Background/Objectives: India has an estimated 220 million people with hypertension; however, more than 90% are undiagnosed, untreated, or treated but remain uncontrolled. This study evaluated whether comprehensive pharmacist-led intervention improves hypertension outcomes. Methods: Patients evaluated by a physician for hypertension had blood pressure measured at the outpatient pharmacy. Individuals found to be hypertensive (or reporting consistently higher readings than measured on the visit day) were randomized to a non-intervention or intervention group using a computer-generated block randomization (block size 6). At the pharmacy, the non-intervention group received usual "Medical Shop" service (dispensing with basic dosing instructions). The intervention group received education on hypertension and complications, adherence counseling, and lifestyle modification guidance to support blood pressure control. Results: Blood pressure control improved progressively in the intervention group after each counseling session. By the fifth visit in Phase 1, 44 patients (48.8%) in the intervention group were normotensive versus 0 (0%) in the non-intervention group. In Phase 2, pharmacist intervention was offered to the Phase 1 non-intervention group; after 6 months, 72.2% were normotensive, 28.8% were pre-hypertensive, and 0% remained hypertensive. Conclusions: Comprehensive pharmacist intervention substantially improved hypertension control, demonstrating the potential for pharmacists to meaningfully improve healthcare outcomes in Indian patients.
Background: Hypertension is a leading cause of cardiovascular disease. Despite effective treatments, the burden of hypertension persists. Timely treatment escalation is recommended to achieve blood pressure targets and reduce long-term risks. This study aimed to describe antihypertensive treatment patterns and determine factors associated with timely versus delayed treatment escalation. Methods: This study was a retrospective, observational secondary data analysis using administrative claims from the Inovalon MORE2 Registry® of Closed Claims and 100% Medicare Fee-for-Service (FFS) databases from 1/1/2019 to 11/30/2022 (Medicare FFS), or 2/28/2024 (MORE2). Eligible patients had ≥ 1 primary inpatient or ≥ 2 outpatient claims with a diagnosis of hypertension (first observed diagnosis = index date), were ≥ 18 years of age, and had ≥ 12 months of continuous database enrollment prior to and ≥ 30 days following the index date. Treatment pattern measures included prescriber specialty, use of combination therapy, antihypertensive class, and timely treatment escalation, defined as escalation to a subsequent line of therapy (LoT) within 3 months. Cardiovascular-Kidney-Metabolic stages were also measured. Logistic regression models were used to evaluate predictors of timely versus delayed treatment escalation to a subsequent LoT, and odds ratios (OR) and 95% confidence intervals (CI) were reported. Results: The sample (N=19,060,253) were majority female (56.0%) with mean (SD) age of 66.8 (15.3). Antihypertensive medications were predominantly prescribed by primary care providers (71.6%-67.7%) across all LoTs. Use of fixed-dose combinations was low and decreased in subsequent LoTs (14.4% to 9.4%). Of patients with a second LoT, 39.4% and 60.6% LoT experienced timely and delayed treatment escalation, respectively. Real-world predictors of timely escalation within 3 months included primary aldosteronism (OR=1.68, 95% CI 1.62-1.76), cardiovascular disease (OR=1.44, 95% CI 1.44-1.45), age ≥65 years (OR=1.33 95% CI 1.33-1.34), and chronic kidney disease (OR=1.27, 95% CI 1.26-1.27). Predictors of delayed escalation included receipt of angiotensin-converting enzyme inhibitors (OR=0.46, 95% CI 0.46-0.46) or angiotensin receptor blockers (OR=0.56, 95% CI 0.56-0.56). Conclusions: Many patients experienced treatment escalation more than 3 months after initial therapy, suggesting delayed time to antihypertensive treatment intensification relative to guideline recommendations. Real-world predictors of timely treatment escalation of antihypertensives included primary aldosteronism, cardiovascular disease, chronic kidney disease, and older age. These findings highlight potential gaps in the management of hypertension and opportunities to improve alignment between clinical practice and hypertension treatment guidelines.
