High Blood Pressure 2016: Why Prevention and Control Are Urgent and Important. The World Hypertension League, International Society of Hypertension, World Stroke Organization, International Diabetes Foundation, International Council of Cardiovascular Prevention and Rehabilitation, International Society of Nephrology

Comparing outcomes of clonidine and captopril in patients with hypertensive urgency: A randomized clinical trial

BACKGROUND

Hypertension (HTN) is the second leading risk factor for death and disability. One fourth of healthcare in Eastern Europe and Central Asia is being spent on blood pressure (BP)-related diseases. An important situation in patients with high BP is hypertensive crisis (BP > 180/120 mmHg), which is divided to hypertensive emergency and urgency. Therefore, here, we decided to compare the effect of captopril and clonidine in patients with hypertensive urgencies, and their side effects.

METHODS

This was a parallel-group randomized clinical trial. Patients, who referred to emergency ward with any symptoms of hypertensive crisis, underwent a careful history taking and clinical examination. Individuals with systolic BP (SBP) ≥ 180 mmHg or diastolic BP (DBP) ≥ 110 mmHg with no evidence of end organ damage were randomly assigned into two interventions, clonidine and captopril. 25% decrease in BP was considered as ideal relief.

RESULTS

Regarding the duration of response to treatment drugs, patients who received clonidine relieved significantly faster than those who received captopril (P = 0.016). Moreover, the frequencies of side effects such as headache, dizziness/vertigo, dry mouth, and drowsiness in the clonidine group were significantly lower than captopril group (P < 0.05).

CONCLUSION

Patients in clonidine group relieved sooner and experienced fewer side effects. Therefore, this study suggests clonidine as a more effective therapeutic for hypertensive urgency compared with captopril.

Adherence to antihypertensive medications among adult hypertensive patients attending chronic follow-up units of Dessie Referral Hospital, Northeastern Ethiopia: A cross-sectional study

Hypertension is the leading cause of increased morbidity and mortality rates worldwide. Despite adherence to therapies is the important determinant of treatment success to reduce apparent resistant hypertension, maintaining good adherence to antihypertensive medications remained the most serious challenge. Thus, this study aimed to assess adherence to antihypertensive medications among adult hypertensive patients in Dessie Referral Hospital.A cross-sectional study design was conducted among hypertensive patients during May and June 2020. The study participants were selected using a systematic random sampling technique. The collected data were entered into EpiData version 4.4 and exported to SPSS version 25.0 software for data cleaning and analysis. Data were analyzed using bivariable and multivariable logistic regression at a 95% confidence interval (CI). A variable that has a P-value < .05 was declared as statistically significant. Hosmer-Lemeshow test was used to test goodness-of-fit and multicollinearity was tested.The overall good adherence to antihypertensive medications was 51.9%; 95% CI: (46.8-58.3%) and poor adherence was 48.1%. Factors associated with good adherence were: sex-female adjusted odd ratio (AOR) = 1.31; 95% CI (1.06-2.52), occupational status-employed AOR = 2.24; 95% CI (1.33-3.72), good knowledge of the disease AOR = 2.20; 95% CI (1.34-3.72) and good self-efficacy AOR = 1.38; 95% CI (1.20-2.13).This study revealed that almost half of the hypertensive patients in Dessie Referral Hospital had good antihypertensive medication adherence. Sex, occupational status, knowledge, and self-efficacy were factors associated with good adherence. Therefore, health education should be given to patients on the importance of complying with medication and patients should be monitored by health extension workers.

