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Sample records for controlling hypertension immediately

  1. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II) : An open-label, randomised controlled trial

    NARCIS (Netherlands)

    Broekhuijsen, Kim; Van Baaren, Gert Jan; Van Pampus, Maria G.; Ganzevoort, Wessel; Sikkema, J. Marko; Woiski, Mallory D.; Oudijk, Martijn A.|info:eu-repo/dai/nl/246958898; Bloemenkamp, Kitty W M; Scheepers, Hubertina C J; Bremer, Henk A.; Rijnders, Robbert J P; Van Loon, Aren J.; Perquin, Denise A M; Sporken, Jan M J; Papatsonis, Dimitri N M; Van Huizen, Marloes E.; Vredevoogd, Corla B.; Brons, Jozien T J; Kaplan, Mesrure; Van Kaam, Anton H.; Groen, Henk; Porath, Martina M.; Van Den Berg, Paul P.; Mol, Ben W J; Franssen, Maureen T M; Langenveld, Josje

    2015-01-01

    Patients with hypertensive disorders of pregnancy usually have the 2 treatment options, either immediate delivery or continuing the pregnancy. Although immediately delivery of the placenta is seen as the more definitive of the 2 treatments, it does carry the potentially higher risks of an earlier bi

  2. Effects of Sublingual Captopril in Immediate Treatment of Hypertensive Crisis

    Directory of Open Access Journals (Sweden)

    H. Kazerani

    2007-04-01

    Full Text Available Introduction & Objective: Sublingual captopril was shown to be a safe and effective drug to control hypertensive urgencies. However the exact time and efficacy of lowering blood pressure (BP is a matter of interest and importance. In this study we evaluated the time and efficacy of 25 mg sublingual captopril in lowering blood pressure. Materials & Methods: In a randomized clinical trial 101 patients (34 men, 67 women with blood pressure of 180/110 mmHg (or more who had no finding of major organ damage (heart – brain -eyes –renal were studied by prescription of 25 mg sublingual captopril. Then systolic and diastolic blood pressure was measured at 5, 10, 15, 20, 25, 30, 40, 50, 60, 75, 90, 105, 120 minutes following drug administration. Data analysis was performed using paired t-test and SPSS software. Results: The results showed that almost all the patients had some decrease in BP. After 120 minutes blood pressure dropped about 5% in 30%, and 5-30% in 70% of patients, compared to first measured BP. Maximal effect was observed in 25-30 minutes after drug administration: after 30 minutes systolic pressure dropped in 68.4% and diastolic pressure in 65.3% of patients about 5-25%. 47 patients had low response to therapy after 60 minutes, so they received another 25 mg captopril sublingual, which BP dropped in 45% of them. 19 patients were prescribed IV furosemide after 120 minutes. This group had resistant HTN and 25 cases of them were treated with ACEI previously. BP decreased gradually and not more than 30% of first BP. None of the patients encountered side effects. Conclusion: Sublingual captopril is a good, safe, effective, available and cost effective drug, with very low side effects in treating patients with hypertensive crisis. It is recommended to use this drug instead of Nifedipine in all hypertensive patients.

  3. Hypertension: issues in control and resistance.

    Science.gov (United States)

    Wofford, Marion R; Minor, Deborah S

    2009-10-01

    Hypertension remains uncontrolled in more than 50% of treated patients. Barriers to hypertension control include those that are patient-related, physician-related, and related to the health system. Identification of uncontrolled hypertension, pseudoresistant hyper-tension, and resistant hypertension require thoughtful attention to accurate blood pressure measurement, lifestyle factors, evaluation for secondary causes of hypertension, and proper treatment. Recent guidelines emphasize the importance of aggressive treatment and referral to hypertension specialists for patients with resistant hypertension, defined as blood pressure that remains above goal despite the use of three appropriate anti-hypertensive agents.

  4. Hypertension control in brazilian publications

    Energy Technology Data Exchange (ETDEWEB)

    Pinho, Natália de Alencar; Pierin, Angela Maria Geraldo, E-mail: pierin@usp.br [Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP (Brazil)

    2013-09-15

    Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used.

  5. Acute blood pressure response in hypertensive elderly women immediately after water aerobics exercise: A crossover study.

    Science.gov (United States)

    Cunha, Raphael Martins; Vilaça-Alves, José; Noleto, Marcelo Vasconcelos; Silva, Juliana Sá; Costa, Andressa Moura; Silva, Christoffer Novais Farias; Póvoa, Thaís Inácio Rolim; Lehnen, Alexandre Machado

    2017-01-01

    Water aerobics exercise is widely recommended for elderly people. However, little is known about the acute effects on hemodynamic variables. Thus, we assessed the effects of a water aerobic session on blood pressure in hypertensive elderly women. Fifty hypertensive elderly women aged 67.8 ± 4.1 years, 1.5 ± 0.6 m high and BMI 28.6 ± 3.9 kg/m(2), participated in a crossover clinical trial. The experiment consisted of a 45-minute water aerobics session (70%-75% HRmax adjusted for the aquatic environment) (ES) and a control session (no exercise for 45 minutes) (CS). Heart rate was monitored using a heart rate monitor and systolic blood pressure (SBP) and diastolic (DBP) measurements were taken using a semi-automatic monitor before and immediately after the sessions, and at 10, 20 and 30 minutes thereafter. It was using a generalized estimating equation (GEE) with Bonferroni's post-hoc test (p exercise, BP declined in ES by a greater magnitude than in CS (SBP 7.5 mmHg, 6.2%, p = 0.005 and DBP 3.8 mmHg, 5.5%, p = 0.013). At 20 minutes after exercise and thereafter, SBP and DBP were similar in both ES and CS. In conclusion, BP returned to control levels within 10-20 minutes remaining unchanged until 30 minutes after exercise, and post-exercise hypotension was not observed. Besides, BP changed after exercise was a safe rise of small magnitude for hypertensive people.

  6. Awareness, Treatment and Control of Hypertension among ...

    African Journals Online (AJOL)

    Awareness, Treatment and Control of Hypertension among Hypertensives in Zaria. ... consistent with follow up and 67.3% reported compliance with their medication. ... Awareness rate did not seem to have affected blood pressure control.

  7. Hypertension: The Demographics of Management and Control.

    Science.gov (United States)

    Ames, Natalie

    1985-01-01

    The ultimate goal of any hypertension control program is reduction of excessive morbidity and mortality from cardiovascular disease. Factors affecting detection of hypertension and compliance with educational intervention are discussed and implications drawn. (MT)

  8. Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups.

    Science.gov (United States)

    Tobe, S W; Moy Lum-Kwong, M; Von Sychowski, S; Kandukur, K; Kiss, A; Flintoft, V

    2014-01-01

    The Heart and Stroke Foundation of Ontario's Hypertension Management Initiative (HMI) was a pragmatic implementation of clinical practice guidelines for hypertension management in primary care clinics. The HMI was a prospective delayed phase cohort study of 11 sites enrolling patients in two blocks starting 9 months apart in 2007. The intervention was an evidence-informed chronic disease management program consisting of an interprofessional educational intervention with practice tools to implement the Canadian Hypertension Education Program's clinical practice guidelines. This study compares the change in blood pressure (BP) from baseline to 9 months after the intervention between groups. In the immediate intervention group, the mean BP at baseline was 134.6/79.1 mm Hg (18.2/11.5) and in the delayed intervention group 134.2/77.1 mm Hg (18.9/11.8). The fall in BP in the immediate intervention group from baseline to 9 months after the intervention was 7.3/3.6 mm Hg (95% confidence interval (CI): 5.9-8.7/2.6-4.5) and in the delayed group 8.1/3.3 mm Hg (95% CI: 7.0-9.3/2.5-4.1) (all Phypertension can rapidly lead to lower BP levels.

  9. Central Systolic Hypertension in Patients with Well-Controlled Hypertension

    Science.gov (United States)

    Potočárová, Mária; Murín, Ján; Kozlíková, Katarína; Luha, Ján; Čaprnda, Martin

    2017-01-01

    Background. Central systolic blood pressure (CSBP) has prognostic significance and simplified devices for its estimation have been introduced recently. The aim of this study was to assess the achievement of the target CSBP in treated hypertensive patients. Subjects and Methods. One hundred patients with well-controlled hypertension were analysed. For CSBP estimation, we used the Arteriograph (TensioMed Ltd.), which uses one cuff for all measurements, the “single-point measurement” approach. Results. We found that 62% of patients had CSBP ≥ 130 mmHg, the suggested cut-off value for hypertension. When sex-specific classification was employed (CSBP ≥ 137 mmHg for female and CSBP ≥ 133 mmHg for male), only 13% of patients (mainly women) remained in the hypertensive range. We also found that 55% of patients had a CSBP higher than brachial pressure. Multiple analyses showed that CSBP was significantly associated with sex, height, and return time. Conclusions. A high proportion of treated hypertensive patients had CSBP levels that exceeded their brachial BP. CSBP positively correlated with lower height and shorter return time of the reflected pressure wave and was significantly higher in females compared to males. These findings suggest that, for CSBP classification, it is important to take height and sex-specific differences into account. PMID:28127560

  10. Controlling Hypertension in Diabetic Patients | Familoni | Nigerian ...

    African Journals Online (AJOL)

    Controlling Hypertension in Diabetic Patients. ... risk factor for both macrovascular and microvascular complications in patients with diabetes. ... about 22.4% of patients with type 1 and 58.9% of patients with type 2 diabetes mellitus in Nigeria.

  11. Pressure Points: Preventing and Controlling Hypertension

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Pressure Points: Preventing and Controlling Hypertension Past Issues / Summer ... turn Javascript on. May is National High Blood Pressure Education Month, a good time for many Americans ...

  12. The prevalence and control of hypertension among patients with ...

    African Journals Online (AJOL)

    The prevalence and control of hypertension among patients with type 2 diabetes ... of the patients who had hypertension were not on anti hypertensive drug treatment. ... Appropriate antihypertensive regimen optimizes nonpharmacological ...

  13. [Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control].

    Science.gov (United States)

    Benítez Camps, M; Egocheaga Cabello, M Isabel; Dalfó Baqué, A; Bajo García, J; Vara González, L; Sanchis Doménech, C; Martín Rioboo, E; Ureña Fernández, T; Domínguez Sardiña, M; Bonet Pla, A

    2015-01-01

    To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

  14. Hypertensive Emergencies in Pregnancy.

    Science.gov (United States)

    Olson-Chen, Courtney; Seligman, Neil S

    2016-01-01

    The prevalence of hypertensive disorders in pregnancy is increasing. The etiology and pathophysiology of hypertensive disorders in pregnancy remain poorly understood. Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality. Treatment of hypertension decreases the incidence of severe hypertension, but it does not impact rates of preeclampsia or other pregnancy complications. Several antihypertensive medications are commonly used in pregnancy, although there is a lack of randomized controlled trials. Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders.

  15. Awareness, Treatment and Control of Pre-hypertension and Hypertension among Adults in Iran.

    Science.gov (United States)

    Esteghamati, Alireza; Etemad, Koorosh; Koohpayehzadeh, Jalil; Abbasi, Mehrshad; Meysamie, Alipasha; Khajeh, Elias; Asgari, Fereshteh; Noshad, Sina; Rafei, Ali; Mousavizadeh, Mostafa; Neishaboury, Mohamad Reza; Afarideh, Mohsen; Nakhjavani, Manouchehr

    2016-07-01

    Hypertension is a major risk factor for non-communicable diseases. Yet, Nation-wide prevalence and trend reports in developing countries are sparsely available. Data from three cycles of Survey of Risk Factors of Non-communicable Diseases (SuRFNCD) 2005 - 2011 were aggregated. In 2011, 8218 adults aged 25 - 70 years were enrolled. For trend analysis 68850, 4184, and 7416 adults aged 25 - 64 years were included from 2005, 2007, and 2011 surveys, respectively. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or receiving anti-hypertensive medication. Pre-hypertension was defined as SBP between 120 - 139 or DBP between 80 - 89 mmHg. The status of awareness, non-pharmacologic treatment (management), pharmacologic treatment, and control (SBP hypertensive individuals were also determined. 25.6% (95%CI: 23.5 - 27.5) of the adults aged 25 - 70 years had hypertension and 39.8% (95%CI: 37.8 - 41.9) had pre-hypertension. The prevalence of hypertension was greater among older adults (P adults with hypertension (25.7% to 24.1%) and pre-hypertension (45.5% to 40.4%) significantly decreased. In 2011, rates for awareness, management, treatment, and control among hypertensives were 43.2% (95%CI: 40.0 - 46.4), 40.3% (95%CI: 37.0 - 43.6), 34.8% (95%CI: 31.5 - 38.2), and 38.6% (95%CI: 33.1 - 44.2), respectively. Over time, status of awareness, management, treatment and control was significantly improved and was more salient among men (P hypertension and pre-hypertension is gradually declining. Despite improvements in awareness, management, treatment and control, these decline rates are still low and initiative strategies need to be implemented to further improve the current status.

