Abstract TP397: Dedicated Stroke Units With Bedside Monitoring and Better Blood Pressure Control

Background and Objective: Patients with ischemic or hemorrhagic stroke require strict BP control to prevent hemorrhagic transformation or hematoma expansion. Acute elevations in BP are often treated with IV labetalol. Dedicated stroke units often have automated bedside monitoring of vital signs. Standard automated BP monitoring alerts practitioners to trends that lead to more steady control of BP rather than frequent acute interventions. We evaluated patients who were treated in a stroke unit after the institution of automated bedside monitoring. Comparison was made to the number of times the patients were dosed acutely using labetalol with a control group of patients who were not receiving automated bedside monitoring. The objective was to determine if there was a significant difference in care. Methods: Patients were evaluated over a 12-month period (2014) after the incorporation of bedside automated BP monitoring in a dedicated stroke unit at a university affiliated, comprehensive stroke center. The number of times each patient during this time frame received IV labetalol for acute elevations in BP was compared with a time period spanning 12-months prior (2013); there was no automated BP monitoring performed. The average interventions were compared with a t-test by using SPSS V22. Comparisons of patient population and type of pathology were matched appropriately. Results: Of the 1,326 patients who presented for ischemic or hemorrhagic strokes during the 24-month period evaluated, 25 required multiple injections of IV labetalol for acute BP control. Of these, 12 patients were on automated vital signs and BP monitoring, and 13 were not. The mean number of IV labetalol interventions implemented in the group being monitored was 2.8, while the mean number of treatments given to patients not being monitored was 5.9 (p=.016). Conclusion: In our study there is a trend towards better blood pressure control with adequate adjustment of oral medications for monitored patients in our dedicated stroke unit. Prevention of sudden elevations in BP may translate into lower rates of hemorrhagic transformation or hematoma expansion and confer better outcomes in stroke patients. Larger prospective studies are required to corroborate our findings.

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Effects of Intermittent Compared With Continuous Energy Restriction on Blood Pressure Control in Overweight and Obese Patients With Hypertension

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.750714 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chao-Jie He ◽

Ye-Ping Fei ◽

Chun-Yan Zhu ◽

Ming Yao ◽

Gang Qian ◽

...

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Body Composition ◽

Systolic Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Energy Restriction ◽

Obese Patients ◽

Continuous Energy ◽

The Mean

Background and Aims: Weight-loss diets reduce body weight and improve blood pressure control in hypertensive patients. Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight reduction. We aimed to compare the effects of IER with those of CER on blood pressure control and weight loss in overweight and obese patients with hypertension during a 6-month period.Methods: Two hundred and five overweight or obese participants (BMI 28.7 kg/m2) with hypertension were randomized to IER (5:2 diet, a very-low-calorie diet for 2 days per week, 500 kcal/day for women and 600 kcal/day for men, along with 5 days of a habitual diet) compared to a moderate CER diet (1,000 kcal/day for women and 1,200 kcal/day for men) for 6 months. The primary outcomes of this study were changes in blood pressure and weight, and the secondary outcomes were changes in body composition, glycosylated hemoglobin A1c (HbA1c), and blood lipids.Results: Of the 205 randomized participants (118 women and 87 men; mean [SD] age, 50.2 [8.9] years; mean [SD] body mass index, 28.7 [2.6]; mean [SD] systolic blood pressure, 143 [10] mmHg; and mean [SD] diastolic blood pressure, 91 [9] mmHg), 173 completed the study. The intention-to-treat analysis demonstrated that IER and CER are equally effective for weight loss and blood pressure control: the mean (SEM) weight change with IER was −7.0 [0.6] kg vs. −6.8 [0.6] kg with CER, the mean (SEM) systolic blood pressure with IER was −7 [0.7] mmHg vs. −7 [0.6] mmHg with CER, and the mean (SEM) diastolic blood pressure with IER was −6 [0.5] mmHg vs. −5 [0.5] mmHg with CER, (diet by time P = 0.62, 0.39, and 0.41, respectively). There were favorable improvements in body composition, HbA1c, and blood lipid levels, with no differences between groups. Effects did not differ according to completer analysis. No severe hypoglycemia occurred in either group during the trial.Conclusions: Intermittent energy restriction is an effective alternative diet strategy for weight loss and blood pressure control and is comparable to CER in overweight and obese patients with hypertension.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000040468.

