PROGNOSTIC SIGNIFICANCE OF VISIT-TO-VISIT VARIABILITY, MEAN AND MAXIMUM BLOOD PRESSURE IN TREATED HYPERTENSIVE PATIENTS WITH HIGH CARDIOVASCULAR RISK

AbstractThe optimal target blood pressure (BP) in the treatment of hypertensive patients remains controversial. Recently, the systolic blood pressure trial (SPRINT) has proposed that a target systolic blood pressure of < 120 mmHg provides prognostic benefit in elderly hypertensive patients at high cardiovascular risk. The results of SPRINT contrast with several other intervention trials which have investigated the effect of intense BP lowering (Secondary Prevention of Small Subcortical Strokes [SPS3], Action to Control Cardiovascular Risk in Diabetes [ACCORD], Heart Outcomes Prevention Evaluation [HOPE]-3). The differences in outcomes in SPRINT vs. other intervention trials are, to a large extend, due to an "unobserved" BP measurement procedure utilized in the SPRINT trial. Thus, a BP goal of < 120 mmHg, at least by conventional BP measurement, remains unproven. Independent of SPRINT the controversial evidence with respect to BP targets calls for further studies and, possibly, for more individualized treatment goals.

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The Condition of Cognitive Functions in Patients with Stage 1 and Stage 2 Hypertension of 2-3 Degrees, with Moderate and High Cardiovascular Risk and Gender Characteristics of the Revealed Disorders

Lviv clinical bulletin ◽

10.25040/lkv2021.01-02.014 ◽

2021 ◽

Vol 1-2 (33-34) ◽

pp. 14-18

Author(s):

V. Skybchyk ◽

◽

O. Pylypiv ◽

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Cardiovascular Risk ◽

Cognitive Functions ◽

Healthy Individuals ◽

High Cardiovascular Risk ◽

Hypertensive Patients ◽

Female Patients ◽

Male Patients ◽

Stage 1

Context. It is known that in addition to transient ischemic attacks and insults, hypertension is often the cause of asymptomatic brain damage, including cognitive impairment (CI). Most of these studies show a positive relationship between midlife hypertension and cognitive decline at the advanced age. CI significantly affect the quality of life of patients, reduce the ability to learn, acquire new knowledge and skills, force them to change their usual way of life and often stop or reduce professional activities. Objective. To analyze the condition of cognitive functions in patients with stage 1 and stage 2 hypertension of 2nd-3rd degrees, with moderate and high cardiovascular risk and evaluate their gender peculiarities. Materials and methods. The study included 90 patients with stage 1 and stage 2 hypertension. The average age of patients with hypertension was 49.66 ± 8.74 years old. The average course of the disease was 7.7 ± 3.9 years. The comparison group consisted of 46 healthy individuals with normal blood pressure levels and without hypertension in anamnesis (the average age - 45.88 ± 3.03 years old). Applied methods included general clinical, methods of neuropsychological testing (MMSE, GPCOG, W. Schulte test), standard general clinical and biochemical laboratory methods (blood lipid spectrum, blood glucose, creatinine with GFR, electrolytes), instrumental (12-lead ECG, ambulatory monitoring of blood pressure, echocardiography in B-, D-modes), and statistical methods. Results. Patients with hypertension scored significantly less on the MMSE scale (26.82 ± 1.41 scores vs. 28.89 ± 0.82 scores, p = 0.001) and GPCOG (6.63 ± 1.88 scores vs. 8.35 ± 0.71 scores, p = 0.001) compared with healthy individuals and spent more time on performing Walter Schulte test (46.51 ± 8.59 seconds vs. 36.69 ± 6.77 seconds, p = 0.001). Moderate CI were detected in 36 patients (40.00 %) among the examined hypertensive patients; it means that the total score of MMSE was 24-26 scores (the norm is 27-30 scores). The total score on the MMSE scale was 25.47 ± 0.88 in hypertensive patients with CI and was significantly lower than in hypertensive patients without CI (р = 0.001). Cognitive functions in patients with CI were characterized by poorer indices of memory, counting and executive functions. It should be noted that the revealed changes had more reliable manifestations in male hypertensive patients. In particular, the total score on the MMSE scale was 26.57 ± 1.37, while in female ones it was 27.19 ± 1.41 scores (p = 0.04). CI on the MMSE scale were diagnosed in 43.4 % (n = 23) of male patients and in 35.1 % (n = 13) of female patients. The total score was also higher on the GPCOG scale in female patients - 6.89 ± 1.85 scores vs. 6.45 ± 1.89 scores, p = 0.26. Instead, the time to complete the tasks according to the Walter Schulte tables was longer in male patients - 47.74 ± 8.85 seconds vs. 47.73 ± 7.99 seconds, p = 0.10, respectively. The parameters of counting functions were significantly lower (p = 0.01) in the group of male hypertensive patients compared with female ones. Besides, men had lower indicators of short-term memory and orientation, women reproduced worse verbal material, but the difference was statistically insignificant (p-value more than 0.05). The sum of scores on the MMSE scale conversely correlated with male gender (r = -0.22, p = 0.03). The risk of low values of MMSE indices in male patients with hypertension was 42.00 % higher than in female ones (OR = 1.42 ± 0.32, with 95% CІ [0.18-2.65]). Conclusions. Hypertension is a significant independent risk factor for developing new cases of cognitive impairment. In particular, among the patients with stage 1 and stage 2 hypertension of 2nd-3rd degrees, with moderate and high cardiovascular risk, moderate cognitive impairment was revealed in 36 patients (40,00 %), the revealed changes were more manifested in male hypertensive patients.

