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We aimed to identify and validate factors related to uncontrolled hypertension. Participants treated with at least one antihypertensive drug from the prospective contemporaneous CoLaus|PsyCoLaus study were enrolled. We investigated the association between hypertension status (uncontrolled, defined as systolic blood pressure [SBP] ≥ 140 mm Hg and/or diastolic blood pressure [DBP] ≥ 90 mm Hg, versus controlled hypertension [SBP/DBP < 140/90 mm Hg]) and potential risk factors. Additionally, the prospective association of uncontrolled hypertension with cardiovascular disease and all-cause mortality was evaluated. 1040 participants recruited between 2003 and 2006 with a mean follow-up of 12.3 years (SD ± 3.4) were included in the analyses. Heavy alcohol consumption, increased BMI, increased ferritin and albuminuria were positively associated with uncontrolled hypertension. Factors inversely associated with uncontrolled hypertension were university degree, current smoker, and high potassium urinary excretion. Uncontrolled hypertension status was not associated with incident ASCVD nor all-cause mortality in our study. In conclusion, uncontrolled hypertension was associated with modifiable factors, such as heavy drinking, obesity and level of education. Further studies should investigate whether including biological markers in clinical practice, such as potassium excretion, ferritin levels, or albuminuria, would help identify individuals who may develop uncontrolled hypertension. [ABSTRACT FROM AUTHOR]

Uncontrolled hypertension increases the risk of complications and premature death, which is a significant global public health concern. Self-management is a concept that involves personal strategies to create self-awareness that leads to changes in self-management behavior. This quasi-experimental study compared self-awareness and self-management behaviors for controlling hypertension: restriction of sodium intake, alcohol consumption, smoking cessation, stress reduction, and increased exercise between the mHealth and the Face-to-Face self-management programs. The participants comprised 50 civil servants affiliated with the Secretariat of the House of Representatives, of whom 25 received the mHealth program and 25 received the Face-to-Face program. Group assignments conducted simple random sampling and matched the age, gender, and education level matching. Research tools included the two programs, the Self-Awareness Assessment and the Self-Management Behaviors Assessment instruments. Descriptive statistics, the chi-square test, the t-test, the Wilcoxon signed-rank test, and the Mann-Whitney U test were used to analyze the data. The findings indicate that, after the experiment, the mHealth group showed a statistically significantly higher mean rank of self-awareness and self-management behaviors than the Face-to-Face group. This study supported the mHealth self-management program's effectiveness over the Face-to-Face Program in increasing self-awareness and self-management behaviors at 12 weeks. Nurses can integrate this program to promote health among Thai people who have access to LINE application communication tools to prevent new cases of hypertension and control hypertension. However, further testing in other population groups is required before it can be widely used nationally. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review provides a practical, evidence-based summary of the physiology, major trial data and clinical role of renal denervation in the treatment of hypertension. Recent Findings: The cornerstone of hypertension therapy remains anti-hypertensive medications although this strategy has significant limitations with poor rates of blood pressure control for most patients. Renal denervation was designed to bypass concerns about medication adherence and provide an "always-on" treatment. Recent trial data and meta-analyses are presented demonstrating a modest, although heterogeneous, response to renal denervation which led to the treatment's recent FDA approval. Improvements in catheter design and renal artery treatment strategy may underlie the improved clinical response to denervation in more recent trials. Summary: Hypertension centers involving multi-disciplinary care teams are equipped to provide patients with advanced diagnostic testing for secondary hypertension, comprehensive non-invasive management strategies and invasive renal denervation to address hypertension. Early referral for patients with uncontrolled hypertension can provide patients with nuanced conservative and interventional options which have the potential to improve hypertension related morbidity and mortality. Future studies are needed to identify which patients are most likely to respond to renal denervation. [ABSTRACT FROM AUTHOR]

Abstract Background The coexistence of obesity and hypertension (HTN) is a global health concern due to its association with various health abnormalities. This study targeted the association between uncontrolled HTN—defined according to the JNC8 guidelines— and different obesity patterns (general and abdominal) among adult hypertensive individuals. Methods Data for the present investigation were obtained from the 2021 STEPwise Approach to NCD Risk Factor Surveillance (STEPS) national survey in Iran. Participants were classified based on general obesity (BMI) and different abdominal obesity patterns (waist circumference [WC], waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]). Data were weighted by sex, age, and residence (rural and urban). Multivariate logistic regression models were performed to determine the association between different obesity patterns and uncontrolled HTN, adjusting for confounders including demographic variables, lifestyle factors, and history of metabolic abnormalities. Results A total of 8,692 hypertensive adult subjects ≥ 18 years were recruited from all provinces in Iran. The overall mean age of participants was 55.8 ± 0.15, and 55.6% being women. The prevalence of general obesity among controlled and uncontrolled hypertensive patients was 30.3% and 69.8%, respectively. Regarding abdominal obesity, the prevalence among controlled and uncontrolled hypertensive patients was 29.8% and 70.2% based on WC, 28.4% and 71.6% based on WHR, and 28.8% and 71.2% based on WHtR, respectively. Compared to normal weight, underweight (adjusted odds ratio [AOR] = 0.94, 95% CI: 0.57–1.56), overweight (1.37 [1.16–1.61]), and general obesity (1.47 [1.24–1.75]) were associated to uncontrolled HTN compared to normal weight. Abdominal obesity according to WC (1.30 [1.13–1.51]), WHR (1.31 [1.10–1.53]), and WHtR (1.39 [1.11–1.74]) was also associated with uncontrolled HTN. Conclusion Both general and abdominal obesity are more prevalent and strongly associated with uncontrolled HTN in hypertensive patients. These findings underscore the need for healthcare providers to implement targeted interventions promoting healthy lifestyle changes to mitigate these risk factors and improve HTN management.

