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Background: The purpose of our study was a comparative assessment of the antihypertensive effectiveness of 2 triple combination antihypertensive therapy (AHT) regimens in a free-dose and fixed-dose combination of perindopril, indapamide, and amlodipine in hypertensive patients with high cardiovascular risk and a poor response to the 2-drug combinations in the clinic practice. Methods and Results: Our study included 143 patients (79 men and 88 women) with arterial hypertension (AH) Grades 1-3 (ESC/ESH, 2018) and high cardiovascular risk who did not achieve the target blood pressure (TBP) on dual combination AHT. The mean age of patients was 55.76±9.35 years; the average duration of AH was 10.69±6.61 years. All patients underwent the examinations according to the 2018 ESC/ESH Guidelines for the management of arterial hypertension. Patients included in the study were divided into 2 groups using the envelope method: Group 1 (n=84) received a fixed-dose, triple combination of perindopril, indapamide, and amlodipine; Group 2 (n=83) received a free-dose combination of these drugs. In both groups, treatment began after discontinuation of previous therapy, with a low dose of a triple combination of antihypertensive drugs (perindopril [5 mg/day], indapamide [1.25 mg/day], amlodipine [5 mg/day]) in the form of a fixed or free combination. The initial doses of perindopril/indapamide/amlodipine in both groups were not statistically different: 6.9±2.4/1.74±0.6/7.1±2.4mg/day in Group 1 and 6.9±2.7/1.95±0.6/7.1±2.5 mg/day in Group 2. After 4 weeks of therapy, if necessary, the doses of drugs were increased, starting with perindopril; the next adjustment of drug doses was carried out after 12 weeks of therapy. The final treatment results were determined after 24 weeks of AHT. Target blood pressure (TBP) of

Abstract Background Hypertension may cause target organ damage (TOD). Target blood pressure (BP) management may not be appropriate in some conditions. Aim We aim to assess the impact of targeted BP management in severe hypertension on renal TOD. Patients & methods This is a prospective cohort study involving patients admitted due to severe hypertension (BP > 180/120) associated with any symptoms. The study involved patients referred to the ICU in our tertiary center during the period between August 2017 and February 2018. All patients underwent target BP treatment according to recent guidelines. Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured in all patients on admission and 24 h later. Patients were divided into Group A (with initial normal hs-TNT) and Group B (with initial high hs-TNT). The main outcome was in-hospital renal-related morbidity (including renal failure). Results Four hundred seventy consecutive patients with hypertensive crises were involved in the study. Group B had a significantly higher incidence of in-hospital mortality (4 patients) and renal TOD (acute renal dysfunction) than Group A (P value = 0.001 and 0.000 respectively). There was a significant difference between initial s.creat on admission and follow-up s.creat values in Group B with significant elevation of their s.creat on the following 24 h (P = 0.002), while this difference is insignificant in Group A (P = 0.34). There was a significant positive correlation between hs-TNT and the follow-up s.creat (P = 0.004). Conclusion In severe HTN, hs-TNT may be elevated due to marked afterload. Patients with severe HTN and high hs-TNT have higher s.creat values, which are associated with an increased risk of renal failure and in-hospital mortality if their BP decreases acutely to the guideline-target BP. Using biomarkers during the management of emergency HTN should be considered before following clinical guidelines. However, our findings do underscore the potential utility of hs-TNT as an indicator for risk stratification in patients with severe or emergency HTN.

Background: Hypertension may cause target organ damage (TOD). Target blood pressure (BP) management may not be appropriate in some conditions. Aim: We aim to assess the impact of targeted BP management in severe hypertension on renal TOD. Patients & methods: This is a prospective cohort study involving patients admitted due to severe hypertension (BP > 180/120) associated with any symptoms. The study involved patients referred to the ICU in our tertiary center during the period between August 2017 and February 2018. All patients underwent target BP treatment according to recent guidelines. Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured in all patients on admission and 24 h later. Patients were divided into Group A (with initial normal hs-TNT) and Group B (with initial high hs-TNT). The main outcome was in-hospital renal-related morbidity (including renal failure). Results: Four hundred seventy consecutive patients with hypertensive crises were involved in the study. Group B had a significantly higher incidence of in-hospital mortality (4 patients) and renal TOD (acute renal dysfunction) than Group A (P value = 0.001 and 0.000 respectively). There was a significant difference between initial s.creat on admission and follow-up s.creat values in Group B with significant elevation of their s.creat on the following 24 h (P = 0.002), while this difference is insignificant in Group A (P = 0.34). There was a significant positive correlation between hs-TNT and the follow-up s.creat (P = 0.004). Conclusion: In severe HTN, hs-TNT may be elevated due to marked afterload. Patients with severe HTN and high hs-TNT have higher s.creat values, which are associated with an increased risk of renal failure and in-hospital mortality if their BP decreases acutely to the guideline-target BP. Using biomarkers during the management of emergency HTN should be considered before following clinical guidelines. However, our findings do underscore the potential utility of hs-TNT as an indicator for risk stratification in patients with severe or emergency HTN. Key points: Question: What is the relationship between troponin in emergency hypertension and the in-hospital outcome of the application of guidelines-targeted blood pressure control? Findings: In this cohort study that included 470 adults, patients with emergency hypertension with positive troponin had worse in-hospital outcomes with increased incidence of renal dysfunction if they were treated to guidelines target blood pressure. Meaning: In emergency hypertension, the management of patients should be individualized according to the results of biomarkers. [ABSTRACT FROM AUTHOR]