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Blood Pressure Control and Antihypertensive Treatment Among Hemodialysis Patients—Retrospective Single Center Experience

Medicina ◽

10.3390/medicina57060590 ◽

2021 ◽

Vol 57 (6) ◽

pp. 590

Author(s):

Piotr Skonieczny ◽

Zbigniew Heleniak ◽

Marek Karowiec ◽

Stanisław Zajączkowski ◽

Leszek Tylicki ◽

...

Keyword(s):

Blood Pressure ◽

Calcium Channel ◽

Blood Pressure Control ◽

Calcium Channel Blockers ◽

Antihypertensive Treatment ◽

Pressure Control ◽

Hemodialysis Patients ◽

Channel Blockers ◽

Renin Angiotensin Aldosterone System ◽

The Mean

Background and Objectives: Hypertension affects at least 80% of hemodialysis patients. Inappropriate control of blood pressure is mentioned as one of the essential cardiovascular risk factors associated with development of cardiovascular events in dialysis populations. The aim of the cross-sectional, retrospective study was the evaluation of the antihypertensive treatment schedule and control of blood pressure in relation to the guidelines in the group of hemodialysis patients. Additionally, we assessed the level of decrease in blood pressure by each group of hypotensive agents. Materials and Methods: 222 patients hemodialyzed in a single Dialysis Unit in three distinct periods of time—2006, 2011, and 2016—with a diagnosis of hypertension were enrolled in the study. The analysis of the antihypertensive treatment was based on the medical files and it consisted of a comparison of the mean blood pressure results reported during the six consecutive hemodialysis sessions. Results: The mean values of blood pressure before hemodialysis were as follows: 134/77, 130/74, and 140/76 mmHg, after hemodialysis 124/74, 126/73, and 139/77 mmHg in 2006, 2011, and 2016 respectively. The goal of predialysis blood pressure control (<140/90) was achieved by up to 64.3% of participants in 2006 as compared to 49.4% in 2016. Additionally, the postdialysis goal (<130/90) reached 57.1% of the study population in 2006 as compared to 27.1% of patients in 2016. The differences in percentage of patients using single, double, triple, and multidrug therapy during observation were not statistically significant. The most often used drugs were ß-blockers, diuretics, and calcium channel blockers in all points of the study. Blockades of the renin–angiotensin–aldosterone system in 2006 and calcium channel blockers in 2011 and 2016 were the drugs with highest impact on lowering blood pressure. Conclusions: The goal of predialysis or postdialysis blood pressure control was achieved in a lower percentage of patients during the period of the study. Blockade of renin–angiotensin–aldosterone system and calcium channel blockers decrease the blood pressure significantly. It is necessary to achieve better control of blood pressure in prevention of cardiovascular incidents.

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Abstract P182: Comparing Blood Pressure Control in Diabetic Versus Nondiabetic Veterans Following Percutaneous Coronary Intervention

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap182 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Sloane A McGraw ◽

Chris Healy ◽

Burhan Mohamedali ◽

Anupama Shivaraju ◽

Adhir Shroff

Keyword(s):

Blood Pressure ◽

Percutaneous Coronary Intervention ◽

Blood Pressure Control ◽

Beta Blockers ◽

Coronary Intervention ◽

Pressure Control ◽

National Committee ◽

Diabetic Patients ◽

Percutaneous Coronary ◽

The Mean

Background: Blood pressure control in patients with coronary artery disease (CAD) or diabetes is essential to decrease morbidity and mortality. The US Joint National Committee VII (JNC-7) recommends systolic blood pressure (SBP) <130 and diastolic blood pressure (DBP) <80. These values can be attained using beta-blockers, angiotensin antagonists, calcium channel blockers, diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of the JNC-7 guidelines, comparing 331 diabetic to 524 non-diabetic patients who underwent percutaneous coronary intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Results: Among the diabetic population, the mean SBP decreased 135 to 131mmHg (p = 0.0014) and mean DBP decreased 72 to 70mmHg (p= 0.0014). In non-diabetics, the mean SBP decreased 133 to 128mmHg (p<0.0001) and mean DBP decreased 73 to 71mmHg (p<0.0007). The percent of diabetics at JNC-7 SBP goal increased from 41 to 50% (136 to 166 of 331) (p= 0.0041), however the percent change at DBP goal was not significant. In non-diabetics, percent at goal for SBP increased 45 to 57% (236 to 299 of 524) (p<0.0001) and for DBP increased 69 to 76% (362 to 398 of 524) (p=0.0075). At six months, among diabetics, the medication usage increased for beta-blockers, from 80 to 92% (265 to 305 of 331) (p<0.0001) and for nitrates from 32 to 37% (106 to 122 of 302) (p=0.0465). Among non-diabetics, use of beta-blockers increased from 68 to 87% (356 to 456 of 524) (p<0.0001) and nitrates from 20 to 25% (105 to 131 of 524) (p=0.0054). Use of angiotensin antagonists also increased from 52 to 71% (272 to 372 if 524) (p<0.0001) among non-diabetics. Conclusions: There were improvements in blood pressure among both populations at six months post-PCI. Both groups attained JNC-7 SBP goals; only non-diabetics achieved DBP goal. Medication use increased for both groups with beta-blockers and nitrates. Angiotensin antagonists only increased significantly among non-diabetics. This demonstrates that post-intervention, tighter control of blood pressure is attempted however levels are not yet optimal.

