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O'Hagan E, McIntyre D, Nguyen T, Tan KM, Hanlon P, Siddiqui M, Anastase D, Lim TW, Uzendu A, Van Nguyen T, Wong WJ, Khor HM, Kumar P, Usherwood T, Chow CK. A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights. Glob Heart 2024; 19:73. [PMID: 39281000 PMCID: PMC11396169 DOI: 10.5334/gh.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/20/2024] [Indexed: 09/18/2024] Open
Abstract
Background Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide. Methods A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use. Findings Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%). Interpretation Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access.
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Affiliation(s)
- Edel O'Hagan
- Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Daniel McIntyre
- Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Tu Nguyen
- The George Institute for Global Health, Level 18, International Towers 3, 300 Barangaroo Ave, Sydney, NSW, 2000, Australia
- Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd Camperdown, NSW, 2050, Australia
| | - Kit Mun Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Clarice Pears building, Byres Road, Glasgow, UK
| | - Maha Siddiqui
- Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Dzudie Anastase
- Clinical Research Education, Networking and Consultancy and Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Toon Wei Lim
- National University Heart Centre, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Anezi Uzendu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Tan Van Nguyen
- University of Medicine & Pharmacy at Ho Chi Minh City, Ho Chi Min City, Vietnam
| | - Wei Jin Wong
- Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd Camperdown, NSW, 2050, Australia
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Subang Jaya, Selangor, Malaysia
| | - Hui Min Khor
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Pramod Kumar
- All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Timothy Usherwood
- Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, The University of Sydney, Entrance K, Level 5, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
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Yirga GK, Mekonen GS, Hiruy EG, Shiferaw K, Bantie B. Non-adherence to appointment follow-up and its associated factors among hypertensive patients in follow-up clinics in South Gondar hospitals. Sci Rep 2024; 14:21336. [PMID: 39266562 PMCID: PMC11393061 DOI: 10.1038/s41598-024-70710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/20/2024] [Indexed: 09/14/2024] Open
Abstract
Hypertension is a persistent systemic Blood Pressure reading of 140/90 mm Hg or greater which is a preventable cause of cardiovascular disease morbidity and mortality. To assess non-adherence to appointment follow-up and its associated factors among Hypertensive patients in the follow-up clinics in South Gondar Hospitals 2023. Institutional-based cross-sectional study design was employed in hospitals in South Gondar from January to February to assess missed appointment follow-up and its associated factors among Hypertensive patients in follow-up clinics. There is one comprehensive specialized hospital and 9 primary hospitals in this zone. Using simple random methods four hospitals were selected by lottery method. The sample was calculated by using the single population proportion formula. The collected data was entered into Epi data version 3.1 and exported to Statistical Package for Social Sciences version 26 for analysis. Bivariate and multivariable logistic regression analysis was performed to determine the association factors. A total of 401 hypertensive patients on hypertensive follow-up were involved with a response rate of 95.02%. Age ranged from 25 to 86 years with a median age of 58.47 years. Of the total of participants, 211 (52.6.) were rural residents. Among the total hypertensive patients in the hypertensive follow-up clinic, 39.2% were non-adherent for their appointment follow-up. Living far from follow-up health facility (AOR: 2.53; 95% CI 1.349-4.743), absence of perceived symptoms (AOR: 4.98; 95% CI 2.888-8.590), patient complaints Pill burdens (AOR: 3.50; 95% CI 2.108-5.825), and poor Awareness about complication of hypertension (AOR: 2.62; 95% CI 1.471-4.673) were significantly associated with missing of their appointment follow-up for the most hypertensive patients. The prevalence of non-adherence to medical follow-up in hypertension is high as compared to different national health policy recommendations. Distance from the health facility, absence of perceived symptoms, Pill burdens, and lack of knowledge about complications of hypertension were significantly associated with Missed appointment follow-up in Hypertensive patient.
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Affiliation(s)
- Gebrie Kassaw Yirga
- Department of Adult Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Getu Sisay Mekonen
- Department of Public Health in Mekane Eyesus Primary Hospital, Debre Tabor, Ethiopia
| | - Endalk Getasew Hiruy
- Department of Adult Health Nursing, College of Health Science, Debremarkos University, Debremarkos, Ethiopia
| | - Kirubel Shiferaw
- Department of Integrated Psychiatry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Andersson U, Nilsson PM, Kjellgren K, Ekholm M, Midlöv P. Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study. Scand J Prim Health Care 2024; 42:415-423. [PMID: 38529930 PMCID: PMC11332292 DOI: 10.1080/02813432.2024.2332745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. DESIGN AND SETTING The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. PATIENTS Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. MAIN OUTCOME MEASURES Association between self-reported BP and 10 self-report lifestyle-related variables. RESULTS Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. CONCLUSION In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
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Affiliation(s)
- Ulrika Andersson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter M. Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karin Kjellgren
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ekholm
- Wetterhälsan Primary Health Care Centre, Jönköping, Region Jönköping County, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Castro-Diehl C, Pirzada A, de Las Fuentes L, Sotres-Alvarez D, Isasi CR, Durazo-Arvizu RA, Makarem N, Perreira KM, Ramos AR, Wassertheil-Smoller S, Stamatakis K, Stickel AM, Redline S, Daviglus ML. Sleep Apnea and Hypertension Control among Hispanic/Latino Adults in the United States: Results from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.13.24307315. [PMID: 38798492 PMCID: PMC11118658 DOI: 10.1101/2024.05.13.24307315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Objectives Hispanic/Latino adults have a high prevalence of uncontrolled hypertension predisposing them to CVD. We hypothesize that sleep apnea severity is associated with uncontrolled blood pressure (BP) and resistant hypertension in Hispanic/Latino adults. Methods This was a cross-sectional study of 2,849 Hispanic Community Health Study/Study of Latinos participants with hypertension (i.e., systolic BP ≥130 mm Hg, or diastolic BP ≥80 mm Hg or self-reported antihypertensive medication use) who were taking at least one class of antihypertensive medication. Participants were categorized as having controlled (BP < 130/80 mmHg among those on hypertension treatment) , uncontrolled (BP ≥ 130/80 mmHg using one or two classes of antihypertensive medications), or resistant hypertension (BP ≥ 130/80 mmHg while on ≥ 3 classes of antihypertensive medications or the use of ≥ 4 classes of antihypertensive medications regardless of BP control). Sleep apnea was classified based on the respiratory event index (REI; events/h) as mild (REI ≥ 5 and < 15), moderate-to-severe (REI ≥ 15), or no sleep apnea (REI < 5). Results In multinomial logistic regression, moderate-to-severe sleep apnea (vs. no sleep apnea) was associated with higher odds of resistant hypertension (Odds Ratio [OR], 2.15; 95% CI, 1.36-3.39 at 4% desaturation and OR 1.68; 95% CI, 1.05-2.67 at 3% desaturation). Neither mild nor moderate-to-severe sleep apnea was associated with uncontrolled hypertension. Conclusion Among diverse Hispanic/Latino persons, moderate-to-severe but not mild sleep apnea was associated with resistant hypertension. Identification and management of sleep apnea in this population may improve BP control and subsequently prevent adverse cardiovascular outcomes.
