A Japan nationwide web-based survey of patient preference for renal denervation for hypertension treatment

Renal denervation is a potential alternative to antihypertensive drug therapy. However, data on patient preference for this treatment option are limited and there are no data specifically from Asian patients. This study evaluated patient preference for renal denervation in patients with hypertension from Japan. Patients were a subset of those who participated in a March 2020 online electronic survey of patients with hypertension who had regularly visited medical institutions for treatment, were receiving antihypertensive drug therapy and had home blood pressure recordings available. The survey included a question about patient preference for treatment with renal denervation. A total of 2,392 patients were included (66% male, mean age 59.8 ± 11.6 years, mean duration of hypertension 11.4 ± 9.5 years). Preference for renal denervation was expressed by 755 patients (31.6%), and was higher in males than in females, in younger compared with older patients, in those with higher versus lower blood pressure, in patients who were less adherent versus more adherent to antihypertensive drug therapy, and in those who did rather than did not have antihypertensive drug-related side effects. Significant predictors of preference for renal denervation on logistic regression analysis were younger patient age, male sex, higher home or office systolic blood pressure, poor antihypertensive drug adherence, the presence of heart failure, and the presence of side effects during treatment with antihypertensive drugs. Overall, a relevant proportion of Japanese patients with hypertension expressed a preference for renal denervation. This should be taken into account when making shared decisions about antihypertensive drug therapy.

Prevalence and incidence of young onset dementia and associations with comorbidities: A study of data from the French national health data system

Background Dementia onset in those aged <65 years (young onset dementia, YOD) has dramatic individual and societal consequences. In the context of population aging, data on YOD are of major importance to anticipate needs for planning and allocation of health and social resources. Few studies have provided precise frequency estimates of YOD. The aim of this study is to provide YOD prevalence and incidence estimates in France and to study the contribution of comorbidities to YOD incidence. Methods and findings Using data from the French national health data system (Système National des Données de Santé, SNDS) for 76% of the French population aged 40 to 64 years in 2016 (n = 16,665,795), we identified all persons with dementia based on at least 1 of 3 criteria: anti-Alzheimer drugs claims, hospitalization with the International Classification of Diseases-10th Revision (ICD-10) dementia code (F00 to F03, G30, G31.0, G31.1, or F05.1), or registration for free healthcare for dementia. We estimated prevalence rate (PR) and incidence rate (IR) and estimated the association of comorbidities with incident YOD. Sex differences were investigated. We identified 18,466 (PRstandardized = 109.7/100,000) and 4,074 incident (IRstandardized = 24.4/100,000 person-years) persons with prevalent and incident YOD, respectively. PR and IR sharply increased with age. Age-adjusted PR and IR were 33% (95% confidence interval (CI) = 29 to 37) and 39% (95% CI = 31 to 48) higher in men than women (p < 0.001 both for PR and IR). Cardio- and cerebrovascular, neurological, psychiatric diseases, and traumatic brain injury prevalence were associated with incident YOD (age- and sex-adjusted p-values <0.001 for all comorbidities examined, except p = 0.109 for antihypertensive drug therapy). Adjustment for all comorbidities explained more than 55% of the sex difference in YOD incidence. The lack of information regarding dementia subtypes is the main limitation of this study. Conclusions We estimated that there were approximately 24,000 and approximately 5,300 persons with prevalent and incident YOD, respectively, in France in 2016. The higher YOD frequency in men may be partly explained by higher prevalence of cardiovascular and neurovascular diseases, substance abuse disorders, and traumatic brain injury and warrants further investigation.

Resistant arterial hypertension: the search of new approaches to antihypertensive drug therapy

Improving the effectiveness of drug therapy and reducing the risk of adverse cardiovascular and renal outcomes in patients with resistant hypertension (HTN) remains an unsolved problem of cardiology. The results of the PATHWAY-2, PATHWAY-3 and ReHOT studies have shown the clinical efficacy of spironolactone, amiloride and, to a lesser extent, the antiadrenergic drugs clonidine, bisoprolol and doxazosin in improving blood pressure (BP) control in this patient population. However, the inclusion of spironolactone and other known drugs in antihypertensive therapy does not ensure the achievement of target BP level in a significant proportion of these patients. The review presents the results of clinical studies of new approaches aimed at increasing the effectiveness of drug therapy in resistant HTN including sodium-glucose cotransporter type 2 inhibitors, brain aminopeptidase A inhibitors, and new antagonists of endothelin receptors.

Evaluation of administration and use of antihypertensive drugs in severe preeclampsia patients at X General Hospital in Jakarta

The high number of maternal mortality rate (MMR) is still a problem in Indonesia. Three ethyologies of maternal death are infection (12%), hypertension in pregnancy (25%) and bleeding (30%). Pre-eclampsia as a form of hypertension during pregnancy requires antihypertensive drug therapy. Rationality assessment for any kinds of pharmacotherapy is based on the right indication, the right medicine, the right patient, and the right dose. The main indication for antihypertensive medication in pregnancy is applied to the mother’s in preventing cerebrovascular disease. The aim of this study was to evaluate the characteristics, patterns and accuracy of the administration and use of antihypertensive drugs in patients with severe preeclampsia at X General Hospital in Jakarta in 2018. It was a non-experimental study with a descriptive and retrospective design using medical records. Administration and use of antihypertensive drugs in patients with severe preeclampsia at the X General Hospital in Jakarta showed 91.9% right indication, 86.72% right drug, 96.9% right patient and only 5.26% right dose with 4.0% accuracy of rational administration and use of drugs. In conclusion, the right dose in the management of patients with severe preeclampsia in X General Hospital in Jakarta is still low. Further training and close monitoring and evaluation on the rational use of antihypertension in severe preeclampsia is needed.

ECHOCARDIOGRAPHIC ASSESSMENT OF HYPERTENSIVE CHANGES IN ELDERLY PATIENTS OF ISOLATED SYSTOLIC HYPERTENSION WITH SPECIAL REFERENCE TO CARDIOVASCULAR COMPLICATIONS

Objective: The objective of the study was to assess the echocardiographic changes and cardiovascular complications in patients with isolated systolic hypertension (ISH). Methods: This was an observational cross-sectional study done in the Departments of General Medicine, Cardiology, and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha, India. Seventy patients above the age of 65 years with systolic blood pressure (BP) ≥140 mm Hg and diastolic BP <90 mm Hg, without any secondary causes of hypertension and antihypertensive drug therapy were selected for this study. Echocardiography and electrocardiography studies were implemented for demonstrating the development of cardiovascular complications. Results: Of 70 cases (41 males and 29 females), 64.3% were asymptomatic and 35.7% were symptomatic, with palpitation being the major symptom, 40% (28 cases) developed retinopathy, 45.71% developed increased left ventricular mass index (p=0.04), 18.57% had increased in LV volume (>90 ml/m2), 30% cases had regional wall motion abnormalities, 27.1% had reduced ejection fraction (<56%), and 52.66% showed LA enlargement in this study (p=0.048). Doppler measurements of diastolic filling were significant in patients with ISH with higher peak atrial velocity (A wave) of 79.71±11.79 cm/s and a lower ratio of peak early to atrial velocity of 0.82±0.29. Conclusion: This study demonstrates that elderly patients with ISH had a prevalence of concentric left ventricular hypertrophy (LVH) which was found to be more in female patients than in male patients followed by left atrial enlargement.