Effects of antihypertensive treatment on endothelial function in postmenopausal hypertensive women. A significant role for aldosterone inhibition

Introduction: Endothelial dysfunction is a well-demonstrated independent predictor of cardiovascular events in hypertensive postmenopausal women. Accordingly, it is plausible that improving endothelial function could represent an adjunctive target for antihypertensive treatment. The aim of our study was to evaluate the effect of pharmacologic treatment on endothelial function in the specific population of hypertensive postmenopausal women. Methods: A total of 320 consecutive hypertensive postmenopausal women underwent a high-resolution ultrasound study of the brachial artery at baseline and after six months, while ‘optimal’ control of blood pressure (maintenance of blood pressure values below 140/90 mmHg at all follow-up visits) was achieved using antihypertensive therapy. Endothelial function was measured as flow-mediated dilation, using ultrasound method. Results: After six months of treatment, flow-mediated dilatation (FMD) had significantly improved in the majority of patients (n = 257 [80.3% of the entire population]; FMD = 8.1 ± 1.0% at baseline vs. 10.6 ± 1.5% after follow-up; p < 0.001), but it had not changed or worsened in others (n = 63 [19.7%]; FMD = 8.2 ± 1.2% at baseline vs. 7.6 ± 1.0% after six months; p = ns). Improvement of endothelial function, at multivariate analysis, resulted independently associated with the use of aldosterone inhibitors (odds ratio = 2.15; 95% confidence interval: 1.55–2.75; p = 0.001). Conclusions: This study demonstrates that a significant improvement in endothelial function may be obtained after six months of an optimal antihypertensive therapy. Among all hypertensive postmenopausal women that achieved an optimal control of blood pressure during follow-up, the use of drugs that inhibit aldosterone receptors was associated with an improvement of endothelial function, beyond the ‘optimal’ blood pressure control.

Download Full-text

Risk factors of uncontrolled hypertension in urban slums of Central India : A Community health worker based two-year follow up

10.1101/2021.02.02.21251036 ◽

2021 ◽

Author(s):

Abhijit P Pakhare ◽

Anuja Lahiri ◽

Neelesh Shrivastava ◽

N Subba Krishna ◽

Ankur Joshi ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Diseases ◽

Blood Pressure Control ◽

Pressure Control ◽

Urban Slum ◽

Primary Care Providers ◽

Uncontrolled Hypertension ◽

Optimal Blood Pressure

AbstractBackgroundHypertension is a leading cause of cardiovascular diseases its control is poor. There exists heterogeneity in levels of blood-pressure control among various population sub-groups. Present study conducted in framework of National Program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) in India, aims to estimate proportion of optimal blood pressure control and identify potential risk factors pertaining uncontrolled hypertension consequent to initial screening.MethodsWe conceived a cohort of individuals with hypertension confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen Accredited Social Health Activists (ASHAs) were trained from within these urban slum communities. Individuals with hypertension were linked to primary care providers and followed-up for next two years. Obtaining optimal blood-pressure control (defined as SBP< 140 and DBP<90 mm of Hg) was a key outcome. Role of baseline anthropometric, and CVD risk factors was evaluated as predictors of blood-pressure control on univariate and multivariate analysis.ResultsOf a total of 6174 individuals, 1571 (25.4%) had hypertension, of which 813 were previously known and 758 were newly detected during baseline survey. Two year follow up was completed for 1177 (74.9%). Blood-pressure was optimally controlled in 301 (26%) at baseline, and in 442 (38%) individuals at two years (absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical-inactivity, higher BMI and newly diagnosed hypertension were significantly associated with uncontrolled blood-pressure.ConclusionsIn the current study we found about six of every ten individuals with hypertension were on-treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Download Full-text

Follow-up of Antihypertensive Therapy Improves Blood Pressure Control: Results of HYT (HYperTension survey) Follow-up

High Blood Pressure & Cardiovascular Prevention ◽

10.1007/s40292-017-0208-1 ◽

2017 ◽

Vol 24 (3) ◽

pp. 289-296 ◽

Cited By ~ 1

Author(s):

F. Fici ◽

G. Seravalle ◽

N. Koylan ◽

I. Nalbantgil ◽

N. Cagla ◽

...