Background: Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost. Purpose: To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population. Materials and Methods: In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out. Results: Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations. Conclusion: This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population.

Background: Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost. Purpose: To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population. Materials and Methods: In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out. Results: Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations. Conclusion: This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population. [ABSTRACT FROM AUTHOR]

Abstract Background Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941 . It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.

Aims: To evaluate the efficacy of different pharmacologic treatment for severe hypertension during pregnancy.Methods: Two reviewers searched Ovid MEDLINE, Ovid EMbase, and the Cochrane Library for randomized clinical trials from the establishment of the database to 15 July 2021 that were eligible for inclusion and analyzed the pharmaceuticals used for severe hypertension in pregnancy.Results: 29 relevant trials with 2,521 participants were involved. Compared with diazoxide in rate of achieving target blood pressure, other pharmaceuticals, including epoprostenol (RR:1.58, 95%CI:1.01–2.47), hydralazine\dihydralazine (RR:1.57, 95%CI:1.07–2.31), ketanserin (RR:1.67, 95%CI:1.09–2.55), labetalol (RR:1.54, 95%CI:1.04–2.28), nifedipine (RR:1.54, 95%CI:1.04–2.29), and urapidil (RR:1.57, 95%CI:1.00–2.47), were statistically significant in the rate of achieving target blood pressure. According to the SUCRA, diazoxide showed the best therapeutic effect, followed by nicardipine, nifedipine, labetalol, and nitroglycerine. The three pharmaceuticals with the worst therapeutic effect were ketanserin, hydralazine, and urapidil. It is worth noting that the high ranking of the top two pharmaceuticals, including diazoxide and nicardipine, comes from extremely low sample sizes. Other outcomes were reported in the main text.Conclusion: This comprehensive network meta-analysis demonstrated that the nifedipine should be recommended as a strategy for blood pressure management in pregnant women with severe hypertension. Moreover, the conventional pharmaceuticals, including labetalol and hydralazine, showed limited efficacy. However, it was important to note that the instability of hydralazine reducing blood pressure and the high benefit of labetalol with high dosages intakes should also be of concern to clinicians.

Background Although numerous studies have demonstrated a strong association between blood pressure (BP) and hemorrhagic complications of antithrombotic therapy, there is still a paucity of information regarding the status of BP control in hypertensive patients on antithrombotic therapy. Methods This cross-sectional, retrospective study was conducted at an outpatient clinic to examine BP control and its associated factors in hypertensive patients receiving or not receiving antithrombotic therapy. Results Of 26,803 outpatients who had scheduled visits in 2018, 7,800 hypertensive patients met the inclusion criteria, of whom 1,727 cases were on oral antithrombotic drugs. Then, target BP values were defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019. While BP values

Abstract Guidelines on the management of hypertension have been developed by various professional bodies and institutions to primarily address the issues of diagnosis, treatment, and control in order to rationalize and improve the management of hypertension. Hypertension guidelines across the world have recently been updated following the new and controversial lower blood pressure threshold of ≥130/80 mmHg for the diagnosis of hypertension adopted by the Americans. While there are differences between the major as well as between the Asian national guidelines, there were also many similarities. This paper discusses and highlights the differences and similarities between the major international guidelines of the American College of Cardiology/American Heart Association, of the European Society of Cardiology/European Society of Hypertension, and of the International Society of Hypertension and also compares them with the Asian guidelines.

