of life.

Risk of Developing Alzheimer's Disease and Related Dementias in ALLHAT Trial Participants Receiving Diuretic, ACE-Inhibitor, or Calcium-Channel Blocker with 18 Years of Follow-Up.

Background: There is no any large randomized clinical trial of antihypertensive drug treatment with 18-year passive follow-up to examine the risk of Alzheimer's Disease (AD) or Related Dementias (ADRD). Methods: Post-trial passive follow-up study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants in 1994-1998 by linking with their Medicare claims data through 2017 among 17,158 subjects in 567 U.S. centers who were free of ADRD at baseline on January 1, 1999. Main outcome was the occurrence of ADRD over 18 years of follow-up. Results: The 18-year cumulative incidence rates were 30.9% for AD, 59.2% for non-AD dementias, and 60.9% for any ADRD. The 18-year cumulative incidence of AD was almost identical for the 3 drug groups (30.5% for chlorthalidone, 31.1% for amlodipine, and 31.4% for lisinopril). The hazard ratios of AD, non-AD dementias and total ADRD were not statistically significantly different among the 3 drug groups. The adjusted hazard ratio of AD was 1.04 (95% CI: 0.94-1.14) for chlorthalidone versus amlodipine, 1.02 (0.92-1.13) for lisinopril versus amlodipine, and 0.98 (0.89-1.08) for lisinopril versus chlorthalidone, which were not significantly different. The risk of AD and non-AD dementias was significantly higher in older subjects, females, blacks, non-Hispanics, subjects with lower education, and subjects with vascular diseases. Conclusion: The risk of ADRD did not vary significantly by 3 antihypertensive drugs in ALLHAT trial participants with 18-years of follow-up. The risk of ADRD was significantly associated with age, gender, race/ethnicity, education, and history of vascular diseases.

Correlation between anti-hypertensive drugs and disease progression among moderate, severe, and critically ill COVID-19 patients in the second referral hospital in Surabaya: A retrospective cohort study.

Background: Hypertension, as the comorbidity accompanying COVID-19, is related to angiotensin-converting enzyme 2 receptor (ACE-2R) and endothelial dysregulation which have an important role in blood pressure regulation. Other anti-hypertensive agents are believed to trigger the hyperinflammation process. We aimed to figure out the association between the use of anti-hypertensive drugs and the disease progression of COVID-19 patients.   Methods: This study is an observational cohort study among COVID-19 adult patients from moderate to critically ill admitted to Universitas Airlangga Hospital (UAH) Surabaya with history of hypertension and receiving anti-hypertensive drugs.   Results: Patients receiving beta blockers only had a longer length of stay than angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ACEI/ARB) or calcium channel blockers alone (17, 13.36, and 13.73 respectively), had the higher rate of intensive care unit (ICU) admission than ACEi/ARB (p 0.04), and had the highest mortality rate (54.55%). There were no significant differences in length of stay, ICU admission, mortality rate, and days of death among the single, double, and triple anti-hypertensive groups. The mortality rate in groups taking ACEi/ARB was lower than other combination.   Conclusions: Hypertension can increase the severity of COVID-19. The use of ACEI/ARBs in ACE-2 receptor regulation which is thought to aggravate the condition of COVID-19 patients has not yet been proven. This is consistent with findings in other anti-hypertensive groups.

Han Chinese specific cytochrome P450 polymorphisms and their impact on the metabolism of anti-hypertensive drugs with adrenoreceptor blocking properties.