  16. Prevalence, awareness and control of hypertension in Uganda.

    Directory of Open Access Journals (Sweden)

    Geofrey Musinguzi

    Full Text Available BACKGROUND: Prevention and control of hypertension are critical in reducing morbidity and mortality attributable to cardiovascular diseases. Awareness of hypertension is a pre-condition for control and prevention. This study estimated the proportion of adults who were hypertensive, were aware of their hypertension and those that achieved adequate control. METHODS: We conducted a community based cross sectional survey among people ≥ 15 years in Buikwe and Mukono districts of Uganda. People had their blood pressure measured and were interviewed about their social-demographic characteristics. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, or diastolic blood pressure ≥ 90 mmHg, or previous diagnosis of hypertension. Participants were classified as hypertensive aware if they reported that they had previously been informed by a health professional that they had hypertension. Control of hypertension among those aware was if systolic blood pressure was <140 mmHg and diastolic blood pressure was <90 mmHg. RESULTS: The age standardized prevalence of hypertension was 27.2% (95% CI 25.9-28.5 similar among females (27.7% and males (26.4%. Prevalence increased linearly with age, and age effect was more marked among females. Among the hypertensive participants, awareness was 28.2% (95% CI 25.4-31.0 higher among females (37.0% compared to males (12.4%. Only 9.4% (95% CI 7.5-11.1 of all hypertensive participants were controlled. Control was higher among females (13.2% compared to males (2.5%. CONCLUSION: More than a quarter of the adult population had hypertension but awareness and control was very low. Measures are needed to enhance control, awareness and prevention of hypertension.

  17. Hypertensive patients in a general practice setting: comparative analysis between controlled and uncontrolled hypertension.

    Science.gov (United States)

    Santiago, Luiz Miguel; Pereira, Carolina; Botas, Philippe; Simões, Ana Rita; Carvalho, Rosa; Pimenta, Gonçalo; Neto, Glória

    2014-01-01

    To study the differences between controlled and uncontrolled hypertensive patients. This was a cross-sectional observational study of the hypertensive population on the lists of three general practitioners in the district of Coimbra in central Portugal in 2013, with a margin of error of 6% and 95% confidence interval in each sample, organized in ascending order of health care user numbers. Data were gathered electronically by the investigators after approval by the Regional Health Authority's ethics committee. A sample of 201 individuals was studied, of whom 104 (51.7%) were male and 86 (42.8%) were aged under 65 (p=0.127 for gender and age-group). Hypertension was controlled in 130 (64.7%). We found significant differences in target organ damage, more frequent in those with controlled hypertension (33.1% vs. 19.7%, p=0.031), in hypertension control, better in those taking at least one anti-hypertensive drug at night (56.9% vs. 29.6%, p<0.001), and in prescription of non-steroidal anti-inflammatory drugs, more frequent in those with uncontrolled hypertension (11.3% vs. 3.8%, p=0.043). Hypertension control is significantly associated with target organ damage, taking at least one anti-hypertensive drug at night and not taking non-steroidal anti-inflammatory drugs simultaneously. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  18. Potassium Intake, Bioavailability, Hypertension, and Glucose Control

    Directory of Open Access Journals (Sweden)

    Michael S. Stone

    2016-07-01

    Full Text Available Potassium is an essential nutrient. It is the most abundant cation in intracellular fluid where it plays a key role in maintaining cell function. The gradient of potassium across the cell membrane determines cellular membrane potential, which is maintained in large part by the ubiquitous ion channel the sodium-potassium (Na+-K+ ATPase pump. Approximately 90% of potassium consumed (60–100 mEq is lost in the urine, with the other 10% excreted in the stool, and a very small amount lost in sweat. Little is known about the bioavailability of potassium, especially from dietary sources. Less is understood on how bioavailability may affect health outcomes. Hypertension (HTN is the leading cause of cardiovascular disease (CVD and a major financial burden ($50.6 billion to the US public health system, and has a significant impact on all-cause morbidity and mortality worldwide. The relationship between increased potassium supplementation and a decrease in HTN is relatively well understood, but the effect of increased potassium intake from dietary sources on blood pressure overall is less clear. In addition, treatment options for hypertensive individuals (e.g., thiazide diuretics may further compound chronic disease risk via impairments in potassium utilization and glucose control. Understanding potassium bioavailability from various sources may help to reveal how specific compounds and tissues influence potassium movement, and further the understanding of its role in health.

  19. Potassium Intake, Bioavailability, Hypertension, and Glucose Control

    Science.gov (United States)

    Stone, Michael S.; Martyn, Lisa; Weaver, Connie M.

    2016-01-01

    Potassium is an essential nutrient. It is the most abundant cation in intracellular fluid where it plays a key role in maintaining cell function. The gradient of potassium across the cell membrane determines cellular membrane potential, which is maintained in large part by the ubiquitous ion channel the sodium-potassium (Na+-K+) ATPase pump. Approximately 90% of potassium consumed (60–100 mEq) is lost in the urine, with the other 10% excreted in the stool, and a very small amount lost in sweat. Little is known about the bioavailability of potassium, especially from dietary sources. Less is understood on how bioavailability may affect health outcomes. Hypertension (HTN) is the leading cause of cardiovascular disease (CVD) and a major financial burden ($50.6 billion) to the US public health system, and has a significant impact on all-cause morbidity and mortality worldwide. The relationship between increased potassium supplementation and a decrease in HTN is relatively well understood, but the effect of increased potassium intake from dietary sources on blood pressure overall is less clear. In addition, treatment options for hypertensive individuals (e.g., thiazide diuretics) may further compound chronic disease risk via impairments in potassium utilization and glucose control. Understanding potassium bioavailability from various sources may help to reveal how specific compounds and tissues influence potassium movement, and further the understanding of its role in health. PMID:27455317

  20. Hypertension

    Science.gov (United States)

    ... Hypertension Triglycerides Featured Resource Find an Endocrinologist Search Hypertension March 2010 Download PDFs English Espanol Editors Robert ... Additional Resources MedlinePlus (NIH) Mayo Clinic What is hypertension? Hypertension, or chronic (long-term) high blood pressure, ...

  1. Clustering of cardiovascular risk factors and hypertension control status among hypertensive patients in the outpatient setting

    Institute of Scientific and Technical Information of China (English)

    刘军

    2014-01-01

    Objective To investigate the status of the clustering of cardiovascular risk factors and hypertension control among hypertensive patients in the outpatient setting in China.Methods This multi-center cross-sectional study was carried out from June to December 2009.Study patients were consecutively recruited from 46

  2. Worsened hypertension control induced by aripiprazole

    Directory of Open Access Journals (Sweden)

    Yasui-Furukori N

    2013-04-01

    Full Text Available Norio Yasui-Furukori, Akira Fujii Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan Abstract: Aripiprazole is widely used in the treatment of schizophrenia and bipolar disorders. Although antipsychotics generally have hypotensive effects, two cases were identified that demonstrated hypertension during the switch from other antipsychotics to aripiprazole. The hypertensive state of these patients recovered after switching back to other antipsychotics, and these cases suggest that aripiprazole may lead to hypertension. Keywords: hypertension, aripiprazole, dopamine antagonist, 5-HT1a

  3. Immediate effect of chandra nadi pranayama (left unilateral forced nostril breathing on cardiovascular parameters in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Ananda Balayogi Bhavanani

    2012-01-01

    Full Text Available Introduction : Recent studies have reported differential physiological and psychological effects produced by exclusive right and left nostril breathing and clinical research is required to prove immediate and sustained efficacy of these techniques in various psychosomatic conditions such as hypertension (HT. The present study was designed to determine immediate effects of 27 rounds of exclusive left nostril breathing, a yogic pranayama technique known as chandra nadi pranayama (CNP on cardiovascular parameters in patients of essential HT. Materials and Methods : Twenty two patients of essential HT under regular standard medical management were individually taught to perform CNP by a qualified yoga instructor with a regularity of 6 breaths/min throughout a performance of 27 rounds of CNP. Pre and post intervention heart rate (HR and blood pressure (BP measurements were recorded using non-invasive semi-automatic BP monitor and Students t test for paired data used to determine significant differences. Results : Twenty seven rounds of CNP produced an immediate decrease in all the measured cardiovascular parameters with the decrease in HR, systolic pressure (SP, pulse pressure, rate-pressure product and double product being statistically significant. Further, gender-based sub-analysis of our data revealed that our male participants evidenced significant reductions in HR and SP with an insignificant decrease in diastolic pressure, while in female participants only HR decreased significantly with an insignificant decrease in SP. Discussion and Conclusion : It is concluded that CNP is effective in reducing HR and SP in hypertensive patients on regular standard medical management. To the best of our knowledge, there are no previously published reports on immediate effects of left UFNB in patients of HT and ours is the first to report on this beneficial clinical effect. This may be due to a normalization of autonomic cardiovascular rhythms with increased

  4. Worsened hypertension control induced by aripiprazole

    OpenAIRE

    Yasui-Furukori N; Fujii A

    2013-01-01

    Norio Yasui-Furukori, Akira Fujii Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan Abstract: Aripiprazole is widely used in the treatment of schizophrenia and bipolar disorders. Although antipsychotics generally have hypotensive effects, two cases were identified that demonstrated hypertension during the switch from other antipsychotics to aripiprazole. The hypertensive state of these patients recovered after switching back to other antipsychot...

  5. Awareness, Prevalence, Treatment, and Control of Hypertension in Western Nepal

    DEFF Research Database (Denmark)

    Neupane, Dinesh; Shrestha, Archana; Mishra, Shiva Raj

    2017-01-01

    BACKGROUND: Hypertension is a significant contributor to cardiovascular and renal diseases. In low-income settings like Nepal, there are few epidemiological studies assessing hypertension burden. Thus, the purpose was to determine prevalence, awareness, treatment, and control of hypertension...... in Nepal. METHODS: A cross-sectional survey was conducted in semi-urban area of western Nepal among randomly selected participants, aged between 25 and 65 years. Systolic blood pressure (BP) ≥140 mm Hg and/or diastolic BP of ≥90 mm Hg and/or taking current antihypertensive medicine defined as hypertension...

  6. Auditing hypertension control and management: a position paper.

    Science.gov (United States)

    Strasser, T

    1996-02-01

    The categorical term "auditing" hypertension control is chosen on purpose, to emphasize the responsibility of health politicians for assessing the quality and effects of interventions in populations. Auditing of hypertension is needed for reasons of Efficacy, Economics and Ethics. An analysis of efficacy should test whether the local strategies of hypertension control are sufficiently adapted to the needs and characteristics of a given population. Economic analyses should consider hypertension control in the perspective of resources and priorities. The ethical imperative requires an assessment and follow-up of the effects of health measures on the population, by the same token as evaluation of treatment results is obligatory in clinical medicine. The WHO/WHL Hypertension Management Audit Project was an attempt to analyze the repercussions of hypertension control programs on selected population. Five approaches were taken: (i) assessment of the epidemiological situation; (ii) clinical analysis on a sample of patients; (iii) assessment of patient satisfaction and of (iv) physicians' knowledge and attitudes; and (v) drug utilization studies. The results showed (a) a mixture of under- and overdiagnosis of hypertension in populations; (b) undertreatment of various degrees; (c) mixed patient satisfaction; (d) partial compliance of physicians' concepts and attitudes with standards promulgated by WHO and ISH; and, (e) great differences (at the time of the study) between drug utilization patterns in different countries.

  7. Guidelines Adherence and Hypertension Control in an Outpatient ...

    African Journals Online (AJOL)

    Tropical Journal of Pharmaceutical Research ... Purpose: To evaluate doctors' adherence to Malaysian Clinical Practice Guideline (CPG) 2008 in ... with guideline adherence and hypertension control in Pulau Pinang Hospital, Malaysia.

  8. On the transition from a nurse-led hypertension clinic to hypertension control in primary care: identifying barriers to and factors acting against continuous hypertension control.

    Science.gov (United States)

    Overgaard Andersen, Ulla; Ibsen, Hans; Tobiassen, Minja

    2016-08-01

    Many hypertensive patients are not treated to target and hence do not benefit fully from the blood pressure-related improvements in cardiovascular health. Hypertensive patients who had primarily been treated to a target goal in a nurse-led hypertension clinic were re-examined to evaluate whether their target goal blood pressure was maintained after their discharge from the hypertension clinic for further control in primary care, and to evaluate potential barriers to and factors acting against continuous hypertension control. The median observation time was 3.6 years (range 3 months to 7.9 years). Only 45.2% of the patients were well controlled at the time of re-examination. No patient-related factors (age, body mass index, gender, attitudes towards medication) predicted the outcome. Two factors were significant in the reduction in continuous hypertension control: the cooperation between the patient and health personnel and the shared commitment towards the target goal were discontinued; and many patients did not make control visits to the general practitioner's office. In conclusion, maintained strict control of hypertension requires both continued close collaboration between the patient and health personnel, with an emphasis on treatment goals, and systematic control visits.

