Changes in motor unit firing pattern are associated with post-exercise blood pressure response in older untreated but not treated hypertensive adults.

This study aimed to determine the difference in motor unit (MU) firing pattern between hypertensive and normotensive individuals, and the relationship between MU firing pattern and post-exercise blood pressure (BP) response in older individuals. Fourteen older untreated (systolic/diastolic BP (SBP/DBP) ≥ 130/80 mmHg, 76 (5) years), 11 treated hypertensive (78 (4) years) and 14 normotensive (SBP/DBP < 130/80 mmHg, 71 (4) years) individuals were studied. Participants performed ramp-up exercises until 50% of maximal voluntary contraction (MVC) of knee extension and five MVCs. During the ramp-up exercise, high-density surface electromyography signals were recorded and each MU firing rate (FR) and recruitment threshold was assessed. The slope of the linear regression between MUFRs and recruitment thresholds was calculated to assess the MU firing pattern. Pre- and post-exercise blood pressure was measured. Change in (∆)SBP from pre- to post-exercise was greater in treated hypertensive than untreated hypertensive individuals (P = 0.026). MUFR was lower in treated hypertensive than untreated hypertensive and normotensive individuals (P < 0.001). Although the slope was not significantly different between groups (P = 0.294), FRs of larger MUs were lower than those of smaller MUs in treated hypertensive and normotensive individuals (P < 0.05) but sustained in untreated hypertensive individuals. The FRs of larger MUs and slope were positively correlated with the ∆SBP only in hypertensive individuals (r = 0.768 and 0.715; P = 0.044 and 0.020). MUFR was lower in treated hypertensive than untreated hypertensive and normotensive individuals. Furthermore, MU firing patterns were associated with the ∆SBP after exercise in older untreated hypertensive individuals, but this relationship was not observed in treated hypertensive and normotensive individuals.

Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial.

BACKGROUND: Silent myocardial infarction (SMI) frequently goes undetected, yet it is associated with increased cardiovascular morbidity and mortality. The impact of intensive systolic blood pressure (SBP) lowering on the risk of SMI in those with hypertension remains uncertain. METHODS: In this post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), participants with serial electrocardiograms (ECGs) during the trial were included. SPRINT investigated the benefit of intensive SBP lowering, aiming for < 120 mmHg compared to the standard SBP goal of < 140 mmHg. Incident SMI was defined as evidence of new MI on an ECG without adjudicated recognized myocardial infarction (RMI). RESULTS: During a median follow-up of 3.9 years, a total of 234 MI events (55 SMI and 179 RMI) occurred. Intensive, compared to standard, SBP lowering resulted in a lower rate of SMI (incidence rate 1.1 vs. 2.3 cases per 1000 person-years, respectively; HR [95% CI]: 0.48 [0.27-0.84]). Similarly, intensive, compared to standard, BP lowering reduced the risk of RMI (incidence rate 4.6 vs. 6.5 cases per 1000 person-years, respectively; HR [95% CI]: 0.71 [0.52-0.95]). No significant differences were noted between the strength of the association of intensive BP control on lowering the risk of SMI and RMI (p-value for HR differences = 0.23). CONCLUSIONS: This study shows that in adults with hypertension, the benefits of intensive SBP lowering, compared with standard BP lowering, go beyond the prevention of RMI to include the prevention of SMI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01206062.

A tryst of 'blood pressure control- sex- comorbidities': the odyssey of basic public health services in Yunnan in quest for truth.

BACKGROUND: The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-"Hypertension" (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern. METHODS: We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities. RESULTS: Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276-4.570), three or more (OR = 5.500, 95%CI: 1.174-25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430-3.289) and (OR = 2.785, 95%CI: 1.242-6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women. CONCLUSIONS: Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding "management of hypertensive comorbidities". This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.

Psychosocial profiles and blood pressure control: results from the multi-ethnic study of atherosclerosis (MESA).

