The Bidirectional Signal Communication of Microbiota-Gut-Brain Axis in Hypertension

Hypertension is a critical risk factor of cardiovascular diseases. A new concept of microbiota-gut-brain axis has been established recently, mediating the bidirectional communication between the gut and its microbiome and the brain. Alterations in bidirectional interactions are believed to be involved in the blood pressure regulation. Neuroinflammation and increased sympathetic outflow act as the descending innervation signals from the brain. Increased sympathetic activation plays a recognized role in the genesis of hypertension. The present evidence demonstrates that gut dysbiosis is associated with central nervous system neuroinflammation. However, how the gut influences the brain remains unclear. We reviewed the roles of neuroinflammation and gut microbiota and their interactions in the pathogenesis of hypertension and described the ascending signaling mechanisms behind the microbiota-gut-brain axis in detail. Additionally, the innovative prohypertensive mechanisms of dietary salt through the microbiota-gut-brain axis are summarized. The bidirectional communication mechanisms were proposed for the first time that the descending signals from the brain and the ascending connections from the gut form a vicious circle of hypertension progression, acting as a premise for hypertension therapy.

The Potency of Bovine Bone Gelatin as Antihypertensive Agent: A Review

This review was purposed to understand the effectiveness of bovine bone gelatin as an antihypertensive agent. This review concerning the effectiveness of bovine bone gelatin as an antihypertensive agent. Hypertension, also called as a silent disease, has become the main cause of coronary heart disease and stroke that contributes to the malfunction of human organs. Changes of lifestyle alongside with science enhancement, provides new inventions regarding methods of hypertension therapy by minimizing the use of synthetic drugs. Collagen tissue of bovine bone gelatin is known to contain angiotensin converting enzyme (ACE) inhibitor, an active peptide that plays a role in lowering blood pressure supporting with the large amount of Gly (27%), Pro (17.6%), and Hyp (14.4%) and repeating pattern of Gly-X-Y. A study was carried out in vivo using injected spontaneously hypertensive rats (SHR) with 30 mg/kg and was able to reduce blood pressure by 15 mmHg. Antihypertensive test with SHR tail-cuff at 30 mg/kg bovine gelatin hydrolysate RGL-(Hyp)-GL and RGM-(Hyp)-GF were 31.3 mmHg and 38.6 mmHg respectively. A study conducted using bovine and porcine gelatin with 30–50 kDa (permeate P1) and 1–2 kDa (permeate P3) was able to reduce blood pressure by 22 mmHg and 21.33 mmHg. In addition, it is still possible conducting research to find out other peptides of bovine bone gelatin that can be used as a future alternative antihypertensive agent.

EVALUASI PENGGUNAAN OBAT ANTIHIPERTENSI PADA PASIEN LANJUT USIA DI RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA MEDAN

Hypertension is called the "silent killer" which is a risk factor for heart disease, stroke and kidney failure. High blood pressure that can not protect properly will increase the mortality and morbidity. Elderly patients aged ≥ 60 years, most of them already have hypertension and even have experienced the risk factors caused by hypertension. The goal of therapy is not to exacerbate organ damage and reduce mortality and improve patient quality so that evaluation is necessary, especially for the selection of antihypertensive drugs. This study aims to meet the suitability of the types of antihypertensive drugs given to elderly patients at the General Hospital of Imelda Pekerja Indonesia Medan with the standard of hypertension treatment. Research data collection was carried out in a retrospective manner in the period January-April 2020. Data were analyzed using the SPSS 21, JNC VIII (2016) method. There were 9 patients (28.1%), the use of antihypertensive drugs in elderly patients who did not comply with the standard recommendations for hypertension therapy and 23 patients (71.9%) who used antihypertensive drugs in accordance with JNC VIII standards.

Effectivity Evaluation of Bisoprolol as Additional Hypertension Therapy in Geriatrics with Type 2 Diabetes Mellitus while ongoing with Dual Oral Anti-Hypertension Agent: A Cohort Study

Background: Bisoprolol is a beta-blocker agent that is widely used as an antihypertensive agent, cardiac rate control, and agent to improve the cardiac ejection fraction. Bisoprolol is commonly added to hypertension therapy in patients with a high risk of heart disease such as hypertension with diabetes. The effectiveness of beta-blocker agents in the treatment of hypertension in geriatrics with diabetes without a history of CVD who are currently using dual therapy is still minimal. Evaluation of this matter needs to be done to complement scientific evidence in the use of bisoprolol in the treatment of hypertension in geriatrics with type 2 diabetes mellitus. Objective: This study aims to compare the effectiveness of bisoprolol as additional therapy in geriatric patients who have diabetes hypertension without CVD history while they are ongoing dual oral antihypertension therapy. Method: A cohort study involving 82 geriatrics was prospectively observed for four weeks. The exposure in this study was the bisoprolol agent. Subjects were divided into two groups, where all patients would undergo dual antihypertensive agents, namely Angiotensin-Receptor-Blocker (ARB) and Calcium-Channel-Blocker (CCB). Reductions in systolic and diastolic blood pressure were observed as primary outcomes, and success in achieving blood pressure goals was observed as a secondary outcome in the study. Result: There was no difference in the decrease in systolic and diastolic blood pressure in the exposure and non-exposure groups (p> 0.05). Judging from the large number of patients who successfully achieved the therapeutic target also showed no significant difference between the exposure and non-exposure groups with systolic and diastolic risk difference (RD) values of 1,091 (CI95%: 0.545-2.184) and 1,222 (CI95%: 0.781-1.913). Conclusion: The addition of bisoprolol agents in geriatric patients with hypertension and diabetes without a history of CVD is not required.