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THE EFFECT OF STATIN ADDED TO ANTIHYPERTENSIVE THERAPY ON ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS AT HIGH CARDIOVASCULAR RISK

Acta biomedica scientifica ◽

10.29413/abs.2018-3.5.4 ◽

2018 ◽

Vol 3 (5) ◽

pp. 27-32

Author(s):

O. V. Fedorishina ◽

K. V. Protasov ◽

A. M. Torunova

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Antihypertensive Therapy ◽

Pulse Wave ◽

Augmentation Index ◽

High Cardiovascular Risk ◽

Hypertensive Patients ◽

Aortic Blood Pressure

Background.Little is known about the effect of statins addition to standard antihypertensive therapy on blood pressure level and vascular stiffness in high-risk hypertensive patients.The aimof the study was to assess the dynamics of vascular stiffness in hypertensive patients of high or very high cardiovascular risk under the influence of rosuvastatin addition to combined two-component amlodipine and lisinopril antihypertensive therapy.Materials and methods.We investigated 60 hypertensive patients who were randomized into two groups: the 1st group received a fixed amlodipine/lisinopril combination, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin. Mean office and ambulatory blood pressure as well as central aortic blood pressure and pulse wave velocity were evaluated in both groups before and after 24-week follow-up period.Results.At end of follow-up period the office and average daily blood pressure significantly decreased in both groups, with more prominent office diastolic blood pressure decline in the 2nd one. The central aortic blood pressure equally decreased in both groups. The augmentation index significantly reduced in both groups, mostly in the 2nd one. The carotid-femoral pulse wave velocity declined in both groups to the same extent. The carotid-radial pulse wave velocity decreased statistically only in the second group.Conclusions.Addition of rosuvastatin to a fixed amlodipine/lisinopril combination in high/very high cardiovascular risk hypertensive patients was accompanied by more pronounced decline of diastolic blood pressure and augmentation index, as well as significantly reduction of pulse wave velocity.

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Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care

Therapeutic Advances in Cardiovascular Disease ◽

10.1177/1753944716677242 ◽

2016 ◽

Vol 11 (2) ◽

pp. 49-56 ◽

Cited By ~ 1

Author(s):

Mohamed Alami ◽

Mustapha El Hattaoui ◽

Mehdi Seqat ◽

Jamaa Sadik ◽

Aicha Aouad ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Cardiovascular Risk ◽

Uncontrolled Hypertension ◽

Newly Diagnosed ◽

High Cardiovascular Risk ◽

Prospective Longitudinal Study ◽

Hypertensive Patients ◽

Prospective Longitudinal

Background: Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. Methods: This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. Results: A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40–60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m2]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. Conclusions: More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

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Cardiovascular Risk Assessment in Hypertensive Patients

American Journal of Hypertension ◽

10.1093/ajh/hpab021 ◽

2021 ◽

Author(s):

Michael C Wang ◽

Donald M Lloyd-Jones

Keyword(s):

Blood Pressure ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Risk Prediction ◽