  9. Effective control of hypertension in adults with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    L Adhikary

    2010-12-01

    Full Text Available INTRODUCTION: Adequate control of hypertension in Chronic Kidney Disease patients is difficult to achieve. This study was designed to analyze the adequacy of Hypertension control in adults with CKD using different classes of antihypertensive drugs. METHODS: A cross-sectional observational study was done that included 85 patients with CKD admitted to our Medicine Department over a period of two years (2006-2008 A.D.. Presence of CKD was defined as glomerular filtration rate 30ug/mg. Adequate blood pressure control was defined as systolic blood pressure less than or equals to 130 and diastolic blood pressure less than or equals to 80 mm Hg. Data and Statistical analysis was done using SPSS Version 12 for Windows. RESULTS: Of all the CKD patients, 51.4% required three Anti-Hypertensive drugs combination for the effective control of Hypertension, while only 21% of CKD patients with hypertension was controlled on two drugs. CONCLUSION: Adequate control of blood pressure in CKD patient was shown to be most effective on combination of three antihypertensive drugs. A poor control was seen on patients taking less than three antihypertensive drugs. Keywords: antihypertensive drug; chronic kidney disease; glomerular filtration rate; hypertension.

  10. Evaluation of Patients Cooperation in Hypertension Control

    Science.gov (United States)

    Brankovic, Suada; Pilav, Aida; Cilovic-Lagarija, Seila; Segalo, Mersa

    2014-01-01

    Introduction: Hypertension (high blood pressure) is one of the most widely spread diseases of our time and one of the leading risk factors for heart and vascular diseases, particularly stroke and coronary heart disease. According to the World Health Organization (WHO) cardiovascular diseases are the leading cause of death in the world of who dies each year about 17 million persons, of which 5 million in Europe. The World Health Organization estimates based on monitoring of demographic trends, trends in mortality and morbidity as economic models, further growth of cardiovascular diseases, especially in developing countries. Goal: Correlate the success of antihypertensive therapy and provoking factors, and to determine the degree of satisfaction with the effect of antihypertensive therapy of the patient. Material and methods: The study was conducted at the Primary Health Care Center Stari Grad - Sarajevo. Conducted is study that included 80 patients. Data for this study were collected by a questionnaire. The questionnaire was completed by the examiner using interviews with patients and their relatives (parents, guardians).After sorting, control and grouping the data were imported into the statistical software package SPSS 20.0, where after defining variables was performed statistical analysis. Results: The average age of male respondents was 60.80±13.03 and 63.50 ± 7.48 years of female respondents. The average value of systolic blood pressure amounted to 148mmHg (130-180), while the average value of diastolic blood pressure was 88.75mmHg (70-120). Student's t test showed that the average value of systolic pressure was statistically significantly different from the reference value (t=2.387, DF=19, p=0.028), and also the average values of diastolic blood pressure were statistically significantly different compared to baseline (p=3.561, DF=19, p=0.002). Of the total number of subjects included in this study good blood pressure control had 58 participants, and the

  11. Hydrologic conditions controlling runoff generation immediately after wildfire

    Science.gov (United States)

    Ebel, Brian A.; Moody, John A.; Martin, Deborah A.

    2012-01-01

    We investigated the control of postwildfire runoff by physical and hydraulic properties of soil, hydrologic states, and an ash layer immediately following wildfire. The field site is within the area burned by the 2010 Fourmile Canyon Fire in Colorado, USA. Physical and hydraulic property characterization included ash thickness, particle size distribution, hydraulic conductivity, and soil water retention curves. Soil water content and matric potential were measured indirectly at several depths below the soil surface to document hydrologic states underneath the ash layer in the unsaturated zone, whereas precipitation and surface runoff were measured directly. Measurements of soil water content showed that almost no water infiltrated below the ash layer into the near-surface soil in the burned site at the storm time scale (i.e., minutes to hours). Runoff generation processes were controlled by and highly sensitive to ash thickness and ash hydraulic properties. The ash layer stored from 97% to 99% of rainfall, which was critical for reducing runoff amounts. The hydrologic response to two rain storms with different rainfall amounts, rainfall intensity, and durations, only ten days apart, indicated that runoff generation was predominantly by the saturation-excess mechanism perched at the ash-soil interface during the first storm and predominantly by the infiltration-excess mechanism at the ash surface during the second storm. Contributing area was not static for the two storms and was 4% (saturation excess) to 68% (infiltration excess) of the catchment area. Our results showed the importance of including hydrologic conditions and hydraulic properties of the ash layer in postwildfire runoff generation models.

  12. Orexin, Stress and Central Cardiovascular Control. A Link with Hypertension?

    Science.gov (United States)

    Carrive, Pascal

    2017-03-01

    Orexin, the arousal peptide, originates from neurons located in an area of the dorsal hypothalamus well known for integrating defense responses and their cardiovascular component. Orexin neurons, which are driven in large part by the limbic forebrain, send projections to many regions in the brain, including regions involved in cardiovascular control, as far down as sympathetic preganglionic neurons in the spinal cord. Central injections of orexin evoke sympathetically mediated cardiovascular responses. Conversely, blockade of orexin receptors reduce the cardiovascular responses to acute stressors, preferentially of a psychological nature. More importantly, lasting upregulation of orexin signaling can lead to a hypertensive state. This can be observed in rats exposed to chronic stress as well as in strains known to display spontaneous hypertension such as the spontaneously hypertensive rat (SHR) or the hypertensive BPH/2J Schlager mouse. Thus, there is a link between orexin, stress and hypertension, and orexin upregulation could be a factor in the development of essential hypertension. Orexin receptor antagonists have anti-hypertensive effects that could be of clinical use.

  13. Hypertension in Iranian Urban Population, Epidemiology, Awareness, Treatment and Control

    Directory of Open Access Journals (Sweden)

    SM Namayandeh

    2011-09-01

    Full Text Available Background: To assess the epidemiological characteristics of hypertensive patients in urban population of Yazd, A cen­tral city in Iran.Methods: This cross sectional study was conducted from 2005-2006 and carried out on population aging 20-74 years. It is a part of the phase I of Yazd healthy heart program that it is a community interventional study for prevention of car­diovascular disease. Data obtained from questionnaires were analyzed by SPSS version 13. P value less than 0.05 were consid­ered significant level.Results: This study comprised of 2000 participants that 847 (42.5% were diagnosed as being hypertensive. After age ad­justment, prevalence of hypertension was 25.6% (23.3% for women and 27.5% for men (P< 0.001. Age, Total cho­lesterol, LDL-cholesterol, triglyceride, fasting blood glucose, impaired glucose tolerance test, body mass index and waist were significantly higher in the hypertensive groups. 53.7% of hypertensive cases were aware of own condition, 45% were treated, and 33.9% of treated were controlled (30.7% and 35.4% in men and women re­spectively. In other word, 24% of all hypertensives (aware or unaware about own blood pressure condition were treated and only 8% of them were controlled. Men significantly had less awareness (P< 0.001, lower tendency to take medi­cation (P< 0.001, and less were controlled (P= 0.046.Conclusion: We understand high prevalence, low awareness, treatment, and control of hypertension and higher preva­lence of other traditional metabolic risk factors in these cases. It seems that urgent preventional studies should be con­ducted in this population.

  14. Cardiac autonomic control in adolescents with primary hypertension

    Directory of Open Access Journals (Sweden)

    Havlíceková Z

    2009-12-01

    Full Text Available Abstract Background Impairment in cardiovascular autonomic regulation participates in the onset and maintenance of primary hypertension. Objective The aim of the present study was to evaluate cardiac autonomic control using long-term heart rate variability (HRV analysis in adolescents with primary hypertension. Subjects and methods Twenty two adolescent patients with primary hypertension (5 girls/17 boys aged 14-19 years and 22 healthy subjects matched for age and gender were enrolled. Two periods from 24-hour ECG recording were evaluated by HRV analysis: awake state and sleep. HRV analysis included spectral power in low frequency band (LF, in high frequency band (HF, and LF/HF ratio. Results In awake state, adolescents with primary hypertension had lower HF and higher LF and LF/HF ratio. During sleep, HF was lower and LF/HF ratio was higher in patients with primary hypertension. Conclusions A combination of sympathetic predominance and reduced vagal activity might represent a potential link between psychosocial factors and primary hypertension, associated with increased cardiovascular morbidity.

  15. Essential hypertensive controlled and normotensive patients. If there are differences?

    Directory of Open Access Journals (Sweden)

    V. V. Syvolap

    2016-10-01

    Full Text Available Ambulatory blood pressure monitoring (ABPM is a modern method of blood pressure (BP investigation recommended by international scientific associations for diagnostics of essential hypertension (EH. However, there are some methodological aspects which are not regulated. Particularly, ABPM parameters have not yet established for those patients in different age groups and pathologies. The aim of the study was to determine peculiarities of ABPM parameters in treated controlled hypertensive and normotensive patients. Materials and methods. 71 patients were included into the study and divided into two groups according to the level of 24-h systolic BP (SBP and 24-h diastolic BP (DBP. There were 50 controlled patients with EH in the first group and 21 normotensive individuals without EH in the second group. Results. In EH patients and normotensive individuals we had statistician difference of such parameters, like the hypertension time index (TI of day SBP parameters (20 (8–31 % vs. 8 (4–18 %; р=0.040; of the square index (SI of hypertension (24 (11–41 mm2/h vs. 8 (2–23 mm2/h; р=0.021; of the square index normalized (SIN of hypertension (1.4 (0.6–2.4 U vs. 0.4 (0.1–1.2 U; р=0.018, and the morning surge of SBP (45±14 mm Hg vs. 37±14 mm Hg; р=0.028, respectively. There is no different in other ABPM parameters. Conclusion. The present data shows that treated controlled hypertensive patients and individuals without EH have statistician difference only in daily SBP of hypertensive indexes (TI, SI, SIN and the morning surge of SBP. The other ABPM parameters, included new one, such as the arterial stiffness index, did not represent statistical difference between groups.

  16. Current status of hypertension control around the world.

    Science.gov (United States)

    Erdine, Serap; Aran, Sinan Nazif

    2004-01-01

    It is well established that hypertension is an important risk factor for cardiovascular disease. Data from epidemiological and observational studies have demonstrated increasing risk of stroke, myocardial infarction, cardiovascular death and all cause mortality associated with high blood pressure. Despite the significance of the problem with respect to overall health, control of high blood pressure is far from being optimal. Data from the National Health and Nutrition Survey have shown that those achieving target blood pressure values less than 140/90 mmHg are only 34% of the hypertensive population. The situation is no better in the rest of the world and even worse in the developing countries. Epidemiological transition taking place in developing countries with a decline in communicable diseases and an increase in noncommunicable have resulted in an improvement in life expectancy, thus causing predictable shifts in causes of death. Aging of the populations, urbanization and socioeconomic changes in the developing world have led to an increase in the prevalence of hypertension, with low control rates due to scarce health resources and insufficient health infrastructure. Thus prevention, detection, treatment and control of hypertension play a crucial role in protection of cardiovascular disease, not only in the developed countries but also in the developing world and implementation of hypertension guidelines should be reinforced around the world.

  17. Effects of wet-cupping on blood pressure in hypertensive patients:a randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Nouran A Aleyeidi; Khaled S Aseri; Shadia M Matbouli; Albaraa A Sulaiamani; Sumayyah A Kobeisy

    2015-01-01

    BACKGROUND: Although cupping remains a popular treatment modality worldwide, its efficacy for most diseases, including hypertension, has not been scientifical y evaluated. OBJECTIVE: We aimed to determine the efficacy of wet-cupping for high blood pressure, and the incidence of the procedure’s side effects in the intervention group. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a randomized control ed trial conducted in the General Practice Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2013 and February 2014. There were two groups (40 participants each):intervention group undergoing wet-cupping (hijama) in addition to conventional hypertension treatment, and a control group undergoing only conventional hypertension treatment. Three wet-cupping sessions were performed every other day. MAIN OUTCOME MEASURE: The mean systolic and diastolic blood pressures were measured using a validated automatic sphygmomanometer. The fol ow-up period was 8 weeks. RESULTS: Wet-cupping provided an immediate reduction of systolic blood pressure. After 4 weeks of fol ow-up, the mean systolic blood pressure in the intervention group was 8.4 mmHg less than in the control group (P = 0.046). After 8 weeks, there were no significant differences in blood pressures between the intervention and control groups. In this study, wet-cupping did not result in any serious side effects. CONCLUSION: Wet-cupping therapy is effective for reducing systolic blood pressure in hypertensive patients for up to 4 weeks, without serious side effects. Wet-cupping should be considered as a complementary hypertension treatment, and further studies are needed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01987583.

  18. Pharmacogenomics considerations in the control of hypertension.

    Science.gov (United States)

    Lupoli, Sara; Salvi, Erika; Barcella, Matteo; Barlassina, Cristina

    2015-11-01

    The response to antihypertensive therapy is very heterogeneous and the need by the physicians to account for it has driven much interest in pharmacogenomics of antihypertensive drugs. The Human Genome Project and the initiatives in genomics that followed, generated a huge number of genetic data that furnished the tools to explore the genotype-phenotype association in candidate genes and at genome-wide level. In spite of the efforts and the great number of publications, pharmacogenomics of antihypertensive drugs is far from being used in clinical practice. In this review, we analyze the main findings available in PubMed from 2010 to 2015, in relation to the major classes of antihypertensive drugs. We also describe a new Phase II drug that targets two specific hypertension predisposing mechanisms.

  19. [Hypertension].

