scholarly journals Long-Term Impact of Different Triple Combination Antihypertensive Medications on Blood Pressure Control, Metabolic Pattern and Incident Events: Data from the Brisighella Heart Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5921
Author(s):  
Arrigo F. G. Cicero ◽  
Federica Fogacci ◽  
Elisabetta Rizzoli ◽  
Sergio D’Addato ◽  
Claudio Borghi
Keyword(s):  
Blood Pressure ◽  
Combination Treatment ◽  
Ace Inhibitors ◽  
Antihypertensive Drugs ◽  
Triple Combination ◽  
Antihypertensive Medications ◽  
Metabolic Pattern ◽  
Heart Study ◽  
Antihypertensive Treatments

The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized Italian cohort. We considered the data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2012 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with <3 or ≥3 antihypertensive drugs without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with Perindopril/Amlodipine/Indapamide, ACE-inhibitors (other than perindopril)/CCBs/Thiazide or ARBs/CCBs/Thiazide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive treatments. The long-term (12 years) effects of the different antihypertensive treatments were compared among the pre-defined groups. During the observation period, there was a trend towards increase in both systolic and diastolic blood pressure (BP) in all the investigated subgroups (p for trend <0.05), but in the subgroup of patients treated with Perindopril/Amlodipine/Indapamide, such increase was significantly lower than in the other groups (p < 0.05). The combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with significantly lower diastolic BP (p < 0.05) and more strictly controlled lipid pattern than other triple combination of anti-hypertensive medications. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow up none of them developed type 2 diabetes, nor had a need for a greater number of antihypertensive drugs to improve BP control, mainly because of a more stable BP control. Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other triple antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/Amlodipine/Indapamide is associated with more protective metabolic profile than any other considered combination antihypertensive medications.

Effects of camel milk hydrolysate on blood pressure and biochemical parameters in fructose-induced hypertensive rats

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mohammad Alshuniaber ◽  
Omar Alhaj ◽  
Qasem Abdallah ◽  
Haitham Jahrami
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Effect ◽  
Antihypertensive Drugs ◽  
Camel Milk ◽  
Short Exposure ◽  
Antihypertensive Activity ◽  
Content Type ◽  
Insulin Levels ◽  
Ace Activity

Purpose This study aims to investigate the antihypertensive effect of camel milk hydrolysate in rats with fructose-induced hypertension. Design/methodology/approach The antihypertensive effect of fermented camel milk was determined using 6 groups comprising 36 Wistar male rats. Blood pressure of rats was altered via exposure to a 10% fructose (w/v) diet in drinking water for 3 weeks before conducting 21 days of treatment. The authors conducted the experiment for short and long term using different doses of 800 and 1,200 mg/kg body weight. Serum was used to assay total cholesterol (TC), triglyceride (TG), glucose and insulin levels using standard biochemical kits. Findings The group that received 1,200 mg hydrolysate camel milk (HM) has significantly (p = 0.003) reduced systolic and diastolic blood pressure after a short exposure time (4–8 h). These effects were significantly (p = 0.005) comparable to the nifedipine (NIF) drug group. Similar long-term (21 days) effects on blood pressure were observed in 1,200 mg HM and NIF groups. Angiotensin-converting enzyme (ACE) activity and levels were also reduced in a correlation with blood pressure reduction only in HM1200 and HM800 treated groups. The authors observed no significant effect on blood pressure in groups receiving the 800 mg HM or 1,200 mg unhydrolyzed camel milk (UM). Rats receiving the 10% fructose diet showed significant differences from control rats regarding their blood biochemistry, including TG, TC, blood glucose and insulin levels. Rats in groups NIF, HM1200 and HM800 showed a significant (p < 0.05) reduction in serum glucose, insulin, TG and TC levels toward the baseline level. Research limitations/implications Further mechanistic investigation on the HM antihypertensive activity is highly recommended before suggesting HM as a product to reduce blood pressure. While drug–food interaction between HM and antihypertensive drugs, especially ACE inhibitors, is probable, UM seems not to affect blood pressure or ACE activity and therefore is expected to have no or minimal effects on the activity of other antihypertensive drugs. Investigation of ACE expression from various organs including lungs and leukocytes is highly recommended in future works using sodium dodecyl-sulfate polyacrylamide gel electrophoresis and western blot analysis or reverse transcription polymerase chain reaction. Originality/value No previous studies have measured the antihypertensive activity of milk hydrolysate mediated by the reduction of ACE activity and levels in plasma. Mechanisms involved in attenuating the levels of ACE warrant further investigation.