Pawitra Jariyasakulwong,1 Doungrut Wattanakitkrileart,1 Kanaungnit Pongthavornkamol,1 Noppawan Piaseu,2 Weranuj Roubsanthisuk3 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Doungrut Wattanakitkrileart, Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand, Email doungrut.wat@mahidol.ac.thIntroduction: Self-care practices are crucial for optimizing blood pressure control and are influenced by multilevel factors.Objective: To examine the influences of multilevel factors on hypertension self-care practices among individuals with uncontrolled hypertension and to determine the relationship between hypertension self-care practices and blood pressure.Methods: The study was conducted in primary, secondary, and tertiary care settings in Bangkok, selected for convenience, where individuals with uncontrolled hypertension were recruited using a convenience sampling method based on specific inclusion criteria. Data were collected using a demographic questionnaire, the Hypertension Knowledge Level Scale, the Newest Vital Sign, the Self-Efficacy to Manage Hypertension Scale, the revised Thai Multidimensional Scale of Perceived Social Support, the Communication Assessment Tool-Nurse, the Neighborhood Scales, and the Hypertensive Self-Care Activity Level Effects. The Cronbach’s alpha coefficients were 0.82, 0.84, 0.81, 0.92, 0.96, 0.73, and 0.72 to 0.96, respectively. Data were analyzed using descriptive statistics, logistic regression, and Pearson’s correlation.Results: A total of 326 participants were included and 80.1% of them had poor hypertension self-care practices. Individuals with moderate social support were 2.23 times more likely to have poor hypertension self-care practices compared to those with high social support (OR = 2.23; 95% CI = 1.11, 4.49; p-value < 0.05). Each unit increase in poorer resources was associated with a 1.05 times higher likelihood of poor hypertension self-care practices (OR = 1.05; 95% CI = 1.02, 1.09; p-value < 0.05). Four out of six domains of hypertension self-care practices—medication adherence, physical activity, smoking status, and alcohol consumption—were significantly associated with diastolic blood pressure (r = − 0.17, p < 0.01; r = − 0.11, p < 0.05; r = 0.23, p < 0.01; and r = 0.15, p < 0.05, respectively).Conclusion: Hypertension self-care practices could be improved through multilevel factors, including social support and neighborhood resources.Keywords: uncontrolled hypertension, self-care, social support, neighborhood resource

Abstract Background Hypertension is a major risk factor for heart disease, heart failure and stroke. Lifestyle changes are recommended as first-line treatment for management of high blood pressure for young adults, when 10-year atherosclerotic cardiovascular disease risk score is

Background: Hypertension is a major risk factor for heart disease, heart failure and stroke. Lifestyle changes are recommended as first-line treatment for management of high blood pressure for young adults, when 10-year atherosclerotic cardiovascular disease risk score is < 10%. If lifestyle changes alone do not control blood pressure, then providers have access to four classes of first-line blood pressure lowering agents to treat hypertension, when other contra-indications are not present. Methods: This is a cross-sectional, retrospective, secondary analysis performed of the MyHEART trial on study participants at enrollment to determine they were prescribed anti-hypertensive medication. Of those prescribed medications, we aimed to determine the frequency first-line medications including thiazide or thiazide-like diuretics, angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers were prescribed. This analysis categorized participants into four medication status categories: no antihypertensive medication, prescribed only first-line antihypertensives, prescribed only non-first-line antihypertensives, and prescribed a combination of first-line and non-first-line antihypertensives. Participant clinical and sociodemographic factors by medication use were evaluated. Linear regression models were fit to determine the association between antihypertensive medication and blood pressure. Results: At enrollment, 157/311 (50.5%) participants were not on antihypertensives. Of the 154 on antihypertensives, reported use included monotherapy 97/154 (63.0%), combined therapy 57/154 (37.0%), only first-line antihypertensive 111/154 (72.0%), and only non-first-line antihypertensives 21/154 (13.6%), and combination of first-line and non-first-line antihypertensives 22/154 (14.2%). Antihypertension medication use varied based on age (p < 0.001), sex (p = 0.008), race (p = 0.001), body mass index (BMI) kg/m2 (p = 0.016), anxiety and/or depression (p = 0.048), diabetes (p = 0.007), and sodium intake (p = 0.042). Participants with only first-line medications had lower in-office systolic (-4.66 mmHg, CI -8.31 to -1.02, p = 0.013) and diastolic (-3.51 mmHg, CI -6.30 to -0.71, p = 0.015), and lower ambulatory diastolic (-2.12 mmHg, CI -4.15 to -0.09, p = 0.041) blood pressure than those without antihypertensives. Conclusions: Among MyHEART study participants, all of which had uncontrolled hypertension, 50.5% were not on an antihypertensive at enrollment. This finding supports the call to improve management of blood pressure earlier in life to potentially contribute to the reduction of long-term cardiovascular disease. Of the participants who were prescribed blood pressure medication, providers prescribed guideline-based antihypertensive therapy the majority of the time, however, this study indicates there may be an opportunity to increase the use of first-line, guideline-based antihypertensives, regardless of age, sex, or type of hypertension to lower long-term cardiovascular risk. Trial registration: https://www.ClinicalTrials.gov Identifier: NCT03158051, registered 5-15-2017. IRB approval obtained: IRB # 2017 − 0372. [ABSTRACT FROM AUTHOR]