Growing research shows psychosocial factors are associated with blood pressure (BP) control among individuals with hypertension. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing profiles among individuals with hypertension. The association of psychosocial profiles and BP control remains unknown. To characterize the psychosocial profiles of individuals with hypertension and assess whether they are associated with BP control over 14 years. We included 2,665 MESA participants with prevalent hypertension in 2002-2004. Nine psychosocial variables representing individual, interpersonal, and neighborhood factors were included. BP control was achieved if systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 9090 mmHg. Latent profile analysis (LPA) revealed an optimal model of three psychosocial profile groups (AIC 121,229; entropy = .88) "Healthy", "Psychosocially Distressed" and "Discriminated Against". Overall, there were no significant differences in systolic and diastolic BP control combined, across the profiles. Participants in the "Discriminated Against" profile group were significantly less likely [OR= 0.60; 95% CI: 0.43, 0.84] to have their DBP < 9090 mmHg as compared to the "Healthy" profile, but this was attenuated with full covariate adjustment. Discrete psychosocial profiles exist among individuals with hypertension but were not associated with BP control after full covariate adjustment.

The natural history of hypertension in older adults: a study of two Finnish generational cohorts born 20 years apart.

BACKGROUND: We conducted a comparative analysis of hypertension prevalence, progression, and treatment in two Finnish population-based cohorts comprising older adults born 20 years apart. The study covered data from pre- and post-HYVET Study eras and spanned the onset of the COVID-19 pandemic. METHODS: All 70-year-old home-dwelling citizens of Turku, in Southwest Finland, were invited to participate in the survey in 1990 (1920-born TUVA cohort) and in 2010 (1940-born UTUVA cohort) with a 25-year follow-up plan. The analyses included those with available data for systolic and diastolic blood pressure (BP), yielding 1015 TUVA and 888 UTUVA participants at baseline. Biomarkers associated with BP were analysed with t- and chi-square tests. RESULTS: At baseline, 83.4% of TUVA and 74.3% of UTUVA participants had uncontrolled BP, with respective antihypertensive medication usage at 36.0% and 55.9% (p < .001 for both between-cohort differences). Systolic BP exhibited an inverted U-shaped trajectory, with TUVA initially 7.8 mmHg higher at 155.4 mmHg than UTUVA (p < .001). However, by the ages 80-82, the difference in systolic BP trajectories between the cohorts was attenuated to 4.0 mmHg (p = .03). Diastolic BP differences were less clinically significant. UTUVA demonstrated higher use of all five conventional antihypertensive categories than TUVA (p ≤ .02 for all categories). CONCLUSIONS: In the early years of older adulthood, the 1940-born cohort showed a positive trend in hypertension management, yet maintained a 74.3% baseline rate of uncontrolled BP. Furthermore, by the ages 81-82, the benefits observed over the 1920-born cohort had lessened, influenced by the COVID-19 pandemic or other lasting factors. Heightened efforts to improve hypertension treatment in older adults remain crucial in the post-HYVET era.

We studied two generational cohorts of older adults from Finland, born 20 years apart, to examine changes in blood pressure readings over time, the prevalence of high blood pressure, and its treatment. Our investigation spanned periods both before and after the HYVET Study, a significant research effort demonstrating the benefits of treating hypertension in older adult patients, reducing the risk of stroke and other causes of mortality. Additionally, we considered the potential impact of the COVID-19 pandemic on blood pressure control.We invited all 70-year-olds living at home in Turku, Southwest Finland, to participate in our survey in 1990 (the 1920-born cohort) and in 2010 (the 1940-born cohort), with plans to follow them for 25 years. We collected data on their blood pressure readings and the medications they were prescribed.At the outset of our study, when participants were 70 years old, a higher proportion of individuals in the 1920-born cohort had uncontrolled high blood pressure compared to those in the 1940-born group. In addition, the participants born in 1940 showed increased usage and a wider selection of antihypertensive medications compared to the 1920-born cohort. Despite this, over 70% of the 70-year-olds even in the 1940-born cohort still had uncontrolled blood pressure. Furthermore, by the time these individuals reached their early 80s, the initial improvements in blood pressure control over the 1920-born cohort had somewhat diminished.Our findings underscore the ongoing need for improvements in managing high blood pressure among older adults. This remains crucial as individuals age, emphasising the importance of continued research to develop better treatment approaches, even after landmark studies like HYVET.

Is Intensive Blood Pressure Control Indicated in Older Patients with Hypertension?