May Measurement Month 2019: an analysis of blood pressure screening results from Argentina

The Argentinean Society of Hypertension, in agreement with the May Measurement Month (MMM) initiative of the International Society of Hypertension, implemented for the third consecutive year a hypertension screening campaign. A volunteer cross-sectional survey was carried out in public spaces and health centres during the month of May 2019 across 33 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg based on the mean of the second and third BP measurements, or in those on treatment for high BP. A total of 94 523 individuals (53.9 ± 17.8 years old, 55 231women and 39 292 men), were evaluated. The age and sex standardized mean BP was 124.7/77.2 mmHg. Among participants, 34.7% were overweight (25-29.9 m/kg²) and 28.7% had obesity (≥30 m/kg²). Individuals identified as being overweight had BP 3/2 mmHg higher and individuals with obesity 6/4 mmHg higher than those with normal weight. The prevalence of hypertension was 52.5%. Although 81.1% were aware and 77.7% were on antihypertensive treatment, only 46.0% of all individuals with hypertension had their BP controlled. Moreover, 19.8% of those not on any antihypertensive medication were found with raised BP. The low level of control of hypertension generates the critical need for the development of community-based prevention strategies reinforcing strategies to increase the awareness and control of hypertension.

[São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020]

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.

[São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020]

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.

Estimation of salt intake assessed by 24-h urinary sodium level among adults speaking different dialects from the Chaoshan region of southern China

OBJECTIVE

Dietary salt intake may vary depending on different lifestyles. We aimed to estimate the different salt intakes and evaluate the knowledge and self-awareness about salt among people speaking the Teochew, Teochew-Hakka and Hakka dialects in the Chaoshan region of southern China.

DESIGN

The study followed a cluster sampling of residents in Chaoshan region. General characteristics, lifestyles, health status as well as knowledge and self-awareness related to salt intake were investigated using a questionnaire. Anthropometric variables as well as Na and K excretion in a 24-h urine collection were measured.

SETTING

Chaoshan region of China.

PARTICIPANTS

Four hundred fifteen adults who spoke only one of these three dialects.

RESULTS

The salt intake of adults who spoke the Teochew, Teochew-Hakka and Hakka dialects was 7·19 (interquartile range (IQR) 5·29-10·17), 9·03 (IQR 6·62-11·54) and 10·12 (IQR 7·61-12·82) g/d, respectively, with significant differences between Teochew and Teochew-Hakka speakers and between Teochew and Hakka speakers (both P < 0·05). The Na:K ratio for adults who spoke the three dialects was 3·00 (IQR 2·00-4·11), 3·50 (IQR 2·64-4·82) and 4·52 (IQR 3·35-5·97), respectively, and differed significantly among the groups (all P < 0·05). Multiple linear regression analysis showed increased Na:K ratio associated with hypertension (β = 0·71, P = 0·043) in Hakka speakers. Knowledge and self-awareness about salt intake were poor in this population.

CONCLUSIONS

Salt intake was closely related to lifestyles and was higher than the upper limit (5 g/d) recommended by the WHO in adults of Chaoshan, especially those speaking the Hakka dialect.

Effectiveness of a Multidisciplinary Approach Intervention to Improve Blood Pressure Control Among Elderly Hypertensive Patients in Rural Thailand: A Quasi-Experimental Study

Purpose

Uncontrolled blood pressure among Thai elderly hypertensive patients is a significant public health issue in primary health care facilities under the Universal Health Coverage Scheme in Thailand. This study examines the effectiveness of a multidisciplinary approach intervention to improve blood pressure control among elderly persons in rural Thailand.

Patients and Methods

This was quasi-experimental study conducted on 200 elderly persons who receive care for hypertension at primary health care facility in rural areas of Thailand. Participants were assigned to either the intervention or control groups. The intervention group was subjected to a multidisciplinary approach intervention program. This program included community-based care for hypertension, family-supportive care for hypertension, antihypertension medication adherence education program, the use of a reminder electronic pill box, and monthly pill counts and blood pressure measurements. The intervention continued for three months. The control group received care for hypertension at the hypertension clinic of the health center. Three measurements were taken at baseline, one month, and three months after the intervention. Data analysis included descriptive statistics and independent sample t-tests. Repeated-measure analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare the differences between the two groups.

