Abstract P128: Direct Observed Therapy In Suspected Resistant Hypertension Is Safe

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Swapnil Hiremath ◽  
Marcel Ruzicka
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Clinical Care ◽  
Treatment Resistant ◽  
Number Of Patients ◽  
Close Observation ◽  
The Mean ◽  
Orthostatic Symptoms ◽  
A Prospective Study

Introduction: Direct observed therapy (DOT) has emerged as a method for assessment of adherence, particularly in patients with apparent treatment-resistant hypertension (ATRH), in clinical care as well as research. We have previously demonstrated that direct observed therapy resulted in controlled hypertension in 30% of patients with ATRH. In this study we report on the safety of DOT in terms of change in blood pressure (BP) and hypotensive symptoms. Methods: Patients with ATRH were enrolled in a prospective study of DOT, which was followed by ambulatory blood pressure monitoring on the same day and at one month. DOT was performed by administering all prescribed BP lowering drugs, supervised by a nurse in an outpatient clinic setting. BP and vitals were measured at baseline and every 30 minutes until BP plateau based on two consecutive BP readings. All BP measurements during DOT were performed using an automated oscillometric BP device. In this study, we report the change in BP during DOT, with incidence of orthostatic symptoms, and decrease in systolic BP > 20 mm Hg as outcomes of interest. Results: 50 patients underwent DOT, 32 men, mean age 62 years on median 4 BP lowering drugs (range 3 to 7). The mean baseline BP was 146/77 mm Hg , and the lowest BP during DOT was 129/68 mm Hg. The median decrease in systolic BP was 14 mm Hg (range 0 to 60) and diastolic BP was 8 mm Hg (range 0 to 37). 5 patients (10%) developed orthostatic symptoms during DOT, none of which required any interventions, and resolved with continued observation. A decrease of > 20 mm Hg in systolic BP was seen in 19 patients (38%), and a systolic BP of < 110 mm Hg was seen in only 6 patients (12%). Conclusions: DOT caused decrease in BP by >20 mmHg in about 40% of patients. While these large acute decreases in BP were largely asymptomatic, close observation of BP is required until peak BP lowering effect wanes. As decrease in BP is driven by the degree of non-adherence and number of prescribed BP lowering drugs, our safety record has limitation dictated by the number of subjects enrolled, and relatively small number of patients with more than 5 BP lowering drugs.

Sympathetic renal denervation treatment in resistant hypertension: one-year follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Moiseeva ◽  
A Caraus ◽  
V Moscalu ◽  
N Ciobanu ◽  
M Abras ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Pharmacological Treatment ◽  
Renal Denervation ◽  
Blood Pressure Monitoring ◽  
Group Versus ◽  
Total Reduction ◽  
Treatment Regimens ◽  
The Mean

Abstract Aims A comparison influence of renal denervation versus pharmacological treatment with sympathetic nervous system blockers on blood pressure in patients with resistant hypertension. Methods 125 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg and confirmation of their resistance were randomly assigned into three groups, depending on medication supplemented to previously administered: IM group – selective I1-imidazoline agonist Moxonidine, IIB group – cardioselective beta-blocker Bisoprolol and IIID group – renal artery denervation. Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 6 and 12 month follow-up. The compliance to drug treatment was confirmed by 8-item Morisky Medication Adherence Scale. Renal denervation was performed with a Symplicity Spyral catheter. Results The mean 24 hour systolic blood pressure (SBP m/24 h) at baseline were 179.0±2.02 mmHg in IM group versus 177.96±2.44 mmHg in IIB group and 176.92±1.97 mmHg in IIID group, p&gt;0.05. Statistically significant dynamics was recorded starting with 3 months of evaluation in all three groups, the group of patients undergoing denervation of the renal arteries demonstrating a net superior effect compared with pharmacological treatment: −6.48±0.81 mmHg in I M group versus −6.2±0.88 mmHg in II B group and −23.28±1.9 mmHg in III D group, p&lt;0.001. The beneficial effect was maintained until the end of the study, when in observational group supplemented with Moxonidine SBP m/24 h were 159.6±1.72 mmHg with a total reduction of −19.9±0.7 mmHg from baseline, in Bisoprolol group −164.08±1.93 mmHg with a reduction of −13.88±1.13 mmHg and 141.76±0.77 mmHg in renal denervation group with a total reduction of −35.16±2.23 mmHg, p&lt;0.001. The mean 24 hour diastolic blood pressure (DBP m/24 h) increased at baseline in all three groups (105.52±1.28 mmHg in IM versus 108.6±1.6 mmHg in IIB and 107.24±0.92 mmHg in IIID, p&gt;0.05) similar to SBP m/24 h noted a significantly reduction at 3 month follow-up: −4.8±0.96 mmHg in IM group versus −3.64±0.47 mmHg in IIB group and −12.08±0.63 mmHg in IIID group, p&lt;0.001. The maximum reduction in DBP m/24 h were registered at 12 month follow-up, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation treatment in amelioration of this parameter: −13.68±0.83 mmHg in IM group versus −10.72±0.64 mmHg in IIB group and −20.2±1.28 mmHg in IIID group, p&lt;0.001. Conclusions The application of all three treatment regimens has been shown to be effective in reducing SBP and DBP values m/24 hours in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment versus both pharmacological treatment regimens. Funding Acknowledgement Type of funding source: None

Treatment-resistant hypertension in the hemodialysis population: a 44-h ambulatory blood pressure monitoring-based study

2020 ◽  
Vol 38 (9) ◽  
pp. 1849-1856
Author(s):  
Francesca Mallamaci ◽  
Claudia Torino ◽  
Pantelis Sarafidis ◽  
Robert Ekart ◽  
Charalampos Loutradis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Treatment Resistant ◽  
Pressure Monitoring

scholarly journals Self home blood pressure monitoring in pregnancy: how reliable is it?