Abstract P348: Association Between Sleep Apnea and Blood Pressure Control Among African-Americans, the Jackson Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Dayna A Johnson ◽  
Stephen J Thomas ◽  
Marwah Abdalla ◽  
Yuichiro Yano ◽  
Na Guo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
African Americans ◽  
Resistant Hypertension ◽  
Significant Risk ◽  
Apnea Hypopnea Index ◽  
Jackson Heart Study ◽  
Antihypertensive Medications ◽  
Heart Study ◽  
The Impact

Background: African-Americans have the highest prevalence of elevated blood pressure (BP) and poorer BP control than other racial/ethnic groups in the US. Untreated sleep apnea, common among minority populations, may explain the high prevalence of uncontrolled BP. We studied the association of objective measurements of sleep apnea severity with resistant hypertension and uncontrolled BP among African-Americans in the Jackson Heart Study (JHS) Sleep Ancillary study. Methods: Between 2012 and 2016, JHS participants (N=913) underwent an in-home sleep apnea study (measuring nasal pressure, abdominal and thoracic inductance plethysmography, oximetry, position, ECG); resting blood pressure; anthropometry; and completed questionnaires. Sleep apnea was defined as an apnea-hypopnea index > 15 and nocturnal hypoxemia was quantified as % sleep time <90% oxyhemoglobin saturation (%Sat<90%). Elevated BP was defined as systolic BP ≥ 140 mmHg or diastolic BP > 90mmHg. Controlled BP was defined as systolic BP <140mmHg or diastolic BP <90mmHg. Uncontrolled BP was defined as having elevated BP with use of < 2 antihypertensive medications. Resistant hypertension was defined as having elevated BP while on 3-4 antihypertensive medications with one being a diuretic; or use of > 4 antihypertensive medications. The study sample was limited to individuals with prevalent hypertension (N=613). Multinomial models were fit to determine the association between sleep apnea severity and resistant hypertension or uncontrolled BP (vs. controlled BP) adjusted for age, sex, education, smoking status, obesity (body mass index>30) and diabetes. Results: The study sample had a mean age of 54.8 years, were predominately female (69.8%), obese (57.8%), and college educated (52.7%). Approximately 40.5% had sleep apnea, which was untreated in 95% of individuals. Among the sample, 25.4% had uncontrolled BP and 4.9% were classified as resistant hypertension. After adjustment for confounders, individuals with sleep apnea had a 2.6-fold higher odds of resistant hypertension (95% confidence interval: 1.1, 5.9). A standard deviation higher %Sat<90% was associated with a 41% higher odds (1.1, 1.8) of resistant hypertension after adjustment for covariates. Sleep apnea and %Sat<90% were not related to uncontrolled BP. Conclusion: Among our sample of African-Americans in the JHS, sleep apnea was related to resistant hypertension but not uncontrolled BP. The study identifies the high burden of untreated sleep apnea in African-Americans and its association with resistant hypertension, a significant risk factor for stroke and heart disease. Research is needed on the impact of treating sleep apnea as a strategy for decreasing resistant hypertension, and thus, narrowing cardiovascular health disparities.

scholarly journals KCNJ5 Somatic Mutation Is a Predictor of Hypertension Remission After Adrenalectomy for Unilateral Primary Aldosteronism

2019 ◽  
Vol 104 (10) ◽  
pp. 4695-4702 ◽  
Author(s):  
Leticia A P Vilela ◽  
Marcela Rassi-Cruz ◽  
Augusto G Guimaraes ◽  
Caio C S Moises ◽  
Thais C Freitas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Somatic Mutation ◽  
Primary Aldosteronism ◽  
Antihypertensive Drugs ◽  
Independent Predictor ◽  
Blood Pressure Response ◽  
Antihypertensive Medications ◽  
Unilateral Adrenalectomy ◽  
Molecular Features ◽  
Endocrine Hypertension

AbstractContextPrimary aldosteronism (PA) is the most common cause of endocrine hypertension (HT). HT remission (defined as blood pressure <140/90 mm Hg without antihypertensive drugs) has been reported in approximately 50% of patients with unilateral PA after adrenalectomy. HT duration and severity are predictors of blood pressure response, but the prognostic role of somatic KCNJ5 mutations is unclear.ObjectiveTo determine clinical and molecular features associated with HT remission after adrenalectomy in patients with unilateral PA.MethodsWe retrospectively evaluated 100 patients with PA (60 women; median age at diagnosis 48 years with a median follow-up of 26 months). Anatomopathological analysis revealed 90 aldosterone-producing adenomas, 1 carcinoma, and 9 unilateral adrenal hyperplasias. All patients had biochemical cure after unilateral adrenalectomy. KCNJ5 gene was sequenced in 76 cases.ResultsKCNJ5 mutations were identified in 33 of 76 (43.4%) tumors: p.Gly151Arg (n = 17), p.Leu168Arg (n = 15), and p.Glu145Gln (n = 1). HT remission was reported in 37 of 100 (37%) patients. Among patients with HT remission, 73% were women (P = 0.04), 48.6% used more than three antihypertensive medications (P = 0.0001), and 64.9% had HT duration <10 years (P = 0.0015) compared with those without HT remission. Somatic KCNJ5 mutations were associated with female sex (P = 0.004), larger nodules (P = 0.001), and HT remission (P = 0.0001). In multivariate analysis, only a somatic KCNJ5 mutation was an independent predictor of HT remission after adrenalectomy (P = 0.004).ConclusionThe presence of a KCNJ5 somatic mutation is an independent predictor of HT remission after unilateral adrenalectomy in patients with unilateral PA.