PURPOSE OF REVIEW: This review aims to evaluate intensive blood pressure control in older adults, assessing its necessity, effectiveness, benefits and risks including cardiovascular outcomes, adverse events, quality of life, and overall mortality. RECENT FINDINGS: Recent studies have supported that intensive antihypertensive treatment lowers the rates of cardiovascular events compared to standard treatment in older patients with hypertension, and it may also reduce the risk of cognitive decline. Intensive blood pressure lowering strategies are associated with reduced risk of cardiovascular morbidity and mortality as well as all-cause mortality, without compromising quality of life or functional status, and are relatively well tolerated in this patient population. Evidence suggests that maintaining systolic blood pressure below 130 mm Hg can yield cardiovascular and cognitive benefits in older patients with hypertension, particularly among those at risk of myocardial infarction or stroke. However, clinicians should vigilantly monitor for adverse events and engage in shared decision-making when pursuing intensive blood pressure goals tailored to individual risks and benefits.

Predicting high blood pressure using machine learning models in low- and middle-income countries.

Responding to the rising global prevalence of noncommunicable diseases (NCDs) requires improvements in the management of high blood pressure. Therefore, this study aims to develop an explainable machine learning model for predicting high blood pressure, a key NCD risk factor, using data from the STEPwise approach to NCD risk factor surveillance (STEPS) surveys. Nationally representative samples of adults aged 18-69 years were acquired from 57 countries spanning six World Health Organization (WHO) regions. Data harmonization and processing were performed to standardize the selected predictors and synchronize features across countries, yielding 41 variables, including demographic, behavioural, physical, and biochemical factors. Five machine learning models - logistic regression, k-nearest neighbours, random forest, XGBoost, and a fully connected neural network - were trained and evaluated at global, regional, and country-specific levels using an 80/20 train-test split. The models' performance was assessed using accuracy, precision, recall, and F1 score. Feature importance analysis identified age, weight, heart rate, waist circumference, and height as key predictors of blood pressure. Across the 57 countries studied, model performances varied considerably, with accuracy ranging from as low as 58.96% in some models for specific countries to as high as 81.41% in others, underscoring the need for region and country-specific adaptations in modelling approaches. The explainable model offers an opportunity for population-level screening and continuous risk assessment in resource-limited settings.

Evaluation of the Efficacy and Safety of Nicardipine Versus Clevidipine for Blood Pressure Control in Hypertensive Crisis.

BACKGROUND: Hypertensive crisis is an acute increase in blood pressure >180/120 mm Hg. A titratable antihypertensive agent is preferred to lower blood pressure acutely in a controlled way and prevent an abrupt overcorrection. Nicardipine and clevidipine are both dihydropyridine calcium channel blockers that provide unique benefits for blood pressure control. OBJECTIVE: The purpose of this study was to compare the efficacy and safety of nicardipine or clevidipine for blood pressure control in the setting of hypertensive crisis. METHODS: This was a single-center, retrospective cohort study. Eligible patients received either nicardipine or clevidipine for the treatment of hypertensive crisis. The primary outcome was achievement of 25% reduction in mean arterial pressure at 1 h. The secondary outcome was achievement of a systolic blood pressure (SBP) of <160 mm Hg at 2-6 h from the start of the infusion. RESULTS: This study included a total of 156 patients, 74 in the nicardipine group and 82 in the clevidipine group. The SBP on admission and at the start of the infusion were similar between groups. There was no difference between groups in achieving a 25% reduction in mean arterial pressure at 1 h. Nicardipine achieved an SBP goal of <160 mm Hg at 2-6 h significantly more often than the clevidipine group (89.2% vs. 73.2%; p = 0.011). CONCLUSIONS: There is no difference between agents for initial blood pressure control in the treatment of hypertensive crisis. Nicardipine showed more sustained SBP control, with a lower risk of rebound hypertension and a significant cost savings compared with clevidipine.

Relationship Between Blood Pressure Control and Self-Care Practices Among Hypertensive Patients Attending Family Medicine Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: Hypertension is one of the most prevalent chronic diseases worldwide and poses a global health challenge. Self-care practices are essential for blood pressure control and reduction of complications of hypertension such as cardiovascular and renal diseases. AIM: The study aimed to assess the relationship between blood pressure control and hypertension self-care practices among hypertensive patients attending the Family Medicine clinic of Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. METHODOLOGY: A descriptive, hospital-based, cross-sectional study was conducted among 407 hypertensive patients attending the outpatient clinic. The participants were recruited using systematic sampling with a sampling interval of 1 in 4. An interviewer-administered questionnaire was used to obtain relevant data. Data analysis was performed using SPSS version 23. RESULTS: A total of 407 participants were enrolled in the study. In this study, 56.8% of the participants had good blood pressure control. On hypertension self-care practices, only 1 % of the participants adhered to low salt diet; 45% adhered to recommended physical activity; 52.8% adhered to weight management; 71.5% had good medication adherence; 93.9% abstained from alcohol and 96.8% of participants abstained from smoking. Overall, none of the domains of hypertension self-care practice was associated with blood pressure control even though there was a trend that those who adhered to the domains of self-care practice had better blood pressure control. CONCLUSION: Hypertension self-care practice among participants could be better. Participants who had good self-care practice had better blood pressure control however; this was not statistically significant.