    Science.gov (United States)

    Ohishi, Mitsuru

    2014-04-01

    Hypertension is well known to one of the risk factors to reduce cognitive function, however, it is still unclear whether anti-hypertensive therapy is effective to prevent development of dementia or Alzheimer's disease. Epidemiological studies suggested antihypertensive therapy from the middle-age could reduce risk of dementia. The meta-analysis including HYVET also suggested blood pressure lowering from the elderly might be also effective to prevent development of dementia. The network meta-analysis and the cohort study using mega-data bank suggested ARB might be effective to prevent development of dementia or Alzheimer's disease compared to administration with other anti-hypertensive drugs. Although the further major clinical investigation is required, anti-hypertensive treatment might be useful to manage hypertensive patients with dementia.

  20. A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia

    Directory of Open Access Journals (Sweden)

    Vallès-Fernandez Roser

    2009-03-01

    Full Text Available Abstract Background Different studies have shown insufficient blood pressure (BP control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. Methods and design Design: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain. Sample: all patients with a diagnosis of hypertension (population based study. Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure. The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non

  1. Hypertension Control and Cardiometabolic Risk: A Regional Perspective

    Directory of Open Access Journals (Sweden)

    Martin Thoenes

    2012-01-01

    Full Text Available Background. We investigated the association between blood pressure control and common cardiometabolic risk factors from a global and regional perspective. Methods. In the present analysis of a large cross-sectional i-SEARCH study, 17.092 outpatients receiving antihypertensive treatment were included in 26 countries. According to clinical guidelines for the management of arterial hypertension, patients were classified based on the level of seated systolic/diastolic blood pressure (SBP/DBP. Uncontrolled hypertension was defined as SBP/DBP ≥140/90 mmHg for non-diabetics, and ≥130/80 mmHg for diabetics. Results. Overall, mean age was 63.1 years, 52.8% were male, and mean BMI was 28.9 kg/m2. Mean SBP/DBP was 148.9/87.0 mmHg, and 76.3% of patients had uncontrolled hypertension. Diabetes was present in 29.1% with mean HbA1c of 6.8%. Mean LDL-cholesterol was 3.2 mmol/L, HDL-cholesterol 1.3 mmol/L, and triglycerides 1.8 mmol/L; 49.0% had hyperlipidemia. Patients with uncontrolled hypertension had a higher BMI (29.4 versus 28.6 kg/m2, LDL-cholesterol (3.4 versus 3.0 mmol/L, triglycerides (1.9 versus 1.7 mmol/L, and HbA1c (6.8 versus 6.7% than those with controlled blood pressure (P<0.0001 for all parameters. Conclusions. Among outpatients treated for arterial hypertension, three quarters had uncontrolled blood pressure. Elevated SBP/DBP and uncontrolled hypertension were associated with increasing BMI, LDL-cholesterol, triglycerides, and HbA1c, both globally and regionally.

  2. Hypertension

    OpenAIRE

    2012-01-01

    Hypertension is responsible for roughly one-in-six adult deaths annually in the United States and is associated with five of the top nine causes of death. 1 Ten trillion dollars is the estimated annual cost worldwide of the direct and indirect effects of hypertension. 2,3 In the U.S. alone, costs estimated at almost $74 billion in 2009 placed a huge economic burden on the health care system. 4 The prevalence of hypertension increases with advancing age to the point where more than half of peo...

  3. Hypertension

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These datasets provide de-identified insurance data for hypertension hyperlipidemia. The data is provided by three managed care organizations in Allegheny County...

  4. Nutritional patterns on prevention and control of hypertension

    Science.gov (United States)

    Ortega Anta, Rosa M; Jiménez Ortega, Ana Isabel; Perea Sánchez, José Miguel; Cuadrado Soto, Esther; López Sobaler, Ana M

    2016-07-12

    Objectives: Hypertension is a common health problem and with severe health impacts, underdiagnosed and modulated by dietary habits, lifestyle and intake of several nutrients, so analyze the latest data on the involvement of nutrition in preventing and control of hypertension is the subject of this review. Methods: Literature search regarding the topic. Results: Although the best known and followed patterns are the restriction in sodium intake, weight control, and moderation in alcohol consumption; improving diet (increasing consumption of cereals, vegetables, fruits...) and physical activity seem to have a major impact on the control of blood pressure, also consume less saturated fat (with increased MUFA and omega-3), adequate intake of calcium, magnesium, protein, vitamin D and fiber and improving the antioxidant capacity of the diet can have great importance in fighting the problem of hypertension. Given that the average Spanish diet does not meet the advised requirements for many of the nutrients mentioned as favorable in control of the blood pressure, an approximation of the diet to the theoretical ideal can be very helpful in the fight against this problem that has great health impact. Conclusions: Improving feeding, increasing the intake of vegetables, legumes, whole grains, dairy, fish, avoiding an inadequate supply of nutrients (especially calcium, magnesium, protein, and vitamin D) can have a greater benefit in controlling blood pressure, than most widespread monitoring restrictive guidelines in practice.

  5. Blood pressure control in patients with arterial hypertension in Slovenia

    Directory of Open Access Journals (Sweden)

    Marija Petek-Šter

    2007-06-01

    Full Text Available Background: Blood pressure control is sub-optimal all over the world. The aim of the study was to find out about the quality of the blood pressure control in Slovenia.Patients and method: Randomly selected general practitioners fulfilled a questionnaire for each of the 20 conse cutive attenders with arterial hypertension. We collected data for 980 patients with arterial hypertension, who attended their general practitioners in September 2006. Data about blood pressure control was taken from the medical record; we took into account the last two blood pressure measurements in the office before the visit in which we selected the study sample.Results: In the sample of 980 patients there were 47.4 % male and 52.6 % female, who were from 20 to 97 years old (average 62.3 years, SD 11.9 years. The target blood pressure was reached in 388 (40.1 % patients with hypertension. 927 (94.6 % patients were given an advice on non-pharmacological measures. In 986 (98.8 % patients antihypertensive drugs were prescribed. 668 (68.2 % patients took a combined antihypertensive treatment. The most frequently prescribed drug classes were blockers of renin-angiotensine system in 843 (86.0 % patients, 225 (23.2 % patients took blockers of renin-angiotensine receptors. In 527 (53.8 % patients antihypertensive treatment was changed during the treatment. Physicians performed at least one measure to improve blood pressure control in 430 (74.3 % patients with uncontrolled hypertension; changes in drug treatment were made in 252 (43.5 % patients.Conclusions: More frequent advice on non-pharmacological measures, more intensive drug treatment and adaptation of treatment to patients lead to better blood pressure control.

  6. [Hypertension: prevalence, early diagnosis, control and trends in Mexican adults].

    Science.gov (United States)

    Campos-Nonato, Ismael; Hernández-Barrera, Lucía; Rojas-Martínez, Rosalba; Pedroza, Adolfo; Medina-García, Catalina; Barquera-Cervera, Simón

    2013-01-01

    The present study aims to describe the prevalence, distribution and trends of hypertension (HT) in Mexican adults ≥20 years, and to describe the prevalence of early diagnosis and treatment of HT. A total of 10 898 adults were considered. The measurement of blood pressure was performed following the procedures recommended by the American Heart Association. An adult was considered, hypertensive when he met the diagnostic criteria of JNC-7. The prevalence of HT was 31.5%, of which 47.3% were unaware of their condition. Pharmacological treatment was not associated with a higher percentage of subjects under control. Prevalences from 2000, 2006 and 2012 suggest that there is a stabilization. A health problem of this magnitude requires better diagnosis, care and training of the medical sector so that appropriate treatments are prescribed and HT control can be enhanced.

  7. 78 FR 48683 - Announcement of Requirements and Registration for Million Hearts® Hypertension Control Challenge

    Science.gov (United States)

    2013-08-09

    ... consumption. To support improved blood pressure control, HHS/CDC is announcing the Million Hearts Hypertension... hypertension control rate will be shared through press releases, the challenge Web site, and Million Hearts and... hypertension may be shared in documents or other communication products that describe generally used...

  8. Baroreflex control of sympathetic activity in experimental hypertension

    Directory of Open Access Journals (Sweden)

    M.C.C. Irigoyen

    1998-09-01

    Full Text Available The arterial baroreceptor reflex system is one of the most powerful and rapidly acting mechanisms for controlling arterial pressure. The purpose of the present review is to discuss data relating sympathetic activity to the baroreflex control of arterial pressure in two different experimental models: neurogenic hypertension by sinoaortic denervation (SAD and high-renin hypertension by total aortic ligation between the renal arteries in the rat. SAD depresses baroreflex regulation of renal sympathetic activity in both the acute and chronic phases. However, increased sympathetic activity (100% was found only in the acute phase of sinoaortic denervation. In the chronic phase of SAD average discharge normalized but the pattern of discharges was different from that found in controls. High-renin hypertensive rats showed overactivity of the renin angiotensin system and a great depression of the baroreflexes, comparable to the depression observed in chronic sinoaortic denervated rats. However, there were no differences in the average tonic sympathetic activity or changes in the pattern of discharges in high-renin rats. We suggest that the difference in the pattern of discharges may contribute to the increase in arterial pressure lability observed in chronic sinoaortic denervated rats.

  9. Prevalence, awareness, treatment, and control of hypertension in Lebanon.

    Science.gov (United States)

    Matar, Dany; Frangieh, Antonio H; Abouassi, Samah; Bteich, Fernand; Saleh, Aline; Salame, Elie; Kassab, Roland; Azar, Rabih R

    2015-05-01

    The prevalence and factors related to hypertension (HTN) treatment and control are well investigated in the Western world but remain poorly understood in the Middle East and in middle-income countries such as Lebanon. In order to measure the prevalence, awareness, treatment, and control rates of HTN in Lebanon, the authors measured blood pressure (BP) in 1697 adults. The prevalence of optimal BP (Lebanon and its overall control is low. Improving awareness is the most important target for intervention. ©2015 Wiley Periodicals, Inc.

  10. Improved blood pressure control among school bus drivers with hypertension.

    Science.gov (United States)

    Doyle, Joseph; Severance-Fonte, Tina; Morandi-Matricaria, Elizabeth; Wogen, Jenifer; Frech-Tamas, Feride

    2010-04-01

    The impact of a hypertension awareness and educational program, BP DownShift, was evaluated among school bus drivers in a southern US state. At baseline (August 2007), blood pressure (BP) measurements, self-reported demographics, and hypertension awareness and management practices were collected from drivers who consented to participate in the study. Interventions included 4 educational mailings, installation of BP machines at all bus terminals, and access to free dietitian consultations and gym memberships. BP was evaluated using Department of Transportation guidelines. BP was remeasured and a survey was administered at follow-up (May 2008). At baseline, 208 drivers consented to the BP screening; 120 (58%) returned for a follow-up assessment. Most participants completing the study were female (73%) and African American (72%). Mean age was 50 years and mean body mass index was 32 kg/m(2); 52% of participants were obese. In all, 58% of participants reported a prior diagnosis of hypertension by a physician, and 63% reported taking antihypertensive medication. Both systolic and diastolic BP (SBP and DBP) were lower at follow-up (135/82 mmHg vs. 145/87 mmHg at baseline; P 10 mmHg, and 44% had a reduction in DBP > 5 mmHg. At follow-up, 58% were controlled to BP improvement in BP control, which may positively impact commercial driver's license recertification as well as improve employee health.

  11. Controlling Hypertension (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2013-04-04

    Hypertension, or high blood pressure, affects one third of U.S. adults and is a leading cause of heart disease and stroke. A recent study found an increase in self-reported high blood pressure among U.S. adults, and an increase in the use of medications to control high blood pressure. In this podcast, Dr. Fleetwood Loustalot discusses the importance of controlling high blood pressure.  Created: 4/4/2013 by MMWR.   Date Released: 4/4/2013.

  12. Barriers to treatment and control of hypertension among hypertensive participants: A community based cross-sectional mixed method study in municipalities of Kathmandu, Nepal

    Directory of Open Access Journals (Sweden)

    Surya Devkota

    2016-08-01

    Full Text Available AbstractIntroduction: Despite the established evidence on benefits of controlling raised blood pressure and development of several guidelines on detection and management of hypertension, people often have untreated or uncontrolled hypertension. In this context, we undertook this study to identify the barriers existing in hypertension treatment and control in the municipalities of Kathmandu district in Nepal. Methods: This was a community based, cross-sectional mixed method study conducted in the municipalities of Kathmandu district in Nepal between January and July 2015. Among 587 randomly selected participants, the aware hypertensive participants were further assessed for the treatment and control of hypertension. For qualitative component, 20 participants having uncontrolled hypertension took part in two focused group discussions and two cardiac physicians participated in in-depth interviews.Results: Out of 587 participants screened, 191 (32.5% were identified as hypertensive. Among 191 hypertensive participants, 118 (61.8% were aware of their problem. Of the 118 aware hypertensive participants, 93 (78.8% were taking medicines, and among those treated, 46 (49.6% had controlled hypertension. Proportions of participants taking anti-hypertensive medications varied significantly with age groups, ethnicity, occupation and income. Hypertension control was significantly associated with use of combination therapy, adherence to medication, follow-up care, counseling by healthcare providers and waiting time in hospital. Being worried that the medicine needs to be taken life-long, perceived side effects of drugs, non-adherence to medication, lost to follow-up, inadequate counseling from physician, and lack of national guidelines for hypertension treatment were the most commonly cited barriers for treatment and control of hypertension in qualitative component of the research.Conclusion: Large proportion of the hypertensive population has the untreated and

  13. Hypertension

    OpenAIRE

    2016-01-01

    Defining hypertension in pregnancy is challenging because blood pressure levels in pregnancy are dynamic, having a circadian rhythm and also changing with advancing gestational age. The accepted definition is a sustained systolic (sBP) of ≥140 mmHg or a sustained diastolic blood pressure (dBP) ≥90 mmHg, by office (or in-hospital) measurement. Measurement of blood pressure in pregnancy should follow standardised methods, as outside pregnancy. Blood pressure measurement may occur in three types...