Catheter-based renal sympathetic denervation (RDN) reduced blood pressure (BP) in multiple randomized sham-controlled trials of patients with uncontrolled hypertension (HTN). We tested proof-of-concept for a more selective treatment strategy, exclusively targeting these areas to improve the efficiency of the procedure. The SPYRAL DYSTAL Pilot study was designed to mirror the SPYRAL HTN-OFF MED Pivotal study, enabling comparison with a propensity score adjusted active-control group. Patients were antihypertensive medication-free for one month before undergoing BP assessment. Those with office BP of 150–180/>90 mmHg and with an ambulatory systolic BP of 140–170 mmHg were selected to undergo open label treatment, delivering energy only to the distal main renal arteries and first order branches. Patients from DYSTAL were compared with patients who underwent maximized RF RDN treatment in the prior randomized OFF MED trial at 3 months. After 3 months, patients resumed antihypertensive medications as indicated. Safety and efficacy outcomes were assessed post hoc through 12 months. The SPYRAL DYSTAL Pilot study treated 56 HTN patients. Baseline office systolic BP (OSBP) and 24-h ambulatory systolic BP (ASBP) were similar between DYSTAL and OFF MED patient groups. The number of ablations (32.3 ± 8.0 vs 46.6 ± 15.3, p < 0.001), procedure time (67 ± 21 min vs 99 ± 36 min; p < 0.001), and contrast volume (173 ± 77 cc vs 208 ± 96 cc; p = 0.014) were significantly lower with the simplified treatment strategy. OSBP and ASBP changes compared with baseline were −9.0 and −1.4 mmHg at 3 months, −20.3 and −13.9 mmHg at 6 months, and −20.3 and −16.6 mmHg at 12 months, respectively. During the medication up-titration phase, BP reductions among DYSTAL patients were similar to reductions observed in OFF MED through 12 months, with comparable number of drugs (1.4 and 1.5 medications, respectively (P=NS)). Two adverse events related to guidewire placement were reported. In this pilot study, focusing ablation treatment on the distal main and proximal branch renal arteries was performed, resulting in fewer RF lesions, and reduced contrast volume and procedure time. Whether BP reductions are similar between a selective vs. maximized RDN approach requires further prospective study. • Renal denervation reduces blood pressure in patient with uncontrolled hypertension. • We assessed whether a more targeted RDN strategy has similar efficacy. • The more targeted approach significantly improved procedural efficiency. • Further studies are needed to fully evaluate the efficacy of the targeted approach. [ABSTRACT FROM AUTHOR]

Summary: Objective: The aim of this study was to determine factors including biochemical markers, dietary habits, and social-anthropometric associated with uncontrolled hypertension among elderly hypertension in rural regions of Vietnam. Methods: This study included 272 hypertension patients aged over 60 years. Demographic data, anthropometric measurements, and risk factors associated with hypertension were from the cross-sectional study of 272 customers at the Medical Examination Department, Samson General Hospital, Thanh Hoa Province, Vietnam. Biochemical markers including total cholesterol, triglycerides, and fasting blood glucose were measured. Dietary habits were by using a frequency questionnaire. Uncontrolled hypertension was defined as systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg in a patient taking anti-hypertensive medication.Generalized multiple linear regression was used to assess the impact of related factors on blood pressure, which were used as the dependent variables. Logistic regression analysis was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of related factors for hypertension status. Results: The study found that men had more uncontrolled hypertension than women among the elderly population. The prevalences of hyperglycemia, hypertriglyceridemia, and hypercholesterolemia were high in both controlled and uncontrolled groups. There was an inverse association between fruits (p=0.021) and vegetable consumption (p=0.038) and a positive correlation between salty habits (p=0.040) and processed food (p

Abstract Background Hypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings. Aim The present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients. Methods A cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension. Results Among 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18–44 (2.05 [1.90–2.21]), Hispanic/Latino ethnicity (1.13 [1.03–1.23]), Medicaid (1.43 [1.29-1.58]) or self-pay (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41–6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08–1.34]), male (1.24 [1.17–1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62]) or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]). Conclusion The results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.

Objectives: Chronic mesenteric ischemia (CMI) typically presents with postprandial pain, food aversion, and weight loss. This case report describes an atypical presentation of CMI with intolerance to anti-hypertensive drugs. Methods: A 54-year-old woman presented with uncontrolled hypertension, bilateral renal artery stenosis, and intolerance to antihypertensive medications. Angiography revealed occlusion of all three mesenteric arteries, compensated by collateral circulation from internal the iliac arteries. Elevated blood pressure was crucial for maintaining intestinal blood flow via collaterals. Results: A right iliac to IMA bypass successfully improved intestinal perfusion, resolving medication intolerance and successfully lowering the patient's blood pressure. Conclusions: This case highlights an exceptional presentation of occlusive mesenteric disease and underscores the importance of individualized approaches in complex mesenteric ischemia cases.

Background: Hypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings. Aim: The present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients. Methods: A cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension. Results: Among 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18–44 (2.05 [1.90–2.21]), Hispanic/Latino ethnicity (1.13 [1.03–1.23]), Medicaid (1.43 [1.29-1.58]) or self-pay (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41–6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08–1.34]), male (1.24 [1.17–1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62]) or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]). Conclusion: The results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is the commonest comorbidity among people with type 2 diabetes mellitus (T2DM). Uncontrolled HTN is a major risk factor for several diseases. This study aimed to determine the magnitude and predictors of uncontrolled HTN among T2DM patients. Methods: A multicenter cross-sectional study was conducted among hypertensive from September 19, 2021 to 17 December 2021. Logistic regression model was conducted to identify predictors of uncontrolled HTN. Uncontrolled BP was defined by systolic BP of ≥130 mmHg and/or diastolic BP of ≥80 mmHg. Results: A total of 400 study participants were included in the analysis, of which 208 (52 %) were females. The mean age of the participants was 60.6 with SD of 10.25 years. The target blood pressure achieved in 156 (39 %) of participants. Age, non-adherence to medications (OR; 2.0; 95 % CI: 1.1–3.6; P = 0.02), not reducing dietary salt (OR; 2.4; 95 % CI: 1.5–3.8; P

Introduction: This study described the different stages of uncontrolled hypertension, and assessed independently of the socio-demographic parameters, the non-modifiable and modifiable factors associated with uncontrolled hypertension at ambulatory care, in urban and peri-urban primary health care centres (PHCCs) of Bobo–Dioulasso, Burkina Faso. Methods: A sample of 380 hypertensive adults were consecutively interviewed from January to February 2022, in 20 public PHCCs, in Bobo-Dioulasso. Sociodemographic, non- and modifiable lifestyle, anthropometric and blood pressure parameters were collected. Descriptive, comparative and logistic regression tests were performed. Results: The participants’ mean age was 56.2 ± 10.4 years and frequency of uncontrolled hypertension stage I, II and III was respectively 40.3 %, 23.3 % and 7.9 %. Those with family history of hypertension was 42.4 %. Participants with monotherapy, bi-therapy and tri-therapy represented 51.6 %, 42.6 % and 2.1 % respectively, while 38.2 % declared to be uncompliant with the therapy. About 36 % were current alcohol users, 29.7 % physically inactive, 23.7 % ate less than three servings of fruits and vegetables (FV), 15.3 % were obese, and 12.9 % current tobacco users. In logistic regression analysis, the presence of family history of hypertension [adjusted odds ratio (aOR) = 2.1; p = 0.005], use of bi-/tri-therapy (aOR = 1.7; p = 0.044), daily intake of less than three FV servings (aOR = 1.9; p = 0.025); non-adherence with therapy (aOR = 3.3, p = 0.0001) and obesity (aOR = 4.5; p = 0.003) were associated with uncontrolled hypertension. Conclusion: Uncontrolled hypertension was high at ambulatory primary care. For its efficient management in secondary prevention, a tailored in-hospital strategy including permanent education for a healthier lifestyle practice is needed; and should be complementary strengthened with specific community-based interventions.