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Lee JS, Bhatt A, Pollack LM, Jackson SL, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries. Telemed J E Health 2024; 30:1262-1271. [PMID: 38241486 PMCID: PMC11065593 DOI: 10.1089/tmj.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mok Y, Matsushita K. Integrating essence of "time" for blood pressure control in nephrology care. Kidney Int 2024; 105:673-674. [PMID: 38519235 DOI: 10.1016/j.kint.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 03/24/2024]
Abstract
Controlling blood pressure (BP) is essential in the management of patients with chronic kidney disease. Reflecting the intrinsic variability of BP, several parameters of BP over time have been shown to predict adverse outcomes. Systolic BP time in target range has been recently proposed as a new promising parameter. Park et al. confirmed its prognostic value in patients with chronic kidney disease. We review the potential clinical usefulness and challenges of this parameter in nephrology care.
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Affiliation(s)
- Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA.
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
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Kim W, Ju YJ, Lee SY. Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study. BMC Public Health 2024; 24:781. [PMID: 38481198 PMCID: PMC10935772 DOI: 10.1186/s12889-024-18130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods. METHODS Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension. RESULTS Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted OR = 1.69, 95% CI: 1.49-1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment. CONCLUSIONS The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension.
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Affiliation(s)
- Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, 16499, Suwon-si Gyeonggi-do, Gyeonggi-do, Republic of Korea
| | - Soon Young Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, 16499, Suwon-si Gyeonggi-do, Gyeonggi-do, Republic of Korea.
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Vestala H, Bendtsen M, Midlöv P, Kjellgren K, Eldh AC. Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care. Scand J Prim Health Care 2024; 42:225-233. [PMID: 38214748 PMCID: PMC10851821 DOI: 10.1080/02813432.2023.2301567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). DESIGN A parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. SETTING 31 primary healthcare centers in Sweden. SUBJECTS 949 patients treated for hypertension. MAIN OUTCOME MEASURES The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. RESULTS At baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. CONCLUSION The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.
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Affiliation(s)
- Hanna Vestala
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Patrik Midlöv
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Kjellgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- University of Gothenburg Centre for Person-Centered Care, University of Gothenburg, Gothenburg
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Kohjitani H, Koshimizu H, Nakamura K, Okuno Y. Recent developments in machine learning modeling methods for hypertension treatment. Hypertens Res 2024; 47:700-707. [PMID: 38216731 DOI: 10.1038/s41440-023-01547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/22/2023] [Accepted: 11/09/2023] [Indexed: 01/14/2024]
Abstract
Hypertension is the leading cause of cardiovascular complications. This review focuses on the advancements in medical artificial intelligence (AI) models aimed at individualized treatment for hypertension, with particular emphasis on the approach to time-series big data on blood pressure and the development of interpretable medical AI models. The digitalization of daily blood pressure records and the downsizing of measurement devices enable the accumulation and utilization of time-series data. As mainstream blood pressure data shift from snapshots to time series, the clinical significance of blood pressure variability will be clarified. The time-series blood pressure prediction model demonstrated the capability to forecast blood pressure variabilities with a reasonable degree of accuracy for up to four weeks in advance. In recent years, various explainable AI techniques have been proposed for different purposes of model interpretation. It is essential to select the appropriate technique based on the clinical aspects; for example, actionable path-planning techniques can present individualized intervention plans to efficiently improve outcomes such as hypertension. Despite considerable progress in this field, challenges remain, such as the need for the prospective validation of AI-driven interventions and the development of comprehensive systems that integrate multiple AI methods. Future research should focus on addressing these challenges and refining the AI models to ensure their practical applicability in real-world clinical settings. Furthermore, the implementation of interdisciplinary collaborations among AI experts, clinicians, and healthcare providers are crucial to further optimizing and validate AI-driven solutions for hypertension management.
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Affiliation(s)
- Hirohiko Kohjitani
- Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Hiroshi Koshimizu
- Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuki Nakamura
- Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasushi Okuno
- Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Girard AA, Denney TS, Gupta H, Dell'Italia LJ, Calhoun DA, Oparil S, Sharifov OF, Lloyd SG. Spironolactone improves left atrial function and atrioventricular coupling in patients with resistant hypertension. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:487-497. [PMID: 38123867 DOI: 10.1007/s10554-023-03013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
To determine the blood pressure independent effects of spironolactone on left atrial (LA) size and function in patients with resistant hypertension (RHTN). Patients with RHTN (n = 36, mean age 55 ± 7) were prospectively recruited. Spironolactone was initiated at 25 mg/day and increased to 50 mg/day after 4 weeks. Other antihypertensives were withdrawn to maintain constant blood pressure. Cardiac magnetic resonance imaging was performed at baseline and after 6 months of spironolactone treatment and changes in LA functional metrics were assessed. LA size and function parameters were improved (p < 0.05) from baseline to month-6: LA volumes indexed to body surface area (LAVI) were reduced (LAVImaximum 41.4 ± 12 vs. 33.2±9.7 mL/m2; LAVIpre-A 32.6 ± 9.8 vs. 25.6 ± 8.1 mL/m2; median LAVIminimum 18.5 [13.9-24.8] vs. 14.1 [10.9-19.2] mL/m2); left atrioventricular coupling index was reduced (28.2 ± 11.5 vs. 22.7 ± 9.2%); LA emptying fractions (LAEF) were increased (median total LAEF 52.4 [48.7-60.3] vs. 55.9 [50.3-61.1] %; active LAEF 40.2 ± 8.6 vs. 43.1 ± 7.8%). LA global longitudinal strain in the active phase was increased (16.3 ± 4.1 vs. 17.8 ± 4.2%). The effect of spironolactone was similar in patients with high (N = 18) and normal (N = 18) aldosterone status (defined by plasma renin activity and 24-h urine aldosterone). Treatment of RHTN with spironolactone is associated with improvements in LA size and function, and atrioventricular coupling, regardless of whether aldosterone levels were normal or high at baseline. This study suggests the need for larger prospective studies examining effects of mineralocorticoid receptor antagonists on atrial function and atrioventricular coupling.