Analisis Faktor yang Berhubungan dengan Kepatuhan Pasien di Kabupaten Banjar

Hypertension is still the most common disease in the world. South Kalimantan Province in 2018 became the province with the highest number of hypertension sufferers in Indonesia. Hypertensive patients will undergo hypertension therapy for the rest of their lives so that blood pressure can still be well controlled. Lifelong therapy can reduce patient compliance in taking hypertension drugs; this can result in failed therapeutic goals and lead to the emergence of other diseases such as myocardial infarction and others. The purpose of this study was to analyze sociodemographic factors and clinical factors that may be related to patient compliance in taking hypertension drugs in Banjar Regency. The results showed that the majority of respondents had low compliance in consuming hypertension drugs. The analysis showed that sociodemographic factors such as gender, age, occupation, and place of getting the drug and clinical factors in the form of drugs used and blood pressure control did not show a significant relationship. The education factor shows a p-value < 0.05, which indicates the education factor has a significant relationship.

HUBUNGAN KEPATUHAN MINUM OBAT DENGAN TEKANAN DARAH PADA PENDERITA HIPERTENSI

AbstrakLatar belakang: Sampai saat ini, hipertensi masih merupakan tantangan besar di Indonesia. Kepatuhan pasien dalam menggunakan obat berpengaruh terhadap keberhasilan terapi pengobatan. Adanya ketidakpatuhan pasien hipertensi dalam minum obat dapat memberikan efek negative yang sangat besar, seperti munculnya komplikasi. Tujuan: Mengetahui hubungan kepatuhan minum obat dengan tekanan darah pada penderita hipertensi di Puskesmas Karangjambu Kabupaten Purbalingga. Metode: Desain penelitian ini adalah cross sectional study. Responden dalam penelitian ini adalah pasien hipertensi di Puskesmas Karangjambu Kbupaten Purbalingga. Sampel diambil menggunakan teknik accidental sampling dengan jumlah 86 responden. Data dikumpulkan pada bulan Mei 2021 menggunakan kuesioner 8 – Item Morisky Medication Aderence Scale (MMAS – 8) dan pengukuran tekanan darah secara langsung. Hasil: Penelitian ini menunjukkan bahwa Sebagian besar responden adlaah perempuan (86%), sebgain besar berada pada kategori tingkat kepatuhan sedang (47%) dan pada kategori hipertensi tahap 2 (63%). Uji stastistik didapatkan nilai p value 0.901 menunjukkan bahwa tidak ada hubungan kepatuhan minum obat dengan tekanan darah pada penderita hipertensi. Kesimpulan: Tidak ada hubungan kepatuhan minum obat dengan tekanan darah pada penderita hipertensi AbstractBackground: In Indonesia, hypertension is still a major problem. Adherence to treatment is critical for hypertension patients' long-term health and well-being. Adherence are required for hypertension therapy to be effective, and altering these patients' behavior has the greatest potential for improving hypertensive control. Objectives: To explore the relationship between medication adherence and blood pressure in hypertension patients. Methods: We used the cross-sectional study. This research sample was hypertension patients at Karangjambu Health Centre Purbalingga Regency. We included 89 respondents by accidental sampling technique. We collected the data by questionnaire. The Gamma & Sommers’d test was performed to analyze the data. Results: This research showed that that the majority of respondents were women (86%), the moderate category had the highest level of adherence (47%) and the most respondents suffer from hypertension stage 2 (63%). The statistical test result of 0.910 suggested that there was no relationship between medication adherence and blood pressure in hypertensive patients. Conclusions: There was also no significant between medication adherence and blood pressure.

The role of diuretics in the treatment of hypertension: a focus on chlorthalidone (lecture)

The lecture discusses the role of thiazide and thiazide-like diuretics, in particular chlorthalidone, in the modern treatment of arterial hypertension. The modern concepts about the mechanism of action of thiazide diuretics and chlorthalidone are presented. Differences in the degree of antihypertensive effect of hydrochlorothiazide and chlorthalidone are discussed. The results of large randomized trials SHEP, MRFIT, ALLHAT were analyzed, in which chlorthalidone therapy significantly reduced the risk of developing cardiovascular and cerebrovascular complications of hypertension. The effect of thiazide diuretics on glucose metabolism and the impact of carbohydrate metabolism disorders during treatment with chlorthalidone on the risk of cardiovascular complications was considered. The lecture also discusses the effect of chlorthalidone therapy on kidney function, the possibility of its use in chronic kidney disease. The data are presented on the prevention of resistant hypertension and chro-nic heart failure during long-term therapy of hypertension with chlorthalidone. The frequency and terms of the development of side effects of hypertension therapy with thiazide-like diuretics were also analyzed.