Abstract Background There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. Methods 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). Results Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547–2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237–1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. Conclusions Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis.

Background: There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. Methods: 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). Results: Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547–2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237–1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. Conclusions: Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis. [ABSTRACT FROM AUTHOR]

Background We aimed to assess factors associated with uncontrolled blood pressure (BP) among individuals with hypertension on treatment, by sex. Methods We conducted a nested cross-sectional analysis using data from the population-based cohort study CONSTANCES, designed as a randomly selected sample of French adults aged 18–69 years at study inception. We included 11 760 participants previously diagnosed with hypertension and taking antihypertensive medications. Uncontrolled BP was defined as mean systolic BP ≥140 mmHg and/or mean diastolic BP ≥90 mmHg. Sex-specific age-adjusted multivariable analyses were performed using logistic regression models stratified by stages of uncontrolled hypertension. Results The mean age of participants was 59.4 years. The prevalence of uncontrolled BP was 51.4%, and it was higher in men than in women [adjusted odds ratio (aOR), 1.80; 95% CI, 1.67–1.94]. In both sexes, the lower the age, the lower the prevalence of uncontrolled hypertension. Low level of education and history of cardiovascular events had, respectively, higher and lower odds of uncontrolled BP. In men, additional risk factors included overweight and obesity (aOR, 1.15; 95% CI, 1.00–1.32; and aOR, 1.45; 95% CI, 1.23–1.70, respectively), lack of physical activity (aOR, 1.20; 95% CI, 1.04–1.40), low adherence to a Dietary Approach to Stop Hypertension diet (aOR, 1.21; 95% CI, 1.05–1.40) and heavy alcohol consumption (aOR, 1.33; 95% CI, 1.08–1.63), with the last two factors persisting across different stages of uncontrolled BP. Conclusions From a population-based perspective, socio-economic and behavioural characteristics were risk factors for uncontrolled hypertension, but they differed by sex and by stage of uncontrolled hypertension. Modifiable risk factors, such as weight, diet, physical activity and alcohol consumption, have an important role in the control of hypertension. [ABSTRACT FROM AUTHOR]

Background: The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts. Methods: This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg). Results: Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P =.006, 95% CI (1.178-2.665)], [RR = 1.772, P =.005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P =.036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P =.041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P =.003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P =.006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P =.030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P =.034, 95% CI (1.072-5.738)]. Conclusion: Alcohol consumption is significantly related to increase BP regardless of HIV infection. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear. Methods: We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication. Results: Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30–3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17–3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12–4.00] p = 0.02). Conclusions: Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03209154. [ABSTRACT FROM AUTHOR]

Introduction: We previously completed a trial of renal pelvic denervation for treating hypertension that reduced blood pressure by the 2-month primary endpoint. However, information on the durability of effectiveness is a critical requirement for device therapy and we now report data up to 12 months. Methods: This was an open-label, single-arm feasibility study in patients with increased blood pressure despite taking an average of 2.7 medications. The key endpoint reported here was ambulatory blood pressure at 12 months following renal pelvic denervation. Results: In the 17 patients (mean age: 56) studied, there was a reduction from the baseline of 148 + 8.7 mm Hg in the primary endpoint of mean daytime systolic blood pressure at 12 months of 19.1 (26.7, 11.6) mm Hg, p < 0.001, as compared with the 2-month result of 19.4 (24.9, 14.0) mm Hg. The 24-h systolic blood pressure fell by 19.3 (26.7, 11.9), p < 0.001, and nighttime systolic fell by 18.7 (27.5, 9.8), p < 0.001, mm Hg at 12 months. Diastolic pressures also fell significantly from baseline at 12 months. As well, automated office systolic blood pressure was reduced from the baseline of 156.5 ± 12.3 by 24.8 (33.2, 16.8) mm Hg, p < 0.001, at 12 months as compared with 22.4 (31.5, 13.3) at 2 months. All blood pressure changes at 12 months were not different from those at 2 months, thus confirming the durability of the procedure. There were no serious procedural, clinical, or laboratory adverse events related to the intervention. Serum creatinine fell from 1.03 ± 0.22 to 0.82 ± 0.16 mg/dL, and estimated glomerular filtration rate rose from 79.6 ± 17.8 to 96.3 ± 16.4 mL/min/1.73 m2 by 12 months, again sustaining effects seen at 2 months. Conclusion: These findings provide evidence that the significant blood pressure-lowering effects of renal pelvic denervation are durable and safe for at least 1 year and provide the basis for a pivotal randomized blinded trial to further define the safety and effectiveness of this procedure. Plain Language Summary: High blood pressure, usually called hypertension, is a major cause of strokes, heart attacks, heart failure, and kidney disease. Reducing blood pressure helps prevent these serious problems but medicines prescribed to do this do not always work well, or may cause annoying side effects. So, there is growing interest in procedures that doctors can perform in people with high blood pressure that can reduce blood pressure for up to a year or more. One such procedure that appears promising is called renal denervation, which means that we disable the nerves that go to the kidney and increase blood pressure. One way this is done is through a procedure performed by kidney doctors similar to ones already widely used in outpatient centers for conditions like kidney stones. A very thin tube (called a catheter) is passed through the bladder into the kidneys and disables the nerves that raise blood pressure. This article describes the effects of this treatment in patients whose blood pressure was high despite taking blood pressure medicines. Their blood pressures fell soon after the procedure, but importantly we can report that these benefits were just as strong 12 months later. There was no evidence that this procedure causes harm to the kidneys or other important organs. The next step in developing this treatment is a large study in 300 patients to confirm its benefits and safety, hopefully making it available to people whose blood pressures cannot be controlled with currently available treatment. [ABSTRACT FROM AUTHOR]

