The impact of duration of the period of home blood pressure assessment on antihypertensive treatment efficiency in real clinical practice

In real clinical practice more and more often doctors treat comorbid patients. The high prevalence of cardiovascular diseases with various comorbid conditions contributes to the progressive increase in the number of patients with a concurrence of several diseases. A comorbid patient is a serious problem for any clinician, since in this case it is necessary to take into account several components of therapy, which makes it difficult to control treatment efficiency, contributes to an increase in polypharmacy, the risk of local and systemic side effects of drugs, and reduces adherence to therapy. A comorbid patient is a serious problem for any clinician. The paper describes and discusses the clinical case of a comorbid patient, who admitted to the cardiological department initially but he had also rheumatological problems (gout), kidney affection.

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The value of blood pressure variability in clinical practice. Opportunities of amlodipine in reducing blood pressure variability (based on the Russian program «VARIATIONS»)

Systemic Hypertension ◽

10.26442/sg29000 ◽

2014 ◽

Vol 11 (1) ◽

pp. 11-16

Author(s):

O D Ostroumova ◽

O V Bondarets ◽

T F Guseva

Keyword(s):

Blood Pressure ◽

Clinical Practice ◽

Diastolic Blood Pressure ◽

Blood Pressure Variability ◽

Short Term ◽

Different Types ◽

Practice Opportunities ◽

The Impact ◽

Dose Dependent ◽

Russian Program

The article discusses the importance of different types of variability in blood pressure (BP) as an independent risk factor for stroke and myocardial infarction in patients with arterial hypertension. The results of the Russian observation program (1500 patients) on the impact of amlodipine show BP variability in real clinical practice. According to the results, amlodipine 5-10 mg after 2 weeks of treatment significantly reduces the variability of systolic and diastolic blood pressure in both sexes. His influence on the short-term variability in diastolic blood pressure is dose-dependent.

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White coat hypertension: current state of the issue

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2021.2.7178 ◽

2021 ◽

Vol 28 (2) ◽

pp. 71-78

Author(s):

K. H. Uvarova

Keyword(s):

Blood Pressure ◽

Antihypertensive Treatment ◽

Blood Pressure Monitoring ◽

Target Organ Damage ◽

Prognostic Significance ◽

Home Blood Pressure ◽

White Coat ◽

White Coat Hypertension ◽

Lifestyle Modifications ◽

Cardiovascular Morbidity And Mortality

More than 30 years have passed since the first description of such a concept as white coat hypertension was presented in the scientific literature, but since then, scientists are paying more and more attention to this condition. White coat hypertension is defined when the blood pressure readings obtained in the doctor’s office meet the criteria for hypertension, but the latter is not confirmed by outpatient or home blood pressure monitoring. Initially, the term was only applied to patients who had not received antihypertensive treatment, but recently this definition has been extended to people who regularly take drugs for lowering blood pressure, and this condition was called uncontrolled white coat hypertension. Some of the world’s most influential organizations in the field of cardiology have not reached a consensus on the definition of white coat hypertension on the background of common criteria, which has affected the differences in blood pressure thresholds according to outpatient monitoring. Quite a few studies in recent years have examined the clinical and prognostic significance of white coat hypertension in terms of its probable effects such as metabolic disorders, subclinical and extracardiac target organ damage, cardiovascular morbidity and mortality, and all-cause mortality. At present, there is no doubt that white coat hypertension is not an innocent condition; however, hypotheses about the prognostic role of this condition and the management of patients with white coat hypertension are still controversial. The question of treating white coat hypertension as a condition remains unsolved and requires further investigation. Today, it is considered most appropriate not to prescribe antihypertensive treatment to persons with office blood pressure at normal or below target levels, but to intensify lifestyle modifications and focus on reduction of cardiovascular risk.

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Impact of the common MTHFR 677C→T polymorphism on blood pressure in adulthood and role of riboflavin in modifying the genetic risk of hypertension: evidence from the JINGO project

BMC Medicine ◽

10.1186/s12916-020-01780-x ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Mary Ward ◽

Catherine F. Hughes ◽

J. J. Strain ◽

Rosie Reilly ◽

Conal Cunningham ◽

...

Keyword(s):

Blood Pressure ◽

Genetic Risk ◽

Antihypertensive Treatment ◽

Methylenetetrahydrofolate Reductase ◽

Randomised Trial ◽

Population Based ◽

Nutrition Survey ◽

Increased Risk ◽

The Impact ◽

Riboflavin Status

Abstract Background Genome-wide and clinical studies have linked the 677C→T polymorphism in the gene encoding methylenetetrahydrofolate reductase (MTHFR) with hypertension, whilst limited evidence shows that intervention with riboflavin (i.e. the MTHFR co-factor) can lower blood pressure (BP) in hypertensive patients with the variant MTHFR 677TT genotype. We investigated the impact of this common polymorphism on BP throughout adulthood and hypothesised that riboflavin status would modulate the genetic risk of hypertension. Methods Observational data on 6076 adults of 18–102 years were drawn from the Joint Irish Nutrigenomics Organisation project, comprising the Trinity-Ulster Department of Agriculture (TUDA; volunteer sample) and the National Adult Nutrition Survey (NANS; population-based sample) cohorts. Participants were recruited from the Republic of Ireland and Northern Ireland (UK) in 2008–2012 using standardised methods. Results The variant MTHFR 677TT genotype was identified in 12% of adults. From 18 to 70 years, this genotype was associated with an increased risk of hypertension (i.e. systolic BP ≥ 140 and/or a diastolic BP ≥ 90 mmHg): odds ratio (OR) 1.42, 95% confidence interval (CI) 1.07 to 1.90; P = 0.016, after adjustment for antihypertensive drug use and other significant factors, namely, age, male sex, BMI, alcohol and total cholesterol. Low or deficient biomarker status of riboflavin (observed in 30.2% and 30.0% of participants, respectively) exacerbated the genetic risk of hypertension, with a 3-fold increased risk for the TT genotype in combination with deficient riboflavin status (OR 3.00, 95% CI, 1.34–6.68; P = 0.007) relative to the CC genotype combined with normal riboflavin status. Up to 65 years, we observed poorer BP control rates on antihypertensive treatment in participants with the TT genotype (30%) compared to those without this variant, CT (37%) and CC (45%) genotypes (P < 0.027). Conclusions The MTHFR 677TT genotype is associated with higher BP independently of homocysteine and predisposes adults to an increased risk of hypertension and poorer BP control with antihypertensive treatment, whilst better riboflavin status is associated with a reduced genetic risk. Riboflavin intervention may thus offer a personalised approach to prevent the onset of hypertension in adults with the TT genotype; however, this requires confirmation in a randomised trial in non-hypertensive adults.

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