Identifying drug-related attributes to personalise antihypertensive agents: the outcome report of patients receiving metoprolol therapy

Background Currently, numerous antihypertensive drugs from different pharmacological classes are available; however, blood pressure control is achieved in only less than a third of patients treated for hypertension. Moreover, providing optimal and personalised treatment for hypertension is challenging. Therefore, in this study, we propose a ‘drug-related attributes’ sensitive spectrum. This novel concept can assist clinicians in selecting an optimal antihypertensive drug and improve blood pressure control after examining the attributes of a patient. Methods We collected clinical data on attributes related to hypertension and its therapy of inpatients from West China Hospital who received metoprolol therapy and constructed the sensitive spectrum using data-visualisation tools. Results Our analysis revealed that haematocrit, haemoglobin, serum creatinine, serum cystatin C, serum urea, age, sex, systolic pressure, diastolic pressure, pulse pressure, and heart rate are metoprolol-related attributes. Conclusion Our study showed that all metoprolol-related attributes identified are reasonable and helpful in improving the personalisation of metoprolol therapy. The proposed drug-related attributes spectrum can help personalise antihypertensive medication. Moreover, data-visualisation tools can be effectively used to mine the drug-related attributes sensitive spectrum.

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.

1127Uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa; pooled analysis using individual participant data

Background Despite the numerous studies on hypertension, the current literature reveals little about the relationship between patient comorbidities and uncontrolled hypertension in sub-Saharan Africa (SSA). We aimed to assess the associations between body size, dyslipidemia, diabetes and uncontrolled hypertension. Methods We harmonised and pooled individual-level data from 25 cross-sectional studies. We did a meta-analysis of individual participant data to assess the association between uncontrolled hypertension with body size, diabetes and dyslipidemia using a logistic regression while adjusting for potential confounders. Results The pooled dataset included 107,339 participants, of whom 64,811 were women and 42,528 were men. The pooled prevalence of uncontrolled hypertension (UHTN) among those on treatment was (3,449) 59.89%. The UHTN estimate ranged from 47.0% in Malawi to 80.0% in Guinea. Significant association were noted between UHTN and diabetes for all countries. The overall pooled estimate for UHTN among patients with diabetes was OR = 1.49 (95% CI 1.30 to 1.67). All countries had significant associations between UHTN and central obesity except for Gambia, Kenya and Tanzania. Study participants from Uganda with central obesity had the highest likelihood of UHTN OR = 1.14 (95% CI 0.38 to 1.89). All countries had significant associations between UHTN and general obesity except for Kenya, Tanzania and Uganda. Conclusions The prevalence of uncontrolled hypertension among patients with comorbidities is high in SSA. Key messages Effective strategies to improve blood pressure control among patients with chronic comorbidities are needed.

Association of Sleep Related Breathing-Disorder with Systemic Hypertension - A Cross Sectional Study from Akola, India

BACKGROUND Hypertension or elevated blood pressure is a serious medical condition, obstructive sleep apnoea (OSA) is an important identifiable cause of hypertension. Early identification and treatment of sleep disordered breathing contributes to prevention of hypertension, and treatment of OSA may improve blood pressure control as well. This observational study was done to demonstrate the association of sleepdisordered breathing with patients who have systemic hypertension. METHODS Total 94 patients were included in this study. Out of ninety-four patients, eleven patients had mild sleep apnoea, nine patients had moderate sleep apnoea, and twelve had severe sleep apnoea. RESULTS In mild OSA there were four patients with blood pressure < 120 / 80 mmHg while seven patients with blood pressure of 121 - 140 / 81 - 90 and there were four patients with blood pressure 141 / 91. In moderate OSA there were 9, 3, 6 and 1 patients in the group of blood pressure < 120 / 80, 121 - 140 / 81 - 90, > 140 - 160 / 91 - 100 and > 160 / 100 mmHg respectively. In severe obstructive sleep apnoea there were 5, 7, 6 and 2 patients in the group of blood pressure < 120 / 80, 121 - 140 / 81 - 90, 141 - 160 / 91 - 100 and > 160 / 100 mmHg respectively. The severity of hypertension is strongly associated with apnoea-hypopnea index (AHI). CONCLUSIONS This study shows a statistically significant association of hypertension with obstructive sleep apnoea and increased severity of hypertension associated with the increased severity of obstructive sleep apnoea hypopnea syndrome (OSAHS). KEY WORDS Hypertension, polysomnography, apnoea / hypopnea index (AHI), Epworth sleepiness scale (ESS), Body Mass Index (BMI), obstructive sleep apnoea (OSA), obstructive sleep apnoea / hypopnea syndrome (OSAHS)

Device Therapy of Hypertension

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.

The single-pill combination or hybrid therapy in prevention of cardiovascular risk. Case reports

In polish population many patients with comorbid hypertension and hypercholesterolemia present low compliance and adherence to medical advising. The achievement of therapeutic goals of blood pressure control and hypercholesterolemia control was about 5,4% in WOBASZ II study. The therapy with antihypertensive drugs and statin in a single-pill combination (SPC) has recently been strengthened in the European and Polish guidelines for the treatment of arterial hypertension and hypercholesterolemia. It seems that therapy induction with SPC by reducing the number of pills to be taken daily could contribute to solve the problem of not undertaking or discontinuing treatment. The combination product present in different doses give possibility of optimization treatment. The use SCP on a larger scale could improve blood pressure control and cholesterol concentration reduction and prevent many of cardiovascular events.