Changing concepts in hypertension management

Criterion-Referenced Standards of Handgrip Strength for Identifying the Presence of Hypertension in Croatian Older Adults

BACKGROUND

It is well known that muscular fitness has been associated with hypertension. However, it is less known which cut-off values of muscular fitness may predict the presence of hypertension. The main purpose of this study was to establish criterion-referenced standards of muscular fitness to define the presence of hypertension in Croatian older adults.

METHODS

In this cross-sectional study, we recruited men and women over 60 years of age. Muscular fitness was assessed by handgrip strength and normalized by height squared. Hypertension was defined as having systolic blood pressure ≥130 mm/Hg or diastolic blood pressure ≥80 mm/Hg.

RESULTS

In older men, the optimal cut-point of muscular fitness in defining hypertension was 15.4 kg/m2. The area under the curve (AUC) was 0.85 (96% CI 0.77 to 0.92, p < 0.001). In older women, the optimal cut-point was 11.8 kg/m2, with an AUC of 0.84 (95% CI 0.80 to 0.89, p < 0.001). Men and women with cut-points of < 15.4 kg/m2 and < 11.8 kg/m2 were 11.8 (OR = 11.8, 95% CI 4.3 to 32.4, p < 0.001) and 10.6 (OR = 10.6, 95% CI 5.7 to 19.7, p < 0.001) times more likely to be diagnosed with hypertension.

CONCLUSIONS

Our newly developed cut-points of muscular fitness assessed by the handgrip strength and normalized by height squared have satisfactory predictive validity properties in detecting men and women aged 60-81 years with hypertension.

State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions

For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well-positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise-induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193-3279, 2022.

Hypertension assessment based on feature extraction using a photoplethysmography signal and its derivatives

Objective.Long-term abnormal blood pressure (BP) can lead to various cardiovascular diseases; therefore, it is significant to assess BP status as a preventative measure. In this study, a feature-extraction-based approach is proposed and performed on an open clinical trial dataset.Approach.Firstly, a complete ensemble of empirical mode decomposition with an adaptive noise algorithm and wavelet threshold analysis is applied to eliminate the noise interference from an original photoplethysmography (PPG) signal compared to other signal filters. Considering the strong connection between hypertension and diabetes, an analysis of variance test with a 95% confidence interval is firstly carried out to select these leading extracted morphological features, which are uniquely related to hypertension, from the PPG signal and its derivatives. Subsequently a variety of classification models are evaluated at different BP levels and their performances are compared.Main results and Significance.The test results demonstrate that the support vector machine classification model achieves a greater performance compared to other explored models in this paper, with accuracy of 78%, 87% and 88% for cases including normal versus prehypertension subjects, normotension versus hypertension subjects and non-hypertension versus hypertension subjects, respectively, which further illustrates the great potential of the proposed method in hypertension assessment.

Hypertension Exercise Videos Reduce Blood Pressure of Hypertension Patients

BACKGROUND: Hypertension is a symptom of a cardiovascular degenerative disease that is mostly experienced by the elderly and cause is not certain. However, the reduction of blood pressure with drugs and non drugs can reduce damage to target organs and prevent cardiovascular diseases. AIM: Identified the effect of hypertension exercise videos of lowering blood pressure. METHODS:  The type of research that has been used is quasi experimental with Pretest and Posttest design with control group. The sampling technique used was random sampling, the number of samples was 30 samples which were the treatment group and 30 samples were control the control group. The data analysis used  was the T test and Wilcoxon and Mann Whitney test. RESULTS:  The mean reduction in systolic blood  pressure in respondents who did exercise  was 13.67 mm Hg with a standard deviation of 10.57, while the mean  in systolic  blood  pressure in respondents who did not exercise was 0.50 mmHg  a pressure were 40.95 in the group of respondents who did hypertension exercise with p value =0.000.This mean that there is significant difference, in the mean reduction in systolic and diastolic blood pressure between respondents those who do exercise. CONCLUSION. Hypertension exercise video reduce blood pressure of hypertension patients.

Position statement on use of pharmacological combinations in a single pill for treatment of hypertension by Argentine Federation of Cardiology (FAC) and Argentine Society of Hypertension (SAHA)

The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.

Physical Exercise for Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition

Hypertension affects more than 40% of adults worldwide and is associated with stroke, myocardial infarction, heart failure, and other cardiovascular diseases. It has also been shown to cause severe functional and structural damage to the brain, leading to cognitive impairment and dementia. Furthermore, it is believed that these cognitive impairments affect the mental ability to maintain productivity at work, ultimately causing social and economic problems. Because hypertension is a chronic condition that requires clinical treatment, strategies with fewer side effects and less-invasive procedures are needed. Physical exercise (PE) has proven to be an efficient and complementary tool for hypertension management, and its peripheral benefits have been widely supported by related studies. However, few studies have specifically examined the potential positive effects of PE on the brain in hypertensive individuals. This narrative review discusses the pathophysiological mechanisms that hypertension promotes in the brain, and suggests PE as an important tool to prevent and reduce cognitive damage caused by hypertension. We also provide PE recommendations for hypertensive individuals, as well as suggestions for promoting PE as a method for increasing cognitive abilities in the brain, particularly for hypertensive individuals.

Hypertension Assessment Using Photoplethysmography: A Risk Stratification Approach

Hypertension is a common chronic cardiovascular disease (CVD). Early screening and diagnosis of hypertension plays a major role in its prevention and in the control of CVDs. Our study discusses the early screening of hypertension while using the morphological features of photoplethysmography (PPG). Numerous morphological features of PPG and its derivative waves were defined and extracted. Six types of feature selection methods were chosen to screen and evaluate these PPG morphological features. The optimal features were comprehensively analyzed in relation to the physiological processes of the cardiovascular circulatory system. Particularly, the intrinsic relation and physiological significance between the formation process of systolic blood pressure (SBP) and PPG morphology features were analyzed in depth. A variety of linear and nonlinear classification models were established for the comparison trials. The F1 scores for the normotension versus prehypertension, normotension and prehypertension versus hypertension, and normotension versus hypertension trials were 72.97%, 81.82%, and 92.31%, respectively. In summary, this study established a PPG characteristic analysis model and established the intrinsic relationship between SBP and PPG characteristics. Finally, the risk stratification of hypertension at different stages was examined and compared based on the optimal feature subset.

Combination therapy in the treatment of hypertension

Hypertension is a major preventable risk factor for atherosclerosis and ischemic heart disease. Although modern and effective antihypertensive drugs are available, most patients remain with a suboptimal blood pressure control. Most hypertensive patients will need a combination of antihypertensive agents to achieve the therapeutic goals – recent guidelines recommend initiating treatment with two drugs in those patients with a systolic blood pressure >20 mmHg and/or a diastolic blood pressure >10 mmHg above the goals, and in those patients with high cardiovascular risk. In addition, approximately 25% of patients will require three antihypertensive agents to achieve the therapeutic targets. In this review, we analyse the latest information available regarding the treatment of hypertension with combination therapy.