ObjectiveHypertension guidelines recommend using home blood pressure (HBP) to diagnose, treat and monitor hypertension. This study aimed to explore the challenges primary care physicians (PCPs) face in using HBP to manage patients with hypertension.MethodA qualitative study was conducted in 2022 at five primary care clinics in Singapore. An experienced qualitative researcher conducted individual in-depth interviews with 17 PCPs using a semi-structured interview guide. PCPs were purposively recruited based on their clinical roles and seniority until data saturation. The interviews were audio-recorded, transcribed verbatim and managed using NVivo qualitative data management software. Analysis was performed using thematic analysis.ResultsPCPs identified variations in patients’ HBP monitoring practices and inconsistencies in recording them. Access to HBP records relied on patients bringing their records to the clinic visit. A lack of seamless transfer of HBP records to the EMR resulted in an inconsistency in documentation and additional workload for PCPs. PCPs struggled to interpret the HBP readings, especially when there were BP fluctuations; this made treatment decisions difficult.ConclusionDespite strong recommendations to use HBP to inform hypertension management, PCPs still faced challenges accessing and interpreting HBP readings; this makes clinical decision-making difficult. Future research should explore effective ways to enhance patient self-efficacy in HBP monitoring and support healthcare providers in documenting and interpreting HBP.

This study investigated the relationship between sleep quality and circadian rhythm chronotype with uncontrolled hypertension. This cross-sectional study was conducted on 170 patients. Sleep quality is classified into two groups: good sleep quality and poor sleep quality. Circadian rhythm has three chronotypes: morning, intermediate, and evening. Of a total of 170 patients, 84 (49.4%) patients were male. The total mean age was 62.8 (±12). The Uncontrolled hypertension odds ratio in patients with poor sleep quality was 18.47 (CI= (5.1, 67); P-value = 0.001). Patients with intermediate rhythms were more likely to have uncontrolled hypertension (OR:4.18, CI= (1.7, 10.5); P-value = 0.002). In the multiple logistic regression model, male gender increased the odds of uncontrolled hypertension in patients with poor sleep quality or intermediate circadian rhythm (OR: 17, CI;(3.7, 78.9); OR:6.83, CI:(2.3, 20.3) respectively). Poor sleep quality and intermedia circadian rhythm were related to uncontrolled hypertension.. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a medical condition of public health concern that increases the risk of chronic noncommunicable diseases and mortalities. In recent years, understanding its coexistence with other comorbidities has been the focus of better management. However, the relationship between hypertension and depression or anxiety has been contentious issue, with diverse findings reported by different studies. Understanding this relationship will be crucial for blood pressure control and reducing the mortality associated with hypertension. Therefore, this study was conducted to determine the association between depression or anxiety and hypertension control. Methods: A cross-sectional study was conducted among 321 hypertensive patients accessing care in two hospitals. Depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). The relationship between blood pressure control and depression or anxiety was assessed using binary logistic regression. Results: The prevalence of depression and anxiety was 12.1% and 23.1%, respectively. Up to 261 (81.3%) participants had uncontrolled blood pressure. Of these 261 participants, 14.2% and 23.4% had depression and anxiety, respectively. Depression was associated with an increased risk of uncontrolled blood pressure after adjusting for sex, smoking cigarettes, age, marital status, and exercise (odds ratio (OR) = 7.751, 95% confidence interval (CI) = 1.79-43.4, P = 0.011). Conclusion: Depression appears to be independently associated with an increased risk of uncontrolled blood pressure. It is therefore relevant for healthcare providers to assess for depression in patients with hypertension to ensure better hypertensive control. [ABSTRACT FROM AUTHOR]

Abstract The benefits of mHealth interventions in uncontrolled hypertension are unclear. To determine whether mHealth effectively improves the control rate of uncontrolled hypertension. PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library were searched for randomized controlled trials (RCTs) from January 2007 to September 2022. The intervention group consisted of mHealth intervention, and the control group was usual care. Random‐effects meta‐analysis models were used to assess pooled mHealth intervention effects and CIs. The primary outcome was the blood pressure (BP) control rate of uncontrolled hypertension. The secondary outcome was the change of BP. Thirteen RCTs were included in this meta‐analysis, of which eight reported the successful BP control rate, 13 reported the change of systolic blood pressure (SBP), and 11 reported the change in diastolic blood pressure (DBP). The mean age of trial participants ranged from 47.7 to 66.9 years old, with a female composition ratio of 40.0%–66.1%. The duration of follow‐up ranged from 3 to 18 months. This study showed a more robust effect size for improving BP control rate by mHealth interventions than usual care (57.5% vs. 40.8% of successful control rate; odds ratio [OR], 2.19 [95% CI, 1.32—3.62]). Furthermore, mHealth significantly reduced SBP by 4.45 mm Hg and DBP by 2.47 mm Hg, and subgroup analysis did not observe the major source of heterogeneity. This meta‐analysis found that mHealth could significantly improve the uncontrolled hypertension control rate and might be a feasible, acceptable, and effective tool for uncontrolled hypertension management.

