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

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.

Treatment of a patient with COVID-19 and adverse premorbid background: A case report

BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults. CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m2, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acidbase balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation. CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.

Blood-Brain Barrier Crossing Renin-Angiotensin Drugs and Cognition in the Elderly: A Meta-Analysis

Hypertension is an established risk factor for cognitive decline and dementia in older adults, highlighting the potential importance of antihypertensive treatments in prevention efforts. Work surrounding antihypertensive treatments has suggested possible salutary effects on cognition and neuropathology. Several studies have specifically highlighted renin-angiotensin system drugs, including AT1-receptor blockers and angiotensin-converting-enzyme inhibitors, as potentially benefiting cognition in later life. A small number of studies have further suggested renin-angiotensin system drugs that cross the blood-brain barrier may be linked to lower dementia risk compared to their nonpenetrant counterparts. The present meta-analysis sought to evaluate the potential cognitive benefits of blood-brain barrier crossing renin-angiotensin system drugs relative to their nonpenetrant counterparts. We harmonized longitudinal participant data from 14 cohorts from 6 countries (Australia, Canada, Germany, Ireland, Japan, United States), for a total of 12 849 individuals at baseline, and assessed for blood-brain barrier crossing potential within antihypertensive medications used by cognitively normal participants. We analyzed 7 cognitive domains (attention, executive function, language, verbal memory learning, recall, mental status, and processing speed) using ANCOVA (adjusted for age, sex, and education) and meta-analyses. Older adults taking blood-brain barrier-crossing renin-angiotensin drugs exhibited better memory recall over up to 3 years of follow-up, relative to those taking nonpenetrant medications, despite their relatively higher vascular risk burden. Conversely, those taking nonblood-brain barrier-penetrant medications showed better attention over the same follow-up period, although their lower vascular risk burden may partially explain this result. Findings suggest links between blood-brain barrier crossing renin-angiotensin drugs and less memory decline.

ANALISIS COST OF ILLNESS PENYAKIT HIPERTENSI DI RUMAH SAKIT UMUM DAERAH PRAYA, NTB

The high prevalence of hypertension and the long-term of antihypertensive treatments required are the main reasons for the need of economic analysis on the costs of hypertensive treatment. This study aims to quantify direct medical cost of hypertension. This study uses retrospective cost of illness analysis in descriptive observational design with heath care perspective. Data were collected from the hospital’s management information system, patient's prescriptions and patient's medical records. Fifty-eight patient’s data were analyzed. Direct medical cost of the patient without comorbidities in stage 1 hypertension was Rp 535,660 ± 100,681, stage 2 hypertension was Rp 381,940 ± 126,423 and hypertensive crises was Rp 456,241 ± 197,959. Direct medical cost of the patients with comorbidities in stage 1 hypertension was Rp 398,750 ± 240,542, stage 2 hypertension was Rp 486,227 ± 241,136 and hypertensive crises was Rp 425,816 ± 140,898. Direct medical costs for patients with compelling indications in stage 1 hypertension was Rp 512,810 ± 152,661, stage 2 hypertension was Rp 444,183 ± 109,162 and hypertensive crises was Rp 410,364 ± 80,388. Cost for drugs was represented as the largest component of direct medical cost (37.49%) followes by cost for ward (26.54%), medical treatment fee (15.88%), medical support fee (9.05%), doctor visit fee (8.12%) and service fee (2.91%). The hypertension's stage, comorbidities and compelling indications are not affecting the cost of therapy. The rational use of drugs will decrease the cost of hypertension treatment.

Influence of Antihypertensive Treatment on RAAS Peptides in Newly Diagnosed Hypertensive Patients

(1) Background: Recently, influences of antihypertensive treatment on the renin–angiotensin–aldosterone system (RAAS) has gained attention, regarding a possible influence on inflammatory and anti-inflammatory pathways. We aimed to study the effects of newly initiated antihypertensive drugs on angiotensin (Ang) II and Ang (1–7) as representers of two counter-regulatory axes. (2) Methods: In this randomized, open-label trial investigating RAAS peptides after the initiation of perindopril, olmesartan, amlodipine, or hydrochlorothiazide, Ang II and Ang (1–7) equilibrium concentrations were measured at 8 a.m. and 12 a.m. at baseline and after four weeks of treatment. Eighty patients were randomized (1:1:1:1 fashion). (3) Results: Between the four substances, we found significant differences regarding the concentrations of Ang II (p < 0.0005 for 8 a.m., 12 a.m.) and Ang (1–7) (p = 0.019 for 8 a.m., <0.0005 for 12 a.m.) four weeks after treatment start. Ang II was decreased by perindopril (p = 0.002), and increased by olmesartan (p < 0.0005), amlodipine (p = 0.012), and hydrochlorothiazide (p = 0.001). Ang (1–7) was increased by perindopril and olmesartan (p = 0.008/0.002), but not measurably altered by amlodipine and hydrochlorothiazide (p = 0.317/ 0.109). (4) Conclusion: The initiation of all first line antihypertensive treatments causes early and distinct alterations of equilibrium angiotensin levels. Given the additional AT1R blocking action of olmesartan, RAAS peptides shift upon initiation of perindopril and olmesartan appear to work in favor of the anti-inflammatory axis compared to amlodipine and hydrochlorothiazide.