Abstract Background Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. Methods Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. Results Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of

Blood pressure (BP) control status was investigated using data of a health checkup held in a Japanese city. In fiscal year 2017, 54,287 persons (age, 40–74 years; males, 49%) underwent the checkup; 28,167 examinees had a systolic BP ≥140 mmHg, a diastolic BP ≥90 mmHg, or took antihypertensive agents. Of these subjects, 20,153 subjects took antihypertensive agents. A BP

Arterial hypertension (AH) is a very significant and most common risk factor for stroke, and lowering blood pressure (BP) is the most effective action to prevent stroke in patients with AH. This article provides an overview of existing randomized clinical trials (RCTs) and meta-analyzes to study the optimal target BP levels in patients with AH and cerebral events with a history of focusing on the geriatric population. As a result of the analysis of literature data, we obtained contradictory results: RCTs showed the benefits of lower target BP, in only two of them the target level of systolic BP (SBP) was less than 130 mm Hg, and the average age of patients included in the RCTs varied from 60 to 68 years, the number of patients older than 75 years was insignificant, and some studies excluded patients older than 85 years. Several subanalyses analyzed by RCTs found a J-shaped relationship between BP levels achieved and the risk of adverse cardiovascular events. One of them showed that with a decrease in BP below the SBP 120 mm Hg and DBP 65 mm Hg higher BP was associated with a lower risk of cardiovascular events. Another one showed that the risk of re-stroke and the risk of subsequent adverse events was statistically significantly higher in patients with an average level of SBP below 120 mm Hg than in patients with a level of SBP of 130139 mm Hg. The meta-analysis published in the Cochrane database did not show significant advantages of lowering BP130/85 mm Hg versus standard lowering BP140160/90100 mm Hg, while another meta-analysis revealed some advantages of a more intense decrease in BP for the prevention of re-stroke. Existing studies did not take into account the heterogeneity of the geriatric population and did not include patients with fraility and multimorbidity patients, and did not take into account the type of stroke to develop a differentiated approach to the tactics of lowering BP in patients of all age groups. Therefore, in relation to the recommended ESC/ESH experts in 2018, target BP levels of 120129/7079 mm Hg (aged 1865 years) and 130139/7079 mmHg (aged 65 years) for patients with AH and a history of cerebral events, there are still some doubts about the benefits of lower target BP values for the prevention of re-stroke and other cardiovascular events for the entire population of geriatric patients, especially patients older than 75, so specially designed randomized controlled trials are needed.

Background: Today, medical technology and healthcare advances have led to an increased life expectancy; however, the prevalence of chronic diseases such as hypertension, diabetes mellitus, stroke, and cardiovascular events is continuously rising. In particular, hypertension is a crucial factor in cardiovascular and cerebrovascular diseases, and it is known that prevention and management are essential. Objectives: This study investigates the prevalence and management of hypertension in Korean adults and evaluates its correlation with the risk of cardiovascular disease (CVD) and stroke. Method: The Korean National Health and Nutritional Examination Survey (KNHANES) database was utilized for this study (https://knhanes.cdc.go.kr). The subjects of this survey were sampled to represent the entire population of Korea. The study aims to assess the risk of CVD and stroke according to the duration of hypertension. We also examined the impact of hypertension control on the risk of CVD and stroke. This study is a retrospective cross-sectional study, so future risks cannot be assessed, but only the disease status at the same time point. Results: A total of 61,379 subjects were enrolled in the KNHANES database, representing Korea’s population of 49,068,178 subjects. The prevalence of hypertension was 25.7% (9,965,618 subjects) of the total population. The prevalence of hypertension increased rapidly with the age of the population. As the duration of hypertension increased, the risks of CVD and stroke also increased. When hypertension lasts longer than 20 years, ischemic heart disease, myocardial infarction, and stroke prevalence were 14.6%, 5.0%, and 12.2%, respectively. However, achieving a target blood pressure (BP) goal below 140/90 mmHg reduced the risk of all CVD and stroke by nearly half. Nevertheless, fewer than two-thirds of patients in Korea with hypertension achieved this targeted blood pressure goal. Conclusions: Our study confirmed that the prevalence of hypertension in Korean adults was higher than a quarter but also showed that the risk of CVD and stroke was significantly reduced by achieving optimal blood pressure control. Based on these results, policy efforts are needed to reach the target BP and improve the treatment rates for hypertension in Korea.

Background: Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods: Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results: Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions: Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital. [ABSTRACT FROM AUTHOR]

Background and Aim: The target blood pressure (BP) in CKD patients on hemodialysis (HD) remains a dilemma. We aimed to study the BP value most representative of the presence or absence/control of hypertension in CKD patients on HD, and how well could ambulatory BP monitoring (ABPM) predict the presence of hypertension. Materials and Methods: A total of 39 patients with CKD on twice-weekly HD were included in the study. BP was recorded with the help of the sphygmomanometer installed in the HD machine at regular intervals, and the same was compared with ABPM continuously for 72 h during the interdialytic period. Bland–Altman analysis and receiver operating characteristic curve were analyzed. Results: The difference between the mean predialysis systolic blood pressure (SBP) and mean ambulatory SBP was 9.09 mmHg (95% confidence interval [CI], -22.92 to + 41.099 mmHg); however, the difference of 4.86 mmHg (95% CI, -17.886 to + 27.606 mmHg) between the mean diastolic ABPM reading and the mean predialysis diastolic BP did not achieve significance. Conclusion: The data suggest that predialysis office SBP invariably overestimates BP and should not be targeted as a BP goal, as it could lead to intradialytic hypotension. For any given SBP, the postdialysis value is more specific in diagnosing hypertension, thereby reflecting a more significant cardiovascular load. To our knowledge this is the first study to use ABPM continuously during the interdialytic period for 72 h.