  14. Immediate processing of erotic stimuli in paedophilia and controls: a case control study.

    Science.gov (United States)

    Habermeyer, Benedikt; Esposito, Fabrizio; Händel, Nadja; Lemoine, Patrick; Klarhöfer, Markus; Mager, Ralph; Dittmann, Volker; Seifritz, Erich; Graf, Marc

    2013-03-19

    Most neuroimaging studies investigating sexual arousal in paedophilia used erotic pictures together with a blocked fMRI design and long stimulus presentation time. While this approach allows the detection of sexual arousal, it does not enable the assessment of the immediate processing of erotically salient stimuli. Our study aimed to identify neuronal networks related to the immediate processing of erotic stimuli in heterosexual male paedophiles and healthy age-matched controls. We presented erotic pictures of prepubescent children and adults in an event related fMRI-design to eight paedophilic subjects and age-matched controls. Erotic pictures of females elicited more activation in the right temporal lobe, the right parietal lobe and both occipital lobes and erotic pictures of children activated the right dorsomedial prefrontal cortex in both groups. An interaction of sex, age and group was present in the right anteriolateral oribitofrontal cortex. Our event related study design confirmed that erotic pictures activate some of the brain regions already known to be involved in the processing of erotic pictures when these are presented in blocks. In addition, it revealed that erotic pictures of prepubescent children activate brain regions critical for choosing response strategies in both groups, and that erotically salient stimuli selectively activate a brain region in paedophilic subjects that had previously been attributed to reward and punishment, and that had been shown to be implicated in the suppression of erotic response and deception.

  15. Hypertension awareness and control among young adults in the national longitudinal study of adolescent health.

    Science.gov (United States)

    Gooding, Holly C; McGinty, Shannon; Richmond, Tracy K; Gillman, Matthew W; Field, Alison E

    2014-08-01

    Young adults are less likely than older adults to be aware they have hypertension or to be treated for hypertension. To describe rates of hypertension awareness and control in a cohort of young adults and understand the impact of health insurance, utilization of preventive care, and self-perception of health on rates of hypertension awareness and control in this age group. Cross-sectional study of 13,512 young adults participating in Wave IV of the National Longitudinal Study of Adolescent Health in 2007-2008. We defined hypertension as an average of two measured systolic blood pressures (SBP) ≥ 140 mmHg, diastolic blood pressures (DBP) ≥ 90 mmHg, or self-report of hypertension. We defined hypertension awareness as reporting having been told by a health care provider that one had high blood pressure, and assessed awareness among those with uncontrolled hypertension. We considered those aware of having hypertension controlled if their average measured SBP was adults with hypertension, 2,531 (76%) were uncontrolled, and 1,893 (75%) of those with uncontrolled hypertension were unaware they had hypertension. After adjustment for age, sex, race/ethnicity, weight status, income, education, alcohol and tobacco use, young adults with uncontrolled hypertension who had (vs. didn't have) routine preventive care in the past 2 years were 2.4 times more likely (95% confidence interval [CI] 1.68-3.55) to be aware, but young adults who believed they were in excellent (vs. less than excellent) health were 64% less likely to be aware they had hypertension (OR 0.36, 95% CI 0.23-0.57). Neither preventive care utilization nor self-rated health was associated with blood pressure control. In this nationally representative group of young adults, rates of hypertension awareness and control were low. Efforts to increase detection of hypertension must address young adults' access to preventive care and perception of their need for care.

  16. Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Vedanthan, Rajesh; Kamano, Jemima H; Naanyu, Violet; Delong, Allison K; Were, Martin C; Finkelstein, Eric A; Menya, Diana; Akwanalo, Constantine O; Bloomfield, Gerald S; Binanay, Cynthia A; Velazquez, Eric J; Hogan, Joseph W; Horowitz, Carol R; Inui, Thomas S; Kimaiyo, Sylvester; Fuster, Valentin

    2014-04-27

    Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and delays in seeking care are associated with increased mortality. Thus, a critical component of hypertension management is to optimize linkage and retention to care. This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive individuals to a hypertension care program and significantly reduce blood pressure among them. The study will be conducted in the Kosirai and Turbo Divisions of western Kenya. An initial phase of qualitative inquiry will assess facilitators and barriers of linkage and retention to care using a modified Health Belief Model as a conceptual framework. Subsequently, we will conduct a cluster randomized controlled trial with three arms: 1) usual care (community health workers with the standard level of hypertension care training); 2) community health workers with an additional tailored behavioral communication strategy; and 3) community health workers with a tailored behavioral communication strategy who are also equipped with smartphone technology. The co-primary outcome measures are: 1) linkage to hypertension care, and 2) one-year change in systolic blood pressure among hypertensive individuals. Cost-effectiveness analysis will be conducted in terms of costs per unit decrease in blood pressure and costs per disability-adjusted life year gained. This study will provide evidence regarding the effectiveness and cost-effectiveness of strategies to optimize linkage and retention to hypertension care that can be applicable to non-communicable disease management in low- and middle-income countries. This trial is registered with (NCT01844596) on 30 April 2013.

  17. Improving Hypertension Control and Patient Engagement Using Digital Tools.

    Science.gov (United States)

    Milani, Richard V; Lavie, Carl J; Bober, Robert M; Milani, Alexander R; Ventura, Hector O

    2017-01-01

    Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital-medicine blood pressure program and compared them with 400 patients (matched to age, sex, body mass index, and blood pressure) in a usual-care group after 90 days. Digital-medicine patients completed questionnaires online, were asked to submit at least one blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. Blood pressure units were commercially available that transmitted data directly to the electronic medical record. Digital-medicine patients averaged 4.2 blood pressure readings per week. At 90 days, 71% of digital-medicine vs 31% of usual-care patients had achieved target blood pressure control. Mean decrease in systolic/diastolic blood pressure was 14/5 mm Hg in digital medicine, vs 4/2 mm Hg in usual care (P digital-medicine group (P = .004). Mean patient activation increased from 41.9 to 44.1 (P = .008), and the percentage of patients with low patient activation decreased from 15% to 6% (P = .03) in the digital-medicine group. A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients.

  18. Predictors of hyperkalemia risk following hypertension control with aldosterone blockade.

    Science.gov (United States)

    Khosla, Nitin; Kalaitzidis, Rigas; Bakris, George L

    2009-01-01

    Aldosterone antagonists have proven efficacy for management of resistant hypertension and proteinuria reduction; however, they are not widely used due to risk of hyperkalemia. This study assesses the risk factors for hyperkalemia in patients with chronic kidney disease (CKD) and resistant hypertension whose blood pressure (BP) is reduced to a guideline goal. This is a two-center study conducted in university-based hypertension clinics directed by clinical hypertension specialists. Forty-six patients with resistant hypertension and stages 2 or 3 CKD (mean estimated glomerular filtration rate (eGFR) 56.5 + or - 16.2 ml/min/1.73 m(2)) were evaluated for safety and efficacy of aldosterone blockade added to preexisting BP-lowering regimens. All patients were on three mechanistically complementary antihypertensive agents including a diuretic and a renin-angiotensin system blocker. Patients were evaluated after a median of 45 treatment days. The primary endpoint was change in systolic BP. Secondary endpoints included change in serum potassium, creatinine, eGFR, diastolic BP and tolerability. The mean age of the patients studied was 64.9 + or - 10.7 years, all were obese and 86% had type 2 diabetes, with 82% being African-American. Addition of aldosterone antagonism yielded a further mean reduction in systolic BP of 14.7 + or - 5.1 mm Hg (p = 0.001). Females with BMI >30 and those with a baseline systolic BP >160 mm Hg were more likely to have a greater BP reduction to aldosterone antagonism. In total, 39% of the patients had a >30% decrease in eGFR when the BP goal was achieved. The mean increase in serum potassium was 0.4 mEq/l above baseline (p = 0.001), with 17.3% manifesting hyperkalemia, i.e. serum potassium >5.5 mEq/l. Predictors of hyperkalemia included a baseline eGFR of 4.5 mEq/l on appropriately dosed diuretics. Contributing risks in this subgroup included a systolic BP reduction of >15 mm Hg associated with an eGFR fall of >30%. Aldosterone antagonism is

  19. [Nursing actions increases the control of hypertensive patients and reduces white-coat effect].

    Science.gov (United States)

    Colósimo, Flávia Cortez; da Silva, Stael Silvana Bagno Eleutério; Toma, Gabriela de Andrade; Pierin, Angela Maria Geraldo

    2012-10-01

    A randomized comparative study was performed to evaluate the control of hypertension with use of home blood pressure measurement (HBPM) and casual blood pressure measurement, and analyze the white coat effect. Hypertensive patients in primary health care units were randomly divided into two groups: group I, participating of the educational activities and group II that followed the routine treatment. The hypertensive patients from group I realized HBPM at the beginning and the end of the study. White-coat effect was evaluated by the difference between the casual blood pressure measurement and HBPM. The study included 290 hypertensive patients, but realized HBPM 82 hypertensive patients. There was increase in blood pressure control from the beginning to end of study in hypertensive patients from group I (p hypertension control was higher than the casual blood pressure measurement (63% vs 50%). The white coat effect was greater in hipertensive patients from group II.

  20. Gender differences in hypertension control among older korean adults: Korean social life, health, and aging project.

    Science.gov (United States)

    Chu, Sang Hui; Baek, Ji Won; Kim, Eun Sook; Stefani, Katherine M; Lee, Won Joon; Park, Yeong-Ran; Youm, Yoosik; Kim, Hyeon Chang

    2015-01-01

    Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients' attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults. This cross-sectional study analyzed data from 653 Koreans aged ≥60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension. Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one's blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013). This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.

  1. Immediate versus delayed postpartum use of levonorgestrel contraceptive implants: a randomized controlled trial in Uganda.

    Science.gov (United States)

    Averbach, Sarah; Kakaire, Othman; Kayiga, Herbert; Lester, Felicia; Sokoloff, Abby; Byamugisha, Josaphat; Dehlendorf, Christine; Steinauer, Jody

    2017-06-10

    Use of long-acting, highly effective contraception has the potential to improve women's ability to avoid short interpregnancy intervals, which are associated with an increased risk of maternal morbidity and mortality, and preterm delivery. In Uganda, contraceptive implants are not routinely available during the immediate postpartum period. The purpose of this study was to compare the proportion of women using levonorgestrel contraceptive implants at 6 months after delivery in women randomized to immediate or delayed insertion. This was a randomized controlled trial among women in Kampala, Uganda. Women who desired contraceptive implants were randomly assigned to insertion of a 2-rod contraceptive implant system containing 75 mg of levonorgestrel immediately following delivery (within 5 days of delivery and before discharge from the hospital) or delayed insertion (6 weeks postpartum). The primary outcome was implant utilization at 6 months postpartum. From June to October 2015, 205 women were randomized, 103 to the immediate group and 102 to the delayed group. Ninety-three percent completed the 6 month follow-up visit. At 6 months, implant use was higher in the immediate group compared with the delayed group (97% vs 68%; P < .001), as was the use of any highly effective contraceptive (98% vs 81%; P = .001). Women in the immediate group were more satisfied with the timing of implant placement. If given the choice, 81% of women in the immediate group and 63% of women in the delayed group would choose the same timing of placement again (P = .01). There were no serious adverse events in either group. Offering women the option of initiating contraceptive implants in the immediate postpartum period has the potential to increase contraceptive utilization, decrease unwanted pregnancies, prevent short interpregnancy intervals, and help women achieve their reproductive goals. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Control of glomerular hypertension by insulin administration in diabetic rats.

    Science.gov (United States)

    Scholey, J W; Meyer, T W

    1989-01-01

    Micropuncture studies were performed in Munich Wistar rats made diabetic with streptozotocin and in normal control rats. Diabetic rats received daily ultralente insulin to maintain moderate hyperglycemia (approximately 300 mg/dl). Group 1 diabetic rats studied after routine micropuncture preparation exhibited elevation of the single nephron glomerular filtration rate (SNGFR) due to increases in the glomerular transcapillary hydraulic pressure difference and glomerular plasma flow rate. In group 2 diabetic rats infusion of insulin to achieve acute blood glucose control normalized the glomerular transcapillary pressure gradient while increasing the glomerular ultrafiltration coefficient, so that SNGFR remained elevated. Persistent elevation of SNGFR despite normalization of the transcapillary pressure gradient was also observed in group 3 diabetic rats infused with insulin plus sufficient dextrose to maintain hyperglycemia. These studies indicate that glomerular capillary hypertension in diabetes is an acutely reversible consequence of insulin deficiency and not the result of renal hypertrophy. PMID:2649514

  3. Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents.

