Compliance with Antihypertensive Therapy after Renal Artery Stenting

2003 ◽  
Vol 5 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Bhagat K. Reddy ◽  
David J. Kennedy ◽  
William R. Colyer ◽  
Mark W. Burket ◽  
William J. Thomas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Systolic Blood Pressure ◽  
Antihypertensive Therapy ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Physical Symptoms ◽  
Antihypertensive Medications ◽  
Critical Determinant ◽  
Improve Blood Pressure Control

Hypertension is an important clinical endpoint after renal artery revascularization for renal artery stenosis (RAS). Medication compliance is a critical determinant of blood pressure control. Although factors influencing compliance are known in essential hypertension, they have not been evaluated in studies investigating renal artery revascularization. The aim of this study was to assess the determinants of compliance to antihypertensive therapy in patients with RAS following renal artery stent placement (RASP). A cross-sectional study evaluating blood pressure, antihypertensive medications, quality of life, compliance, and determinants of compliance to antihypertensive therapy was undertaken in 112 patients undergoing RASP. Additionally, cardiovascular risk factors, antihypertensive medications, and cardiovascular history were reported. Self-reported compliance was 79% ± 24% (scale of 0% [none] to 100% [complete] compliance) in patients after RASP. Determinants of compliance by multivariate analysis included physical symptoms, which correlated negatively to compliance and included loss of appetite (r2 = 0.26, P < 0.0001), dizziness (r2 = 0.06, P < 0.01), and cough (r2 = 0.03, P < 0.05). Systolic blood pressure correlated positively with compliance (r2 = 0.03, P < 0.05). The number or class of antihypertensive medications did not influence compliance. Patients' physical symptoms and level of systolic blood pressure, rather than the number or class of medications, influence compliance in patients with continued hypertension after RASP. Attention to physical symptoms may help to improve blood pressure control in this population.

scholarly journals Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations

2018 ◽  
Author(s):  
Jacqueline R. Halladay ◽  
Kaitlin C. Lenhart ◽  
Kimberly Robasky ◽  
Wendell Jones ◽  
Wayne F. Homan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Complex Traits ◽  
Pressure Control ◽  
Patient Specific ◽  
Candidate Snps ◽  
Case Control Studies ◽  
Improve Blood Pressure Control ◽  
One Year

Background: As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: i) determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large case-control studies, are applicable to blood pressure control in subjects from a rural population; ii) measure the association of these SNPs with subjects&rsquo; responsiveness to the hypertension intervention; and iii) identify other SNPs that may help understand patient-specific responses to an intervention. Methods and Results: We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) or Caucasian Americans (CAU). Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. Conclusions: Identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual&rsquo;s success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with making decisions to improve patient outcomes. Further investigation is required to determine the role of this genetic variance with respect to the management of hypertension such that more precise treatment recommendations may be made in the future as part of personalized medicine.

Device Therapy of Hypertension

2021 ◽  
Vol 128 (7) ◽  
pp. 1080-1099
Author(s):  
Felix Mahfoud ◽  
Markus P. Schlaich ◽  
Melvin D. Lobo
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Blood Pressure Control ◽  
Carotid Body ◽  
Renal Denervation ◽  
Pressure Control ◽  
Hypertension Control ◽  
Baroreflex Activation Therapy ◽  
Improve Blood Pressure Control ◽  
Activation Therapy

In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.

scholarly journals Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease

2017 ◽  
Vol 167 (6) ◽  
pp. 375 ◽  
Author(s):  
Srinivasan Beddhu ◽  
Michael V. Rocco ◽  
Robert Toto ◽  
Timothy E. Craven ◽  
Tom Greene ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Cardiovascular Outcomes
Sign in / Sign up

Export Citation Format

Share Document