Intracranial hemorrhage and stroke are primary causes of maternal mortality in pregnancies affected by hypertensive disorders. As such antihypertensive therapy plays a crucial role in the management of severe hypertension. However, the target level to achieve the best outcome for both – mother and fetus – is still unclear. Moreover, given the lack of well-designed randomized controlled trials with standardized key outcomes, the current choice of antihypertensive medications depends rather on clinicians’ preference. Furthermore, data on long-term outcomes of offspring is not available. Therefore, there is an urgent need for randomized trials comparing different anti-hypertensive options to address efficacy and safety questions.

Aim. To study the clinical outcomes (achievement of target blood pressure [BP]) and tolerability of antihypertensive and hypolipidemic therapy with fixed combinations of indapamide/perindopril, amlodipine/perindopril, amlodipine/indapamide/perindopril and rosuvastatin in patients with hypertension and high/very high cardiovascular risk in real clinical practice.Material and methods. The study included 16,788 patients from 104 cities of the Russian Federation. The duration of observation was 12 weeks. All patients had three monitoring visits. BP level was measured twice during the visits: the arithmetic mean of the obtained parameters was calculated. The results of the study were analyzed and presented by descriptive statistics.Results. The average age of the patients was 60.6±10.2 years; 42.2% of the patients were men and 57.8% women. Patients who demonstrated systolicdiastolic hypertension (BP>140/90 mm Hg) at the initial visit accounted for 73.9% (n=12,413) of the total number of participants. The average level of systolic BP at the inclusion into the study was 162.94±13.07 mm Hg, the level of diastolic BP was 93.43±8.61 mm Hg. As expected, the Russian population consists of over 90% of patients with very high (57%; n=9,586) and high (35.9%; n=6,022) additional cardiovascular risk. Despite the fact that the overwhelming majority of patients with hypertension had a high and very high additional risk, more than a third of patients received monotherapy to control their BP level (36.8%; n=6,182), while 13.8% of patients (n=2,321) had never received antihypertensive therapy before. According to the results of therapy with combination drugs based on perindopril, 92.7% of patients managed to reach the target BP levels of

Arterial hypertension (AH) is an important public health problem worldwide. The high prevalence of hypertension can partially be explained by an increase in blood pressure (BP) with age and a rapid increase in the elderly population (over 65 years old). Despite the effect of age on BP, evidence of target blood pressure values for its control in patients of older age groups with AH is limited, especially if they have frailty. There are data from a number of studies that reveal a relationship between lower BP levels and all-cause mortality in patients with AH in older age groups. In clinical practice, decisions regarding BP targets are especially difficult in elderly people with frailty who often do not meet the criteria for inclusion in randomized controlled trials and for this group of elderly people the clinical recommendations of leading communities do not give a specific answer about the target BP level. The evidence base regarding the target BP values in the treatment of AH in patients of older age groups with frailty presented in this review is not numerous, but its analysis suggests the advantages of higher BP numbers, with maximum systolic BP values of 165 mm Hg and diastolic BP of 90 mm Hg, while lower BP levels may be unsafe in terms of increasing the risk of adverse cardiovascular events and mortality from both cardiovascular causes and all causes. Polymorbidity in combination with polypharmacy and an increased risk of adverse events require a patient-oriented individual approach to the appointment of antihypertensive therapy. For a final decision on the management tactics of patients with AH and frailty, large, specially designed randomized clinical trials are needed.