Background: Policosanol has beneficial effects on the lipid profile and the vascular system. Meta-analyses of previous clinical trials concluded that policosanol can reduce blood pressure. This post-hoc analysis evaluated the effects of policosanol on the lipid profile and blood pressure in Cuban patients with prehypertension and stage I hypertension Methods: A multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted. Patients with pre-hypertension or grade I hypertension were randomized to receive policosanol 20 mg/day or placebo for 12 weeks. The primary efficacy endpoint was lipid profile progression. Changes in blood pressure were predetermined as secondary efficacy endpoints. Physical and blood safety indicators, as well as adverse events (AE), were monitored. Statistical analysis was performed using the intention-to-treat method. Results: Four hundred patients: 296 women, 104 men (mean age 46.3 years), with pre-hypertension or grade I hypertension were eligible for randomization. Groups were homogeneous at baseline. At study completion, Policosanol significantly lowered low-density lipoprotein-cholesterol (LDL-C), total cholesterol and increased high-density lipoprotein-cholesterol (HDL-C) in these patients. Policosanol significantly reduced blood pressure vs baseline and placebo. Policosanol was safe and well tolerated, not significantly changing any safety indicator. Twelve patients reported AE, all transient, with similar frequency in both groups. Conclusions: Policosanol (20 mg/day) for twelve weeks produced beneficial changes on the lipid profile and was effective for lowering blood pressure to Cuban patients with pre-hypertension and grade I hypertension, being safe and well tolerated.
Preeclampsia (PE) remains a leading cause of maternal and neonatal morbidity and mortality globally. Among several experimental models developed to interrogate the pathogenesis of PE, the mouse model employing systemic infusion or transgenic overexpression of soluble fms-like tyrosine kinase-1 (sFlt1) has gained widespread use due to its capacity to induce cardinal features of the human disease. These include maternal hypertension, renal injury, endothelial dysfunction, placental abnormalities, fetal growth restriction, and adverse long-term outcomes. This review critically evaluates the sFlt1-based mouse model of PE, highlighting its utility for understanding the pathogenesis of angiogenic imbalance and its sequelae. We contrast findings from this model with clinical observations in human PE and discuss applications for studying early-onset versus late-onset forms. Finally, we address limitations and propose strategies to enhance its translational relevance. Placing the model in the context of human disease helps guide its use in future preclinical and translational research.
Hypertension is an emerging health concern in Cameroon that is expected to cause a heavy health burden in the future. Prevention and management with non-pharmacological interventions are feasible and effective. This article highlights the benefits, and challenges of implementing non-pharmacological interventions in Cameroon and proposes strategies to improve the situation.
Bilateral renal artery stenosis (RAS) causing recurrent hypertensive emergency and pulmonary oedema is difficult to manage. Use of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) is usually contraindicated. We present a systematic review of literature and a case vignette which highlights the useful properties of this mineralocorticoid receptor antagonists (MRAs) in this scenario.
Elderly stroke outpatients, without aphasia, hemiplegia, or spatial neglect in their post-acute phase, are typically monitored on a quarterly, physician-visit schedule. Thus, the patient's status goes unreported between visits unless a remarkable untoward event occurs.
Background:We tried to understand whether or not there is a long term effect of smoking on the body weight. Method:Consecutive daily smokers at least with a history of one pack-year and age and sex-matched non-smokers were studied. Results:The study included 247 smokers (173 males) and 167 non-smokers (112 males).The mean age of smokers was 46.2 years, and 70.0% of them were males.Plasma triglycerides (163.1 versus 151.3 mg/dL, p < 0.05), low density lipoproteins (LDL) (123.8 versus 117.5 mg/dL, p < 0.05), erythrocyte sedimentation rate (ESR) (10.6 versus 9.3 mm/h, p < 0.05), and C-reactive protein (CRP) (2.3 versus 2.0 mg/L, p < 0.05) were higher in the smokers.Whereas high density lipoproteins (HDL) (40.9 versus 44.0 mg/dL, p < 0.05) and fasting plasma glucose (FPG) (102.3 versus 111.6 mg/dL, p = 0.007) values and prevalence of diabetes mellitus (8.9% versus 14.3%, p < 0.05) were lower in the smokers.Interestingly, the body weight (76.1 versus 74.7 kg) and body mass index (BMI) (26.6 versus 26.5 kg/ m 2 ) were higher in the smokers, nonsignificantly (p > 0.05 for both).Smokers had a mean history of 20.5 ± 15.0 (1-100) pack years. Conclusion:Smoking may cause a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies all over the body.Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG negative acute phase reactants indicating such inflammatory effects in the body.Probably due to the low-grade nature of inflammation caused by smoking, the body weight and BMI were not suppressed in the smokers in long term.