Results

At one month and three months after the intervention, the multidisciplinary approach intervention controlled blood pressure more effectively compared with the control group. Furthermore, the intervention group had lower systolic and diastolic blood pressure compared with the control group (P-value < 0.001).

Conclusion

These results suggest that the multidisciplinary approach intervention can be effective in controlling blood pressure in elderly hypertensive patients. Future studies should investigate a cost-effective means of integrating multidisciplinary approach interventions in routine hypertension care for elderly hypertensive patients.

The relationship between Life Style and mental health among medical students in Kermanshah

INTRODUCTION

Given the close relationship between life style and mental health and the importance of students as valuable human resources, the present study aimed at determining the relationship between life style and mental health among medical students in Kermanshah.

METHODS

This is a descriptive-correlational study that was conducted in 2018. The study involved 200 medical students. The sampling method was convenience sampling. Demographic questionnaire, general health questionnaire, and life style questionnaire were used for data collection. The data were analyzed Pearson's correlation test and regression analysis. The significance level was considered 0.05.

RESULTS

The mean mental health score of the students was 25.43 ± 13.02 (2 points higher than the cutoff point of this test). The life style of 59.5 students was moderate. The results showed that all life style subscales had a negative significant relationship with the total mental health score and all its subscales (P < 0.05). Among the life style subscales, the highest relationship and predictive power to mental health were obtained for psychological health, social health, sport and fitness, and environmental health (R ² = 0.48, P < 0.001).

CONCLUSION

According to the results, the life style of most medical students in the final year of Kermanshah University of Medical Sciences was moderate. Further, the students had a better life style, and they had higher mental health. Therefore, considering the vital role of medical students in providing and promoting community health, the need for more detailed planning and interventions to improve their life style and mental health is essential.

Development and Psychometric Evaluation of the Elderly Hypertension Self-Care Index

PURPOSE

This study was done to develop and evaluate the psychometric properties of the Elderly Hypertension Self-Care Index.

METHODS

This was an exploratory mixed method study. Items were developed through conducting a qualitative study with conventional content analysis approach and comprehensively reviewing the existing literature. Then, the developed index was assessed for face, content, and construct validity as well as reliability.

RESULTS

Analyses identified four themes of self-care: intelligent acceptance, self-actualization in the pass of the disease, effective supporters, and destructive constraints. Exploratory factor analysis revealed that only 28 items were appropriate which were loaded on six factors, accounting for 45.035% of the total variance of hypertension self-care. Cronbach's alpha and test-retest intraclass correlation coefficients of the index were 0.80 and 0.96, respectively.

CONCLUSION

The Elderly Hypertension Self-Care Index showed that it is a valid and reliable index in the elderly health context; and can be used for self-care assessment among elderly people with hypertension.

Hypertension control in Argentina, in the middle of a long road

In Argentina, cardiovascular diseases are the leading cause of death and represent 1/3 of total mortality. In 2017, hypertension prevalence for inhabitants ≥18 years old was 36.3%, and its level of knowledge and control (<140/90 mm Hg) were 61% and 24%, respectively. Furthermore, 56% of people treated with antihypertensive drugs do not reach therapeutic goal. In addition to this, prevalence of other risk factors, such as sedentary lifestyle, overweight-obesity, high blood glucose/diabetes, and high cholesterol, has worsened in the last 5 years. The governmental initiative "Less Salt More Life" intends to reduce salt consumption in the entire population and promoted a National Law, which establishes the progressive salt reduction in processed foods. This initiative is probably related to the reduction of salt use after cooking or sitting at the table, observed in the Risk Factors National Survey. Furthermore, previously published studies showed, in relatively small samples from Argentina, that populational blood pressure can be decreased and hypertension control can be improved using community-based or multicomponent intervention programs. However, no specific designed national effort for hypertension control is now officially applied. In consequence, we believe that, in order to increase hypertension control, the effort should not focus on developing new strategies, but on quickly implementing and maintaining those local multicomponent interventions that have already proven to be effective.