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Evaluation of Hemodynamic Changes in Patients with Carotid Stenosis Undergoing Carotid Endarterectomy in Razi Hospital

Tabari Biomedical Student Research Journal ◽

10.18502/tbsrj.v2i2.3760 ◽

2020 ◽

Author(s):

Hossein Hemmati ◽

Sajedeh Shirzadi ◽

Zakiyeh Jafaryparvar ◽

Mohaya Farzin ◽

Sasan Andalib ◽

...

Keyword(s):

Blood Pressure ◽

Longitudinal Study ◽

Carotid Artery ◽

Systolic Blood Pressure ◽

Carotid Endarterectomy ◽

Blood Pressure Control ◽

Carotid Artery Stenosis ◽

Vital Signs ◽

Pressure Control ◽

Hemodynamic Changes

Introduction: The purpose of this longitudinal study was to determine the extent of hemodynamic changes after carotid antrectomy in patients with carotid artery stenosis hospitalization to intensive care unit (ICU) of Razi Hospital and how factors affect it and provide necessary measures to improve blood pressure control and increase the quality of life in these patients. Material and Methods: This is a longitudinal study in which all patients with carotid artery stenosis referred to Razi Hospital of Rasht from 2006 to 2016 who underwent carotid endarterectomy were enrolled. Changes in vital signs including systolic and diastolic pressure, heart rate and body temperature of patients who were checked every 6 hours before and after surgery, in the second 24 hours after surgery, ICU, Length of hospital stay and ICU mortality were recorded. Results: In this study, the mean age of patients was 68.42 ± 9.97 years. Sixty-four (97%) patients had at least one underlying disease. Our results showed that there was a statistically significant difference in systolic blood pressure at the time of surgery. Means preoperative systolic blood pressure was 119.89±11.89 and this mean increases to 138.89±16.66 at 48 hours after surgery. Conclusion: The results of this study showed that blood pressure control in patients with blood pressure changes during and after surgery; hemodynamic changes after endarterectomy and the everyday dangers of cerebral hemorrhage decreased and prevented vascular thrombosis. It can be concluded that controlling hemodynamic parameters as well as vital signs of patients resulted in the relative stability of these parameters. Ultimately the death rate slaked to nought.

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A Profile of Renal Function in Northern Cameroonians with Essential Hypertension

Cardiorenal Medicine ◽

10.1159/000455680 ◽

2017 ◽

Vol 7 (4) ◽

pp. 324-333 ◽

Cited By ~ 1

Author(s):

Marcel Tangyi Tamanji ◽

Divine Amagho Ngwakum ◽

Olivier Pancha Mbouemboue

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Blood Pressure Control ◽

Filtration Rate ◽

Pressure Control ◽

Systematic Evaluation ◽

Hypertensive Patients ◽

The Mean

Background/Aim: The two-way cause and effect relationship existing between high blood pressure and kidney dysfunction is currently a well-documented phenomenon with patients in either category being almost equally predisposed to the other pathology. Our goal was to assess the renal function capacity of hypertensive patients in our setting. Methods: This cross-sectional descriptive study involved the determination of blood pressure levels and the collection of blood and urine samples for the measurement of renal function markers. Hypertensive patients who came for medical follow-up constituted the study participants, and were enrolled consecutively into the study from February to May 2015. Data analysis was performed using the SPSS 20.0 software, and significant differences were determined at p < 0.05. Results: The prevalence of elevated creatinine and urea levels were 35 and 27%. Eighty percent of the participants had a decreased glomerular filtration rate (≤90 mL/min/1.73 m3), with at least 36% recording less than 60 mL/min/1.73 m3. Proteinuria and glucosuria were recorded in 15% and 8% of the participants, respectively. The mean diastolic pressure was observed to be significantly higher in participants with proteinuria (p = 0.016), and participants' weight directly correlated with systolic blood pressure (p = 0.015). Furthermore, the mean estimated glomerular filtration rate was relatively lower in participants >60 years compared to those <60 years (p < 0.001). Conclusion: Renal function is often perturbed in hypertensive patients, and good blood pressure control may reduce the progression of renal impairment. Thus, a systematic evaluation of renal function in addition to blood pressure control in hypertensive patients is indispensable towards effectively reducing the occurrence of renal events and preventing end-stage renal disease.