CONTEXTE: L'hypertension est l'une des maladies chroniques les plus répandues dans le monde et représente un défi de santé publique mondial. Les pratiques d'autosoins sont essentielles pour contrôler la pression artérielle et réduire les complications de l'hypertension telles que les maladies cardiovasculaires et rénales. OBJECTIF: L'étude visait à évaluer la relation entre le contrôle de la pression artérielle et les pratiques d'autosoins de l'hypertension chez les patients hypertendus fréquentant la clinique de médecine familiale de l'hôpital universitaire d'enseignement de l'État de Lagos (LASUTH), Lagos, Nigéria. MÉTHODOLOGIE: Une étude descriptive, hospitalière, transversale a été menée auprès de 407 patients hypertendus fréquentant la clinique externe. Les participants ont été recrutés en utilisant un échantillonnage systématique avec un intervalle d'échantillonnage de 1 sur 4. Un questionnaire administré par un intervieweur a été utilisé pour obtenir les données pertinentes. L'analyse des données a été effectuée à l'aide de SPSS version 23. RÉSULTATS: Un total de 407 participants ont été inclus dans l'étude. Dans cette étude, 56,8 % des participants avaient un bon contrôle de la pression artérielle. En ce qui concerne les pratiques d'autosoins de l'hypertension, seulement 1 % des participants adhéraient à un régime pauvre en sel ; 45 % adhéraient à l'activité physique recommandée ; 52,8 % adhéraient à la gestion du poids ; 71,5 % avaient une bonne observance médicamenteuse ; 93,9 % s'abstenaient d'alcool et 96,8 % des participants s'abstenaient de fumer. Dans l'ensemble, aucun des domaines des pratiques d'autosoins de l'hypertension n'était associé au contrôle de la pression artérielle, même s'il existait une tendance selon laquelle ceux qui adhéraient aux domaines des pratiques d'autosoins avaient un meilleur contrôle de la pression artérielle. CONCLUSION: Les pratiques d'autosoins de l'hypertension chez les participants pourraient être améliorées. Les participants qui avaient de bonnes pratiques d'autosoins avaient un meilleur contrôle de la pression artérielle, mais cela n'était pas statistiquement significatif. MOTS CLÉS: Hypertension, Contrôle de la pression artérielle, Pratiques d'autosoins, Gestion du mode de vie.

Effect of Motivational Interviewing on Lifestyle Modification among Patients with Hypertension Attending the Family Medicine Clinics of ISTH, Irrua, Nigeria (Milmaph Study) - A Randomised Control Trial Study Protocol.

BACKGROUND: Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. METHODS: The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification. STUDY OUTCOME: The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months. CONCLUSION: Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

CONTEXTE: L'hypertension est l'une des principales causes de morbidité et de mortalité à l'échelle mondiale. Plus d'un quart des patients hypertendus ont une hypertension non contrôlée. La modification du mode de vie a été démontrée pour améliorer le contrôle de la pression artérielle, ainsi les mesures qui aideraient les patients hypertendus à réaliser une modification positive de leur mode de vie amélioreraient le contrôle de la PA. L'étude vise à déterminer l'effet des entretiens motivationnels sur la modification du mode de vie et le contrôle de la pression artérielle chez les patients hypertendus fréquentant les cliniques de médecine familiale de l'hôpital spécialisé d'enseignement d'Irrua (ISTH), Irrua, Nigeria. MÉTHODES: L'étude proposée sera un essai contrôlé randomisé (PACTR202301917477205). Environ 212 adultes âgés de 18 à 65 ans atteints d'hypertension se présentant aux cliniques de médecine familiale de l'ISTH seront randomisés en groupes d'intervention et de contrôle. Le groupe d'intervention recevra un entretien motivationnel (EM) sur la modification du mode de vie au début de l'étude et mensuellement pendant 6 mois en plus des soins standard pour la prise en charge de l'hypertension. Le groupe témoin recevra uniquement les soins standard pour la prise en charge de l'hypertension sans EM et sera vu mensuellement pendant 6 mois. Les deux groupes seront évalués au départ et à 6 mois. Au début, une technique qualitative sera utilisée pour déterminer la raison de la non-adoption de la modification du mode de vie. RÉSULTAT DE L'ÉTUDE: Le critère de jugement principal sera la modification du mode de vie à 6 mois, tandis que le critère de jugement secondaire sera le contrôle de la pression artérielle à 6 mois. CONCLUSION: Les résultats de l'étude fourniront des moyens rentables de contrôle de la pression artérielle et de réduction de la charge de morbidité de l'hypertension au Nigeria. MOTS-CLÉS: hypertension, entretien motivationnel, modification du mode de vie, contrôle de la pression artérielle, médecine familiale.