Aim. To study the pharmacoepidemiological features of the prescription of antihypertensive fixed dose combinations and their efficacy in hypertensive patients in the real outpatient practice in Vladivostok city.Material and methods. Hypertensive patients aged 1 8 years and older (n=268) observed in Vladivostok polyclinics from October to December 2017 were included into the study. All patients did not have target blood pressure (BP) levels. The analysis of the medical prescriptions of antihypertensive fixed dose combinations in Vladivostok polyclinics was performed. Two-component (perindopril + amlodipine) or three-component (perindopril + amlodipine + indapamide) fixed dose combinations were prescribed by physician in accordance with instructions for medical use and their pharmacological characteristics. The study was non-interventional and included 3 visits for the initial examination, prescription and correction of therapy, considering its efficacy. All patients were determined for glomerular filtration rate using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Formula), changes in BP. Patients performed self-esteem on a 1 0-point visual analogue scale (VAS).Results. Only 23.4% of patients reached target BP levels in the first month of observation, and 84.5% of patients after 3 months of observation. 30 (1 1.2%) patients had replacement with double antihypertensive fixed dose to triple combination combinations during the study. 68.6% of patients did not have a replacement for the initial prescribed antihypertensive fixed dose combinations due to the achievement of target BP. The number of patients with moderately and markedly reduced glomerular filtration rate was reduced significantly. Initially, the patients included into the study assessed health (according to adapted VAS) for 5.6±1.4 points, and after 3 months of follow-up - for 7.9±1.7 points.Conclusion. The use of antihypertensive fixed dose combinations containing ACE inhibitor (perindopril), calcium channel blocker (amlodipine) and thiazide-like diuretic (indapamide) resulted in achievement of target BP levels in 84.5% of patients after 3 months of follow-up. Also, the use of double and triple fixed dose combinations had a nephroprotective effect, manifested in an increase in the number of patients ( + 19.3%) with a glomerular filtration rate more than 60 ml/min/1,73м2 and a positive effect on the patient's well-being.

Background: Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. Methods: Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. Results: Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130–139/80–89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130–139/80–89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130–139/80–89 mmHg and BP 120–129/70–79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130–139/80–89 mmHg at all ages. Conclusions: In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130–139/80–89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130–139/80–89 mmHg at the age of ≥ 70. [ABSTRACT FROM AUTHOR]

Objectives: We retrospectively assessed both blood pressure response to management in a specialist Hypertension Clinic and the predictors of response. Design: Retrospective data audit. Setting: Hypertension Clinic at Guy's and St Thomas' Hospitals, London, UK. Participants: One hundred and twenty-two sequential patients attending the clinic between January 2017 and October 2018. Patients were excluded if they had previously been seen in the clinic, failed to attend their initial appointment or did not return after their initial appointment. Outcome measure: Change in blood pressure readings between first and last recorded appointments. Results: Systolic blood pressure decreased from 149 ± 20 mmHg to 140 ± 17 mmHg, and diastolic blood pressure from 92 ± 13 to 86 ± 1 mmHg, between the first and last recorded appointments (P < 0.05 for each). Those patients who reached target blood pressure were significantly younger than those who did not (age 45 ± 14 versus 52 ± 17 years, P = 0.0171); however, the degree of blood pressure reduction was independent of age, and younger subjects had a baseline blood pressure significantly lower than older subjects. Sex, body mass index and lifestyle interventions had an important effect on blood pressure reduction; however, these were not associated with attainment of target blood pressure. Conclusion: Specialist hypertension input is effective in helping patients to achieve target blood pressure, especially so in younger as compared to older hypertensive patients, but this appears to be related to the fact that blood pressure in younger patients is already closer to target at baseline. Blood pressure reduction is greater in women, those with higher body mass index and those who receive lifestyle interventions. [ABSTRACT FROM AUTHOR]

It is widely accepted that hypertension constitutes a significant cardiovascular risk factor and that treating high blood pressure (BP) effectively reduces cardiovascular risk. An important issue in Asia is not just the high prevalence of hypertension, particularly in some countries, but also the low level of awareness and treatment rates in many regions. The 2017 update of the American College of Cardiology/American Heart Association hypertension guidelines raised the question about which BP threshold should be used to diagnose and treat hypertension. Although there is a theoretical rationale for a stricter BP criterion in Asia given the ethnic-specific features of hypertension in the region, the majority of countries in Asia have retained a diagnostic BP threshold of ≥140/90 mm Hg. Although lowering thresholds might make theoretical sense, this would increase the prevalence of hypertension and also markedly reduce BP control rates. In addition, there are currently no data from robust randomized clinical trials of the benefits of the lower targets in preventing cardiovascular disease and reducing cardiovascular risk, particularly in high-risk patients and especially for Asian populations. There is also no defined home BP treatment target level for an office BP treatment target of 130/80 mm Hg. However, in this regard, in the interim, lifestyle modifications, including reducing body weight and salt intake, should form an important part of hypertension management strategies in Asia, while studies on treating at lower BP threshold level in Asians and getting to lower BP targets will be helpful to inform and optimize the management of hypertension in the region. [ABSTRACT FROM AUTHOR]