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Affiliation(s)
- Andrew A Girard
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | | | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- VA Medical Center, Birmingham, AL, USA
| | - David A Calhoun
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Vascular Biology and Hypertension Program, UAB, Birmingham, AL, USA
| | - Oleg F Sharifov
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 143, Birmingham, AL, 35294, USA.
| | - Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- VA Medical Center, Birmingham, AL, USA
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11
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Desson Z, Sharman JE, Searles A, Schutte AE, Delles C, Olsen MH, Ordunez P, Hure A, Morton R, Figtree G, Webster J, Jennings G, Redfern J, Nicholls SJ, McNamara M, Deeming S, Doyle K, Ramanathan S. Improving the accuracy of blood pressure measuring devices in Australia: a modelled return on investment study. J Hum Hypertens 2024; 38:177-186. [PMID: 37938294 PMCID: PMC10844083 DOI: 10.1038/s41371-023-00866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 11/09/2023]
Abstract
The VALID BP project was initiated to increase the availability of validated blood pressure measuring devices (BPMDs). The goal is to eliminate non validated BPMDs and minimise over- and underdiagnosis of hypertension caused by inaccurate readings. This study was undertaken to assess the potential return on investment in the VALID BP project. The Framework to Assess the Impact of Translational Health Research was applied to the VALID BP project. This paper focuses on the implementation of the cost benefit analysis aspect of this framework to monetise past research investment and model future research costs, implementation costs, and benefits. Analysis was based on reasoned assumptions about potential impacts from availability and use of validated BPMDs (assuming an end goal of 100% validated BPMDs available in Australia by 2028) and improved skills leading to more accurate BP measurement. After 5 years, with 20% attribution of benefits, there is a potential $1.14-$1.30 return for every dollar spent if the proportion of validated BPMDs and staff trained in proper BP measurement technique increased from 20% to 60%. After eight years (2020-2028) and assuming universal validation and training coverage, the returns would be between $2.70 and $3.20 per dollar spent (not including cost of side effects of unnecessary medication or downstream patient impacts from unmanaged hypertension). This modelled economic analysis indicates there will be positive downstream economic benefits if the availability of validated BPMDs is increased. The findings support ongoing efforts toward a universal regulatory framework for BPMDs and can be considered within more detailed future economic analyses.
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Affiliation(s)
- Zachary Desson
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew Searles
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alexis Hure
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Rachael Morton
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Jacqui Webster
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Garry Jennings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | | | - Simon Deeming
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Kerry Doyle
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia.
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
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12
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Rijal A, Adhikari TB, Dhakal S, Maagaard M, Piri R, Nielsen EE, Neupane D, Jakobsen JC, Olsen MH. Effects of adding exercise to usual care on blood pressure in patients with hypertension, type 2 diabetes, or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. J Hypertens 2024; 42:10-22. [PMID: 37796224 DOI: 10.1097/hjh.0000000000003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Exercise is the most recommended lifestyle intervention in managing hypertension, type 2 diabetes, and/or cardiovascular disease; however, evidence in lowering blood pressure is still inconsistent and often underpowered. METHOD We conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials adding any form of trialist defined exercise to usual care versus usual care and its effect on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in participants with hypertension, type 2 diabetes, or cardiovascular disease searched in different databases from inception to July 2020. Our methodology was based on PRISMA and Cochrane Risk of Bias-version1. Five independent reviewers extracted data and assessed risk of bias in pairs. RESULTS Two hundred sixty-nine trials randomizing 15 023 participants reported our predefined outcomes. The majority of exercise reported in the review was dynamic aerobic exercise (61%), dynamic resistance (11%), and combined aerobic and resistance exercise (15%). The trials included participants with hypertension (33%), type 2 diabetes (28%), or cardiovascular disease (37%). Meta-analyses and trial sequential analyses reported that adding exercise to usual care reduced SBP [mean difference (MD) MD: -4.1 mmHg; 95% confidence interval (95% CI) -4.99 to -3.14; P < 0.01; I2 = 95.3%] and DBP (MD: -2.6 mmHg; 95% CI -3.22 to -2.07, P < 0.01; I2 = 94%). Test of interaction showed that the reduction of SBP and DBP was almost two times higher among trials from low-and middle-income countries (LMICs) as compared to high-income countries (HICs). The exercise induced SBP reduction was also higher among participants with hypertension and type 2 diabetes compared to participants with cardiovascular disease. The very low certainty of evidence warrants a cautious interpretation of the present results. CONCLUSION Adding any type of exercise to usual care may be a potential complementary strategy for optimal management of blood pressure for patients with hypertension, type 2 diabetes, or cardiovascular disease, especially, in LMICs.PROSPERO registration number CRD42019142313.
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Affiliation(s)
- Anupa Rijal
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark
| | - Tara Ballav Adhikari
- Department of Public Health, Research Unit for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - Sarmila Dhakal
- Center for Research on Environment, Health and Population Activities (CREPHA), Kusunti, Lalitpur, Nepal
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koge
| | - Reza Piri
- Department of Clinical Research, University of Southern Denmark
- Department of Nuclear Medicine, Odense University Hospital
- Department of Cardiology, Odense University Hospital, Odense Denmark
| | - Emil Eik Nielsen
- Department of Regional Health Research, University of Southern Denmark
- Department of Cardiology, Odense University Hospital, Odense Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Baltimore, Mayland, USA
| | - Janus Christian Jakobsen
- Department of Regional Health Research, University of Southern Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark
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13
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Lee WL, Danaee M, Abdullah A, Wong LP. Is the Blood Pressure-Enabled Smartwatch Ready to Drive Precision Medicine? Supporting Findings From a Validation Study. Cardiol Res 2023; 14:437-445. [PMID: 38187511 PMCID: PMC10769613 DOI: 10.14740/cr1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Background The popular wrist-worn wearables recording a variety of health metrics such as blood pressure (BP) in real time could play a potential role to advance precision medicine, but these devices are often insufficiently validated for their performance to enhance confidence in its use across diverse populations. The accuracy of BP-enabled smartwatch is assessed among the multi-ethnic Malaysians, and findings is discussed in comparison with conventional automated upper-arm BP device. Methods Validation procedures followed the guidelines by the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). Quota sampling was employed to obtain eligible patients with normal and abnormal BP as per guideline. The measurements of BP were taken at wrist using HUAWEI WATCH D (test BP); and the readings were assessed against reference BP by the mercury sphygmomanometer. Agreement statistics and linear regression analyses were performed. Results BP measurements (234 data pairs) from 78 patients that fulfilled AAMI/ESH/ISO protocol were analyzed. The BP readings taken by the HUAWEI WATCH D were comparable to reference BP by sphygmomanometer based on 1) Criterion 1: systolic blood pressure (SBP) = -0.034 (SD 5.24) and diastolic blood pressure (DBP) = -0.65 (SD 4.66) mm Hg; and 2) Criterion 2: SBPs = -0.034 (SD 4.18) and DBPs = -0.65 (SD 3.94) mm Hg. Factors of sociodemographic characteristics, anthropometric measurements, cardiovascular comorbidities, and wrist hair density were not significantly associated with the mean BP differences. Conclusions HUAWEI WATCH D fulfilled criteria 1 and 2 of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) guidelines. It can be recommended for clinical use across a wider population. The rich data from real-time BP measurements in concurrent with other health-related parameters recorded by the smartwatch wearable offer opportunities to drive precision medicine in tackling therapeutic inertia by personalizing BP control regimen.