Introduction: Cytochrome P450 (CYP) is a monooxygenase superfamily mediating the elimination of anti-hypertensive drugs. Polymorphisms of CYP would lead to differential drug efficacy. Building relationships between genotype and phenotype will benefit individual medical treatment of hypertension.Areas covered: The review systematically summarizes the polymorphisms of four CYPs (CYP2C9, CYP2C19, CYP2D6, and CYP3A4) concentrated distributed in the Han Chinese population. Moreover, the activity of variants on metabolizing anti-hypertensive drugs are reviewed, especially drugs with adrenoceptor blocking properties, as well as their clinical relevancies.Expert opinion: The polymorphisms of CYP can cause stratification in drug exposure of antihypertensive drugs. Although the clinical relevance has been built partially, the translational medicine still lacks reliable data support. Furthermore, the studies have demonstrated that even the same CYP variant will exhibit different catalytic capability for different drugs, which is another obstacle to hinder its application. With the deepening of multiomics research and structural biology, nucleotide polymorphisms can be combined with transcriptome, proteome, metabolome and molecular structure analyses to study the susceptibility to hypertension and drug efficacy. A complete data chain would be further estabolished by combining studies of pharmacokinetics-pharmacodynamics, which can effectively promote the precise application of anti-hypertensive drugs.

The Relationship Between Anti-Hypertensive Drugs and Cancer: Anxiety to be Resolved in Urgent.

Hypertension is the prevailing independent risk factor for cardiovascular disease worldwide. Anti-hypertensive drugs are the common and effective cure for lowering blood pressure in patients with hypertension. However, some large-scale clinical studies have pointed out that long-term ingestion of some oral anti-hypertensive drugs was associated with risks of incident cancer and the survival time. In contrast, other studies argue that anti-hypertensive drugs are not related to the occurrence of cancer, even as a complementary therapy of tumor treatment. To resolve the dispute, numerous recent mechanistic studies using animal models have tried to find the causal link between cancer and different anti-hypertensive drugs. However, the results were often contradictory. Such uncertainties have taken a toll on hypertensive patients. In this review, we will summarize advances of longitudinal studies in the association between anti-hypertensive drugs and related tumor risks that have helped to move the field forward from associative to causative conclusions, in hope of providing a reference for more rigorous and evidence-based clinical research on the topic to guide the clinical decision making.

Facts and reflections on COVID-19 and anti-hypertensives drugs.

Based on some publications that associate SARS-CoV-2 infection with the use of anti-hypertensive drug groups such as angiotensin-converting-enzyme inhibitors (e.g. enalapril) or angiotensin II receptor blockers (e.g. losartan), many patients from South America, Central America or Spain, have stopped or intend to interrupt their treatments with these drugs. Hence, it may exist ominous consequences due to this drop out. For this reason, it is necessary to quickly warn about this situation and the risks associated with it.

Could Anti-Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID-19 Infection? Data From Centers of Southern Italy.

BACKGROUND Coronavirus disease 2019 (COVID-19) is the cause of a pandemic disease, with severe acute respiratory syndrome by binding target epithelial lung cells through angiotensin-converting enzyme 2 in humans. Thus, patients with hypertension with COVID-19 could have worse prognosis. Indeed, angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers may interfere with angiotensin-converting enzyme 2 expression/activity. Thus, patients with hypertension undergoing angiotensin-converting enzyme inhibitor and/or angiotensin receptor blockers drug therapy may be at a higher risk of contracting a serious COVID-19 infection and should be monitored. Moreover, in the present study we investigated the effects of angiotensin-converting enzyme inhibitor versus angiotensin receptor blockers versus calcium channel blockers on clinical outcomes as mechanical ventilation, intensive care unit admissions, heart injury, and death in 62 patients with hypertension hospitalized for COVID-19 infection. METHODS AND RESULTS The multicenter study was prospectively conducted at Department of Infectious Diseases of Sant'Anna Hospital of Caserta, and of University of Campania "Luigi Vanvitelli" of Naples, at Department of Advanced Surgical and Medical Sciences of University of Campania "Luigi Vanvitelli," Naples, and at General Medical Assistance Unit "FIMG," Naples, Italy. Lowest values of left ventricle ejection fraction predicted deaths (1.142, 1.008-1.294, P<0.05), while highest values of interleukin-6 predicted the admission to intensive care unit (1.617, 1.094-2.389), mechanical ventilation (1.149, 1.082-1.219), heart injuries (1.367, 1.054-1.772), and deaths (4.742, 1.788-8.524). CONCLUSIONS Anti-hypertensive drugs didn't affect the prognosis in patients with COVID-19. Consequently, tailored anti-inflammatory and immune therapies in addition to chronic antihypertensive therapy, could prevent a worse prognosis, as well as improve the clinical outcomes in patients with hypertension with COVID-19 infection.

