scholarly journals Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

2017 ◽  
Vol 2 (9) ◽  
pp. e411-e419 ◽  
Author(s):  
Marjan W Attaei ◽  
Rasha Khatib ◽  
Martin McKee ◽  
Scott Lear ◽  
Gilles Dagenais ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Low Income ◽  
Pressure Control ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Blood Pressure Lowering ◽  
Middle Income ◽  
Pressure Lowering

scholarly journals Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Anna Paczkowska ◽  
Karolina Hoffmann ◽  
Krzysztof Kus ◽  
Dorota Kopciuch ◽  
Tomasz Zaprutko ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drug ◽  
Blood Pressure Control ◽  
Combined Treatment ◽  
Pressure Control ◽  
Antihypertensive Drug Therapy ◽  
Blood Pressure Lowering ◽  
Hypertensive Patients ◽  
Pressure Lowering ◽  
Β Blockers

Background. Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals. Objectives. The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. Methodology. A cross-sectional retrospective study consisted of 204 patients aged 18–65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility. Results. As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI + β-blockers and tritherapy such as diuretics + β-blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy ( p = 0.0001 ). Conclusion. During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies.

scholarly journals MON-205 Effectiveness of Pre-Op α-Blockade on Intra-Op Blood Pressure Control in Patients with Pheochromocytoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Julia Caroline Wingate Lake ◽  
Richard J Comi
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Cumulative Dose ◽  
Hypertensive Crisis ◽  
Pressure Control ◽  
Volume Replacement ◽  
Perioperative Outcomes ◽  
Preoperative Treatment ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

Abstract Pheochromocytoma are rare tumors arising from catecholamine producing chromaffin tissue. Surgical manipulation of pheochromocytoma inevitably leads to supraphysiologic levels of circulating catecholamines. Such manipulation has the potential to lead to an intra-operative hypertensive crisis, cardiac arrhythmia, myocardial infarction, or pulmonary edema. When inadequately primed pre-operatively, a patient exposed to such surges may experience life-threatening consequences. Phenoxybenzamine is a non-competitive, non-selective α 1 and α 2 receptor antagonist that prevents blood pressure liability during surgical resection of pheochromocytoma. Previous literature has suggested that phenoxybenzamine affords more pronounced peri-operative systolic blood pressure control as compared to selective alpha-blockers. This superior control potentially is at the cost of postoperative hypotension owing to the irreversible nature of phenoxybenzamine.1 Our study compares the effects of pre-operative phenoxybenzamine on perioperative outcomes at a single tertiary medical center from 2004 to 2019. The cumulative pre-operative phenoxybenzamine dose was compared to the maximum intra-operative blood pressure, need for IV blood pressure lowering medications, duration of vasopressor need, volume replacement need, duration of time in the OR, duration of hospital stay, and pre-operative catecholamine levels. We speculate that increased phenoxybenzamine exposure will result in reduced peak intra-operative blood pressure and need for IV blood pressure lowering medications but may increase the need for post-resection intra-operative vasopressors and post-resection volume replacement. After IRB approval, (ID #00031606), we performed a data warehouse query for the ICD 9 and 10 codes of “pheochromocytoma” and “paraganglioma”. Patients who did not have confirmed pheochromocytoma on pathology were excluded. Data was collected retrospectively on 30 patients who underwent adrenalectomy for pheochromocytoma. 14 charts were excluded due to incomplete intra-operative anesthetic documentation. Our results suggest that there is no significant correlation between peak intra-operative MAP and cumulative phenoxybenzamine exposure. The cumulative dose of pre-operative phenoxybenzamine did not correlate with the number of anti-hypertensive medications used intra-operatively. An increased cumulative dose of pre-operative phenoxybenzamine was not associated with an increased duration of intra-operative vasopressor medications. Intra-operative volume replacement needs were surprisingly reduced with increased cumulative pre-operative phenoxybenzamine exposure. 1 P.A. van der Zee, A. de Boer. Pheochromocytoma: A review on preoperative treatment with phenoxybenzamine or doxazosin. The Netherlands Journal of Medicine. May 2014; Vol. 72 No 4, 190-201.

Abstract 025: Factors Influencing Blood Pressure Control and Adherence in a Middle income Country That Provides Universal Free Access to a Comprehensive Hypertension Program

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Daniela Sandoval Huenchual ◽  
Carolina Nazzal ◽  
Tomás Romero
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
National Health ◽  
Low Income ◽  
Pressure Control ◽  
Multivariable Logistic Regression Analysis ◽  
Free Access ◽  
Psychosocial Characteristics ◽  
Middle Income ◽  
Hypertensive Patients