Hypertension (HTN) is a systemic disease characterized by the force of pressure within the arterial vessels. HTN is a modifiable risk factor for multiple health outcomes, including cardiovascular disease and stroke, which have substantial impact on an individual's quality of life and the healthcare system as a whole.
To evaluate the initial implementation effectiveness of an ambulatory blood pressure monitoring (ABPM) protocol based on provider perception through survey and assesses its fidelity, adoption, and impact in an academic outpatient clinic.
Uncontrolled BP is a major health problem both in developed and developing countries. Life style, behavioral or genetic factors are some of the risk factors for uncontrolled BP. There are many researches have done on the risk factors for hypertension.
The international society of hypertension, like other societies, defines isolated systolic hypertension (ISAH) as a brachial arterial pressure value greater than 140 mmHg of systolic values and less than 90 mmHg of diastolic values .
Daily consumption of coffee, either regular or espresso, or other caffeinated beverages before a reading results in elevated blood pressure. Caffeine is widely distributed throughout the body and it is water and fat soluble
Background: Little is known about the potency of isometric exercise for blood pressure control among hypertensive stroke survivors (HSS). Meanwhile, the isometric exercise regimen stands to be a preferable intervention for at-risk subjects even at acute phases as it could be carried out at a resting position compared to aerobic and resistance exercise regimens. Objective: This study investigated the acute effect of isometric exercise training protocol on blood pressure of hypertensive stroke survivors in the University of Benin Teaching Hospital, Benin city. Methods: This study adopted the experimental research design. The sample size of 12-hypertensive stroke survivors from the neurology outpatient clinic of the University of Benin Teaching Hospital was randomly selected from amongst the hypertensive stroke survivors who met the inclusion criteria. The participants were further randomly allotted to the experimental and control groups. The instruments employed include several measuring and timing equipment. The trial proceeded for four weeks during which a combination of unilateral isometric handgrip and unilateral isometric quadriceps exercise training was administered on the experimental group in two sessions per week. Results: Findings revealed there was no significant difference in the effect of isometric exercise training on systolic blood pressure but there was a significant difference in diastolic blood pressure parameters taken from both the right and left sides of the brachial arteries. Conclusion: The acute responses of this study support the clinical significance of isometric exercise training as a time-efficient, valuable new therapeutic adjunct, and effective training modality to reduce blood pressure and thereby assist in regulating and preventing a recurrent stroke in hypertensive stroke survivors. To confirm this, an expanded study in terms of duration was suggested to investigate the adaptation of this study.
Hypertension has been on high prevalence recently in developing countries of which Ghana is of no exception. Over the period, hypertension education has mostly been geared towards people who already have been diagnosed of the condition leaving most of the general population in the dark. This untargeted portion of the population tend to predispose themselves to the condition as they ignorantly involved themselves in high-risk activities.