Blood pressure control and impact on cardiovascular events in patients with type 2 diabetes mellitus: A critical analysis of the literature. / Metas de control de la presión arterial e impacto sobre desenlaces cardiovasculares en pacientes con diabetes mellitus tipo 2: un análisis crítico de la literatura.

High blood pressure in individuals with type2 diabetes mellitus increases the risk of cardiovascular events. The international management guidelines recommend starting pharmacological treatment with blood pressure values >140/90mmHg. However, there is no optimal cut-off point from which cardiovascular events can be reduced without causing adverse events. A blood pressure range of >130/80 to <140/90mmHg seems to be adequate. These values can be achieved through non-pharmacological (diet, exercise) and pharmacological interventions (using drugs that have been shown to reduce cardiovascular events). The choice of one or several drugs must be individualised, according to factors including, ethnicity, age, and associated comorbidities, among others.

Hyperuricemia Associated with Thiazide Diuretics in Hypertensive Adults.

Introduction Thiazide diuretics are essential first-line anti-hypertensive drugs which not only maintain blood pressure but also reduce stroke and congestive heart failure associated with morbidity and mortality in hypertensive patients. However, thiazide diuretics are associated with elevated serum uric acid (SUA) levels. This study aimed to evaluate the impact of thiazide diuretic use on their SUA levels among hypertensive individuals of Pakistan. Methods In this cross-sectional, prospective study, adult hypertensive patients were recruited. They were divided into two groups - thiazide diuretic group and non-thiazide group. Demographic characteristics, hypertension-related characteristics, and SUA levels were included. Data were then entered and analysed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY, USA). Results In the thiazide group, 24.5% were hyperuricemic as compared to 15.3% in the non-thiazide group (p=0.03). The overall mean SUA levels in the thiazide group were significantly higher than those in the non-thiazide group (5.9 ± 2.1 vs. 5.3 ± 2.7 mg/dL; p=0.02). Males in the thiazide group also showed a similar pattern (5.9 ± 2.3 vs. 5.1 ± 2.1 mg/dL; p=0.02); however, the differences were insignificant in females. Patients using thiazide diuretics for one to three years were more non-hyperuricemic than hyperuricemic (p=0.000). Among hyperuricemic patients, 36.5% were taking thiazides for three to four years and 46% were taking them for more than four years (p<0.05). Conclusion Hyperuricemia is a more common occurrence in thiazide diuretic users as compared to non-users. The overall sample, and men using thiazide diuretics, reported a higher mean SUA as compared to non-users. As the years of thiazide usage advanced, the number of hyperuricemic participants also significantly increased.

[Principal conclusions of the Argentine Consensus on Arterial Hypertension]. / Principales conclusiones del Consenso Argentino de Hipertensión Arterial.

A summary is presented in this article of the principal concepts of the Argentine Consensus on Arterial Hypertension, which has been carried out for the first time jointly by the three main scientific societies associated with the diagnosis and treatment of arterial hypertension in Argentina (Argentine Society of Arterial Hypertension, Argentine Society of Cardiology and Argentine Federation of Cardiology). Among its main points, is emphasised the need to improve the diagnosis and control of high blood pressure, the use of ambulatory blood pressure measurement techniques, the importance of the risk stratification of the hypertensive patient, and the early use of pharmacological combinations in the treatment as a means to quickly achieve control. Finally, it lists the main recommendations for the management of hypertension in special populations, such as pregnant women, elderly people, diabetics, resistant patients, as well as patients with chronic kidney disease.