Use of a Statistical Adaptive Treatment Strategy Approach for Emulating Randomized Controlled Trials Using Observational Data: The Example of Blood-Pressure Control Strategies for the Prevention of Cardiovascular Events Among Individuals With Hypertension at High Cardiovascular Risk.

Statistical approaches to adaptive treatment strategies (ATS) can be used to mimic the sequential decision-making inherently found in clinical practice. To illustrate the use of a statistical ATS approach, we emulated a target trial of different blood pressure (BP) control plans for the prevention of cardiovascular events among individuals with hypertension at high cardiovascular risk, inspired by the Systolic Blood Pressure Intervention Trial (SPRINT). We included 103,708 patients with hypertension and a "QRISK3" estimated 10-year risk of cardiovascular disease of ≥20% who initiated an antihypertensive drug between 1998 and 2018. Dynamic marginal structural models estimated the comparative effects of treating patients with intensive (target BP: 130/80 mm Hg), standard (140/90 mm Hg), and conservative (150/90 mm Hg) BP control strategies. The adjusted hazard ratios (HRs) for the intensive versus standard strategy were 0.96 (95% confidence interval (CI): 0.92, 1.00) for major adverse cardiovascular events and 0.93 (95% CI: 0.88, 0.97) for death from cardiovascular causes. For the conservative versus standard strategy, they were 1.06 (95% CI: 1.02, 1.10) and 1.08 (95% CI: 1.03, 1.13), respectively. These results are largely compatible with SPRINT. ATS can be used to emulate randomized controlled trials of complex treatment strategies in an observational setting and represents an alternative approach for situations where randomized controlled trials are not feasible.

Left Bundle Branch Area Pacing Contributes to a Greater Acute Blood Pressure Reduction Compared to Right Ventricular Pacing.

Background: Several previous studies have explored the potential arterial blood pressure (BP) changes in patients undergoing right ventricular pacing (RVP), however, the relationship between left bundle branch area pacing (LBBAP) and BP variations remains unknown. This study aimed to examine the acute BP variations following LBBAP and RVP implantation in patients with bradycardia. Methods: We conducted a single-center retrospective study including all patients who underwent de-novo dual-chamber pacemaker implantation between January 2019 and June 2021. Patients were divided into two groups, LBBAP and RVP, and propensity score-matching (PSM) was used to balance confounding factors. Three time periods were defined according to the timing of the implant: baseline (within 24 hours before implantation), hyper-acute period (0-24 hours post-implantation), and acute period (24-48 hours post-implantation). BP was measured at least three times per period using an arm pressure cuff and then averaged for analysis, which allowed us to determine the acute impact of pacemaker implantation on BP. Results: From a cohort of 898 patients, 193 LBBAP receivers were matched to 193 RVP receivers. A significant decrease in systolic BP (SBP) after the implantation was observed in the study cohort, from baseline 137.3 ± 9.2 mmHg to the acute period of 127.7 ± 9.4 mmHg (p < 0.001). The LBBAP group exhibited a greater SBP reduction than the RVP group ( Δ 11.6 ± 6.2 mmHg vs. Δ 7.6 ± 5.8 mmHg, p < 0.001). In further subgroup analysis, LBBAP receivers who had high baseline SBP (p < 0.001) and those without using anti-hypertensive drugs (p = 0.045) appeared to have a higher magnitude of SBP reduction. Conclusions: Permanent pacemaker implantation may contribute to an acute decrease in systolic BP, which was more pronounced in LBBAP receivers. Future experimental and clinical investigations are necessary to explore the underlying mechanisms and the long-term hemodynamic effects of LBBAP versus RVP.

