Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

Identification and management of resistant hypertension

Resistant hypertension is defined as blood pressure being higher than the patient's target blood pressure despite the use of three or more different types of antihypertensive drugs at the optimal dose, and one of them should be a diuretic. The evaluation of patients with resistant hypertension should first confirm that they have true resistant hypertension. By eliminating or correcting false resistance factors, such as white coat hypertension, poor blood pressure measurement technique, poor drug compliance, improper dosage or combination of antihypertensive drugs, and white coat effects and clinical inertia. Resistant hypertension therapy includes improved compliance with the use of drugs, secondary hypertension detection and treatment, use of lifestyle measures and treatment of obesity, and other comorbidities. switching to a long-acting diuretic type of thiazide like chlorthalidone could improve the BP from the patients taking hydrochlorothiazide. This review paper illustrates briefly the identification of the underlying causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension.

May Measurement Month 2019: an analysis of blood pressure screening results from Colombia

Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.

PREDICTION OF HYPERTENSION RISKS WITH FEATURE SELECTION AND XGBOOST

There are about 1 billion hypertensives patients on a global scale. Hypertension has become the main cause of shorter lifespan and disability for humans worldwide. In this essay, we constructed a new model based on hybrid feature selection and the standard XGBoost for hypertension detection and prediction. After having successfully utilized Lasso regression to identify hypertension-related factors, we used the standard XGBoost model for hypertension prediction. The result from the experiments conducted on the data from the BRFSS shows that proposed model can achieve 77.2% accuracy and 84.6% AUC, both about 7% higher than that without the nonoptimized model. Our proposed model can not only be used to predict the risk of hypertension, but also provide customers with suggestions on how to lead a healthy lifestyle.

Improved agreement and diagnostic accuracy of a cuffless 24-h blood pressure measurement device in clinical practice

A cuffless blood pressure (BP) device (TestBP) using pulse transit time is in clinical use, but leads to higher BP values compared to a cuff-based 24 h-BP reference device (RefBP). We evaluated the impact of a recent software update on BP results and TestBP’s ability to differentiate between normo- and hypertension. 71 individuals had TestBP (Somnotouch-NIBP) and RefBP measurements simultaneously performed on either arm. TestBP results with software version V1.5 were compared to V1.4 and RefBP. Mean 24 h (± SD) BP for the RefBP, TestBP-V1.4 and TestBP-V1.5 were systolic 134.0 (± 17.3), 140.8 (± 20) and 139.1 (± 20) mmHg, and diastolic 79.3 (± 11.7), 85.8 (± 14.1) and 83.5 (± 13.0) mmHg, respectively (p-values < 0.001). TestBP-V1.5 area under the curve (95% confidence interval) versus RefBP for hypertension detection was 0.92 (0.86; 0.99), 0.94 (0.88; 0.99) and 0.77 (0.66; 0.88) for systolic and 0.92 (0.86; 0.99), 0.92 (0.85; 0.99) and 0.84 (0.74; 0.94) for diastolic 24 h, awake and asleep BP respectively. TestBP-V1.5 detected elevated systolic/diastolic mean 24 h-BP with a 95%/90% sensitivity and 65%/70% specificity. Highest Youden’s Index was systolic 133 (sensitivity 95%/specificity 80%) and diastolic 87 mmHg (sensitivity 81%/specificity 98%). The update improved the agreement to RefBP. TestBP was excellent for detecting 24 h and awake hypertensive BP values but not for asleep BP values.

Expert Hypertension Detection System Featuring Pulse Plethysmograph Signals and Hybrid Feature Selection and Reduction Scheme

Hypertension is an antecedent to cardiac disorders. According to the World Health Organization (WHO), the number of people affected with hypertension will reach around 1.56 billion by 2025. Early detection of hypertension is imperative to prevent the complications caused by cardiac abnormalities. Hypertension usually possesses no apparent detectable symptoms; hence, the control rate is significantly low. Computer-aided diagnosis based on machine learning and signal analysis has recently been applied to identify biomarkers for the accurate prediction of hypertension. This research proposes a new expert hypertension detection system (EHDS) from pulse plethysmograph (PuPG) signals for the categorization of normal and hypertension. The PuPG signal data set, including rich information of cardiac activity, was acquired from healthy and hypertensive subjects. The raw PuPG signals were preprocessed through empirical mode decomposition (EMD) by decomposing a signal into its constituent components. A combination of multi-domain features was extracted from the preprocessed PuPG signal. The features exhibiting high discriminative characteristics were selected and reduced through a proposed hybrid feature selection and reduction (HFSR) scheme. Selected features were subjected to various classification methods in a comparative fashion in which the best performance of 99.4% accuracy, 99.6% sensitivity, and 99.2% specificity was achieved through weighted k-nearest neighbor (KNN-W). The performance of the proposed EHDS was thoroughly assessed by tenfold cross-validation. The proposed EHDS achieved better detection performance in comparison to other electrocardiogram (ECG) and photoplethysmograph (PPG)-based methods.

Hypertension Awareness, Treatment, and Control in Mexico: An Opportunistic Medical Student-led Blood Pressure Screening Campaign – A Cross-sectional Study

Background: Hypertension is still a growing public health problem in Mexico. An estimated 151% increase in the number of individuals with hypertension is expected for 2050 if actions are not taken in the country. The aim of this study is to describe hypertension awareness, treatment, control and its associated factors in participants of an opportunistic medical student-led blood pressure screening campaign in Mexico. Methods: A cross-sectional study, using convenience sampling was performed, including participants aged 18 years and older from 15 Mexican states. Each participant completed a questionnaire about risk factors and had three BP measurements taken. Hypertension was defined as ≥140/90 mmHg. Multiple imputation with linear regression was performed where data was missing. Results: From a population of 2 545 participants, 623 (24.5%) participants had hypertension. Of those with hypertension, 81.9% had a previous diagnosis of hypertension and only 16.1% were not on medication at the time of screening; 61% were controlled, 121% were uncontrolled patients and 18% were not aware they had hypertension. High marginalization was found to have the biggest proportion of uncontrolled cases (33%), while the number of unaware hypertensives in very low marginalization states doubled the national figure. More than half the participants taking antihypertensive agents were on a single medication, achieving control in almost 8 in 10 patients. Conclusion: It is important to continue making and supporting awareness raising campaigns in different settings across the country to generate more evidence and lead to better programs for improving hypertension detection in Mexico.