Genome-Wide Meta-Analysis of Blood Pressure Response to β1-Blockers: Results From ICAPS (International Consortium of Antihypertensive Pharmacogenomics Studies)

BackgroundThere exists a wide interindividual variability in blood pressure (BP) response to β1-blockers. To identify the genetic determinants of this variability, we performed a pharmacogenomic genome-wide meta-analysis of genetic variants influencing β1-blocker BP response.Methods and ResultsGenome-wide association analysis for systolic BP and diastolic BP response to β1-blockers from 5 randomized clinical trials consisting of 1254 patients with hypertension of European ancestry were combined in meta-analysis and single nucleotide polymorphisms (SNPs) with P<10-4 were tested for replication in 2 independent randomized clinical trials of β1-blocker-treated patients of European ancestry (n=1552). Regions harboring the replicated SNPs were validated in a β1-blocker-treated black cohort from 2 randomized clinical trials (n=315). A missense SNP rs28404156 in BST1 was associated with systolic BP response to β1-blockers in the discovery meta-analysis (P=9.33×10-5, β=-3.21 mm Hg) and replicated at Bonferroni significance (P=1.85×10-4, β=-4.86 mm Hg) in the replication meta-analysis with combined meta-analysis approaching genome-wide significance (P=2.18×10-7). This SNP in BST1 is in linkage disequilibrium with several SNPs with putative regulatory functions in nearby genes, including CD38, FBXL5, and FGFBP1, all of which have been implicated in BP regulation. SNPs in this genetic region were also associated with BP response in the black cohort.ConclusionsData from randomized clinical trials of 8 European ancestry and 2 black cohorts support the assumption that BST1 containing locus on chromosome 4 is associated with β1-blocker BP response. Given the previous associations of this region with BP, this is a strong candidate region for future functional studies and potential use in precision medicine approaches for BP management and risk prediction.

Hypertension knowledge, attitudes, and practices of nurses and physicians in primary care in Ulaanbaatar Mongolia

Increased blood pressure is a leading risk for death globally, and interventions to enhance hypertension control have become a high priority. An important aspect of clinical interventions is understanding the knowledge, attitudes, and practices (KAP) of differing primary healthcare practitioners. We examined KAP surveys from 803 primary care practitioners in Ulaanbaatar, Mongolia (response rate 80%), using a comprehensive KAP survey developed by the World Hypertension League (WHL). The WHL KAP survey uniquely includes an assessment of key World Health Organization recommended interventions to enhance hypertension control. There were few substantive differences between healthcare professional disciplines. Primary care practitioners mostly had a positive attitude toward hypertension management. However, confidence and practice in performing specific tasks to control hypertension were suboptimal. A low proportion indicated they systematically screened adults for hypertension and many were not aware of the need to or were confident in prescribing more than two antihypertensive medications. It was the practice of a high proportion of doctors to not pharmacologically treat most people with hypertension who were at high cardiovascular risk. There was a reluctance by physicians to task share hypertension diagnosis, drug prescribing and assessing cardiovascular risk to nurses. The minority of health care professions use a hypertension management algorithm, and few have patient registries with performance reporting functions. There were few substantive differences based on the age, gender, and years of clinical practice of the practitioners. The study findings support the need for standardized education and training of primary care practitioners in Ulaanbaatar to enhance hypertension control.

Home blood pressure control status in 2017-2018 for hypertension specialist centers in Asia: Results of the Asia BP@Home study