    Science.gov (United States)

    Melgarejo, Jesus D; Maestre, Gladys E; Thijs, Lutgarde; Asayama, Kei; Boggia, José; Casiglia, Edoardo; Hansen, Tine W; Imai, Yutaka; Jacobs, Lotte; Jeppesen, Jørgen; Kawecka-Jaszcz, Kalina; Kuznetsova, Tatiana; Li, Yan; Malyutina, Sofia; Nikitin, Yuri; Ohkubo, Takayoshi; Stolarz-Skrzypek, Katarzyna; Wang, Ji-Guang; Staessen, Jan A

    2017-07-01

    Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues. © 2017 American Heart Association, Inc.

  4. Hypertension treatment and control in a rural cohort in Thiruvallur, Tamil Nadu, India

    OpenAIRE

    Prabhdeep Kaur; Sudha Ramachandra Rao; Ramachandran Venkatachalam; Kanagasabai Kaliaperumal

    2016-01-01

    Hypertension is a public health problem with low detection and treatment rates in India. We resurveyed 1284 patients with hypertension already identified in baseline survey of the cohort in Thiruvallur district, Tamil Nadu, India. The objective was to estimate the proportion of patients with drug treatment, hypertension control and lifestyle modification at follow-up (median follow-up 27 months). Overall, only 19.9% of the patients took drugs and 45.3% had blood pressure under control. Among ...

  5. Assessment of hypertension levels control and management (hypertension "AUDIT" project). Study in a population of workers.

    Science.gov (United States)

    Carp, C; Enăchescu, D; David, I; Nandriş, G; Calangiu, G; Coman, I; Apetrei, E; Stoian, I; Ginghină, C

    1990-01-01

    The hypertension AUDIT project (WHO) was used for the study of large populations of workers in two Romanian industrial centers, Slatina and Sibiu, constituted into two main groups. The objects of the study were: the detection of new cases of arterial hypertension (AH) and of their proportion as compared with older cases, the assessment of the quality of diagnosis control and treatment methodology as well as the estimation of the patient's attitude regarding the conditions of treatment and of the physician's knowledge and attitude regarding AH. Group I (Slatina) included 22,839 workers and the program was applied in 15,740 randomly chosen subjects. Group II (Sibiu) included 14,874 workers of whom 2,838 were randomly chosen for study. From a total of 606 (6.20%) subjects aged 35 to 64 years with AH in both groups, 494 (81.51%) were older cases and 112 (18.48%) were newly detected. The prevalence of AH was found to increase with age and to be higher in women aged 55 to 64 years. The treatment in older cases from both groups was considered effective in 232 cases (46.96%) (of which 26 (11.2%) with overtreatment) and insufficient in 262 (53%). The reasons alleged by the patients for the late detection of AH were the absence of symptoms and a casual interest for their state of health. The risk factors were systematically checked. Smoking was found in 30.36% of the subjects in group I and in 31% of those in group II. The use of diagnostic laboratory procedures was corresponding to the present recommendations. The nonpharmaceutic therapy was frequently recommended, especially reduction of salt consumption. Besides that, pharmaceutic treatment was indicated in most of the patients (63% in group I and 90% in group II). Diuretics (41.26% in group I and 75% in group II), and beta blocking drugs (35.3% in group I and 70% in group II) were the most frequently administered and in a lesser proportion vasodilators with central or peripheral action, calcium blockers, Rauwolfia and

  6. 75 FR 37295 - Control of Immediate Precursor Used in the Illicit Manufacture of Fentanyl as a Schedule II...

    Science.gov (United States)

    2010-06-29

    ... 812(b). ANPP is the immediate chemical intermediary in the synthesis process currently used by... Enforcement Administration 21 CFR Part 1308 RIN 1117-AB16 Control of Immediate Precursor Used in the Illicit... the precursor chemical, 4-anilino-N-phenethyl-4-piperidine (ANPP) as an immediate precursor for the...

  7. The advantages of combination therapy on hypertension: development of immediate release perindopril-indapamide tablet and assessment of bioequivalence studies.

    Science.gov (United States)

    Ölçer, A; Ölçer, M; İnce, I; Karasulu, E

    2016-03-01

    Hypertension has a major associated risk for organ damage and mortality, which is further heightened in patients with prior cardiovascular events, comorbid diabetes mellitus, microalbuminuria and renal impairment. Convers Plus tablet including perindopril erbumine (PE), which is an angiotensin converting enzyme (ACE) inhibitor, and indapamide, which is diuretic, was designed as a combined tablet to succes in the treatment of hypertension. Physico-pharmaceutical properties and characterization studies were evaluated in vitro conditions. Later on in vivo study was planned as a cross-designed, randomized, open-labeled, single-dose, single-center study via peroral route in 24 healthy male subjects. In this study, bioequivalence with primary pharmacokinetical target parameters reference (Bipreterax 4/1.25 mg Tablet-S.A.Servier Benelux N.V.) and test (Convers Plus 4/1.25 mg Tablet-ARGESAN Pharmaceutical Company) tablets have been found bioequivalent. The results of pharmacokinetic parameters for perindopril, perindoprilat and indapamide were found as Cmax = 23.179 µg/mL, tmax = 0.729 h, t1/2 = 1.429 h; AUC0-t = 26.998 µgs/mL, AUC0-inf = 27.117 µgs/mL; Cmax = 1.834 µg/mL, tmax = 8.792 h, t1/2 = 40.699 h; AUC0-t = 54.828 µgs/mL, AUC0-inf = 77.113 µgs/mL; Cmax = 18.994 µg/mL, tmax = 3.417 h, t1/2 = 16.626 h and AUC0-t = 385.829 µgs/mL, AUC0-inf = 410.728 µgs/mL respectively. In conclusion, physico-pharmaceutical properties and results of clinical trials show that Convers Plus tablets have been found as bioequivalent for perindopril, perindoprilat and indapamide in terms of AUC and Cmax, in 90% confidence limits.

  8. Awareness, treatment and control of hypertension in Nepal: findings from the Dhulikhel Heart Study

    Science.gov (United States)

    Karmacharya, Biraj M; Koju, Rajendra P; LoGerfo, James P; Chan, Kwun Chuen Gary; Mokdad, Ali H; Shrestha, Archana; Sotoodehnia, Nona; Fitzpatrick, Annette L

    2017-01-01

    Objectives Although previous studies have suggested alarming rise in the prevalence of hypertension in Nepal, there is dearth of information on its awareness, treatment and control. In this cross-sectional study, we assessed awareness, treatment and control of hypertension among 298 hypertensive adults from the suburban town of Dhulikhel, Nepal. Methods This cross-sectional study is based on Dhulikhel Heart Study, which included 1073 adults, aged ≥18 years, recruited from randomly selected households. Comprehensive health interviews and blood pressure measurements were completed during home interviews. Hypertensives (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or receiving antihypertensive medication) were further evaluated for awareness, treatment and control of hypertension. Multivariate regression model quantified the association of the sociodemographic characteristics and the cardiovascular disease (CVD) risk factors with hypertension awareness. Differences between sociodemographic characteristics and CVD risk factors with treatment and control of hypertension were tested using χ2 tests. Results A total of 43.6% of all hypertensives (n=298) were aware of their hypertension status. In multivariate analyses, hypertension awareness was associated with increasing age (p<0.001). More than three-fourth (76.1%) of those who were aware of their hypertension status (n=130) were currently on treatment. There were significant differences in treatment status by sex, occupation, age, income quartiles and body mass index. Only 35.3% of those on treatment (n=99) had blood pressure control. Conclusions The levels of awareness, treatment and control of hypertension in this sample of Nepalese adults were low. PMID:28123454

  9. Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran

    Directory of Open Access Journals (Sweden)

    Sayed Fazel Zinat Motlagh

    2015-01-01

    Full Text Available Hypertension is the first and the most common risk factor to diseases such as cardiovascular, stroke, and renal diseases. The aim of this study was to determine the factors relevant to hypertension knowledge, treatment, and control in southern Iran. In this cross-sectional study, conducted in Kohgiluye Boyer-Ahmad province, south of Iran, a total of 1836 hypertension patients were randomly selected to participate voluntarily in the study. Hypertension treatment and its control were defined during study. In addition, knowledge about hypertension was measured by hypertension knowledge level scale (HK-LS. Treatment rates were 75.5 and 37.7 percent for female and male, respectively. Habitat, education, income, family history with hypertension, smoking, and time of diagnosis to the disease were found to be related to the treatment of the disease. Control rates were 30.7 and 31.4 for males and females, respectively. Habitat, education, and time of diagnosis to the disease were related to control. Over 50 percent of patients had average knowledge on hypertension. Considering the low rate of control and knowledge on hypertension among patients, health care providers should reinforce their services to improve appropriate knowledge level among elders and, also, plan comprehensive programs to promote health in order to encourage patients change and reform their life style.

  10. Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran.

    Science.gov (United States)

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Ghafari, Sayed Rashid; Parisay, Zafar; Golabi, Mohamad Reza; Eslami, Ahmad Ali; Babouei, Amin

    2015-01-01

    Hypertension is the first and the most common risk factor to diseases such as cardiovascular, stroke, and renal diseases. The aim of this study was to determine the factors relevant to hypertension knowledge, treatment, and control in southern Iran. In this cross-sectional study, conducted in Kohgiluye Boyer-Ahmad province, south of Iran, a total of 1836 hypertension patients were randomly selected to participate voluntarily in the study. Hypertension treatment and its control were defined during study. In addition, knowledge about hypertension was measured by hypertension knowledge level scale (HK-LS). Treatment rates were 75.5 and 37.7 percent for female and male, respectively. Habitat, education, income, family history with hypertension, smoking, and time of diagnosis to the disease were found to be related to the treatment of the disease. Control rates were 30.7 and 31.4 for males and females, respectively. Habitat, education, and time of diagnosis to the disease were related to control. Over 50 percent of patients had average knowledge on hypertension. Considering the low rate of control and knowledge on hypertension among patients, health care providers should reinforce their services to improve appropriate knowledge level among elders and, also, plan comprehensive programs to promote health in order to encourage patients change and reform their life style.

  11. The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension.

    Science.gov (United States)

    Daugherty, Stacie L; Powers, J David; Magid, David J; Masoudi, Frederick A; Margolis, Karen L; O'Connor, Patrick J; Schmittdiel, Julie A; Ho, P Michael

    2012-08-01

    Patients with resistant hypertension are at risk for poor outcomes. Medication adherence and intensification improve blood pressure (BP) control; however, little is known about these processes or their association with outcomes in resistant hypertension. This retrospective study included patients from 2002 to 2006 with incident hypertension from 2 health systems who developed resistant hypertension or uncontrolled BP despite adherence to ≥3 antihypertensive medications. Patterns of hypertension treatment, medication adherence (percentage of days covered), and treatment intensification (increase in medication class or dose) were described in the year after resistant hypertension identification. Then, the association between medication adherence and intensification with 1-year BP control was assessed controlling for patient characteristics. Of the 3550 patients with resistant hypertension, 49% were male, and mean age was 60 years. One year after resistance hypertension determination, fewer patients were taking diuretics (77.7% versus 92.2%; PTreatment was intensified in 21.6% of visits with elevated BP. Increasing treatment intensity was associated with 1-year BP control (adjusted odds ratio, 1.64 [95% CI, 1.58-1.71]). In this cohort of patients with resistant hypertension, treatment intensification but not medication adherence was significantly associated with 1-year BP control. These findings highlight the need to investigate why patients with uncontrolled BP do not receive treatment intensification.

  12. Evaluation of Pulmonary Hypertension with CMR: Pulmonary Hypertension 
Patients and Healthy Volunteers Control Study

    Directory of Open Access Journals (Sweden)

    Meng WANG

    2016-05-01

    Full Text Available Background and objective The clinical course of pulmonary hypertension (PH is one of progressive deterioration interspersed with episodes of acute decompensation. It is difficult to predict when patients will die because death may come either suddenly or slowly due to progressive heart failure. The aim of this study is to investigate morphology, function and hemodynamics in PH, compared with healthy people, and to investigate the clinical value of detection of PH by use of cardiac magnetic resonance (CMR parameters. Methods CMR was performed in 56 PH patients collected from Tianjin Medical University General Hospital from January 2012 to December 2014 and 22 healthy controls. The following parameters were calculated: right ventricle (RV end-diastolic volume (EDV, end-systolic volume (ESV, ejection fraction (EF, myocardial mass (MM, RV fractional area change (RVFAC, interventricular septal curvature (CIVS, left ventricular free wall curvature (CFW, and CIVS/CFW, main pulmonary artery (MPA positive peak velocity, maximal area, minimal area and distensibility. Comparisons of CMR measurements between PH patients and controls were analyzed by using the student t-tests. Receiver operating characteristic (ROC curve analysis was used to compare the PH diagnostic abilities for four parameters (MPA positive peak velocity, distensibility, curvature ratio, and RVFAC and combined CMR parameter. P<0.05 was considered significant. Results Compared with healthy controls, RV morphology, function and hemodynamics of PH group declined and deteriorate obviously. The ROC curve analysis showed that among the four parameters distensibility of MPA had the highest AUC value (AUC=0.95. Additionally, combined CMR parameter (positive peak velocity+distensibility+curvature ratio+RVFAC had even higher AUC (AUC=0.988. Conclusion Comprehensive CMR parameters is conducive to accurately reflect the overall state RV-pulmonary circulation in patients with PH.