Intensive blood pressure control and the progression of IgA nephropathy: a cohort study using marginal structural models.

BACKGROUND: In chronic kidney disease, current guidelines recommend systolic blood pressure (SBP) below 120 mmHg. However, the renoprotective effect of intensive blood-pressure (BP) lowering on immunoglobulin A nephropathy (IgAN) remains undetermined. We aimed to determine the effect of intensive BP control on the progression of IgAN. METHODS: At Peking University First Hospital, 1530 patients with IgAN were enrolled. An examination of the relationship between baseline and time-updated BP and composite kidney outcomes, defined as development of end-stage kidney disease (ESKD) or a 30% decline in estimated glomerular filtration rate (eGFR), was conducted. Baseline and time-updated BPs were modeled using multivariate causal hazards models and marginal structural models (MSMs). RESULTS: In a median follow-up of 43.5 (interquartile range 27.2, 72.7) months, 367 (24.0%) patients experienced the composite kidney outcomes. No significant associations were found between baseline BP and the composite outcomes. Using MSMs with time-updated SBP for analysis, a U-shaped association was found. In reference to SBP 110-119 mmHg, hazard ratios (95% confidence intervals) for the SBP categories <110, 120-129, 130-139 and ≥140 mmHg were 1.48 (1.02-2.17), 1.13 (0.80-1.60), 2.21 (1.54-3.16) and 2.91 (1.94-4.35), respectively. The trend was more prominent in patients with proteinuria ≥1 g/day and eGFR ≥60 mL/min/1.73 m2. After analyzing time-updated diastolic BP, no similar trend was observed. CONCLUSIONS: In patients with IgAN, intensive BP control during the treatment period may retard the kidney disease progression, but the potential risk of hypotension still needs to be considered.

Hypertension treatment in patients with sleep apnea from the European Sleep Apnea Database (ESADA) cohort - towards precision medicine.

We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta-blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta-blocker was associated with lower systolic blood pressure, particularly in non-obese middle-aged males with hypertension. Conversely, the combination of a beta-blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate-severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross-sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted.

The correlation between different antihypertensive treatments and prognosis of cardiovascular disease in hypertensive patients.

OBJECTIVE: To determine the association between different antihypertensive regimens and cardiovascular disease (CVD) outcomes in hypertensive patients. METHOD: This single center retrospective cohort study analyzed 602 hypertensive patients with complete medical records at Zhongnan Hospital of Wuhan University, China, from January 2016 to November 2022. Baseline data and follow-up data of the included patients were collected, including demographic and clinical characteristics and laboratory results. RESULTS: During the 5-year follow-up period, CVD outcomes occurred in 244 hypertensive patients (40.53%). Compared with patients receiving regular antihypertensive treatment, the incidence of adverse cardiovascular events in patients receiving irregular antihypertensive treatment was significantly higher (62 [55.86%] vs 182 [37.07%], HR 1.642, 95% CI 1.227-2.197, p < 0.001). In subgroup analysis, the results showed that the incidence of CVD was not identical (χ2 = 9.170, p = 0.010). The incidence of adverse cardiovascular events was highest in the single-drug antihypertensive treatment group (43.60%), followed by the multi-drug combination group (41.51%), and lowest in the two-drug combination group (29.58%). Kaplan-Meier curve showed that hypertensive patients treated with two-drug combination antihypertensive had longer overall survival time. We further compared the incidence of CVD between standard blood pressure and intensive blood pressure control, and found no significant difference in the incidence of adverse cardiovascular events between treatment to a systolic blood pressure (SBP) target of less than 140 mmHg compared with a SBP target of less than 120 mmHg (105 [43.93%] vs 35 [29.66%], HR 1.334, 95% CI 0.908-1.961, p = 0.142). CONCLUSION: The incidence of adverse cardiovascular events was significantly different among different antihypertension treatments. Kaplan-Meier survival curve showed that hypertensive patients receiving two-drug combination antihypertensive treatment had longer overall survival time.

Hypertension medication from guidelines to practice: A cohort study in western Iran.