Clinical Management ◽

Prognostic Significance ◽

Quantitative Risk Assessment ◽

Cardiovascular Risk Assessment ◽

Hypertensive Patients ◽

Cardiovascular Risk Prediction

Abstract Hypertension is a highly prevalent and causal risk factor for cardiovascular disease (CVD). Quantititaive cardiovascular risk assessment is a new paradigm for stratifying hypertensive patients into actionable groups for clinical management and prevention of CVD. The large heterogeneity in hypertensive patients makes this evaluation complex, but recent advances have made CV risk assessment more feasible. In this review, we first describe the prognostic significance of various levels and temporal patterns of blood pressure. We then discuss cardiovascular risk prediction equations and the rationale of taking global risk into account in hypertensive patients. Finally, we review several adjunctive biomarkers that may refine risk assessment in certain patients. We observe that, beyond individual cross-sectional measurements, both short-term and long-term blood pressure patterns are associated with incident CVD; that current cardiovascular risk prediction performs well, and its incorporation into hypertension management is associated with potential population benefit; and that adjunctive biomarkers of target organ damage show the most promise in sequential screening strategies that target biomarker measurement to patients in whom the results are most likely to change clinical management. Implementation of quantitative risk assessment for CVD has been facilitated by tools and direct electronic health record integrations that make risk estimates accessible for counseling and shared decision making for CVD prevention. However, it should be noted that treatment does not return an individual to the risk of someone who never develops hypertension, underscoring the need for primordial prevention in addition to continued innovation in risk assessment.

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Demographic and clinical characteristics of hypertensive patients in the internal medicine outpatient clinic of a university hospital in Rio de Janeiro

Sao Paulo Medical Journal ◽

10.1590/s1516-31802004000300003 ◽

2004 ◽

Vol 122 (3) ◽

pp. 87-93 ◽

Cited By ~ 13

Author(s):

Elizabeth Silaid Muxfeldt ◽

Armando da Rocha Nogueira ◽

Gil Fernando Salles ◽

Kátia Vergetti Bloch

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Control ◽

Rio De Janeiro ◽

Pressure Control ◽

Organ Damage ◽

University Hospital ◽

High Cardiovascular Risk ◽

Hypertensive Patients

CONTEXT: Hypertension is one of the most important cardiovascular risk factors but its control is still a challenge for physicians all around the world. For blood pressure control to be improved, it is important to guarantee the quality of attendance provided for hypertensive patients, especially in teaching hospitals, where future physicians are being trained. OBJECTIVE: To characterize the profile of hypertensive patients attending the internal medicine outpatient clinic of a university hospital in Rio de Janeiro,describing their cardiovascular risk and identifying flaws in the treatment provided for severely hypertensive patients, in order to implement an arterial hypertension management program. TYPE OF STUDY: A descriptive cross-sectional population-based study. SETTING: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. METHODS: The study was carried out over a period of four months, involving all the hypertensive patients under treatment in the outpatient unit. The attending physician obtained information relating to demographic features, cardiovascular risk factors, target organ damage, blood pressure levels, therapeutic regimens and compliance with treatment. Means and the respective standard deviations and proportions were used to describe the distribution of patient data. RESULTS: Of the total number of patients seen, 24.2% (1,699 patients) were hypertensive. Women accounted for 65.0% of the patients. The mean age was 63.9 years. Dyslipidemia (49.2%) and diabetes (29.8%) were the most frequently reported risk factors and heart disease was the most prevalent end-organ damage. Seventy percent of the patients were classified as high cardiovascular risk. In spite of the high intensity treatment provided for the most severe patients (19.4% on a regimen of 3 or more antihypertensive drugs), the rate of blood pressure control was low (27%). CONCLUSIONS: The patients with arterial hypertension under treatment at the university hospital had a profile of high cardiovascular risk and poor blood pressure control. Greater effort for improving hypertension control is needed, since this is the only way to reduce the morbidity and mortality rates of cardiovascular diseases.

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Ambulatory blood pressure monitoring in hypertensive patients with high cardiovascular risk: a cross-sectional analysis of a 20 000-patient database in Spain

Journal of Hypertension ◽

10.1097/hjh.0b013e32809874a2 ◽

2007 ◽

Vol 25 (5) ◽

pp. 977-984 ◽

Cited By ~ 81

Author(s):

Manuel Gorostidi ◽

Javier Sobrino ◽

Julián Segura ◽

Cristina Sierra ◽

Álex de la Sierra ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

High Cardiovascular Risk ◽

Cross Sectional ◽

Hypertensive Patients ◽

Patient Database ◽

Sectional Analysis

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Abstract 113: Ambulatory Blood Pressure in Hypertensive Patients with Inclusion Criteria for the SPRINT Trial

Hypertension ◽

10.1161/hyp.68.suppl_1.113 ◽

2016 ◽

Vol 68 (suppl_1) ◽

Author(s):

Alejandro De La Sierra ◽

Jose R Banegas ◽

Juan A Divison ◽

Manuel Gorostidi ◽

Ernest Vinyoles ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Antihypertensive Therapy ◽