Abstract Background By the lengthening of life span, the incidence of chronic diseases such as hypertension and uncontrolled hypertension has increased. This study aims to determine the prevalence of uncontrolled hypertension and its related factors in the age group of 50–74 years in Shahroud, northeast Iran. Methods The data of the third phase of the Shahroud Eye Cohort Study were used in this study. This phase of the cohort study included 4394 participants aged 50 to 74 years from the previous phases. In addition to ophthalmological and optometric examinations, demographic characteristics, blood biochemistry tests, and blood pressure measurements were performed in this phase. Individuals with a blood pressure ≥ 140/90 mm/Hg (being treated or not treated with antihypertensive medicines) were defined as uncontrolled hypertension. In patients with diabetes and chronic kidney disease, blood pressure equal to or higher than 130/80 mm/Hg was considered uncontrolled hypertension. Descriptive statistics and multiple logistic regression were used to analyze the data. Findings Overall, the prevalence of uncontrolled hypertension out of all the participants was 61.7% (95% CI: 60.3–63.2). Multiple regression results showed that the male gender (OR: 2.1, 95% CI: 1.5–2.9), patients with diabetes (OR:3.2, 95% CI: 2.4–4.3), and patients with chronic kidney disease (CKD) (OR: 3.2, 95% CI: 2.5–4.1) increased the risk of uncontrolled hypertension while in patients with cardiovascular disease (OR: 0.6, 95% CI: 0.4–0.8) and polypharmacy (OR: 0.2, 95% CI: 0.1–0.2) reduced the risk of uncontrolled hypertension. Conclusion The present study showed that uncontrolled hypertension has a high prevalence, and factors such as male gender, diabetes, and CKD are associated with this disorder. So, it is recommended to take the necessary measures to formulate and implement immediate actions to prevent or control hypertension.

[Display omitted] [ABSTRACT FROM AUTHOR]

Renal denervation (RDN) reduces blood pressure (BP) in patients with uncontrolled hypertension in the absence of antihypertensive medications. This trial assessed the safety and efficacy of RDN in the presence of antihypertensive medications. SPYRAL HTN-ON MED is a prospective, randomized, sham-controlled, patient- and assessor-blinded trial enrolling patients from 56 clinical centers worldwide. Patients were prescribed 1 to 3 antihypertensive medications. Patients were randomized to radiofrequency RDN or sham control procedure. The primary efficacy endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 6 months between groups using a Bayesian trial design and analysis. The treatment difference in the mean 24-hour ambulatory systolic BP from baseline to 6 months between the RDN group (n = 206; −6.5 ± 10.7 mm Hg) and sham control group (n = 131; −4.5 ± 10.3 mm Hg) was −1.9 mm Hg (95% CI: −4.4 to 0.5 mm Hg; P = 0.12). There was no significant difference between groups in the primary efficacy analysis with a posterior probability of superiority of 0.51 (Bayesian treatment difference: −0.03 mm Hg [95% CI: −2.82 to 2.77 mm Hg]). However, there were changes and increases in medication intensity among sham control patients. RDN was associated with a reduction in office systolic BP compared with sham control at 6 months (adjusted treatment difference: −4.9 mm Hg; P = 0.0015). Night-time BP reductions and win ratio analysis also favored RDN. There was 1 adverse safety event among 253 assessed patients. There was no significant difference between groups in the primary analysis. However, multiple secondary endpoint analyses favored RDN over sham control. (SPYRAL HTN-ON MED Study [Global Clinical Study of Renal Denervation With the Symplicity Spyral Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications]; NCT02439775) [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. Methods: Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. Results: 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). Conclusion: Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. Trial registration: NCT02381275. [ABSTRACT FROM AUTHOR]

BACKGROUND Ocedurenone (KBP-5074), a nonsteroidal mineralocorticoid receptor antagonist, is documented to lower blood pressure in patients with stage 3b/4 chronic kidney disease (CKD) with uncontrolled or resistant hypertension (BLOCK-CKD study). However, the efficacy and safety of Ocedurenone in subgroups such as Hispanic patients or those with stage 4 CKD, diabetes, or very high albuminuria have not been reported. METHODS A total of 162 patients were enrolled in the BLOCK-CKD study. The primary endpoint of these analyses was change in systolic blood pressure (SBP) from baseline to day 84. Prespecified subgroup analysis of SBP focused on demographic (e.g. ethnicity, age) and medical (e.g. CKD stage, diabetes, albuminuria, baseline estimated glomerular filtration rate [eGFR]). The safety analysis focused on changes in serum potassium levels from baseline. RESULTS SBP reductions were consistent across subgroups compared with the overall study cohort. Placebo-adjusted SBP reductions were observed in Hispanic patients (−8.1 and −9.9 mm Hg for 0.25 and 0.5 mg, respectively, total n = 35) and patients with CKD stage 4 (−9.3 and −10.4 mm Hg for 0.25 and 0.5 mg, respectively, total n = 64), diabetes (−6.9 and −11.6 mm Hg for 0.25 and 0.5 mg, respectively, total n = 51), and very high albuminuria (−13.1 and −12.3 mm Hg for 0.25 and 0.5 mg, respectively, total n = 85). Changes in serum potassium were similar across all patient subgroups regardless of baseline eGFR, diabetes status, or degree of proteinuria. No cases of hyperkalemia required intervention or resulted in study discontinuation. CONCLUSIONS Ocedurenone consistently reduced in SBP in all patient subgroups. Moreover, while small elevations in serum potassium occurred, they were not associated with Ocedurenone or study discontinuation. [ABSTRACT FROM AUTHOR]

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48–3.87], treatment adherence [0.46; 0.21–0.97], salt consumption [28.35; 7.87–102.04], physical activity [0.22; 0.13–0.37], current alcohol use [2.10; 1.22–3.61], and current cigarette smoking [4.79; 1.88–12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure. [ABSTRACT FROM AUTHOR]