Keyword(s):

Blood Pressure ◽

Antihypertensive Therapy ◽

Blood Pressure Control ◽

Pressure Control

Download Full-text

Optimal Blood Pressure Control Improves Left Ventricular Torsional Deformation and Vascular Function in Newly Diagnosed Hypertensives: a 3-Year Follow-up Study

Journal of Cardiovascular Translational Research ◽

10.1007/s12265-019-09951-9 ◽

2020 ◽

Vol 13 (5) ◽

pp. 814-825 ◽

Cited By ~ 5

Author(s):

Stavros Tzortzis ◽

Ignatios Ikonomidis ◽

Hellen Triantafyllidi ◽

Paraskevi Trivilou ◽

George Pavlidis ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Vascular Function ◽

Pressure Control ◽

Left Ventricular ◽

Newly Diagnosed ◽

Torsional Deformation ◽

Follow Up Study ◽

Optimal Blood Pressure

Download Full-text

DYNAMICS OF FUNCTIONAL STATE OF KIDNEYS IN PATIENTS WITH RESISTANT HYPERTENSION AND CHRONIC KIDNEY DISEASE ACCORDING TO LONG-TERM FOLLOW-UP

International Medical Journal ◽

10.37436/2308-5274-2020-4-1 ◽

2020 ◽

pp. 5-11

Author(s):

O. O. Matova ◽

K. I. Serbeniuk ◽

L. V. Bezrodna ◽

V. B. Bezrodnyi ◽

V. V. Radchenko

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Antihypertensive Therapy ◽

Functional State ◽

Resistant Hypertension ◽

Pressure Control

Resistant hypertension and chronic kidney disease are closely related from a pathogenetic and clinical point of view. To study the dynamics of functional state of kidneys and as well as to identify the predictors of its improvement, 117 patients with resistant hypertension were examined. Dynamic follow−up of patients included monitoring of antihypertensive therapy, blood pressure, biochemical and humoral parameters during 3, 6 and 36 months of treatment. The findings have shown that a significant long−term improvement in blood pressure control in the patients with chronic kidney disease improves their function and also has a nephroprotective effect in patients without any signs of renal damage. The established prognostic value of the higher initial creatinine content for the improvement of renal function in patients with resistant hypertension is stipulated with a positive effect of antihypertensive therapy on the glomerular filtration rate dynamics. The close association between improved renal function and lower baseline levels of interleukin 6 as well as an active renin in the blood may indicate a role for systemic inflammation and renin−angiotensin−aldosterone system activity in the renal dysfunction development. Prolonged improvement in blood pressure control in the patients with resistant hypertension without diabetes is associated with a stable level of urinary albumin excretion, whereas in patients with diabetes, an albuminuria increases over time. The study concluded that independent predictors of improved renal function in patients with resistant hypertension are higher baseline creatinine and lower glomerular filtration rate, lower concentrations of interleukin 6, active renin and plasma potassium. Key words: resistant arterial hypertension, chronic kidney disease, functional state of kidneys, antihypertensive therapy.

Download Full-text

Abstract P188: Blood Pressure Control And Glaucoma Risk In Older Women

Hypertension ◽

10.1161/hyp.78.suppl_1.p188 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Bernhard Haring ◽

Kathleen Hovey ◽

Michael La Monte ◽

Chris Andrews ◽

Nazmus Saquib ◽

...

Keyword(s):

Blood Pressure ◽

Antihypertensive Treatment ◽

Proportional Hazards ◽

Elderly Women ◽

Pressure Control ◽

Cox Proportional Hazards ◽

Prior History ◽

Increased Risk ◽

Elevated Systolic Blood Pressure

Objective: Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to risk of incident glaucoma in a large cohort of elderly women. Methods: Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women’s Health Initiative Study (WHI). Blood pressure was measured in-clinic at baseline and after 3 years using standardized procedures and average BP was calculated. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates. Results: During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥140 mmHg or diastolic BP ≥80 mmHg were not at higher risk of developing glaucoma (HR 0.97, 95% CI 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared to women with a systolic BP <120 mmHg or a diastolic BP 60-<80 mmHg. Among women on antihypertensive treatment, neither systolic BP ≥140 mmHg nor diastolic BP ≥80 mmHg was associated with an increased risk of glaucoma (HR 0.91 [0.82-1.01] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mmHg was not associated with a higher risk compared to a diastolic BP 60-<80 mmHg. Conclusions: BP control is not associated with an increased or decreased glaucoma risk in elderly women.