2018 ◽  
Vol 7 (2) ◽  
pp. 419
Author(s):  
Hemapriya L. ◽  
Nagaraj Desai ◽  
Ambarish Bhandiwad
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Self Monitoring ◽  
Medical College ◽  
The Mean ◽  
The Difference ◽  
A Prospective Study ◽  
The Impact ◽  
In Pregnancy

Background: The use of automated blood pressure monitors in pregnancy has become increasingly popular, as more women tend to get involved in their healthcare. Not only does it reduce clinician visits, it also helps to eliminate the white coat hypertension.Methods: We conducted a prospective study in the antenatal department of JSS Medical College and Hospital, Mysuru; over a period of one year, from July 2016 to June 2017. The blood pressures of 50 women were recorded at four different periods of gestation using the conventional ‘Diamond mercury Sphygmomanometer’ versus the automated ‘Omron HEM 7130’ home BP monitor and compared.Results: The recordings of systolic blood pressure at home were consistently less than the office measurements at all periods of gestation. However, the difference was not statistically significant. The comparison of diastolic pressures revealed minimal variations between the mean of the office and home blood pressure recordings. The mean arterial pressure also revealed a similar trend.Conclusions: Self-monitoring of blood pressure is a feasible and acceptable option to pregnant women. It might make antenatal care more effective, but we need further research to establish safety and efficacy, the impact on women and health professionals, and how best to use the results.

scholarly journals Improvement of Blood Pressure Control by Adherence Check in Patients With Apparent Treatment-Resistant Hypertension: A Case Series

2020 ◽  
Vol 13 ◽  
pp. 117954762090488
Author(s):  
Keiko Hosohata ◽  
Ayaka Inada ◽  
Saki Oyama ◽  
Takashi Doi ◽  
Iku Niinomi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Case Series ◽  
Pressure Control ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Uncontrolled Blood Pressure ◽  
Important Challenge ◽  
Prescribed Medicines

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

scholarly journals COGNITIVE IMPAIRMENT, THEIR DYNAMICS AND STRUCTURE IN THE ACUTE AND RECOVERY PERIODS OF STROKE, DEPENDING ON ARTERIAL HYPERTENSION SEVERITY AND DURATION

2018 ◽  
Vol 13 (3-4) ◽  
pp. 22-27
Author(s):  
T.M. Cherenko ◽  
Yu.L. Heletyuk
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Cognitive Status ◽  
Neurological Deficits ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
The Mean

Relevance. Cognitive impairment is common in the post-stroke period. Different characteristics of arterial hypertension (AH), namely its severity, duration and variability of blood pressure, can affect the development of cognitive impairment in stroke patients. Objective: to investigate cognitive impairment, their dynamics and structure in acute and recovering stroke periods, depending on the arterial hypertension severity and duration. Materials and methods. 150 patients with a primary ischemic stroke and history of hypertension: 74 (49,3 %) women and 76 (50,7 %) men, the mean age (67,4±0,7) years have been examined. Neurological deficits was evaluated by the NIHSS scale. The cognitive status was evaluated by the MMSE scale at the end of an acute period of 21 days and 1 year. Diagnosis of hypertension was based on the clinical and instrumental examination results and medical documents. Daily blood pressure monitoring was using on admission and every 4 hours during 6 days of acute stroke stage. Mean SBP, mean DBP, maximum SBP and DBP, standard deviation (SD) of SBP and DBP were studied. Results. By the mean score on the MMSE scale, there are differences in patients during acute post-stroke period, depending on the severity of hypertension: 27,2±0,6 points in the case of hypertension stage 1, 24,3±0,6 in the case of hypertension stage 2 and 20,7±0,8 in case of AH stage 3, (p=0.001). By this indicator, patients with different AH duration were different: 26,4±0,9 points; 25,1±0,5 points; 20,5±0,7 points, respectively. The significance of these differences by the mean values of MMSE score was obtained in patients with a duration of AH less than 5 years and more than 10 years, as well as when comparing the group of "6-10 years" and "over 10 years" (p=0,001). Significant differences in the structure of cognitive deficits severity, depending on the hypertension stage and its duration, were observed only in patients with moderate and severe stroke (p=0,006). Cognitive deterioration a year after a stroke was observed in 40 (31,5 %) patients. They have significantly higher mean values SD 1-3, SD 1-6, SBP on the first day after a stroke, and duration of hypertension. Conclusions. The relationship between the degree of intellectual decline and the duration of hypertension (r=0,592, p=0,001), severity of hypertension (r=0,459, p=0,001) was found. The severity of the neurological deficiency affects the structure of cognitive impairment at discharge in patients with different severity and duration of hypertension, and higher mean values of the variability of blood pressure from 1 to 6 days, SBP on the first day after stroke and higher duration of hypertension in the history is associated with a negative dynamics of cognitive impairment in stroke patients in a year after stroke.

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