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Affiliation(s)
- Wan Ling Lee
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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14
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Mohammed H, Chen HB, Li Y, Sabor N, Wang JG, Wang G. Meta-Analysis of Pulse Transition Features in Non-Invasive Blood Pressure Estimation Systems: Bridging Physiology and Engineering Perspectives. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:1257-1281. [PMID: 38015673 DOI: 10.1109/tbcas.2023.3334960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The pulse transition features (PTFs), including pulse arrival time (PAT) and pulse transition time (PTT), hold significant importance in estimating non-invasive blood pressure (NIBP). However, the literature showcases considerable variations in terms of PTFs' correlation with blood pressure (BP), accuracy in NIBP estimation, and the comprehension of the relationship between PTFs and BP. This inconsistency is exemplified by the wide-ranging correlations reported across studies investigating the same feature. Furthermore, investigations comparing PAT and PTT have yielded conflicting outcomes. Additionally, PTFs have been derived from various bio-signals, capturing distinct characteristic points like the pulse's foot and peak. To address these inconsistencies, this study meticulously reviews a selection of such research endeavors while aligning them with the biological intricacies of blood pressure and the human cardiovascular system (CVS). Each study underwent evaluation, considering the specific signal acquisition locale and the corresponding recording procedure. Moreover, a comprehensive meta-analysis was conducted, yielding multiple conclusions that could significantly enhance the design and accuracy of NIBP systems. Grounded in these dual aspects, the study systematically examines PTFs in correlation with the specific study conditions and the underlying factors influencing the CVS. This approach serves as a valuable resource for researchers aiming to optimize the design of BP recording experiments, bio-signal acquisition systems, and the fine-tuning of feature engineering methodologies, ultimately advancing PTF-based NIBP estimation.
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15
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Faezi A, Afshar HL, Rahimi B. Identifying factors that affect the use of health information technology in the treatment and management of hypertension. BMC Med Inform Decis Mak 2023; 23:235. [PMID: 37872522 PMCID: PMC10591361 DOI: 10.1186/s12911-023-02284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 09/02/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND We conducted this study with the aim of identifying factors that affect the use of health information technology in the treatment and management of hypertension. METHODS This paper is a descriptive-analytic study conducted in 2022. To obtain relevant articles, databases including Scopus, Web of Science, IEEE, and PubMed were searched and the time period was between 2013 and 2022. Based on the review of similar articles, a five-point Likert scale checklist was developed in the second phase. The statistical population of the present study was specialist physicians (N = 40) and patients (N = 384). In order to analyze the data, SPSS Statistics 24 was used. To analyze the data obtained from the checklist, we used summary statistics (mean and standard deviation). RESULTS As a result of the review literature process, 50 papers were screened, that based we can distinguish motivational and inhibitory factors affecting the use of health information technology in hypertension management. Indeed, Motivational factors and inhibitory factors can be classified into five groups: organizational, economic, technical, personal, and legal/moral factors. Based on the results of the checklist, the factors that were identified as most influential on motivation and inhibitory patients and specialist physicians' to use of health information technology to manage and treat hypertension. CONCLUSION Utilizing technologies for hypertension, its management can be improved by identifying motivating and inhibiting factors. Our approach can improve the acceptability of these technologies, save costs, reduce long-term complications of hypertension, and improve patient quality of life.
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Affiliation(s)
- Aysan Faezi
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran.
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hadi Lotfnezhad Afshar
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Bahlol Rahimi
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
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16
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Wu H, Xiao Z. A knowledge graph-based analytical model for mining clinical value of drug stress echocardiography for diagnosis, risk stratification and prognostic evaluation of coronary artery disease. Int J Cardiol 2023; 387:131107. [PMID: 37271285 DOI: 10.1016/j.ijcard.2023.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
The three major techniques for clinically diagnosing coronary heart disease, including angina associated with myocardial ischemia, are coronary angiography, myocardial perfusion imaging, and drug stress echocardiography. Compared to the first two methods, which are invasive or involve the use of radionuclides, drug stress echocardiography is increasingly used in clinical practice due to its non-invasive, low-risk, and controllable nature, and wide applicability. We developed a novel methodology to demonstrate knowledge graph-based efficacy analysis of drug stress echocardiography as a complement to traditional meta-analysis. By measuring coronary flow reserve (CFR), we discovered that regional ventricular wall abnormalities (RVWA) and drug-loaded cardiac ultrasound can be used to detect coronary artery disease. Additionally, drug-loaded cardiac ultrasound can be used to identify areas of cardiac ischemia, stratify risks, and determine prognosis. Furthermore, adenosine stress echocardiography(ASE) can determine atypical symptoms of coronary heart disease with associated cardiac events through CFR and related quantitative indices for risk stratification. Using a knowledge graph-based approach, we investigated the positive and negative effects of three drugs - Dipyridamole, Dobutamine, and Adenosine - for coronary artery disease analysis. Our findings show that Adenosine has the highest positive effect and the lowest negative effect among the three drugs. Due to its minimal and controlled side effects, and high sensitivity for diagnosing coronary microcirculation disorders and multiple lesions, adenosine is frequently used in clinical practice.