Download Full-text

G-Protein Receptor Kinase 4 Polymorphism and Response to Antihypertensive Therapy

Clinical Chemistry ◽

10.1373/clinchem.2014.226605 ◽

2014 ◽

Vol 60 (12) ◽

pp. 1543-1548 ◽

Cited By ~ 8

Author(s):

Anne M Muskalla ◽

Paolo M Suter ◽

Matthias Saur ◽

Albina Nowak ◽

Martin Hersberger ◽

...

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

G Protein ◽

Antihypertensive Therapy ◽

Blood Pressure Control ◽

Antihypertensive Treatment ◽

Pressure Control ◽

Receptor Kinase ◽

Arterial Blood ◽

Protein Receptor

Abstract BACKGROUND G-protein receptor kinase 4 polymorphism influences blood pressure regulation via modulation of dopamine receptor D1 in renal proximal tubular cells. We investigated the role of G-protein receptor kinase 4 polymorphism in the response to hypertensive therapy in patients with essential hypertension. METHODS In a prospective study, we assessed the G-protein receptor kinase 4 polymorphisms R65L, A142V, and A486V in 100 hypertensive patients. We analyzed the association of the 3 gene variants on blood pressure control and response to antihypertensive therapy with single-locus analysis, haplotype analysis, and regression analysis. RESULTS Hypertensive individuals with a homozygous double variant of 65L and 142V needed significantly more antihypertensive treatment (number of antihypertensives 2.59 vs 1.95, P = 0.043) and especially diuretic therapy (0.82 vs 0.49, P = 0.029) to reach the same mean arterial blood pressure than did homozygous carriers of only 1 variant or heterozygous/wild-type carriers of R65L, A142V, and A486V alleles. CONCLUSIONS G-protein receptor kinase 4 polymorphism is associated with antihypertensive treatment response in patients with essential hypertension. Determination of G-protein receptor kinase 4 polymorphism may improve individual antihypertensive blood pressure control in patients with essential hypertension.

Download Full-text

Blood Pressure Control and Cardiovascular and Mortality Risk in VA Nursing Home Residents

Innovation in Aging ◽

10.1093/geroni/igab046.2315 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 608-608

Author(s):

Xiaojuan Liu ◽

Sei Lee ◽

Michael Steinman ◽

Laura A Graham ◽

Yongmei Li ◽

...

Keyword(s):

Blood Pressure ◽

Nursing Home ◽

Mortality Risk ◽

Nursing Home Residents ◽

Pressure Control ◽

Veterans Affairs ◽

Antihypertensive Medications ◽

All Cause Mortality ◽

Optimal Blood Pressure

Abstract Optimal blood pressure (BP) control in nursing home residents is controversial and this population has been excluded from trials. We evaluated the associations of BP level with cardiovascular (CV) events and all-cause mortality across antihypertensive medication categories in Veterans Affairs (VA) nursing home residents. Data for 18,589 residents aged 65 years and older was obtained from the VA Corporate Data Warehouse from October 2006 through September 2017. Baseline systolic BP (SBP) and diastolic BP (DBP) were divided into categories and analyses were stratified by antihypertensive therapy (0, 1, and ≥2 medications). Over a median follow-up of 1.8 years, CV events occurred in 3,519 (19%) residents and 15,897 (86%) residents died. In participants on no BP medications, high SBP (>150 mmHg) was associated with a greater risk of CV events (adjusted [cause-specific] hazard ratio, 1.39; 95% confidence interval, 0.94-2.06) compared with normal SBP (110-130mmHg). By contrast, in participants on ≥2 BP medications, the subgroup with low SBP (<110 mmHg) had a higher CV risk (1.38; 1.20-1.57). For DBP, in participants without BP medications, there were no differences in CV risk across DBP subgroups. Whereas among those on 1 or ≥2 medications, DBP <60 mmHg was associated with a higher CV risk (1.26; 1.03-1.55 and 1.35; 1.18-1.54, respectively) compared with normal DBP (70-80 mmHg). Participants with low SBP (<110 mmHg) and DBP (<70 mmHg) had an increased mortality risk regardless of the number of medications. These findings suggest a potential risk of low BP among nursing home residents on multiple antihypertensive medications.

Download Full-text