Although hypertension is the leading cause of cardiovascular disease and premature death worldwide, it remains difficult to control. The prevalence of uncontrolled and resistant hypertension (RH) may be underestimated and can reach up to 50% of all hypertensive patients. The aim of this observational study was to analyze the prevalence of hypertension, uncontrolled hypertension and RH, and their associations with risk factors or diseases in a large cohort of patients referred to primary care physician. In a population of 228406 adults, we only collected data from people with a diagnosis of arterial hypertension for a total of 43,526 patients. For this purpose, we used the MySQL database, run by Azalea.NET, built on the medical records of 150 General Practitioners (GPs). Patient data included sex, age, blood pressure (BP) values, number of antihypertensive drugs and presence of major cardiovascular comorbidities. We classified patients with RH as those treated with 3 different antihypertensive agents, with recorded BP ≥ 140/90 mmHg, or patients taking ≥ 4 medications. The prevalence of hypertension was 19.06%, that of resistant hypertension was 2.46% of the whole population and 20.85% of the hypertensive group. Thirteen thousand hundred, forty-six patients (30.20% of the hypertensive group) had uncontrolled BP (≥ 140/90 mmHg), whereas 16,577 patients did not have BP measurements done in the last 2 years (38.09% of the hypertensive group). Patients with uncontrolled BP were mainly female, used less drugs and showed a lower prevalence of all major cardiovascular comorbidities, except for diabetes. Instead, patients with RH had a significantly higher prevalence of all considered comorbidities compared to those without RH. Our results evidence that a broad number of patients with hypertension, especially those without comorbidities or with a low number of antihypertensive drugs, do not achieve adequate BP control. To improve the clinical management of these patients it is very important to increase the collaboration between GPs and clinical specialists of hypertension. [ABSTRACT FROM AUTHOR]

Uncontrolled arterial hypertension is a major global health issue. Catheter-based renal denervation has shown to lower blood pressure in sham-controlled trials and represents a device-based, complementary treatment option for hypertension. In this situation assessment, the authors, who are practicing experts in hypertension, nephrology, general practice and cardiology in the Republic of Ireland, discuss the current evidence base for the BP-lowering efficacy and safety of catheter-based renal denervation with different modalities. Although important questions remain regarding the identification of responders, and long-term efficacy and safety of the intervention, renal denervation has the potential to provide much-needed help to address hypertension and its adverse consequences. The therapeutic approach needs to be multidisciplinary and personalised to take into account the perspective of patients and healthcare professionals in a shared decision-making process. [ABSTRACT FROM AUTHOR]

The benefits of mHealth interventions in uncontrolled hypertension are unclear. To determine whether mHealth effectively improves the control rate of uncontrolled hypertension. PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library were searched for randomized controlled trials (RCTs) from January 2007 to September 2022. The intervention group consisted of mHealth intervention, and the control group was usual care. Random‐effects meta‐analysis models were used to assess pooled mHealth intervention effects and CIs. The primary outcome was the blood pressure (BP) control rate of uncontrolled hypertension. The secondary outcome was the change of BP. Thirteen RCTs were included in this meta‐analysis, of which eight reported the successful BP control rate, 13 reported the change of systolic blood pressure (SBP), and 11 reported the change in diastolic blood pressure (DBP). The mean age of trial participants ranged from 47.7 to 66.9 years old, with a female composition ratio of 40.0%–66.1%. The duration of follow‐up ranged from 3 to 18 months. This study showed a more robust effect size for improving BP control rate by mHealth interventions than usual care (57.5% vs. 40.8% of successful control rate; odds ratio [OR], 2.19 [95% CI, 1.32—3.62]). Furthermore, mHealth significantly reduced SBP by 4.45 mm Hg and DBP by 2.47 mm Hg, and subgroup analysis did not observe the major source of heterogeneity. This meta‐analysis found that mHealth could significantly improve the uncontrolled hypertension control rate and might be a feasible, acceptable, and effective tool for uncontrolled hypertension management. [ABSTRACT FROM AUTHOR]

Background: By the lengthening of life span, the incidence of chronic diseases such as hypertension and uncontrolled hypertension has increased. This study aims to determine the prevalence of uncontrolled hypertension and its related factors in the age group of 50–74 years in Shahroud, northeast Iran. Methods: The data of the third phase of the Shahroud Eye Cohort Study were used in this study. This phase of the cohort study included 4394 participants aged 50 to 74 years from the previous phases. In addition to ophthalmological and optometric examinations, demographic characteristics, blood biochemistry tests, and blood pressure measurements were performed in this phase. Individuals with a blood pressure ≥ 140/90 mm/Hg (being treated or not treated with antihypertensive medicines) were defined as uncontrolled hypertension. In patients with diabetes and chronic kidney disease, blood pressure equal to or higher than 130/80 mm/Hg was considered uncontrolled hypertension. Descriptive statistics and multiple logistic regression were used to analyze the data. Findings: Overall, the prevalence of uncontrolled hypertension out of all the participants was 61.7% (95% CI: 60.3–63.2). Multiple regression results showed that the male gender (OR: 2.1, 95% CI: 1.5–2.9), patients with diabetes (OR:3.2, 95% CI: 2.4–4.3), and patients with chronic kidney disease (CKD) (OR: 3.2, 95% CI: 2.5–4.1) increased the risk of uncontrolled hypertension while in patients with cardiovascular disease (OR: 0.6, 95% CI: 0.4–0.8) and polypharmacy (OR: 0.2, 95% CI: 0.1–0.2) reduced the risk of uncontrolled hypertension. Conclusion: The present study showed that uncontrolled hypertension has a high prevalence, and factors such as male gender, diabetes, and CKD are associated with this disorder. So, it is recommended to take the necessary measures to formulate and implement immediate actions to prevent or control hypertension. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia (TN) is characterized by sudden, severe, brief, stabbing, usually unilateral, and recurrent pain within one or more branches of the trigeminal nerve. It is divided into three types: (1) primary or classical TN, which requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression, (2) secondary to other identifiable neurologic causes such as multiple sclerosis and intracranial space-occupying lesion, and (3) idiopathic, in which the etiology is unknown. Treatment and prognosis depend on the type. We present this case of an elderly woman with an unusual presentation of TN in a previously diagnosed case. The episodes were increasing in severity and duration, not responding to medical management, allodynia and constant pain was present, and they were accompanied by uncontrolled hypertension. These features strongly suggested other likely causes such as intracranial space-occupying lesions, multiple sclerosis, and central pain. Expert consultations from physicians and neurologists were sought for control of hypertension and reaching a diagnosis. Magnetic resonance angiogram of the brain was done and a diagnosis of classical TN with persistent background facial pain was established. The treatment was successfully done by radiofrequency ablation of the Gasserian ganglion. The pain and blood pressure responded to the treatment. [ABSTRACT FROM AUTHOR]