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Blood Pressure Control and Associated Factors Among Hypertensive Patients Attending Shashemene Referral Hospital, Oromia, Ethiopia

Hospital Pharmacy ◽

10.1177/00185787211061372 ◽

2021 ◽

pp. 001857872110613

Author(s):

Aliyi Anota ◽

Teshome Nedi

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Blood Pressure Control ◽

Associated Factors ◽

Antihypertensive Drugs ◽

Pressure Control ◽

Referral Hospital ◽

Hypertensive Patients ◽

The Mean ◽

Study Participants

Background: Hypertension is public health challenge worldwide. It is defined as persistently elevated arterial blood pressure (BP), systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or use of antihypertensive medication in adults older than 18 years. The aim of this study was to assess blood pressure control and associated factors among hypertensive patients attending the outpatient department of Shashemene Referral Hospital. Methods: Hospital based cross sectional study was conducted to determine level of blood pressure control and associated factors among hypertensive patients on medical follow-up. A medical chart review and interview was conducted from July 1 to October 31 2018. Result: A total of 325 participants were included in this study with response rate of 320 (98.5%). More than half of study participants were males 171 (53.4%). The mean age of the respondents was 55.10 (SD ± 12.7) years and majority of the respondents 191 (59.7%) were within age of less than 60 years old. The mean Systolic blood pressure (SBP) was 131.80 mmHg (SD ± 20.92) while the mean diastolic blood pressure (DBP) was 82.30 mmHg (SD ± 10.52). About 51.30% of study participants had a controlled SBP and 54.7% had a controlled DBP. The overall control of BP was achieved in 40.3% of the study participants. Multivariable logistic regression analysis showed that age, experience of side effects, frequency of BP measuring, number of antihypertensive drugs used, duration on antihypertensive, source of medication and physical exercise showed significant association with blood pressure control. Conclusion: Blood pressure control level among chronic hypertensive patients at outpatient department was low. Age of patients, educational level, experience of side effects, and number of antihypertensive drugs used were important determinant factors associated with blood pressure control among study participants.

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The Impact of Planned Visits on Patients with Type 2 Diabetes Mellitus

Clinical medicine Endocrinology and diabetes ◽

10.4137/cmed.s2157 ◽

2009 ◽

Vol 2 ◽

pp. CMED.S2157

Author(s):

Jim Nuovo

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Confidence Interval ◽

Blood Pressure Control ◽

Comparison Group ◽

Pressure Control ◽

Nurse Educator ◽

The Mean

Objectives To investigate whether planned visits improve glycemic, blood pressure and lipid control among patients with type 2 diabetes mellitus (DM). Methods The study was conducted from July 2007 to February 2008 at a primary care clinic in Rancho Cordova, California. One hundred eighty-three patients were invited to come to a planned visit. On the day of the visit, they were provided a copy of their most recent test results and information on American Diabetes Association recommendations for A1C, lipid, and blood pressure control. Afterwards, they met with their physician for a 15-minute focused appointment. Finally, they met with a diabetic nurse educator. There was no subsequent contact with the nurse educator after the planned visit. We compared the baseline measurements to those from a follow-up visit with the primary care provider at a follow-up over a 6 month period. The comparison group in this study were those who did not accept the invitation for a planned visit. Their outcomes were monitored over the same time horizon. Results One hundred eighty-three patients attended one of a total of five planned visit sessions. There were 212 patients in the comparison group. There were no significant differences for the measured baseline characteristics. There were significant improvements in A1C, LDL-C, and diastolic blood pressure control in the planned visit group. The mean A1C change was –0.61% (95% confidence interval, –0.28, –0.70); P < 0.001). The mean LDL-C change was -8.8 mg/dL (95% confidence interval, –12.2, 6.1); P < 0.05. The mean diastolic blood pressure change was -2.0 mmHg (95% confidence interval, –4.7, 6.7); P < 0.05. Patients who participated in a planned visit also reported a significantly higher frequency of self-care behaviors and greater understanding about diabetes care. Discussion Planned visits led to improvements in glycemic, lipid and blood pressure control over a 6 month observation period. Patients attending planned visits also reported improvements in self-care behaviors and a greater understanding about diabetes care.

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