Background: Blood pressure (BP) control is the most-established method for the prevention of chronic kidney disease (CKD) progression. However, the ideal BP target for CKD patients is still under debate. Methods: We performed a survey of regular registered members of the Korean Society of Nephrology to determine physician perceptions of BP control in patients with CKD. In addition, we evaluated the target BP achievement rate using data from the APrODiTe-2 study. Results: Two-thirds of physicians considered the target BP for CKD to be < 130/85 mmHg. The systolic BP (SBP) thresholds for diabetic CKD, proteinuria ≥ 300 mg/day, 30 ≤ glomerular filtration rate (GFR) < 60 mL/min/1.73 m², age < 60 years, and the presence of atherosclerotic (ASO) complications were significantly lower than the SBP thresholds of the opposite parameters. The three major hurdles to controlling BP were non-compliance with lifestyle modification and medications, and self-report of well-controlled home BP. Most physicians prescribed home and ambulatory BP monitoring to less than 50% of their patients. The target BP achievement rates using the SBP thresholds in this survey were as follows: non-diabetic (69.3%); diabetic (29.5%); proteinuria < 300 mg/day (72.3%); proteinuria > 300 mg/day (33.7%); GFR ≥ 60 (76.4%); GFR < 30 (47.8%); no evidence of ASO (67.8%); and the presence of ASO (42.9%). Conclusion: The target BP was lower in patients with higher cerebro-cardiovascular risks. These patient groups also showed lower target BP achievement rates. We also found a relatively lower application and clinical reflection rate of home or ambulatory BP monitoring.

Aim. To compare the dynamics of intrarenal vascular resistance (IRVR), circadian blood pressure (BP) profile and glomerular filtration rate (GFR) in patients with arterial hypertension (HT) and type 2 diabetes mellitus (DM) who achieved the target BP levels (

A bidirectional relationship between hypertension and kidney disease, with one exacerbating the effect of the other, is well established. Elevated blood pressure (BP) is a well-recognized, modifiable risk factor for cardiovascular (CV) disease as well as for development and progression of chronic kidney disease and, therefore, the identification of optimal BP target is a key issue in the management of renal patients. Recent large trials and real life cohort studies have indicated that below a definite BP value renal protection seems to plateau and too low levels may even be associated with a paradoxical increase in renal morbidity, thus reviving the debate about the so called BP -renal function J-curve relationship. Existing evidence supports a systolic target around 130 mm Hg to combine both renal and CV protection and possibly lower levels in the presence of overt proteinuria. [ABSTRACT FROM AUTHOR]

In SPRINT (Systolic Blood Pressure Intervention Trial), use of the Omron 907XL blood pressure (BP) monitor set at 5 minutes of antecedent rest to record BP produced an automated office BP value 7/6 mm Hg lower than awake ambulatory BP at 27 months. The authors studied the impact on automated office BP of setting the Omron 907XL to 0 minutes instead of 5 minutes of rest in patients with readings in the lower normal BP range, similar to on-treatment BP in the SPRINT intensive therapy group. Patients (n = 100) in cardiac rehabilitation were randomized to three BP readings at 1-minute intervals using an Omron 907XL BP device set for 5 or 0 minutes of antecedent rest. Mean (±standard deviation) automated office BP (mm Hg) after 5 minutes of rest (120.2 ± 14.6/66.9 ± 8.6 mm Hg) was lower (P < .001/P < .01) than without rest (124.2 ± 16.4/67.9 ± 9.1 mm Hg). When target BP is in the lower normal range, automated office BP recorded without antecedent rest using an Omron 907XL device should be higher and closer to the awake ambulatory BP, compared with readings taken after 5 minutes of rest. [ABSTRACT FROM AUTHOR]

Purpose: comparative evaluation of parameters of quality of life of patients with hypertension complicated by the development of stroke and their dynamics hypotensive therapy.Materials and methods: 49 patients divided into two groups. Study group comprised 24 patients (8 women and 16 men) suffering from hypertension complicated by cerebral stroke. The comparison group included 25 patients (13 women and 12 men) with hypertension duration of 10,8 ± 1,6 years. To assess the quality of life used SF-36 questionnaire. Levels of anxiety and depression were assessed by scales Spielberg - Hanin and Beck. Types of attitude towards the disease diagnosed using methods TOBOL.Results: the study of emotional status before treatment showed an increase of the level of anxiety, the presence of depression, reduced quality of life in all respects the SF-36.Summary: On a background of antihypertensive therapy with the achievement of target BP levels in both groups were recorded improved quality of life, psycho-emotional state, established highly adaptive form of relationship to the disease.