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Affiliation(s)
- Hongyi Wu
- Department of Cardiology, Zhongshan Hospital affiliated to Fudan University, Shanghai, China.
| | - Zhifeng Xiao
- School of Engineering, Penn State Erie, The Behrend College, Erie, 16563, PA, USA.
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17
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Dele-Ojo BF, Oseni TIA, Duodu F, Echieh CP, Blankson PK, Alabi BS, Sarpong DF, Tayo BO, Boima V, Coleman MA, Ogedegbe G. The effect of mobile health technology on blood pressure control among patients with hypertension in Ghana and Nigeria. RESEARCH SQUARE 2023:rs.3.rs-3272069. [PMID: 37790348 PMCID: PMC10543310 DOI: 10.21203/rs.3.rs-3272069/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background More than half of patients with hypertension in sub-Saharan African do not achieve blood pressure control. This study determined the effect of mobile health technology on systolic blood pressure reduction and blood pressure (BP) control among patients with hypertension in Nigeria and Ghana. Methods A randomised control trial of 225 adults with hypertension attending two General/Medical Outpatient Clinics each in Nigeria and Ghana was randomized into intervention (n = 116) and control (n = 109) arm respectively. Patients in the intervention arm received messages twice weekly from a mobile app for six months in addition to the usual care while the control arm received usual care only. The study outcomes were systolic blood pressure (SBP) reduction and blood pressure control at six months, while the secondary outcome was medication adherence at six months. Data were collected at 0 and 6 months, it was analysed using SPSS-21 software at a significance level of p < 0.05. Binary logistic regression was used to generate the predictors of good blood pressure control. Results The mean age for the control and intervention were 60.2 ± 13.5 and 62.6 ± 10.8 years respectively; p-value = 0.300. The intervention group had greater reductions in SBP (-18.7mmHg vs -3.9mmHg; p < 0.001) and greater BP control rate (44.3% vs 24.8%; p-value 0.002). Conclusions The mobile health intervention resulted in significant SBP reduction rate and improvement in BP control rate in the 6th month. However, improvement in adherence level in the 3rd month and was not sustained in the 6th month. The addition of mobile health technology may be extended for use in the national hypertension control plan. Female gender, formal education and being in the intervention arm were predictors of blood pressure control.
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18
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Kim BS, Kim JH, Kim W, Kim WS, Park S, Lee SJ, Kim JY, Lee EM, Ihm SH, Pyun WB, Shin JH, Shin J. Clinical and life style factors related to the nighttime blood pressure, nighttime dipping and their phenotypes in Korean hypertensive patients. Clin Hypertens 2023; 29:21. [PMID: 37525293 PMCID: PMC10391961 DOI: 10.1186/s40885-023-00241-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Non-dipping or reverse dipping patterns are known to be associated with adverse cardiovascular prognosis among the general population and clinical cohort. Few large sized studies have explored factors including sleep duration and sleep quality related to nighttime blood pressure (BP) and nocturnal dipping patterns. METHODS Among 5,360 patients enrolled in Korean multicenter nationwide prospective Registry of ambulatory BP monitoring (KORABP), 981 subjects with complete data on sleep duration, sleep quality assessed using a 4-point Likert scale, and clinical variables were included in the analysis. Phenotypes of nighttime BP pattern were categorized as extreme dipper, dipper, non-dipper, and reverse dipper. Hypertension was defined as a 24-h ambulatory BPs were 130/80 mmHg or higher. RESULTS Among 981 subjects, 221 were normotensive, 359 were untreated hypertensive, and 401 were treated hypertensive. Age of the participants were 53.87 ± 14.02 years and 47.1% were female. In overall patients, sleep duration was 431.99 ± 107.61 min, and one to four points of sleep quality were observed in 15.5%, 30.0%, 30.4%, and 24.2%, respectively. Of the 760 hypertensive patients, extreme dipper, dipper, non-dipper, and reverse dipper were observed in 58 (7.63%), 277 (36.45%), 325 (42.76%), and 100 (13.16%), respectively. In multiple linear regression analysis, sleep duration (β = 0.0105, p < 0.001) and sleep quality (β = -0.8093, p < 0.001) were associated with nighttime systolic BP and sleep quality was associated with extent of nighttime systolic BP dipping (β = 0.7622, p < 0.001) in hypertensive patients. In addition, sleep quality showed positive association with dipper pattern (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 1.03-1.30) and showed negative association with reverse dipper pattern (OR = 0.73, 95% CI = 0.62-0.86) in multiple logistic regression analyses. CONCLUSION When adjusted covariates, less sleep duration and poor sleep quality were positively associated with nighttime systolic BP. Additionally, sleep quality was the independent associated factor for dipper and reverse dipper phenotypes. The study also found that male sex, low estimated glomerular filtration rate, high ambulatory BP, low office BP, and poor sleep quality were associated with blunted nighttime SBP dipping.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Wan Kim
- Division of Cardiology, Department of Internal Medicine, Gwangju Veterans Hospital, Gwangju, South Korea
| | - Woo Shik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, South Korea
| | - Sang Jae Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Sanbon, South Korea
| | - Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Catholic University School of Medicine, Seoul, South Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ehwa Women's University Seoul Hospital, Seoul, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222, Wangsimni-Ro, Sungdong-Gu, Seoul, 04763, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222, Wangsimni-Ro, Sungdong-Gu, Seoul, 04763, South Korea.