Ambulatory Blood Pressure ◽

Normal Values ◽

Inclusion Criteria ◽

High Cardiovascular Risk ◽

Exclusion Criteria ◽

Hypertensive Patients ◽

Mean Values

The SPRINT trial has demonstrated the benefit of intensive BP reduction in hypertensive patients at high cardiovascular risk. Values of ABPM are of potential interest in such patients to better select those who will benefit of a lower BP target. We aimed to evaluate ABPM values in a large cohort of patients potentially candidates (meeting inclusion criteria) for the SPRINT trial. Moreover, in patients on antihypertensive therapy who also fulfill SPRINT criteria, except for clinic SBP ≥ 130 mmHg, we evaluated 24-hour SBP values among those who had clinic SBP < 120; between 120 and 139, or ≥ 140. From the database of the Spanish ABPM Registry containing 115708 patients, we identified 39132 (34%, 51% women, mean age 65 years) who fulfill both inclusion and exclusion criteria of the SPRINT trial. Mean values of clinic SBP were 151±11 mmHg, whereas corresponding values for 24-h SBP were 130±13 mmHg. Overall, 52% of patients had 24-h SBP below 130 mmHg. The proportion varied from 69% in those with clinic BP 130-139 to 34% in those with clinic BP ≥ 170 mmHg. Among 34328 treated patients who fulfilled SPRINT inclusion criteria (except for clinic BP ≥ 130), 1014 (3%) had clinic SBP < 120 mmHg, and 5330 (16%) values between 120 and 139 mmHg. The remaining 27984 patients were not controlled and had clinic SBP ≥ 140 mmHg. Values of 24 h SBP below 130 mmHg were seen in 88% of those with clinic BP < 120, in 74% of those with clinic BP 120-139, and in 47% of those with clinic BP ≥ 140 mmHg. The corresponding proportion of patients having 24-h SBP < 100 mmHg were 7.7%, 1.1%, and 0.6%. We conclude that ABPM assessment could be necessary in the evaluation of hypertensive patients at high CV risk before targeting the BP goal, as roughly half of them may have normal values of 24-h SBP (< 130 mmHg). In addition, targeting clinic BP below 120 mmHg is accompanied by 8% of patients with 24-h SBP below 100 mmHg.

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The major arteries and skin microcirculatory vessels status and antihypertensive therapy effect on them in hypertensive patients with high and very high cardiovascular risk

Systemic Hypertension ◽

10.26442/sg29123 ◽

2016 ◽

Vol 13 (2) ◽

pp. 11-16

Author(s):

E V Mordvinova ◽

E V Oshchepkova ◽

A A Fedorovich ◽

A R Zairova ◽

O A Pogorelova ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

High Risk ◽

Antihypertensive Therapy ◽

The State ◽

High Cardiovascular Risk ◽

Hypertensive Patients ◽

Local Stiffness ◽

Very High ◽

Large Vessels

Aim: to assess the state of the large blood vessels and skin microcirculatory vessels and the effects of angiotensin II receptor blockers (ARB) on them in hypertensive patients with high and very high cardiovascular risk (CVR). Subjects and methods. We examined 59 hypertensive patients aged 35-60 years, of which 29 high CVR subjects and 30 very high CVR (without antihypertensive therapy within 2 weeks prior to the study). In all subjects the evaluation of target organ damage, laser Doppler flowmetry (LDF) with initial perfusion parameters registration and amplitude-frequency spectrum of LDF-grams analysis, registration of central blood pressure, local stiffness parameters and photoplethysmography (PTMG) were performed. The second study was carried out after 2 weeks of antihypertensive treatment with ARB. Results. A significant increase in endothelial rhythm amplitude and coefficient of variation in very high risk hypertensive patients in comparison with a group of high-risk patients was found. In the group of very high-risk hypertensive patients central arterial pressure, augmentation index and local stiffness values were higher (n/a), the rate of carotid arteries extensibility was significantly reduced. There was a significant large vessels impairment in very high risk group according PTMG data. Target blood pressure level achieved in up to 80% of patients after 2 weeks treatment. During the re-examination a statistically significant improvement in the large arteries was found, LDF parameters also improved, but significant values was not reached. Conclusion. The findings suggest that with increasing degree of CVR in patients with hypertension there is a progressive deterioration of both large vessels and microcirculation state. After short-term antihypertensive therapy the function of large vessels improve in very high risk hypertensive patients, but the state of the microvasculature not changes significantly.

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