Background/Aims: This study aimed to evaluate the severity of obesity and its impact on achieving target blood pressure and metabolic derangement in obese individuals. Methods: This cross-sectional and population-based study was conducted between January and December 2012. A total of 1837 consecutive obese patients admitted to our outpatient clinic were enrolled. The anthropometric and blood pressure measurements, bioelectrical impedance fat analysis, blood sample analysis, impaired glucose status, metabolic syndrome, and insulin resistance of 1265 obese patients were compared between groups of patients separated by severity of obesity. Results: Only approximately one-third of patients with previous hypertension achieved normal blood pressure. In addition, the majority of patients without previous hypertension had higher blood pressure at the end of the study compared with baseline. The percent of patients with an impaired fasting blood glucose ≥100 mg/dL was 38.5%. The frequency of impaired glucose tolerance was 39.1% in the patients who underwent OGTT Body mass index (BMI) was associated with impaired blood glucose, hypertension, insulin resistance, and the development of metabolic syndrome. The incidences of metabolic syndrome, insulin resistance, impaired glucose tolerance, and uncontrolled blood pressure were significantly different between groups of differing obesity severity (ppp=0.041, and pConclusion: The severity of obesity was associated with the failure to achieve target blood pressure and metabolic syndrome. Based on our data, blood pressure and metabolic parameters in obese patients should be monitored frequently and treated with caution.

Aim. To compare the effectiveness of three variants of long-term combination antihypertensive therapy (AHT), based on two methods of renin-angiotensinaldosterone system (RAAS) inhibition (angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARAII)) or on calcium channel blockade with a dihydropyridine calcium channel blocker (CCB), all of which were administered in order to achieve target levels of blood pressure (BP). To develop an algorithm for differential administration of combination AHT in patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2). Material and methods. The study included 71 patients (mean age 56,8±6,5 years) with AH and DM-2, but without clinically manifested nephroangopathy. The therapy course (30–32 weeks) was completed by 69 patients. All participants were randomised into three groups. The ACEI+CCB group (n=22) received perindopril (5–10 mg/d), indapamide SR (1,5 mg/d), and amlodipine (5–10 mg). The ARAII+CCB group (n=25) was administered valsartan (80–160 mg/d), indapamide SR, and amlodipine. The CCB+BAB group (n=22) received amlodipine (5–10 mg/d), indapamide SR, and metoprolol succinate (50–100 mg/d). The doses of AHT wereincreased stepwise. At baseline and after 30–32 weeks of the treatment, 24-hour BP monitoring (BPM), renal artery ultrasound and Doppler ultrasound, carbohydrate and lipid metabolism assessment, and 24-hour albumin excretion measurement were performed. Results. Target BP levels were achieved in the majority of patients from all three groups. For the two-component combination AHT, target BP levels were achieved more often with the combination of RAAS inhibitors and indapamide SR, compared to the combination of CCB and indapamide SR. Most patients receiving the latter combination required additional administration of a third medication, in order to achieve adequate BP control. The combination of CCB and BAB increased intrarenal vascular resistance and less effectively controlled night-time systolic AH, compared to the combination of RAAS inhibitors and CCB. The combination of ACEI and CCB, compared to the ARAII+CCB combination, was associated with improved glycemic control, effective reduction of the duration of night-time diastolic AH and night-time heart rate, and normalisation of initially elevated intrarenal vascular resistance at the level of segmental intrarenal arteries. These findings were used for the development of the algorithm for differential administration of combination AHT in patients with AH and DM-2. Conclusion. In DM-2 patients, long-term combination AHR with ACEI and CCB demonstrates more beneficial effects on the metabolic and neurohumoral regulation processes, compared to the combination of ARAII and CCB. These benefits are particularly pronounced in patients with inadequate glycemic control and increased intrarenal vascular resistance. The combination of CCB and BAB inadequately controls night-time systolic AH and does not improve renal hemodynamics.

Aim. (1) To investigate clinical characteristics of primary care patients with arterial hypertension (AH), according to the achievement of target blood pressure (BP) levels; (2) to assess the effectiveness of therapeutic measures aimed at achieving target BP and maintaining its long-term control. Material and methods. This retrospective analysis included the data from ambulatory medical records of 5558 AH patients, who attended primary care centres in 2007. Clinical characteristics were compared in patients with achieved vs. non-achieved target BP levels. According to the national AH guidelines (2004), the completeness of examination, pharmaceutical therapy tactics, and frequency of the follow-up were assessed in both groups. Results. Based on the 2007 data, target BP levels were maintained in 28% of AH patients. Mean BP level was 144/87 mm Hg. Patients with optimal BP levels, compared to their peers with inadequate BP control, had significantly (p