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Al Saleh Y, Al Busaidi N, Al Dahi W, Almajnoni M, Mohammed AS, Alshali K, Al-Shamiri M, Al Sifri S, Arafah M, Chan SP, El-Tamimi H, Hafidh K, Hassanein M, Shaaban A, Sultan A, Grassi G. Roadmap for the Management of Type 2 Diabetes and Hypertension in the Middle East: Review of the 2022 EVIDENT Summit. Adv Ther 2023; 40:2965-2984. [PMID: 37233878 PMCID: PMC10271906 DOI: 10.1007/s12325-023-02529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
Type 2 diabetes mellitus (T2DM) and hypertension are leading risk factors for death and disability in the Middle East. Both conditions are highly prevalent, underdiagnosed and poorly controlled, highlighting an urgent need for a roadmap to overcome the barriers to optimal glycaemic and blood pressure management in this region. This review provides a summary of the Evidence in Diabetes and Hypertension Summit (EVIDENT) held in September 2022, which discussed current treatment guidelines, unmet clinical needs and strategies to improve treatment outcomes for patients with T2DM and hypertension in the Middle East. Current clinical guidelines recommend strict glycaemic and blood pressure targets, presenting several treatment options to achieve and maintain these targets and prevent complications. However, treatment targets are infrequently met in the Middle East, largely due to high clinical inertia among physicians and low medication adherence among patients. To address these challenges, clinical guidelines now provide individualised therapy recommendations based on drug profiles, patient preferences and management priorities. Efforts to improve the early detection of prediabetes, T2DM screening and intensive, early glucose control will minimise long-term complications. Physicians can use the T2DM Oral Agents Fact Checking programme to help navigate the wide range of treatment options and guide clinical decision-making. Sulfonylurea agents have been used successfully to manage T2DM; a newer agent, gliclazide MR (modified release formulation), has the advantages of a lower incidence of hypoglycaemia with no risk of cardiovascular events, weight neutrality and proven renal benefits. For patients with hypertension, single-pill combinations have been developed to improve efficacy and reduce treatment burden. In conjunction with pragmatic treatment algorithms and personalised therapies, greater investments in disease prevention, public awareness, training of healthcare providers, patient education, government policies and research are needed to improve the quality of care of patients with T2DM and/or hypertension in the Middle East.
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Affiliation(s)
- Yousef Al Saleh
- Dr. Mohammad AlFagih Hospital, Riyadh, Kingdom of Saudi Arabia.
| | - Noor Al Busaidi
- National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Oman
- Oman Diabetes Association, Muscat, Oman
| | | | - Munawar Almajnoni
- Department of Cardiology, My Clinic, Jeddah, Kingdom of Saudi Arabia
- Saudi Society of Echocardiography, Jeddah, Kingdom of Saudi Arabia
| | - Al Saeed Mohammed
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Bahrain Defence Force Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Khalid Alshali
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mostafa Al-Shamiri
- Department of Cardiac Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Saud Al Sifri
- Al Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | | | - Siew Pheng Chan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hassan El-Tamimi
- Mohammed Bin Rashid University of Medicine and Health Science, Dubai, United Arab Emirates
- Department of Cardiology, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Khadija Hafidh
- Diabetes Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Mohamed Hassanein
- Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - Ashraf Shaaban
- Diabetes Control Centre, Ghassan Najib Pharaon Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ali Sultan
- Diabetes Centre, International Medical Centre Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
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20
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Trimarco V, Manzi MV, Izzo R, Mone P, Lembo M, Pacella D, Esposito G, Falco A, Morisco C, Gallo P, Santulli G, Trimarco B. The therapeutic concordance approach reduces adverse drug reactions in patients with resistant hypertension. Front Cardiovasc Med 2023; 10:1137706. [PMID: 37215551 PMCID: PMC10196370 DOI: 10.3389/fcvm.2023.1137706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Adverse drug reactions (ADRs) remain among the leading causes of therapy-resistant hypertension (TRH) and uncontrolled blood pressure (BP). We have recently reported beneficial results in BP control in patients with TRH adopting an innovative approach, defined as therapeutic concordance, in which trained physicians and pharmacists reach a concordance with patients to make them more involved in the therapeutic decision-making process. Methods The main scope of this study was to investigate whether the therapeutic concordance approach could lead to a reduction in ADR occurrence in TRH patients. The study was performed in a large population of hypertensive subjects of the Campania Salute Network in Italy (ClinicalTrials.gov Identifier: NCT02211365). Results We enrolled 4,943 patients who were firstly followed-up for 77.64 ± 34.44 months, allowing us to identify 564 subjects with TRH. Then, 282 of these patients agreed to participate in an investigation to test the impact of the therapeutic concordance approach on ADRs. At the end of this investigation, which had a follow-up of 91.91 ± 54.7 months, 213 patients (75.5%) remained uncontrolled while 69 patients (24.5%, p < 0.0001) reached an optimal BP control. Strikingly, during the first follow-up, patients had complained of a total of 194 ADRs, with an occurrence rate of 68.1% and the therapeutic concordance approach significantly reduced ADRs to 72 (25.5%). Conclusion Our findings indicate that the therapeutic concordance approach significantly reduces ADRs in TRH patients.
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Affiliation(s)
- Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, “Federico II” University, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Pasquale Mone
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, “Federico II” University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Angela Falco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, “Federico II” University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
| | - Paola Gallo
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York, NY, USA
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
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21
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Zhao W, Liu L, Chen L. Comparison of antihypertensive drugs amlodipine and perindopril on blood pressure variability after long-term treatment of hypertension induced by apatinib and bevacizumab. CHINESE J PHYSIOL 2023; 66:137-143. [PMID: 37322624 DOI: 10.4103/cjop.cjop-d-22-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
The purpose of this study was to elucidate the therapeutic effect of different antihypertensive drugs (amlodipine and perindopril) on hypertension induced by apatinib and bevacizumab. Sixty patients with hypertension treated with apatinib or bevacizumab were selected and divided into two groups: one group was treated with amlodipine and the other group was treated with perindopril. Before and after treatment, the dynamic blood pressure (BP) measurement (systolic BP [SBP] and diastolic BP [DBP]), echocardiography (left ventricular end-diastolic diameter, interventricular septal thickness [IVST], left ventricular posterior wall thickness [LVPWT], and left atrial diameter [LAD]), and detection of nitric oxide (NO) content in venous blood were performed. In the amlodipine group, the 24hSBP, 24hSSD, 24hSCV, daytime mean SBP (dSBP), daytime mean SSD (dSSD), daytime mean SBP CV, night mean SBP (nSBP), night mean SSD, 24hDBP, 24hDSD, 24 h DBP CV, daytime mean DBP (dDBP), daytime mean DSD (dDSD), daytime mean DBP CV, night mean DBP (nDBP), LAD, and LAD index (LADi) after treatment were all lower than before treatment, while NO was higher than before treatment (all P < 0.05). In the perindopril group, the 24hSBP, dSBP, nSBP, 24hDBP, dDBP, nDBP, LAD, LADi, IVST, LVPWT, and left ventricular mass index (LVMI) after treatment were lower than before treatment, and NO level after treatment was higher than before treatment (all P < 0.05). After treatment, the 24hSBP, 24hSSD, dSBP, dSSD, nSBP, 24hDBP, 24hDSD, dDBP, dDSD, nDBP, night mean DSD, and NO were all lower while the LAD, LADi, IVST, LVPWT, and LVMI were higher in the amlodipine group than those in the perindopril group (all P < 0.05). Our study suggests that the SBP and DBP variability of amlodipine in the treatment of hypertension induced by apatinib and bevacizumab is slightly better than that of perindopril, but the effect of perindopril in improving endothelial function indices NO and echocardiographic data is better than that of amlodipine.