  13. Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease

    Science.gov (United States)

    Appel, Lawrence J.; Wright, Jackson T.; Greene, Tom; Agodoa, Lawrence Y.; Astor, Brad C.; Bakris, George L.; Cleveland, William H.; Charleston, Jeanne; Contreras, Gabriel; Faulkner, Marquetta L.; Gabbai, Francis B.; Gassman, Jennifer J.; Hebert, Lee A.; Jamerson, Kenneth A.; Kopple, Joel D.; Kusek, John W.; Lash, James P.; Lea, Janice P.; Lewis, Julia B.; Lipkowitz, Michael S.; Massry, Shaul G.; Miller, Edgar R.; Norris, Keith; Phillips, Robert A.; Pogue, Velvie A.; Randall, Otelio S.; Rostand, Stephen G.; Smogorzewski, Miroslaw J.; Toto, Robert D.; Wang, Xuelei

    2013-01-01

    BACKGROUND In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients. METHODS We randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years. RESULTS During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard-control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; P = 0.27). However, the effects differed according to the baseline level of proteinuria (P = 0.02 for interaction), with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; P = 0.01). CONCLUSIONS In overall analyses, intensive blood-pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, and others.) PMID:20818902

  14. Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension

    NARCIS (Netherlands)

    R. Anchala (Raghupathy); N.K. Kannuri (Nanda); H. Pant (Hira); H. Khan (Hassan); O.H. Franco (Oscar); E. di Angelantonio (Emanuele); D. Prabhakaran (Dorairaj)

    2014-01-01

    textabstractBackground: A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before. Methods: Medline, Web of Science, and Scopus database

  15. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)

    Science.gov (United States)

    von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Helewa, Michael; Hutton, Eileen; Koren, Gideon; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G.; Moutquin, Jean-Marie

    2016-01-01

    To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. Clinical Trial Registration— URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN

  16. Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey

    Directory of Open Access Journals (Sweden)

    Abdalla A. Saeed

    2011-01-01

    Full Text Available This cross-sectional study aimed at estimating prevalence, awareness, treatment, control, and predictors of hypertension among Saudi adult population. Multistage stratified sampling was used to select 4758 adult participants. Three blood pressure measurements using an automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled. Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In conclusion prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension.

  17. Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial.

    Science.gov (United States)

    Turok, David K; Leeman, Lawrence; Sanders, Jessica N; Thaxton, Lauren; Eggebroten, Jennifer L; Yonke, Nicole; Bullock, Holly; Singh, Rameet; Gawron, Lori M; Espey, Eve

    2017-08-23

    Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery <37.0 weeks' gestational age, chorioamnionitis, postpartum hemorrhage, contraindications to levonorgestrel intrauterine device insertion, and medical complications of pregnancy that could affect breast-feeding. We conducted per-protocol analysis as the primary approach, as it is considered the standard for noninferiority studies; we also report the alternative intent-to-treat analysis. We powered the study for the primary outcome, breast-feeding continuation at 8 weeks, to detect a 15% noninferiority margin between groups, requiring 132 participants in each arm. The secondary study outcome, time to lactogenesis, used a validated measure, and was analyzed by survival analysis and log rank test. We followed up participants for ongoing data collection for 6 months. Only the data analysis team was blinded to the intervention. We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate

  18. The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients

    OpenAIRE

    Aziz Kamran; Ali Akbar Shekarchi; Elham Sharifian; Heshmatolah Heydari

    2016-01-01

    Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Arda...

  19. Control of oxidative stress in microcirculation of spontaneously hypertensive rats.

    Science.gov (United States)

    DeLano, F A; Balete, R; Schmid-Schönbein, G W

    2005-02-01

    One mechanism for organ damage in individuals with arterial hypertension may be due to oxygen free radical production. This study was designed to localize free radicals in a microvascular network of mature spontaneously hypertensive rats (SHRs) and normotensive Wistar-Kyoto (WKY) rats. Because glucocorticoids play a role in pressure elevation of SHRs, we investigated their role in microvascular free radical formation. Oxygen radical production in mesentery was detected by tetranitroblue tetrazolium reduction to formazan aided by digital light-absorption measurements. Formazan deposits were observed in the endothelial cells and lumens of all microvessels and in lymphatic endothelia but were fewer in tissue parenchyma. The formazan distribution in younger (14-16 wk old) WKY rats and SHRs was heterogeneous with low values in capillaries and small arterioles/venules (formazan density in SHRs to the level of WKY rats, whereas dexamethasone supplementation of the adrenalectomized rats caused elevation in the larger venules of SHRs. In older (40 wk old) SHRs, formazan levels were elevated in all hierarchies of microvessels. After pressure reduction was employed with chronic hydralazine treatment, the formazan deposits were reduced in all locations of the microcirculation in both WKY rats and SHRs. Elevated formazan deposits were also found in lymphatic endothelium. These results suggest that oxygen free radical production is elevated in both high- and low-pressure regions of SHR microcirculation via a process that is controlled by glucocorticoids. Older SHRs have higher formazan levels than younger SHRs in all microvessels. Chronic hydralazine treatment, which serves to reduce arterial blood pressure, attenuates tetranitroblue tetrazolium reduction in WKY rats and SHRs even in venules of the microcirculation, which has no micropressure elevation. Free radical production may be a more global condition in SHRs and may not be limited to arteries and arterioles.

  20. Improving Hypertension Control in Diabetes Mellitus The Effects of Collaborative and Proactive Health Communication

    Science.gov (United States)

    Naik, Aanand D.; Kallen, Michael A.; Walder, Annette; Street, Richard L.

    2013-01-01

    Background Communication between patients and clinicians using collaborative goals and treatment plans may overcome barriers to achieving hypertension control in routine diabetes mellitus care. We assessed the interrelation of patient–clinician communication factors to determine their independent associations with hypertension control in diabetes care. Methods and Results We identified 566 older adults with diabetes mellitus and hypertension at the DeBakey VA Medical Center in Houston, Tex. Clinical and pharmacy data were collected, and a patient questionnaire was sent to all participants. A total of 212 individuals returned surveys. Logistic regression analyses were performed to assess the effect of patient characteristics, self-management behaviors, and communication factors on hypertension control. Three communication factors had significant associations with hypertension control. Two factors, patients' endorsement of a shared decision-making style (odds ratio 1.61, 95% confidence interval 1.01 to 2.57) and proactive communication with one's clinician about abnormal results of blood pressure self-monitoring (odds ratio 1.89, 95% confidence interval 1.10 to 3.26), had direct, independent associations in multivariate regression. Path analysis was used to investigate the direct and indirect effects of communication factors and hypertension control. Decision-making style (β=0.20, P<0.01) and proactive communication (β=0.50, P<0.0001) again demonstrated direct effects on hypertension control. A third factor, clinicians' use of collaborative communication when setting treatment goals, had a total effect on hypertension control of 0.16 (P<0.05) through its direct effects on decision-making style (β=0.28, P<0.001) and proactive communication (β=0.22, P<0.01). Conclusions Three communication factors were found to have significant associations with hypertension control. Patient–clinician communication that facilitates collaborative blood pressure goals and

  1. The prevalence, awareness and control rate of hypertension among elderly in northwest of Iran

    Science.gov (United States)

    Ghaffari, Samad; Pourafkari, Leili; Tajlil, Arezou; Sahebihagh, Mohammad Hassan; Mohammadpoorasl, Asghar; Tabrizi, Jafar Sadegh; Nader, Nader D; Azizi Zeinalhajlou, Akbar

    2016-01-01

    Introduction: Adequate treatment of hypertension is infrequent in older patients. Determining the prevalence of hypertension in older patients, identifying the pattern of the treatment in this age group and evaluating their awareness of the disease may help healthcare systems to devise appropriate programs for controlling the disease. Methods: This descriptive cross sectional study included a sample from population of Tabriz, a large city in North-West of Iran, who were 60 years or older. Data collection and blood pressure measurements were conducted in the households of the participants from 1st June 2015 through 1st August 2015. Hypertension was defined as systolic and/or diastolic blood pressure (DBP) ≥150/90 mm Hg or receiving anti-hypertensive medications. Prevalence and determinants of hypertension, awareness of patients about their diagnosis and prevalence of treatment and adequately controlled blood pressure were determined. Results: The prevalence of hypertension was 68.0%. Among hypertensive patients 81.8% were aware of their diagnosis, 78.0% were receiving antihypertensive medications. Among treated patients, 46.2% were adequately controlled. In univariate analysis, prevalence of hypertension was significantly higher in women (74.0% vs. 60.7%, P < 0.001). Women were more likely to be aware of diagnosis and to receive antihypertensive medications; however, the prevalence of adequately controlled blood pressure was similar in treated men and women. Among included variables in logistic regression analysis, older age, lower number of family members in household, cardiac diseases, being on low salt low fat diet, higher Body mass index (BMI) and not being educated were independently associated with having hypertension. Conclusion: Hypertension is highly prevalent among older population of Tabriz. Despite high rate of treatment, the rates of control are relatively low, indicating a demand for prevention and better management of hypertension in older

  2. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial.

    Science.gov (United States)

    Beselga, Carlos; Neto, Francisco; Alburquerque-Sendín, Francisco; Hall, Toby; Oliveira-Campelo, Natália

    2016-04-01

    Mobilization with movement (MWM) has been shown to reduce pain, increase range of motion (ROM) and physical function in a range of different musculoskeletal disorders. Despite this evidence, there is a lack of studies evaluating the effects of MWM for hip osteoarthritis (OA). To determine the immediate effects of MWM on pain, ROM and functional performance in patients with hip OA. Randomized controlled trial with immediate follow-up. Forty consenting patients (mean age 78 ± 6 years; 54% female) satisfied the eligibility criteria. All participants completed the study. Two forms of MWM techniques (n = 20) or a simulated MWM (sham) (n = 20) were applied. pain recorded by numerical rating scale (NRS). hip flexion and internal rotation ROM, and physical performance (timed up and go, sit to stand, and 40 m self placed walk test) were assessed before and after the intervention. For the MWM group, pain decreased by 2 points on the NRS, hip flexion increased by 12.2°, internal rotation by 4.4°, and functional tests were also improved with clinically relevant effects following the MWM. There were no significant changes in the sham group for any outcome variable. Pain, hip flexion ROM and physical performance immediately improved after the application of MWM in elderly patients suffering hip OA. The observed immediate changes were of clinical relevance. Future studies are required to determine the long-term effects of this intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Multimorbidity and blood pressure control in 37 651 hypertensive patients from Danish general practice

    DEFF Research Database (Denmark)

    Paulsen, Maja Skov; Andersen, Morten; Thomsen, Janus L

    2013-01-01

    Patients with hypertension are primarily treated in general practice. However, major studies of patients with hypertension are rarely based on populations from primary care. Knowledge of blood pressure (BP) control rates in patients with diabetes and/or cardiovascular diseases (CVDs), who have...

  4. Management of Hypertension in Private Practice: A Randomized Controlled Trial in Continuing Medical Education.

    Science.gov (United States)

    Gullion, David S.; And Others

    1988-01-01

    A randomized control trial was used to evaluate a physician education program designed to improve physician management of patients' hypertension, hypertension-related behaviors, and diastolic blood pressure. It was suggested that more intensive continuing medical education programs are needed to improve physician performance and patient outcome.…

  5. Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents

    DEFF Research Database (Denmark)

    Melgarejo, Jesus D.; Maestre, Gladys E; Thijs, Lutgarde

    2017-01-01

    Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10...

  6. Hypertension guidelines: Evidence-based treatments for maintaining blood pressure control.

    Science.gov (United States)

    Davis, Leslie Louise

    2015-06-11

    Approximately one in three adults in the United States has hypertension. This article provides an update on the latest JNC-8 guideline for treating hypertension in adults. Emphasis is placed on new and updated information and implications for primary care clinicians to help patients achieve and maintain better blood pressure control.