To analyze ambulatory and clinical tactics in target blood pressure (BP) achievement, 60 ambulatory medical cards and 60 hospital medical histories of patients with arterial hypertension (AH) were analyzed. Target BP levels were registered in 60% of ambulatory patients. Despite the fact that 93,3% of the patients needed more aggressive antihypertensive treatment, only in 37%, such an attempt (increasing the dose and/or administering combined therapy) had been done. The mean number of medications had decreased during the control year. Thiazide diuretics (TD) and calcium antagonists (CA) were rarely administered. By the end of the control year, target BP levels were achieved in 15% only. Therapy change frequency in those achieving and not achieving target BP levels varied from 0 to 14 (on average, 3,8), mostly due to “incorrect” prescriptions. Target BP level achievers received ACE inhibitors and TD more often. The main reason for hospitalization was uncontrolled AH (67,5%) due to irregular regimen of pharmaceutical therapy (64,9%). During the hospitalization, target BP levels were achieved in 97,5%, at Day 9 on average. After admission, most patients received combined three-component therapy, including TD and CA. The АВС/VEN-analysis demonstrated low prevalence of effective medication administration and a three-fold increase in the second-choice medication use. The results obtained confirm the potential for target BP level achievement in high and very high-risk AH patients, and demonstrated real-world mistakes in ambulatory management of AH.

Aim. To analyze ambulatory and hospital tactics of target blood pressure (BP) achievement.Material and methods. In total, 60 ambulatory and 40 hospital case histories of AH patients were analyzed.Results. Target BP levels were achieved in 6,7% of ambulatory patients. Even though 93,3% needed more aggressive antihypertensive therapy, only in 37%, some treatment optimization efforts were performed (dose increase and/or combined therapy prescription). Mean number of medications prescribed decreased during the control year. The rates of thiazide diuretics (tD) and calcium antagonists (CA) prescription were inadequately low. By the end of control year, target BP levels were achieved in 15% only. Therapy change rates in achievers and non-achievers varied from 0 to 14 (average one-year rate 3,8). Typically, achievers received АСГ inhibitor and tD combination. Main indication for hospitalization was uncontrolled AH (67,5%), due to irregular medication intake (64,9%). During hospitalization, target BP levels were achieved in 97,5% of the patients. Soon after admission, most hospitalized patients were administered three-agent combination therapy, including tD and АСГ inhibitors.Conclusion. The possibility of achieving target BP in high and very high-risk AH patients was successfully proven. Real-world lapses in ambulatory management of this patient group, leading to inadequate AH control, were identified.

Background/Aims: This study aimed to evaluate the severity of obesity and its impact on achieving target blood pressure and metabolic derangement in obese individuals. Methods: This cross-sectional and population-based study was conducted between January and December 2012. A total of 1837 consecutive obese patients admitted to our outpatient clinic were enrolled. The anthropometric and blood pressure measurements, bioelectrical impedance fat analysis, blood sample analysis, impaired glucose status, metabolic syndrome, and insulin resistance of 1265 obese patients were compared between groups of patients separated by severity of obesity. Results: Only approximately one-third of patients with previous hypertension achieved normal blood pressure. In addition, the majority of patients without previous hypertension had higher blood pressure at the end of the study compared with baseline. The percent of patients with an impaired fasting blood glucose ≥100 mg/dL was 38.5%. The frequency of impaired glucose tolerance was 39.1% in the patients who underwent OGTT Body mass index (BMI) was associated with impaired blood glucose, hypertension, insulin resistance, and the development of metabolic syndrome. The incidences of metabolic syndrome, insulin resistance, impaired glucose tolerance, and uncontrolled blood pressure were significantly different between groups of differing obesity severity (p<0.001, p<0.001, p=0.041, and p<0.001, respectively). Conclusion: The severity of obesity was associated with the failure to achieve target blood pressure and metabolic syndrome. Based on our data, blood pressure and metabolic parameters in obese patients should be monitored frequently and treated with caution. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Increasing awareness, treatment and control rates of hypertensive patients is a worldwide problem especially in Central and East European countries. The objective of the study was to determine the yearly changes in the achievement of treatment targets according to ESC 2003-2007 guidelines for the management of arterial hypertension in a preventive profiled ambulatory cardiology setting. Patients and method: The study included 6591 hypertensive patients examined between 2002-2010 in the Procardia preventive ambulatory in Târgu Mureș, Romania. The sex distribution of the studied patients was 45.64% male average age 57.45 years, and 54.36% female average age 61.28 years. Patients received individually tailored self control education, lifestyle advice and drug treatment - the primary care providers were informed in detailed medical reports. We studied the yearly achievement of target blood pressure levels. We also analysed the frequency of investigations carried out for the global risk assessment screening for subclinical organ damage. We used "MedPrax" integrated patient data management system as an electronic health record. Statistical analysis was performed with the Open Office Calc programme. Results: Target blood pressure values (under 140/90 mmHg in non diabetic patients and 130/80 in diabetic patients) were reached in 27.51%. The percentage of patients treated to target increased progressively from 15.25% to 36.29%. Conclusions: The activity of the studied cardiology ambulatory setting provided a yearly increase in the level of blood pressure target achievement. Further improvement measures are needed to increase blood pressure control rates, with a specific attention to the diabetic patients. [ABSTRACT FROM AUTHOR]