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Affiliation(s)
- Weichao Zhao
- Department of Cardiovascular Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lanbo Liu
- Department of Cardiovascular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqiang Chen
- Department of Cardiovascular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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22
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Cao M, Zhang Z. Adjuvant music therapy for patients with hypertension: a meta-analysis and systematic review. BMC Complement Med Ther 2023; 23:110. [PMID: 37024863 PMCID: PMC10077636 DOI: 10.1186/s12906-023-03929-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND High blood pressure, anxiety, depression and sleep disorder is very common in patients with hypertension. We aimed to perform a meta-analysis to evaluate the effects of adjuvant music therapy for patients with hypertension, to provide insights to the clinical management of hypertension. METHODS Two authors searched PubMed, Embase, Web of Science, the Cochrane Library, Chinese National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Databases for randomized controlled trials (RCTs) on the role of music therapy in hypertension up to Oct 15, 2022. RevMan 5.3 software was used for meta-analysis. RESULTS A total of 20 RCTs including 2306 patients were finally included. 1154 patients received music therapy. Meta-analysis showed that music therapy can effectively reduce the systolic blood pressure(MD = - 9.00, 95%CI: - 11.99~- 6.00), diastolic blood pressure(MD = -6.53, 95%CI: -9.12~- 3.93), heart rate (MD = -3.76, 95%CI: -7.32~- 0.20), self-rating anxiety scale (SAS) score(MD =-8.55, 95%CI: -12.04~-4.12), self-rating depression scale (SDS) score(MD = -9.17, 95%CI: -13.85~-5.18), Hamilton anxiety scale (HAMA), score(MD = -3.37, 95%CI: - 5.38~- 1.36), PSQI score(MD =-1.61, 95%CI:-2.30~- 0.93) compared with routine therapy in patients with hypertension(all P < 0.05). No publication bias in the synthesized outcomes were found (all P > 0.05). CONCLUSION Music therapy can effectively control blood pressure and heart rate, reduce anxiety and depression levels, and improve sleep quality in hypertensive patients. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies.
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Affiliation(s)
- Min Cao
- Shaoxing University Yuanpei College, No. 2799 Qunxian Zhong Road, Yuecheng District, Shaoxing, Zhejiang, China.
| | - Zhiyuan Zhang
- Shaoxing University Yuanpei College, No. 2799 Qunxian Zhong Road, Yuecheng District, Shaoxing, Zhejiang, China.
- Hunan international econonmics university, Hunan, China.
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23
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Andersson U, Nilsson PM, Kjellgren K, Hoffmann M, Wennersten A, Midlöv P. PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care. J Hypertens 2023; 41:246-253. [PMID: 36394295 PMCID: PMC9799039 DOI: 10.1097/hjh.0000000000003322] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/16/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90 mmHg by improving the management of hypertension in daily life from a person-centred perspective. METHODS In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1 : 1 to either the intervention or usual care group. The intervention included daily measurement - via the participant's mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90 mmHg at 8 weeks and 12 months. Significance was tested by Pearson's chi 2 -test. RESULTS A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90 mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group ( P = 0.006). At 12 months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90 mmHg ( P = 0.071). CONCLUSION The proportion of participants with a controlled BP of less than 140/90 mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12 months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (NCT03554382).
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Affiliation(s)
- Ulrika Andersson
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University
| | | | - Karin Kjellgren
- University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
| | - Mikael Hoffmann
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
| | - André Wennersten
- Department of Clinical Sciences Malmö, Lund University, Malmö
- Clinical Studies Sweden – Forum South, Skåne University Healthcare, Lund, Sweden
| | - Patrik Midlöv
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University
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24
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Parati G, Goncalves A, Soergel D, Bruno RM, Caiani EG, Gerdts E, Mahfoud F, Mantovani L, McManus RJ, Santalucia P, Kahan T. New perspectives for hypertension management: progress in methodological and technological developments. Eur J Prev Cardiol 2023; 30:48-60. [PMID: 36073370 DOI: 10.1093/eurjpc/zwac203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 01/14/2023]
Abstract
Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | | | - David Soergel
- Cardiovascular, Renal, and Metabolic Drug Development, Novartis, Basel, CH 4056, Switzerland
| | - Rosa Maria Bruno
- Paris Cardiovascular Research Centre (PARCC-INSERM U970) & Université de Paris, Paris 75015, France
| | - Enrico Gianluca Caiani
- Politecnico di Milano, Electronics, Information and Bioengineering Department, Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), National Research Council of Italy (CNR), Milan 20133 & 24-10129, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen NO-5020, Norway
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg 66123, Germany
| | - Lorenzo Mantovani
- Value-based Healthcare Unit, IRCCS MultiMedica Research Hospital, University of Milan, Milan, Italy
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6HD, UK
| | - Paola Santalucia
- Italian Association Against Thrombosis and Cardiovascular Diseases (ALT Onlus), Milan 20123, Italy
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm SE 182 88, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm SE 182 88, Sweden
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25
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Angelaki E, Barmparis GD, Kochiadakis G, Maragkoudakis S, Savva E, Kampanieris E, Kassotakis S, Kalomoirakis P, Vardas P, Tsironis GP, Marketou ME. Artificial intelligence-based opportunistic screening for the detection of arterial hypertension through ECG signals. J Hypertens 2022; 40:2494-2501. [PMID: 36189460 DOI: 10.1097/hjh.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Hypertension is a major risk factor for cardiovascular disease (CVD), which often escapes the diagnosis or should be confirmed by several office visits. The ECG is one of the most widely used diagnostic tools and could be of paramount importance in patients' initial evaluation. METHODS We used machine learning techniques based on clinical parameters and features derived from the ECG, to detect hypertension in a population without CVD. We enrolled 1091 individuals who were classified as hypertensive or normotensive, and trained a Random Forest model, to detect the existence of hypertension. We then calculated the values for the Shapley additive explanations (SHAP), a sophisticated feature importance analysis, to interpret each feature's role in the Random Forest's results. RESULTS Our Random Forest model was able to distinguish hypertensive from normotensive patients with accuracy 84.2%, specificity 78.0%, sensitivity 84.0% and area under the receiver-operating curve 0.89, using a decision threshold of 0.6. Age, BMI, BMI-adjusted Cornell criteria (BMI multiplied by RaVL+SV 3 ), R wave amplitude in aVL and BMI-modified Sokolow-Lyon voltage (BMI divided by SV 1 +RV 5 ), were the most important anthropometric and ECG-derived features in terms of the success of our model. CONCLUSION Our machine learning algorithm is effective in the detection of hypertension in patients using ECG-derived and basic anthropometric criteria. Our findings open new horizon in the detection of many undiagnosed hypertensive individuals who have an increased CVD risk.