Aim: Evaluation of the status of uncontrolled hypertension in diagnosed hypertensives who had been advised drug treatment in the rural areas of 6 districts in Jammu & Kashmir (J&K) and also the risk factors associated with it. Methods: The study was a cross-sectional observational study conducted between August 2020 to July 2021 in the form of health camps in six government health centres in 6 different rural districts. The camps were focussed on patients with hypertension, diabetes with or without heart disease. The areas included Machil in Kupwara, Khan Sahib in Budgam, Rajpora and Hawal in Pulwama, Rainawari in the Srinagar, Banihal in Ramban, and Jagti in Jammu.Enrolled patients were examined for body weight, blood pressure (BP), random blood sugar and serum lipid profile. The definition of hypertension was as per the eighth Joint National Committee (JNC-8) guidelines. Results: A total of 600 patients (50.1% males) were evaluated. Of these 335 (55%) had history of being diagnosed hypertension and had been recommended drugs for BP control Male: Female ratio 1:0.8.211(63.5%) of these had un controlled blood pressures on measurement.Two or more drugs had been prescribed in 65 (30.8%) patients, 34 (16%) were taking only single drug and 112(53%) were not on any drug. Uncontrolled hypertension was seen more often in age group of 40–60 years (49%), subjects more than 60 years had it in 40%.The comparison of risk factors between patients with diagnosed hypertension with those without it revealed use of tobacco, consumption of salted tea, presence of diabetes, dyslipidaemia as significant factors for the presence of uncontrolled hypertension. Conclusion: Uncontrolled hypertension in known patients prescribed drugs is highly prevalent in the rural population of J&K. Steps to mitigate this problem are needed on top priority.

BackgroundRenal sympathetic denervation (RDN) has been shown to lower arterial blood pressure both in the presence and in the absence of antihypertensive medication in an observation period of up to 3 years. However, long-term results beyond 3 years are scarcely reported.MethodsWe performed a long-term follow-up on patients who were previously enrolled in a local renal denervation registry and who underwent radiofrequency RDN with the Symplicity Flex® renal denervation system between 2011 and 2014. The patients were assessed to evaluate their renal function by performing 24-hour ambulatory blood pressure measurement (ABPM), recording their medical history, and conducting laboratory tests.ResultsAmbulatory blood pressure readings for 24 h were available for 72 patients at long-term follow-up (FU) [9.3 years (IQR: 8.5–10.1)]. We found a significant reduction of ABP from 150.1/86.1 ± 16.9/12.0 mmHg at baseline to 138.3/77.1 ± 16.5/11.1 mmHg at long-term FU (P 60 ml/min/1.73 m2, while a non-significant decrease was observed in patients with an initial eGFR

Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Resistant hypertension (HTN), despite the tremendous advances in pharmacotherapy, is a major global problem. Transcatheter renal denervation (RDN) could be a pertinent strategy for resistant HTN and patients with poor pharmacotherapy adherence. Nonetheless, the adoption of energy-based RDN in clinical practice is slow and alternative approaches are needed. Areas covered: The review focuses on the assessment of the Peregrine System Infusion Catheters. The system is designed for chemically mediated transcatheter RDN by the infusion publications on the Peregrine system. The theoretical assumptions for chemically mediated RDN, design of the system, data from preclinical and clinical studies, and further perspectives are discussed. Expert opinion: Peregrine System Infusion Catheters are the only catheter on the market designed for chemically mediated RDN by the infusion of the neurolytic agent. Chemical neurolysis more efficiently destroys nerves around the renal artery in comparison to energy-based catheters, due to deeper tissue penetration and circumferential distribution resulting in a wider range of effective nerve injury. Chemically mediated RDN by the infusion of the neurolytic agent (alcohol) has an excellent safety profile as confirmed in initial clinical trials which also suggested high efficacy. Currently, there is an ongoing phase III sham-control study. Other possible applications of this technology include clinical settings like heart failure or atrial fibrillation. [ABSTRACT FROM AUTHOR]

Abstract Therapy adherence significantly determines the success of antihypertensive therapy, especially in patients with resistant hypertension. Our study investigates the impact of drug adherence on the efficacy of Baroreflex‐activation‐therapy (BAT). In this retrospective analysis, the authors measured blood pressure (BP) and antihypertensive medication adherence (by gas chromatography‐mass spectrometry [GC‐MS] urine analysis) before and 6 months after BAT initiation. Adherence was defined as detection of ≥80% intake of prescribed medication at the time of follow‐up. Response to BAT was defined as BP drop ≥5 mmHg in systolic 24 h‐ambulatory BP (ABP) after 6 months. Overall patients (n = 38) median medication adherence was low, but rose from 60% (IQR 25%–100%) to 75% (IQR 38%–100%; p = .0194). After 6 months of BAT, mean systolic and diastolic office BP (‐21 ± 25 mmHg and ‐9 ± 15 mmHg; p

Mohamed Sheikh Hassan, Abdiladhif Mohamed Ali, Mohamed Farah Osman, Abdulkadir Ahmed Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Mohamed Sheikh Hassan, Email dr.m.qalaf@gmail.comIntroduction: The basal ganglia, which comprise many subcortical nuclei, constitute an integrated functional unit of the brain. Spontaneous hemorrhage of the basal ganglia is mostly unilateral and secondary to uncontrolled hypertension. Simultaneous bilateral basal ganglia hemorrhage (SBBGH) is very rare. So far, only 40 cases have been documented so far.Case Presentation: Here, we report a 37-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion, and right-sided weakness for 2 days. An urgent non-contrast brain CT performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the basal ganglia. On admission, blood pressure was 220/120. Other vital signs were normal. The patient was admitted to the ICU, IV antihypertensive and antiedema medications were given. After clinical improvement, he was transferred to the neurology ward on the fifth day. After another 5 days in the neurology inpatient ward, the patient clinically improved and was referred to the rehabilitation department.Conclusion: Due to the rarity of SBBGH, it is particularly interesting to report this remarkable case of a man with simultaneous spontaneous bilateral ganglia hemorrhage secondary to uncontrolled hypertension.Keywords: uncontrolled hypertension, bilateral basal ganglia, hemorrhagic stroke