A self-measured home blood pressure (BP)-guided strategy is an effective practical approach to hypertension management. The Asia BP@Home study is the first designed to investigate current home BP control status in different Asian countries/regions using standardized home BP measurements taken with the same validated home BP monitoring device with data memory. We enrolled 1443 medicated hypertensive patients from 15 Asian specialist centers in 11 countries/regions between April 2017 and March 2018. BP was relatively well controlled in 68.2% of patients using a morning home systolic BP (SBP) cutoff of <135 mm Hg, and in 55.1% of patients using a clinic SBP cutoff of <140 mm Hg. When cutoff values were changed to the 2017 AHA/ACC threshold (SBP <130 mm Hg), 53.6% of patients were well controlled for morning home SBP. Using clinic 140 mm Hg and morning home 135 mm Hg SBP thresholds, the proportion of patients with well-controlled hypertension (46%) was higher than for uncontrolled sustained (22%), white-coat (23%), and masked uncontrolled (9%) hypertension, with significant country/regional differences. Home BP variability in Asian countries was high, and varied by country/region. In conclusion, the Asia BP@Home study demonstrated that home BP is relatively well controlled at hypertension specialist centers in Asia. However, almost half of patients remain uncontrolled for morning BP according to new guidelines, with significant country/regional differences. Strict home BP control should be beneficial in Asian populations. The findings of this study are important to facilitate development of health policies focused on reducing cardiovascular complications in Asia.

Monitoring and evaluation framework for hypertension programs. A collaboration between the Pan American Health Organization and World Hypertension League

The Pan American Health Organization (PAHO)-World Hypertension League (WHL) Hypertension Monitoring and Evaluation Framework is summarized. Standardized indicators are provided for monitoring and evaluating national or subnational hypertension control programs. Five core indicators from the World Health Organization hearts initiative and a single PAHO-WHL core indicator are recommended to be used in all hypertension control programs. In addition, hypertension control programs are encouraged to select from 14 optional qualitative and 33 quantitative indicators to facilitate progress towards enhanced hypertension control. The intention is for hypertension programs to select quantitative indicators based on the current surveillance mechanisms that are available and what is feasible and to use the framework process indicators as a guide to program management. Programs may wish to increase or refine the number of indicators they use over time. With adaption the indicators can also be implemented at a community or clinic level. The standardized indicators are being pilot tested in Cuba, Colombia, Chile, and Barbados.

DNA Methylation Analysis Identifies Loci for Blood Pressure Regulation

Genome-wide association studies have identified hundreds of genetic variants associated with blood pressure (BP), but sequence variation accounts for a small fraction of the phenotypic variance. Epigenetic changes may alter the expression of genes involved in BP regulation and explain part of the missing heritability. We therefore conducted a two-stage meta-analysis of the cross-sectional associations of systolic and diastolic BP with blood-derived genome-wide DNA methylation measured on the Infinium HumanMethylation450 BeadChip in 17,010 individuals of European, African American, and Hispanic ancestry. Of 31 discovery-stage cytosine-phosphate-guanine (CpG) dinucleotides, 13 replicated after Bonferroni correction (discovery: N = 9,828, p < 1.0 × 10-7; replication: N = 7,182, p < 1.6 × 10-3). The replicated methylation sites are heritable (h2 > 30%) and independent of known BP genetic variants, explaining an additional 1.4% and 2.0% of the interindividual variation in systolic and diastolic BP, respectively. Bidirectional Mendelian randomization among up to 4,513 individuals of European ancestry from 4 cohorts suggested that methylation at cg08035323 (TAF1B-YWHAQ) influences BP, while BP influences methylation at cg00533891 (ZMIZ1), cg00574958 (CPT1A), and cg02711608 (SLC1A5). Gene expression analyses further identified six genes (TSPAN2, SLC7A11, UNC93B1, CPT1A, PTMS, and LPCAT3) with evidence of triangular associations between methylation, gene expression, and BP. Additional integrative Mendelian randomization analyses of gene expression and DNA methylation suggested that the expression of TSPAN2 is a putative mediator of association between DNA methylation at cg23999170 and BP. These findings suggest that heritable DNA methylation plays a role in regulating BP independently of previously known genetic variants.

Experts Provide a Glimpse of the New Post-SPRINT Era of Hypertension

In advance of the new guidelines being published this year, the author discusses treatment targets, diagnostics, and public policy with three hypertension experts.