Diabetes mellitus is a silent killer and one of the leading causes of death globally. Its complications include damage to the brain, heart, kidney and the limbs. More than 50% of people living with the disease are oblivious to it especially in Nigeria where poor healthcare, unhealthy diet, sedentary lifestyle and poverty persist. Unfortunately, Civil Service workers in Osogbo,
Background: Intradialytic hypotension (IDH) is the most common complication during hemodialysis procedure. Midodrine, an oral α-1 adrenergic agonist, is commonly used to prevent IDH. However, limited data is available to demonstrate midodrine effectiveness in prevention of IDH in high-risk hemodialysis patients. Objective: To describe the clinical outcomes of using midodrine in patients receiving hemodialysis concerning the incidence of IDH. Also, we aimed to explore the appropriate dose for midodrine use to prevent IDH. Methodology A retrospective cohort of adult with end-stage-renal failure. Exposure: Midodrine. Outcomes measure: IDH was defined as a decline in systolic blood pressure (SBP) by ≥20 mmHg or a decline in main arterial pressure (MAP) by ≥10 mmHg during hemodialysis session. Recurrent IDH was defined as three or more episodes of IDH throughout a year of starting midodrine. Analysis: A descriptive analysis of the frequency of IDH and recurrent IDH. We also, compared the risk of recurrent IDH across various doses of midodrine use. Result: From a total of 68-screened patients’ charts, 45 patients were included in the final analysis. 41.8% (n=28) of the study population had an IDH that required additional interventions to restore the SBP and MAP. IDH occurred in 68% (n=19, P=0.03) of patients with hypoalbuminemia. Recurrent IDH occurred in 36% (n=16) of the patients over their hemodialysis procedure. Incidence of treatment failure (57%, p= 0.02) and recurrent IDH (36%, p=0.04) were statistically significant in patients who received midodrine three time per week (57%) in comparison to those who received more than three days per week Conclusion: This exploratory study shows that a considerable proportion of patients receiving midodrine did not develop IDH or recurrent IDH. A long-term follow-up study with larger number of patients in comparison to the control group would be useful to evaluate the magnitude of efficacy of midodrine in hemodialysis patients with high risk for IDH. Moreover, a future prospective trial that focus on an important clinical outcomes such as cardiovascular events and mortality with midodrin is warranted.
Recent guidelines have suggested combination therapy as initial treatment in hypertensive patients with ≥ grade 2 hypertension, aiming to achieve target blood pressure (BP) goal faster and more effectively. Both calcium channel blockers (CCBs) and angiotensin converting enzyme inhibitors (ACEIs) are in the list of first-line antihypertensives, however the choice of the combination therapy is left to the discretion of the clinician, and there are concerns that ACEIs are less effective in BP reduction among black hypertensives.
Introduction: It has been demonstrated that the noninvasive evaluation of aortic blood pressure has a prognostic value but limited by the inaccuracy linked to technical errors and a differences in the pressure wave analysis. Aims: The aim of this study was to compare two methods used to validate the non-invasively central blood pressure waveforms obtained with an oscillometic device, with those recorded by intra-arterial measurements at the aortic level. Methods: In this study were included 20 subjects, 10 males (68 ± 12-years-old, BMI: 27.4 ± 4.6 Kg/m2) and 10 females (77 ± 8-years-old, BMI: 28.5 ± 5.3 Kg/m2). The analysed cohort was composed of patients with diagnosis of coronary artery disease. Invasive and non-invasive data used in this research were previously analysed using a widely reported methodology and published by our group. The invasive aortic pressure recording was synchronically acquired with an oscillometric brachial acquisition and, then a reconstruction of central pressure wave was performed. In this research a correlation analysis using the entire aortic pressure cycle was performed. Results: Coefficient values found of the whole population, using the entire aortic pressure cycle, were similar to those obtained using the mean value of the cBP cardiac cycle (0.88 versus 0.89; respectively). On the contrary, the slope of the regression line determined by invasive versus noninvasive cBP loops (n = 20) using the entire cBP cycle exhibit a remarkable decrease with respect to that obtained using the mean aortic pressure cycle (0.98 versus 0.77). Conclusions: In a first step, applying an interpolation procedure by means of oversampling and digital low pass filter, we found a high correlation between invasive and noninvasive instantaneous aortic pressure waveforms in: Men, women and the whole population, In a second step, results in terms of correlation coefficient and the slope derived from the regression analysis of invasive and non-invasive using a new data analysis allow to confirm high correlation coefficients and a more realistic slope value of the invasive versus non-invasive pressure wave relationship.