PURPOSE: Hypertension (HTN) is one of the most common risk factors for non-communicable chronic diseases. The aim of the current study is to evaluate the prescribing patterns of antihypertensive medications in Kermanshah Province, west of Iran. METHODS: The Ravansar Non-Communicable Diseases (RaNCD) cohort study is the first Kurdish community-based study; subjects' age ranged from 35 to 65 years. In order to examine the use of medications to control blood pressure, participants were asked to bring all prescribed medications to the study center. Treatments were compared with 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the management of arterial HTN. RESULTS: From a total of 10 040 participants in RaNCD cohort, 1575 (15.7%) individuals were hypertensive, of whom, 1271 (80.7%) people were aware of their condition. From 1153 (73.20%) people under treatment, 840 (72.8%) had their HTN properly controlled. The most common medications used to treat HTN were losartan (27.5%), metoprolol (14.3%), and captopril (11.9%). Regardless of type of treatment, 49.3% of all patients have received the medication for l 6 ≥ years. The most commonly used drugs were ß-blockers and angiotension receptor blockers as 620 (31.0%) and 612 (30.6%), respectively. Multivariable analysis showed that female gender, those receive ≥3 antihypertensive agents, and using preferred combinations were associated with a better blood pressure control. In addition, the probability of hypertension control was less likely with increasing duration of treatment (i.e >6 years) and in obese patients with ≥35 kg/m2 . CONCLUSIONS: Even though adherence to the international guidelines was acceptable, improvements can be made for better control of HTN. Therefore, it is imperative to educate healthcare professionals on improving their selection of antihypertensive medications and combination therapy for hypertensive patients.

Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients.

BACKGROUND: Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension. METHODS: Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The "KHB-method" was used to perform mediation analysis. RESULTS: Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78-7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control. CONCLUSIONS: Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.

The Impact of Timing of Fixed Dose Triple Antihypertensive Combinations on Ambulatory Blood Pressure Monitoring Parameters.

INTRODUCTION: Re-establishing "dipping" physiology significantly reduces cardiovascular events. The aim was to investigate the effect of timing of fixed dose triple antihypertensive combinations on blood pressure (BP) control. METHODS: One hundred sixteen consecutive patients (62.7 ± 10.7 years, 38 men) with grade II hypertension were randomized into four groups. Group 1 and Group 2 patients were given angiotensin converting enzyme inhibitor-based triple antihypertensive pills to be taken in the morning or evening, respectively while Group 3 and Group 4 patients were given angiotensin receptor blocker (ARB) based triple antihypertensive pills to be taken in the morning or evening, respectively. All patients underwent 24-h ambulatory BP monitoring 1 month after the initiation of treatment. RESULTS: There were not any significant differences in the characteristics, BP values and loads among groups. All patients in each group had good BP control. Dipping pattern in systolic BP was observed significantly less in Group 3 patients taking ARB in the morning (3 patients) compared to other groups (12 patients) in each group, [P = .025]. Similarly, dipping pattern in diastolic BP was observed significantly less in Group 3 patients (4 patients) compared to others (13 patients) in Group 1 and 15 patients in Group 2 and Group 4, [P = .008]. Nondipping pattern was significantly associated with taking ARB in the morning, even when adjusted by age, sex, and other comorbidities. CONCLUSION: Fixed dose triple antihypertensive drug combinations enable good BP control regardless of the timing of drug while ARB-based ones may be taken in the evening to ensure dipping physiology.

Improving Hypertension Control in Vulnerable Populations Around the World.

PURPOSE OF REVIEW: This review aims to describe recent literature, guidelines, and approaches to reveal and reduce hypertension burden in disadvantaged populations. Hypertension is a major global health issue and the most potent risk factor for cardiovascular disease, morbidity, and mortality. It disproportionally affects vulnerable populations, including low-, middle-, and high-income countries. Specifically, the burden of hypertension is higher in US Black adults, and addressing social determinants of health is crucial for reducing disparities among vulnerable populations worldwide. RECENT FINDINGS: Multifactorial approaches, including lifestyle modifications and combination drug therapy, are essential in managing hypertension. Community-based interventions, team-based care, and telehealth strategies can also improve hypertension control. Additionally, renal nerve denervation is a potential treatment for resistant hypertension. Overall, to reduce the global hypertension burden among vulnerable populations, emphasis should be placed on equitable healthcare access and application of evidence-based medicine.

Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study.

BACKGROUND: In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. OBJECTIVE: We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. METHODS: This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ≥18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. RESULTS: A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. CONCLUSIONS: Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension.