scholarly journals Prognostic Value of a Riser Pattern of Nighttime Blood Pressure in Very Elderly Adults of ≥80 Years: A General Practice-Based Prospective SEARCH Study

2020 ◽  
Vol 33 (6) ◽  
pp. 520-527 ◽  
Author(s):  
Takeshi Fujiwara ◽  
Satoshi Hoshide ◽  
Hiroshi Kanegae ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
General Practice ◽  
Very Elderly ◽  
Antihypertensive Medications ◽  
Event Risk ◽  
Practice Population ◽  
Elderly Outpatients ◽  
Nighttime Blood Pressure ◽  
Study Participants

Abstract BACKGROUND We examined our hypothesis that participants with higher mean nighttime blood pressure (BP) levels and/or those with a riser BP pattern, both measured by ambulatory blood pressure (BP) monitoring (ABPM), would show higher risk for cardiovascular disease (CVD) events compared to those with normal nighttime BP levels or a normal dipper BP pattern of circadian BP rhythm, even in very elderly participants in a general practice population. METHODS This prospective observational study enrolled 485 very elderly outpatients of ≥80 years (mean age: 83.2 ± 3.3 years; 44.7% male; 89.3% using antihypertensive medications). The prevalences of extreme dipper, dipper, nondipper, and riser status were 15.5%, 38.6%, 32.2%, and 13.8%, respectively. RESULTS During a mean follow-up of 3.9 years (1,734 person-years), 41 CVD events occurred. The participants with a riser pattern (higher nighttime systolic BP [SBP] than daytime SBP) showed a significantly higher risk for CVD events with adjustment for covariates: hazard ratio (HR), 2.61; 95% confidence interval (CI), 1.03–6.62. Even after adjusting for covariates and mean nighttime SBP level, the CVD risks in participants with a riser pattern remained significant: HR, 3.11; 95% CI, 1.10–8.88. On the other hand, all BP variables showed no significant risks for CVD events. In addition, when we divided study participants into quartiles by their ambulatory BP levels, none of the ambulatory BP variables showed a J- or U-shaped relationship with CVD event risk. CONCLUSIONS In very elderly general practice outpatients, a riser BP pattern was significantly associated with CVD events independently of mean nighttime BP.

scholarly journals Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population

Hypertension ◽  
2016 ◽  
Vol 68 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Satoshi Hoshide ◽  
Yuichiro Yano ◽  
Hajime Haimoto ◽  
Kayo Yamagiwa ◽  
Kiyoshi Uchiba ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
General Practice ◽  
Coronary Artery ◽  
Home Blood Pressure ◽  
Practice Population ◽  
Artery Disease

scholarly journals Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension—Pro Side of the Argument

Hypertension ◽  
2021 ◽  
Vol 78 (3) ◽  
pp. 879-893
Author(s):  
Ramón C. Hermida ◽  
Artemio Mojón ◽  
Michael H. Smolensky ◽  
José R. Fernández
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medications ◽  
Nighttime Blood Pressure

Abstract 65: Effects of Immediate Blood Pressure Reduction on Two-Year Mortality and Major Disability in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jiang He ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Dali Wang ◽  
Chung-Shiuan Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Antihypertensive Treatment ◽  
Blood Pressure Reduction ◽  
Control Group ◽  
Antihypertensive Medications ◽  
Vascular Events

Although elevated blood pressure (BP) is very common in patients with acute ischemic stroke, the management of hypertension among them remains controversial. We tested the effect of immediate BP reduction on two-year mortality and major disability in acute ischemic stroke patients. The China Antihypertensive Trial in Acute Ischemic Stroke, a randomized, single-blind, blinded end-points trial, was conducted in 4,071 patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment (n=2,038) or to discontinue all antihypertensive medications (n=2,033) during hospitalization. Post-treatment follow-ups were conducted at 3, 12, and 24 months after hospital discharge. The primary outcome was a composite of death and major disability at the two-year follow-up visit. Mean SBP was reduced by 21.8 in the treatment group and 12.7 mm Hg in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mm Hg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At two-year follow-up, study outcomes were obtained in 1945 (95.4%) participants in the treatment group and 1925 (94.7%) in the control group. 78.8% of the patients in the treatment group and 72.6% in the control group reported the use of antihypertensive medications (p<0.001). SBP was 138.8 mmHg in the antihypertensive treatment group and 139.7 in the control group (p=0.02). Among patients in the antihypertensive treatment group, 24.5% (476/1945) died or had a major disability, compared with 22.1% (425/1925) in the control group (odds ratio 1.14 [95% CI 0.99 to 1.33], p=0.078). Hazard ratios for all-cause mortality (1.01 [0.81, 1.25], p=0.95), recurrent stroke (0.91 [0.73, 1.13], p=0.40), and vascular events (0.97 [0.79, 1.19], p=0.76) were not statistically significant comparing the antihypertensive treatment group to the control group. The effect of antihypertensive treatment did not differ by pre-defined subgroups. In conclusion, among patients with acute ischemic stroke, BP reduction with antihypertensive medications during hospitalization did not reduce or increase the composite outcome of death and major disability over two years.

General Practice Blood Pressure Recording in Scotland: Variations in the Classification of Hypertension

1996 ◽  
Vol 41 (4) ◽  
pp. 108-109
Author(s):  
B.S. Henderson ◽  
M.W. Taylor ◽  
R.M. Milne ◽  
R.J. Taylor ◽  
L.D. Ritchie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Promotion ◽  
General Practice ◽  
Diastolic Pressure ◽  
Computer Software ◽  
Significant Risk ◽  
Practice Population ◽  
Wide Range ◽  
Health Promotion Activity

A questionnaire concerning blood pressure assessment, as part of health promotion activity, was circulated to all 770 Gpass practices in Scotland producing a 64.6% response rate. The results reveal a wide range in both the systolic and diastolic levels chosen to classify blood pressure as normal, borderline raised or raised. Practices are using a variety of values to indicate hypertension when considering systolic and, to a lesser extent, diastolic pressure. The variations found suggest that both over and under treatment are a significant risk to patients. The introduction of the 1993 health promotion regulations means that practices are required to actively target their practice population for blood pressure assessment and appropriate intervention. We suggest that this process will be enhanced if doctors are encouraged to adopt the established guidelines for the classification of blood pressure or general practice computer software is adapted to offer blood pressure protocol support.

scholarly journals Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument

Hypertension ◽  
2021 ◽  
Vol 78 (3) ◽  
pp. 871-878
Author(s):  
Ricky D. Turgeon ◽  
Andrew D. Althouse ◽  
Jordana B. Cohen ◽  
Bogdan Enache ◽  
John B. Hogenesch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medications ◽  
Nighttime Blood Pressure

scholarly journals P1806OUTCOMES OF PEDIATRIC RENOVASCULAR HYPERTENSON: A SINGLE-CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jiwon Jung ◽  
Joo Hoon Lee ◽  
Kun suk Kim ◽  
Young Seo Park
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Blood Pressure Control ◽  
Antihypertensive Agents ◽  
Good Control ◽  
Pressure Control ◽  
Renovascular Disease ◽  
Antihypertensive Medications

Abstract Background and Aims Renovascular disease is rare but important treatable cause of secondary hypertension in children. We aimed to evaluate the clinical presentations and long-term outcomes of pediatric patients with renovascular hypertension (RVH). Method We retrospectively reviewed medical records of patients with renovascular disease at our center between 1994 and 2019. Clinical courses including status of hypertension control with preservation of renal function during follow up were evaluated. Results 20 patients were diagnosed with RVH. 50 % (n = 10) were male, and median age at diagnosis was 10.1 (range 1.3 – 17.2) years, and median follow up period was 8.7 (range 0.1 – 24.6) years. 50 % (n = 10) presented with incidently detected high blood pressure (8 patients without symptoms, one with headache, and the other one with proteinuria), 25 % (n = 5) first admitted due to heart failure symptoms, and the rest (25 %, n = 5) presented with neurologic symptoms including seizure or paraplegia. Majority had no underlying disease except for 3 patients with Moyamoya disease. 80 % (n = 16) had unilateral renovascular stenosis. All patients showed elevated basal random renin activity (median 20.0, range 2.5 – 62.1 ng/ml/hr), and 45 % (n = 9) patients showed elevated basal random aldosterone level (median 822, range 266 – 2440 pg/ml). All patients needed antihypertensive medications for blood pressure control; 35 % (n = 7) of patients gained good control of blood pressure only with antihypertensive agents including angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), 40 % (n = 8) of patients who underwent percutaneous transluminal angioplasty all still needed antihypertensive agents including ACEI for blood pressure control. 20 % (n = 4) of the patients initially showed profoundly low relative function of involved kidney on diuretic scan, leading to nephrectomy. Three of these patients with nephrectomy successfully discontinued all antihypertensive agent gaining good control of blood pressure. The remaining one patient showed progressive deterioration of relative function on the involved side of kidney during 13 years, ended up with nephrectomy, but couldn’t discontinue ACEI. Glomerular filtration rate (GFR) was within normal range for all patients at diagnosis. For patients without nephrectomy, mean relative function of the involved kidney on diuretic scan was 33.5 ± 11.4 % at diagnosis. There was no significant change or deterioration of relative renal function during a mean follow up period of 10 ± 8 (median 11.5, range 0 – 19.5) years, although they all used ACEI/ARB. All patients including patients with nephrectomy showed normal GFR with a mean of 114.1 ± 19.5 ml/min/1.73 m2 at the last follow up. Conclusion Antihypertensive medications including ACEI and ARB were safely used with no further deterioration of the renal function of the involved side with or without angioplasty. Pediatric RVH is well managed with preserved renal function in long-term follow up.

scholarly journals Blood Pressure Control among Hypertensive Diabetic Patients on Follow-Up at Chronic Clinic of Nekemte Referral Hospital in West Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mohammed Gebre Dedefo ◽  
Dureti Bayisa Gemechu ◽  
Ginenus Fekadu ◽  
Tesfa Tekle Dibessa
Keyword(s):  
Blood Pressure ◽  
Cigarette Smoking ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Referral Hospital ◽  
Multivariable Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Modifiable Factors ◽  
Study Participants

Background. Hypertension is a prevalent comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age. Adults with diabetes historically have two or three times higher rate of cardiovascular disease (CVD) than adults without diabetes. Objective. The aim of this study was to assess blood pressure (BP) control and its predictors among hypertensive diabetic patients on follow-up at the chronic clinic of Nekemte Referral Hospital (NRH) in West Ethiopia. Methods. A cross-sectional study was conducted among hypertensive adult patients comorbid with diabetes taking antihypertensive drugs for at least one year in NRH. Both bivariable and multivariable analyses were done. The odds ratio, along with 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multivariable logistic regression analysis. The level of statistical significance was declared at p value <0.05 levels. The patient’s written informed consent was obtained after explaining the purpose and procedures of the study. Results. A total of 186 study participants were included in this study. The mean age of the participants was 51.2 ± 12.2 years. Blood pressure and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. In the multivariable analysis, age ≥60 years (AOR = 4.537, 95% CI = 1.142–18.024, p=0.032), duration with hypertension ≥5 years (AOR = 3.534, 95% CI = 1.062–11.760, p=0.040), cigarette smoking (AOR = 7.697, 95% CI = 2.356–25.146, p=0.001), nonadherence (AOR = 6.584, 95% CI = 2.337–18.553, p<0.001), and uncontrolled glycaemia (AOR = 21.630, 95% CI = 8.057–58.070, p<0.001) were independent predictors of uncontrolled blood pressure. Conclusion. Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions on modifiable factors should be done to improve BP control of patients’ comorbid with diabetes.

Abstract WP190: Assessing The Performance Of The Framingham Stroke Risk Prediction Score In The REGARDS Cohort

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Leslie A McClure ◽  
Dawn O Kleindorfer ◽  
Mary Cushman ◽  
Elsayed Z Soliman ◽  
George Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Racial Differences ◽  
Risk Score ◽  
Stroke Risk ◽  
White Men ◽  
Left Ventricular ◽  
Antihypertensive Medications ◽  
Risk Period ◽  
Event Rates

INTRODUCTION: The most well-known stroke risk score is the Framingham Stroke Risk Score (FSRS). However, the FSRS was developed during the higher stroke risk period of the 1990’s, and has not been validated for African Americans. Methods: Among participants in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, we compared expected annualized stroke rates predicted from the FSRS to observed stroke rates overall and within strata defined by FSRS risk factors (age, sex, systolic blood pressure, use of antihypertensive medications, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy and prevalent coronary heart disease). Results: Among 27,748 participants stroke-free at baseline, 715 stroke events occurred over 5.6 years of follow-up. FSRS-estimated incidence of stroke was 1.6 times higher than observed rates for black men, 1.9 times higher for white men (Table 1). This overestimation was consistent among most subgroups of FSRS factors including by categories of predicted FSRS level and blood pressure (Table 1). The overestimation was smaller for low predicted-risk blacks and among white females with higher SBP. Conclusions: While higher FSRS was associated with higher stroke risk, the FSRS overestimated observed stroke rates in this study, particularly in certain subgroups. This may be due to temporal declines in stroke rates, secular trends in prevention treatments, or differences in populations studied. More accurate estimates of event rates are critical for planning research, including clinical trials, and targeting health-care efforts.

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