Evaluation of Antihypertensive Treatment Inoutpatients at Batang Beruh Helath Centre Sidikalang

Hypertension is a cardiovascular disease with a high prevalence and risk of death in developed and developing countries with blood pressure reach ≥140/90 mmHg. Hypertension is the 3rd cause of death after stroke and tuberculosis, reached 6.7% of the population of deaths at all ages in Indonesia. Results of Basic Health Research (Riskesdas) Balitbangkes showed that the national prevalence of hypertension reached 31.7%. The National Formulary (Fornas) is a list of drugs compiled based on the latest scientific evidence by the National Committee for the Compilation of the Fornas. Evaluation of the appropriateness of antihypertensive treatments in outpatients at Batang Beruh Health Centre Sidikalang seen from the National Formulary was the aim of this study. This research is non-experimental, quantitative descriptive was conducted in May - July 2019 at Batang Beruh Health Centre Jl. Pahlawan Sidikalang, Sidikalang District of Dairi, North Sumatra. The population was 231 hypertensive patients using antihypertensive drugs, with sampling using the Slovin formula, amounted to 70 respondents. Based on the research conducted, in the Calcium Antagonist group, the names of the antihypertensive drugs used are Amlodipine and Nifedipine. Meanwhile, in the ACEIs group, the drug used is Captopril. Whereas in the Angiotensin II receptor antagonist group, the drugs used are Micardis, Valsartan and Candesartan. Whereas in the Diuretic group, the antibiotic used is Furosemide.

Glucose-Dementia Association is Consistent Over Blood Pressure/Antihypertensive Groups

Background: Higher glucose levels are associated with dementia risk in people with and without diabetes. However, little is known about how this association might vary by hypertension status and antihypertensive treatment. Most studies on modifiable dementia risk factors consider each factor in isolation. Objective: To test the hypothesis that hypertension and antihypertensive treatments may modify associations between glucose levels and dementia. Methods: Analyses of data generated from a research study and clinical care of participants from a prospective cohort of dementia-free older adults, including glucose measures, diabetes and antihypertensive treatments, and blood pressure data. We defined groups based on blood pressure (hypertensive versus not, ≥140/90 mmHg versus <140/90 mmHg) and antihypertensive treatment intensity (0, 1, or ≥2 classes of antihypertensives). We used Bayesian joint models to jointly model longitudinal exposure and time to event data. Results: A total of 3,056 participants without diabetes treatment and 480 with diabetes treatment were included (mean age at baseline, 75.1 years; mean 7.5 years of follow-up). Higher glucose levels were associated with greater dementia risk among people without and with treated diabetes. Hazard ratios for dementia were similar across all blood pressure/antihypertensive treatment groups (omnibus p = 0.82 for people without and p = 0.59 for people with treated diabetes). Conclusion: Hypertension and antihypertensive treatments do not appear to affect the association between glucose and dementia risk in this population-based longitudinal cohort study of community-dwelling older adults. Future studies are needed to examine this question in midlife and by specific antihypertensive treatments.

Anxiety Disorder Associated with the COVID-19 Pandemic Causes Deterioration of Blood Pressure Control in Primary Hypertensive Patients

Objective: The new coronavirus disease (COVID-19) has spread rapidly all over the world and caused anxiety disorders. Recent studies have also shown that the prevalence of depression and anxiety increased during the COVID-19 outbreak. We aimed to evaluate the anxiety and depression levels during the pandemic and identify the effect of pandemic-related stress on blood pressure (BP) control in primary hypertensive patients. Method: A total of 142 patients with primary hypertension (HT) who continued to use the same antihypertensive drugs before and during the pandemic were included in the study. Twenty-four -hour Ambulatory Blood Pressure Monitoring (ABPM) and the Hospital Anxiety and Depression Scale (HADS) questionnaire were applied to patients. We retrospectively reviewed 24-h ABPM records of the same patients for the year before the pandemic. Results: Daytime, nighttime and 24 -hour-systolic blood pressure (SBP) levels as well as daytime, nighttime, and 24- hour-diastolic blood pressure (DBP) levels, were significantly elevated during the COVID-19 outbreak compared to the pre-pandemic period (p<0.001). Higher HADS-A scores (HADS-A ≥7) were significantly associated with much greater increase in BP compared to the patients with lower HADS-A scores. Conclusion: Psychological stress due to the COVID-19 outbreak led to worsening of the regulation of BP in controlled hypertensive patients whose antihypertensive treatments did not change.