Referrals to, and characteristics of patients attending a specialist hypertension clinic

Semaglutide and blood pressure: an individual patient data meta-analysis

BACKGROUND AND AIMS

Randomized clinical trials (RCTs) assessing semaglutide reported reductions of systolic blood pressure (SBP) in trial populations with baseline blood pressure in the normotensive range. This study aimed to determine whether this SBP reduction is greater in hypertensive groups.

METHODS

Individual patient data (IPD) from three RCTs examining the effect of semaglutide 2.4 mg on body weight over 68 weeks were included. Trial participants were categorized according to a hypertension diagnosis, treatment or baseline measurement (HTN), baseline SBP > 130 mmHg (HTN130) or >140 mmHg (HTN140), and those with apparent resistant hypertension (RH). The primary analysis compared the in-trial change in SBP in the semaglutide and placebo arms. Alterations of anti-hypertensive medications were quantified by treatment intensity score and compared between arms. These analyses were performed using analysis of covariance.

RESULTS

Overall, 3136 participants were included. The difference in SBP change between the treatment (n = 2109) and placebo (n = 1027) groups was -4.95 mmHg [95% confidence interval (CI) -5.86 to -4.05] overall. This difference was -4.78 mmHg (95% CI -5.97 to -3.59) for HTN, -4.93 mmHg (95% CI -6.75 to -3.11) for HTN130, -4.09 mmHg (95% CI -7.12 to -1.06) for HTN140, and -3.16 mmHg (95% CI -8.69-2.37) for RH. Reduction in SBP was mediated substantially by weight loss. The anti-hypertensive treatment intensity score decreased for those on semaglutide compared to placebo (-0.51; 95% CI -0.71 to -0.32).

CONCLUSIONS

This IPD analysis of three large RCTs found blood pressure reductions with semaglutide in participants with hypertension that were similar to those seen in all trial participants. This finding may in part be due to concurrent reductions to anti-hypertensive medications. These results suggest that semaglutide is a useful adjunctive treatment for patients with hypertension and obesity.

The Effect of Semaglutide on Blood Pressure in Patients without Diabetes: A Systematic Review and Meta-Analysis

(1) Background: Recent advances in the pharmacological treatment of obesity with glucagon-like peptide-1 receptor agonists (GLP-1 RA) highlight the potential to target excess body weight to improve blood pressure (BP). This review aimed to determine the BP reduction in trials of semaglutide for weight reduction in patients without diabetes. (2) Methods: Relevant studies were identified via a search of research databases. Studies were screened to include randomized controlled trials (RCTs) of semaglutide versus a placebo in adults. Pooled and sensitivity analyses were performed, and risk of bias was assessed. (3) Results: six RCTs, with 4744 participants, were included in the final analysis. At baseline, the cohorts in these studies had a mean BP in the normotensive range. The mean difference in systolic BP was -4.83 mmHg (95% CI: -5.65 to -4.02), while that for diastolic BP was -2.45 mmHg (95% CI: -3.65 to -1.24). All included studies were of a high methodological quality. (4) Conclusions: A clinically significant reduction in BP was evident following semaglutide treatment in normotensive populations without diabetes. The effect of semaglutide in those with obesity and hypertension is as yet undetermined. Targeting excess body weight may be a novel therapeutic strategy for these patients.

The development and evaluation of a nurse anaesthesia model for practice in South Africa

Objective

This article aimed to present a developed model for nurse anaesthesia practice in South Africa and then to evaluate the model by national and international anaesthetist experts.

Methods

For the model development, a theory-generative research design was used as guided by Chinn & Kramer. The study included four steps to develop and evaluate the model: step one, concept analysis; step two, placing the concepts into relationships; step three, description and critical reflection of the model; step four, evaluation of the model. For evaluation of the model, data were collected using individual, in-depth interviews. Four South African medical specialist anaesthesiologists and four international nurse anaesthetists were interviewed. Transcribed interviews were analyzed using Tesch’s eight steps of thematic data analysis.

Results

The model was described in four phases: relationship phase, working phase, termination phase, and independent phase. The model shows a development process of a student nurse anaesthetist by a nurse anaesthetist facilitator to the mastery of the scope of practice of a nurse anaesthetist. Two themes (six categories) emerged through thematic analysis: the model and guidelines for implementation were found to be appropriate (model and guidelines for implementation are important because of the need for nurse anaesthetist, the model is applicable because it is described as comprehensive, the relationship phase was found to be important and the interdependence between disciplines is imperative, the affirmation that mastery has to be attained by nurse anaesthetists due to the complexity of services rendered), anticipated limitations to the South African nurse anaesthetist (the need to identify complex patients and limitations on the setting and refer to higher level of care, limitations due to red tape).

Conclusions

This model provides fertile soil to inform and outline the education (curriculum) and practice (scope of practice) and research for nurse anaesthesia practice in South Africa.

Clinical characteristics of two groups commonly referred to an Irish hypertension service-patients with resistant hypertension and young adults with hypertension

BACKGROUND

The management of hypertension is primarily performed in primary care settings in many health systems. However, two groups of patients often require specialist input: patients with resistant hypertension (RH) and young adults with hypertension.

AIMS

To elucidate these groups by examining the characteristics of patients attending an Irish hypertension service, thus informing future management of hypertension.

METHODS

Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Following patient consent, patient data were recorded to identify patient characteristics as well as the results of investigations, blood pressure (BP) measurements and the anti-hypertensive treatment of the study participants which were then analysed.

RESULTS

Two hundred thirty-six patients were included in the study. Compared to those without RH, the RH group were more likely to be obese (OR 2.59 [95% CI 1.06 to 6.33]), to have cardiovascular disease (OR 3.07 [95% CI 1.56 to 6.02]) and to have a non-dipping BP pattern (OR 3.86 [95% CI 1.57 to 9.47]). Young adults comprised 27% of the cohort. Forty-seven percent of these patients were obese, 15.9% had hypertension in pregnancy and 22.2% had chronic headaches. Despite being prescribed less anti-hypertensives (1.41 vs 2.28; p < 0.05), the majority of young patients had a BP less than 140/90 mmHg, comparing favourably with older patients (OR 2.25 [95% CI 1.20 to 4.27]).

CONCLUSION

This contemporary study highlights the high prevalence of obesity among RH patients and young adults with hypertension. Findings suggest that programs to combat hypertension must include interventions to address obesity.