scholarly journals A Medication Synchronization Program and Blood Pressure Levels in a Community Pharmacy: Protocol (Preprint)

2018 ◽  
Author(s):  
Anthony Pattin ◽  
Rebekah L Panak ◽  
Rebecca Hunold ◽  
Abagail Kirwen ◽  
Samantha R Minnich ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Outcomes ◽  
Cardiovascular Complications ◽  
Care Group ◽  
Prescription Medications ◽  
Improve Medication Adherence ◽  
Antihypertensive Medications ◽  
History Of ◽  
The Impact

BACKGROUND The lack of adherence to prescribed antihypertensive medication occurs in 50% of patients and leads to poor health outcomes and increased medical costs. Consistent use of antihypertensive medications among patients with hypertension is essential to the reduction of short- and long-term cardiovascular complications. Strategies to improve medication adherence include syncing prescription medications in the pharmacy, which allow patients to retrieve chronically prescribed medications in one visit. The adoption of medication synchronization has been shown to improve adherence to medications; however, there is a lack of data showing if the intervention reduces blood pressure and improves long-term health outcomes. OBJECTIVE This study aims to determine the association between participation in an appointment-based medication synchronization service and blood pressure levels among patients on antihypertensive medications. METHODS This longitudinal prospective cohort study will observe changes in blood pressure among individuals in a medication synchronization program and those in a usual care group. Patients on at least two antihypertensive medications and four total medications have been recruited to participate in the study. All participants will be required to have at least a 6-month history of filling prescriptions at the pharmacy prior to enrollment in the study. Based on an estimated standard deviation of 14 mmHg, a sample size of 70 participants provides approximately 80% power with a two-sided .05 significance to detect a difference of 9 mmHg blood pressure between the two cohorts. RESULTS As of the publication of this paper, patients are completing final blood pressure visits at the pharmacy and medication data are being collected from the pharmacy. Once patients complete all blood pressure visits, data analysis will begin. CONCLUSIONS This study will link medication synchronization and changes in blood pressure levels among individuals with hypertension. This study will provide preliminary data for a randomized clinical trial that will assess the impact of medication synchronization on blood pressure. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12527

scholarly journals Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience

2019 ◽  
Vol 16 (4) ◽  
pp. 65-69
Author(s):  
Nina Yu Savelyeva ◽  
Anna Yu Zherzhova ◽  
Ekaterina V Mikova ◽  
Liudmila I Gapon ◽  
Grigorii V Kolunin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Renal Arteries ◽  
Radiofrequency Denervation ◽  
Intact Kidney ◽  
Resistant Arterial Hypertension

Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.

scholarly journals A comparative study on the adherence to anti-hypertensive medications in urban and rural areas of Hubballi

2019 ◽  
Vol 6 (4) ◽  
pp. 1701 ◽  
Author(s):  
Pratibha Rao Katapadi ◽  
Dattatreya D. Bant
Keyword(s):  
Blood Pressure ◽  
Rural Areas ◽  
Rural Population ◽  
Antihypertensive Drugs ◽  
Cross Sectional Study ◽  
Uncontrolled Hypertension ◽  
Public Health Issue ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Hypertensive Patients

Background: Hypertension is a significant public health issue worldwide and can have deleterious effects on the health when it is not under control. Adherence to antihypertensive medications is thus necessary for better control of blood pressure and to reduce the risk of complications. There are various factors which support or hinder the patient’s adherence to anti- hypertensive treatment. Thus this study was done to reflect the factors influencing the adherence to antihypertensive drugs among urban and rural population.Methods: A community based cross sectional study was conducted in urban and rural field practice areas of Karnataka Institute of Medical Sciences, Hubballi. A semi-structured questionnaire was used for data collection among the known hypertensive patients. The data was entered in Microsoft Excel and analysed using SPSS software.Results: Most of the hypertensive patients were aged 45 and above (89.5%). A total of 73.5% of the participants were adherent to antihypertensive medications and adherence was more among urban (76%) as compared to rural population (71%). Knowledge regarding complications of uncontrolled hypertension was the major factor for adherence in both the areas. The mean systolic and diastolic blood pressure was controlled in patients who were adherent.Conclusions: There is a higher level of adherence to antihypertensive medications in urban population as compared to rural population of Hubballi. The findings suggest patient factors, clinical factors and socio-demographic factors play an important role in determining the adherence to the medication.

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