Background: Limited information exists on the association of clinical, socio-economic, psychosocial factors and free access to national health programs with blood pressure control (BPC) and adherence to therapy (Rx) in developing middle income countries. Methods: Cross-sectional study in randomly selected 992 hypertensive patients (30 to 64 years of age) served in the Chilean national Cardiovascular Health Program (CVHP) that provides free medical care and life style modification counseling to approximately 75% of the population. Association of education, income, diabetes, obesity, physical activity, psychosocial characteristics, smoking, abnormal alcohol use with BPC and adherence to Rx was evaluated in patients with at least 1 year in the CVHP. Adherence to Rx and psychosocial characteristics were assessed using validated questionnaires. Odds ratios (OR) with 95% of confidence intervals for uncontrolled BP (≥140/90 mm/Hg) and no adherence to Rx were obtained through multivariable logistic regression analysis adjusted for all variables included in the study (see Table). Results: A larger number of women (65.2%) were part of the study. BPC was achieved in 53.5% of patients and 38.7% were adherent to Rx. Uncontrolled BP was significantly associated with non adherence (OR: 1.34 [95% CI 1.09 - 1.65]); other associations are shown in table. Discussion and Conclusions: In hypertensive patients followed in the CVHP, BPC was achieved in 53.5%. It is of note that a 2010 Chilean National Health Survey reported BPC in 16.7% of the population and in 45.3% of subjects that stated to be under Rx. Uncontrolled BP and low Rx adherence were significantly associated to male gender, also underrepresented in the study population (34.8%) and low Rx adherence to high score of emotional stress and depression, underlining need of measures addressing those issues. Low adherence was associated to low income notwithstanding free access to care and therapy.

scholarly journals Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

2020 ◽  
Author(s):  
Ranjit Mohan Anjana ◽  
Viswanathan Mohan ◽  
Sumathy Rangarajan ◽  
Hertzel C Gerstein ◽  
Ulagamadesan Venkatesan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Wealth Index ◽  
Mortality Rates ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Urban Rural ◽  
Design And Methods

<b>Objectives: </b>We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. <p><b>Research design and methods:<a></a><a> </a></b>Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. </p> <p><b>Results:</b> Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p<0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1000 person years, p<0.001) and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1000 person years, p<0.001) were considerably higher in LIC compared to MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioural risk factors and treatments [Hazards ratio (95% Confidence Interval): 1.89 (1.58 – 2.27) to 1.78 (1.36 – 2.34)].</p> <p><b>Conclusions: </b>CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. </p>

scholarly journals Contrasting associations between diabetes and cardiovascular mortality rates in low, middle and high-income countries – Cohort study data from 143,567 individuals in 21 countries – The PURE study

2020 ◽  
Author(s):  
Ranjit Mohan Anjana ◽  
Viswanathan Mohan ◽  
Sumathy Rangarajan ◽  
Hertzel C Gerstein ◽  
Ulagamadesan Venkatesan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Wealth Index ◽  
Mortality Rates ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Urban Rural ◽  
Design And Methods

<b>Objectives: </b>We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. <p><b>Research design and methods:<a></a><a> </a></b>Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. </p> <p><b>Results:</b> Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p<0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1000 person years, p<0.001) and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1000 person years, p<0.001) were considerably higher in LIC compared to MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioural risk factors and treatments [Hazards ratio (95% Confidence Interval): 1.89 (1.58 – 2.27) to 1.78 (1.36 – 2.34)].</p> <p><b>Conclusions: </b>CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. </p>

scholarly journals Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

2020 ◽  
Author(s):  
Ranjit Mohan Anjana ◽  
Viswanathan Mohan ◽  
Sumathy Rangarajan ◽  
Hertzel C Gerstein ◽  
Ulagamadesan Venkatesan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Wealth Index ◽  
Mortality Rates ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Urban Rural ◽  
Design And Methods

<b>Objectives: </b>We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. <p><b>Research design and methods:<a></a><a> </a></b>Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. </p> <p><b>Results:</b> Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p<0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1000 person years, p<0.001) and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1000 person years, p<0.001) were considerably higher in LIC compared to MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioural risk factors and treatments [Hazards ratio (95% Confidence Interval): 1.89 (1.58 – 2.27) to 1.78 (1.36 – 2.34)].</p> <p><b>Conclusions: </b>CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. </p>

scholarly journals Daily inhalation of hydrogen gas has a blood pressure-lowering effect in a rat model of hypertension

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kazuhisa Sugai ◽  
Tomoyoshi Tamura ◽  
Motoaki Sano ◽  
Shizuka Uemura ◽  
Masahiko Fujisawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Parasympathetic Nervous System ◽  
Pressure Control ◽  
Hydrogen Gas ◽  
Blood Pressure Lowering ◽  
Blood Pressure Lowering Effect ◽  
Night Time ◽  
Lowering Effect ◽  
Pressure Lowering

AbstractA recent clinical study demonstrated that haemodialysis with a dialysate containing hydrogen (H2) improves blood pressure control in end-stage kidney disease. Herein, we examined whether H2 has a salutary effect on hypertension in animal models. We subjected 5/6 nephrectomised rats to inhalation of either H2 (1.3% H2 + 21% O2 + 77.7% N2) or control (21% O2 + 79% N2) gas mixture for 1 h per day. H2 significantly suppressed increases in blood pressure after 5/6 nephrectomy. The anti-hypertensive effect of H2 was also confirmed in rats in a stable hypertensive state 3 weeks after nephrectomy. To examine the detailed effects of H2 on hypertension, we used an implanted telemetry system to continuously monitor blood pressure. H2 exerted an anti-hypertensive effect not only during daytime rest, but also during night-time activities. Spectral analysis of blood pressure variability revealed that H2 improved autonomic imbalance, namely by suppressing the overly active sympathetic nervous system and augmenting parasympathetic nervous system activity; these effects co-occurred with the blood pressure-lowering effect. In conclusion, 1-h daily exposure to H2 exerts an anti-hypertensive effect in an animal model of hypertension.

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