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Affiliation(s)
- Eleni Angelaki
- Institute of Theoretical and Computational Physics and Department of Physics, University of Crete, Crete, Greece
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Georgios D Barmparis
- Institute of Theoretical and Computational Physics and Department of Physics, University of Crete, Crete, Greece
| | - George Kochiadakis
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | | | - Eirini Savva
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | | | - Spyros Kassotakis
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | | | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
- Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | - Giorgos P Tsironis
- Institute of Theoretical and Computational Physics and Department of Physics, University of Crete, Crete, Greece
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
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26
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Wang D, Ali F, Liu H, Cheng Y, Wu M, Saleem MZ, Zheng H, Wei L, Chu J, Xie Q, Shen A, Peng J. Quercetin inhibits angiotensin II-induced vascular smooth muscle cell proliferation and activation of JAK2/STAT3 pathway: A target based networking pharmacology approach. Front Pharmacol 2022; 13:1002363. [PMID: 36324691 PMCID: PMC9618806 DOI: 10.3389/fphar.2022.1002363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022] Open
Abstract
The rapid growth of vascular smooth muscle cells (VSMCs) represents crucial pathological changes during the development of hypertensive vascular remodeling. Although quercetin exhibits significantly therapeutic effects on antihypertension, the systematic role of quercetin and its exact mode of action in relation to the VSMCs growth and its hypertension-related networking pharmacology is not well-documented. Therefore, the effect of quercetin was investigated using networking pharmacology followed by in vitro strategies to explore its efficacy against angiotensin II (Ang II)-induced cell proliferation. Putative genes of hypertension and quercetin were collected using database mining, and their correlation was investigated. Subsequently, a network of protein-protein interactions was constructed and gene ontology (GO) analysis was performed to identify the role of important genes (including CCND1) and key signaling pathways [including cell proliferation and Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway]. We therefore further investigated the effects of quercetin in Ang II-stimulated VSMCs. This current research revealed that quercetin significantly reduced the cell confluency, cell number, and cell viability, as well as expression of proliferating cell nuclear antigen (PCNA) in Ang II-stimulated VSMCs. Mechanistic study by western blotting confirmed that quercetin treatment attenuated the activation of JAK2 and STAT3 by reducing its phosphorylation in Ang II stimulated VSMCs. Collectively, the current study revealed the inhibitory effects of quercetin on proliferation of Ang II stimulated VSMCs, by inhibiting the activation of JAK2/STAT3 signaling might be one of underlying mechanisms.
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Affiliation(s)
- Di Wang
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Farman Ali
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Huixin Liu
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Ying Cheng
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Meizhu Wu
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Muhammad Zubair Saleem
- Fujian Key Laboratory of Natural Medicine Pharmacology, Fujian Medical University, Fuzhou, Fujian, China
| | - Huifang Zheng
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Lihui Wei
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Jiangfeng Chu
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Qiurong Xie
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
| | - Aling Shen
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
- *Correspondence: Aling Shen, ; Jun Peng,
| | - Jun Peng
- Clinical Research Institute, the Second Affiliated Hospital and Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular Diseases, Fuzhou, Fujian, China
- *Correspondence: Aling Shen, ; Jun Peng,
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27
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Platonova EV, Fedorova EY, Gorbunov VM. Office blood pressure: overcoming the problems of diagnosis and control of arterial hypertension treatment. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Some national guidelines since 2017 considered the most common method for diagnosing and controlling hypertension (HTN) (office blood pressure (OBP) measurement) as screening only. Automated OBP (AOBP) measurement claims to be a unique method by obtaining a standardized result, even in primary health care. AOBP improves the reliability of data by reducing the influence of various errors on result. However, although the level of AOBP is on average lower than similar OBP in clinical and research practice and is comparable to the mean 24-hour BP monitoring, at present, all international guidelines emphasize the mandatory use of ambulatory BP measurements for diagnostic purposes. Whether the results of AOBP and the reference level ≥130/80 mm Hg are equivalent with the same OBP level, the use of which is associated with an increase in the prevalence of hypertension and insufficient control of antihypertensive therapy, is a question for research. Compared with conventional OBP, the use of AOBP in conjunction with outpatient measurement leads to a reduction in the proportion and timing of initiation of treatment in patients with masked HTN, whose cardiovascular risk is similar to that of patients with stable HTN. However, the widespread implementation of AOBP is hindered by the high cost and lack of accumulated data. The review analyzes in detail the limitations and advantages of various types of BP measurement, as well as the potential of using AOBP in modern clinical and research practice.
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Affiliation(s)
- E. V. Platonova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. Yu. Fedorova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
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28
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Perindopril/Indapamide/Amlodipine in Hypertension: A Profile of Its Use. Am J Cardiovasc Drugs 2022; 22:219-230. [PMID: 35257306 PMCID: PMC8964631 DOI: 10.1007/s40256-022-00521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/01/2022]
Abstract
The single-pill combination (SPC) of perindopril (PER)/indapamide (IND)/amlodipine (AML) is a valuable and convenient treatment option for patients with hypertension controlled with two-drug SPC of PER/IND + AML given as two separate pills at the same dose level. PER [an angiotensin-converting enzyme (ACE) inhibitor], IND (a thiazide-like diuretic) and AML (a calcium channel blocker) are well established antihypertensive agents, which have been available for a long time as monotherapies and dual SPCs and have complementary mechanisms of action. Once-daily PER/IND/AML provided effective BP control, with good tolerability, in patients with uncontrolled hypertension in clinical trials and in large observational prospective studies. The efficacy and tolerability of PER/IND/AML was similar to that of PER/IND + AML in a randomized clinical trial. The therapeutic effect of PER/IND/AML was associated with improved health-related quality of life. Thus, switching from the two-pill PER/IND + AML regimen to single-pill PER/IND/AML reduces pill burden and simplifies drug administration, which may improve adherence to treatment, leading to better BP control and clinical outcomes.
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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 1076] [Impact Index Per Article: 358.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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