  7. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results

    Institute of Scientific and Technical Information of China (English)

    ZHANG Cao-jin; HUANG Yi-gao; HUANG Xin-sheng; HUANG Tao; HUANG Wen-hui; XIA Chun-li; MO Yu-jing

    2012-01-01

    Background Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA.This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults.Methods After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH,transcatheter closure of PDA was performed.Patients were followed up clinically and echocardiographically at 24 hours,1 month,3months,6 months,12 months and 24 months after occlusion.Results Twenty-nine patients had successful occlusion,pulmonary artery pressure (PAP),left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106±25) mmHg vs.(50±14) mmHg,P <0.01; (63.7±7.2)% vs.(51.4±10.1)%,P <0.01 and (36.9±8.2)% vs.(28.9±8.6)%,P <0.05,respectively).At 1 month after PDA closure,the signs and symptoms improved markedly in all 29 patients,and PDAs were completely closed and remained closed during the follow-up.Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion.Nine patients whose pulmonary vascular resistence (PVR) >6 Wood units accepted targeted PAH therapy.After 1 to 3 months of peroral drug therapy,their exercise tolerance improved from New York Heart Association (NYHA) class Ⅲ-Ⅳ to NYHA class Ⅰ.During follow-up,no latent arrhythmias were found,the left atrial diameter (LAD),left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P <0.05),and FS and LVEF recovered compared to the immediate postclosure state.However,FS and LVEF remained low compared to the preclosure state.Conclusions Transcatheter closure

  8. Health Insurance Coverage and Hypertension Control in China: Results from the China Health and Nutrition Survey.

    Science.gov (United States)

    Liao, Yi; Gilmour, Stuart; Shibuya, Kenji

    2016-01-01

    China has rapidly expanded health insurance coverage over the past decade but its impact on hypertension control is not well known. We analyzed factors associated with hypertension and the impact of health insurance on the management of hypertension in China from 1991 to 2009. We used individual-level data from the China Health and Nutrition Survey (CHNS) for blood pressure, BMI, and other socio-economic variables. We employed multi-level logistic regression models to estimate the factors associated with prevalence and management of hypertension. We also estimated the effects of health insurance on management of hypertension using propensity score matching. We found that prevalence of hypertension increased from 23.8% (95% CI: 22.5-25.1%) in 1991 to 31.5% (28.5-34.7%) in 2009. The proportion of hypertensive patients aware of their condition increased from 31.7% (28.7-34.9%) to 51.1% (45.1-57.0%). The proportion of diagnosed hypertensive patients in treatment increased by 35.5% in the 19 years, while the proportion of those in treatment with controlled blood pressure remained low. Among diagnosed hypertensives, health insurance increased the probability of receiving treatment by 28.7% (95% CI: 10.6-46.7%) compared to propensity-matched individuals not covered by health insurance. Hypertension continues to be a major health threat in China and effective control has not improved over time despite large improvements in awareness and treatment access. This suggests problems in treatment quality, medication adherence and patient understanding of the condition. Improvements in hypertension management, quality of medical care for those at high risk, and better health insurance packages are needed.

  9. [Acupuncture in fibromyalgia: a randomized, controlled study addressing the immediate pain response].

    Science.gov (United States)

    Stival, Rebecca Saray Marchesini; Cavalheiro, Patrícia Rechetello; Stasiak, Camila Edith Stachera; Galdino, Dayana Talita; Hoekstra, Bianca Eliza; Schafranski, Marcelo Derbli

    2014-01-01

    To evaluate the efficacy of acupuncture in the treatment of fibromyalgia, considering the immediate response of the visual analogue pain scale (VAS) as its primary outcome. Randomized, controlled, double-blind study including 36 patients with fibromyalgia (ACR 1990) selected from the outpatient rheumatology clinic, Santa Casa de Misericórdia, Ponta Grossa, PR. Twenty-one patients underwent an acupuncture session, under the principles of the traditional Chinese medicine, and 15 patients underwent a placebo procedure (sham acupuncture). For pain assessment, the subjects completed a Visual Analogue Scale (VAS) before and immediately after the proposed procedure. The mean change in VAS was compared among groups. The variation between the final and initial VAS values was -4.36±3.23 (P=0.0001) in the treatment group and -1.70±1.55 in the control group (P=0.06). The difference in terms of amplitude of variation of VAS (initial - final VAS) among groups favored the actual procedure (P=0.005). The effect size (ES) for the treatment group was d=1.7, which is considered a large effect. Although small, the statistical power of the sample for these results was very relevant (94.8%). Acupuncture has proven effective in the immediate pain reduction in patients with fibromyalgia, with a quite significant effect size. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  10. Effects of maternal hypertension on the neonatal haemogram in southern Nigeria: A case-control study.

    Science.gov (United States)

    Okoye, Helen C; Eweputanna, Lisa I; Korubo, Kaladada I; Ejele, Oseikhuemen A

    2016-12-01

    Hypertension in pregnancy is a leading cause of maternal and neonatal morbidity and mortality. This study aimed to compare the hematological parameters in neonates of hypertensive mothers with those of normotensive mothers, and also to compare the incidence of polycythaemia, neutropenia and thrombocytopenia in both groups. This was a hospital-based case control study. Three milliliters of cord blood from neonates of women with hypertension in pregnancy and those of normotensive pregnant women were sampled for haemogram parameters using a 3-part autoanalyser. Haematocrit and white blood cell differentials were done manually. Data were analysed using SPSS version 16. A total of 200 neonates were recruited, comprising 100 neonates of mothers with hypertensive disorders of pregnancy and 100 neonates of normotensive mothers. The mean haematocrit was significantly higher in neonates of hypertensive mothers than those of normotensive mothers. The neutrophil and platelet counts of neonates of hypertensive mothers were significantly lower than those of normotensive mothers. The incidences of polycythaemia, neutropenia, and thrombocytopenia were found to be 8%, 15%, and 38% among neonates of hypertensive mothers and 0%, 2%, and 8% among neonates of normotensive mothers, respectively. These incidences were significantly different between the groups. There was a positive association between hypertension in pregnancy and neonatal polycythaemia, neutropenia, and thrombocytopenia. Haematological parameters of neonates of mothers with hypertension in pregnancy should be properly evaluated and monitored to reduce the chances of developing complications associated with these abnormalities.

  11. Safety of placebo controls in pediatric hypertension trials.

    Science.gov (United States)

    Smith, P Brian; Li, Jennifer S; Murphy, M Dianne; Califf, Robert M; Benjamin, Daniel K

    2008-04-01

    Many clinical trials, including those in pediatric populations, use a placebo arm for medical conditions for which there are readily available therapeutic interventions. Several short-term efficacy trials of antihypertensive medications performed in response to Food and Drug Administration-issued written requests have used a placebo arm; whether the use of a placebo arm is safe in children with hypertension is unknown. We sought to define the rates of adverse events in 10 short-term antihypertensive trials to determine whether these trials resulted in increased risk to pediatric patients receiving placebo. We combined patient-level data from 10 antihypertensive efficacy trials performed in pediatric patients that were submitted to the Food and Drug Administration from 1998 to 2005. We determined the number and type of all of the adverse events reported during the placebo-controlled portion of the clinical trials and compared these numbers between the patients who received placebo and those who received active drug. Among the 1707 children in the 10 studies, we observed no differences in the rates of adverse events reported between the patients who received placebo and those who received active drug. Only 5 patients suffered a serious adverse event during the trials; none were thought by the investigators to be related to study drug, and only 1 occurred in a patient receiving placebo. Short-term exposure to placebo in pediatric trials of antihypertensive medications appears to be safe.

  12. Hyperventilation Therapy for Control of Posttraumatic Intracranial Hypertension

    Directory of Open Access Journals (Sweden)

    Daniel Agustín Godoy

    2017-07-01

    Full Text Available During traumatic brain injury, intracranial hypertension (ICH can become a life-threatening condition if it is not managed quickly and adequately. Physicians use therapeutic hyperventilation to reduce elevated intracranial pressure (ICP by manipulating autoregulatory functions connected to cerebrovascular CO2 reactivity. Inducing hypocapnia via hyperventilation reduces the partial pressure of arterial carbon dioxide (PaCO2, which incites vasoconstriction in the cerebral resistance arterioles. This constriction decrease cerebral blood flow, which reduces cerebral blood volume and, ultimately, decreases the patient’s ICP. The effects of therapeutic hyperventilation (HV are transient, but the risks accompanying these changes in cerebral and systemic physiology must be carefully considered before the treatment can be deemed advisable. The most prominent criticism of this approach is the cited possibility of developing cerebral ischemia and tissue hypoxia. While it is true that certain measures, such as cerebral oxygenation monitoring, are needed to mitigate these dangerous conditions, using available evidence of potential poor outcomes associated with HV as justification to dismiss the implementation of therapeutic HV is debatable and remains a controversial subject among physicians. This review highlights various issues surrounding the use of HV as a means of controlling posttraumatic ICH, including indications for treatment, potential risks, and benefits, and a discussion of what techniques can be implemented to avoid adverse complications.

  13. Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients

    Institute of Scientific and Technical Information of China (English)

    ZHENG Ying; CAI Guang-yan; CHEN Xiang-mei; FU Ping; CHEN Jiang-hua; DING Xiao-qiang; YU Xue-qing

    2013-01-01

    Background Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited.The aim of the present study was to investigate the prevalence,awareness,treatment,and control of hypertension in the non-dialysis CKD patients through a nationwide,multicenter study in China.Methods The survey was performed in 61 tertiary hospitals in 31 provinces,municipalities,and autonomous regions in China (except Hong Kong,Macao,and Taiwan).Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol.Hypertension was defned as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg,and/or use of antihypertensive medications.BP <140/90 mmHg and <130/80 mmHg were used as the 2 thresholds of hypertension control.In multivariate logistic regression with adjustment for sex and age,we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.Results The analysis included 8927 non-dialysis CKD patients.The prevalence,awareness,and treatment of hypertension in non-dialysis CKD patients were 67.3%,85.8%,and 81.0%,respectively.Of hypertensive CKD patients,33.1% and 14.1% had controlled BP to <140/90 mmHg and <130/80 mmHg,respectively.With successive CKD stages,the prevalence of hypertension in non-dialysis CKD patients increased,but the control of hypertension decreased (P<0.001).When the threshold of BP <130/80 mmHg was considered,the risk of uncontrolled hypertension in CKD 2,3a,3b,4,and 5 stages increased 1.3,1.4,1.4,2.5,and 4.0 times compared with CKD 1 stage,respectively (P<0.05).Using the threshold of <140/90 mmHg,the risk of uncontrolled hypertension increased in advanced stages (P<0.05).Conclusions The prevalence of hypertension Chinese non-dialysis CKD patients was high,and the hypertension control was suboptimal.With successive CKD stages,the risk of uncontrolled hypertension increased.

  14. [Status of prevalence, awareness, treatment and controll on hypertension among adults in 10 regions, China].

    Science.gov (United States)

    Guo, Jie; Yu, Canqing; Lyu, Jun; Guo, Yu; Bian, Zheng; Zhou, Huiyan; Tan, Yunlong; Pei, Pei; Chen, Junshi; Chen, Zhengming; Li, Liming

    2016-04-01

    To describe the status of prevalence, awareness, treatment, and control of hypertension among half a million adults in 10 regions under the China Kadoorie Biobank (CKB) cohort. The baseline survey of CKB was performed in 10 areas across China during 2004-2008, included 512 891 adults aged from 30 to 79 years. Regional differences of prevalence, awareness, treatment and control of hypertension were compared after adjustment for age and/or sex. The overall prevalence of hypertension from the CKB was 35.2% (180 612/512 891), with the highest as 44.4% in Zhejiang and the lowest as 22.0% in Haikou. Prevalence in the rural areas (35.1%) was higher than that in the urban areas (32.1%), with statistical significance (Phypertension, 59 703 (33.1%) were aware of hypertension, 65 172 (36.1%) were receiving anti-hypertension treatment and 22 329 (12.4%) were under controll. However, only a small part of those receiving treatment were under controll (30.5%, 19 884/65 172) in this study. The control of hypertension and of those receiving treatment were higher in Suzhou for males (17.4%, 39.1%), while were higher in Liuzhou for females (23.5%, 42.6%) than those in other regions. Participants under the CKB presented relatively high prevalence of hypertension, but lower rates on awareness, treatment and control of hypertension. Distribution of awareness, treatment, and control of hypertension varied greatly among the ten areas, under the CKB.

  15. Certain modifiable risk factors in essential hypertension: a case-control study

    Directory of Open Access Journals (Sweden)

    Sunil M. Sagare, S. S. Rajderkar B. S. Girigosavi

    2011-01-01

    Full Text Available Essential hypertension accounts for 90% of all cases of hypertension. Though it is a one of major risk factors for cardiovascular diseases, it is a condition with its own risk factors. Overall prevalence of hypertension is increasing over the years in India (from 3.57% in 1977 to 20-30% after 1995. Considering the public health importance of ‘Essential Hypertension’ the present study was conducted. The objective was to study role of certain risk factors in essential hypertension. A case control study was conducted in rural township of Tasgaon; in Sangli district of Maharashtra during 2001-2002, to study role of certain modifiable risk factors in essential hypertension in 21-60 years age group. 165 cases of essential hypertension were selected by systematic random sampling from two private hospitals & O.P.D. of RHTC, Tasgaon and 330, age & sex matched controls were selected in the ratio of 1:2. A significant association was found between essential hypertension and various risk factors including smoking, its frequency and duration, alcoholic status, leisure time physical inactivity, restless sleep, BMI, mental stress, mixed diet and salt intake. Smoking of more than 10 cigarettes or bidi had 3.23 times risk of developing hypertension than smoking up to 10 cigarettes or bidi.

  16. Prevalence, awareness, treatment and control of coexistence of diabetes and hypertension in thai population.

    Science.gov (United States)

    Tiptaradol, Siriwat; Aekplakorn, Wichai

    2012-01-01

    Diabetes and hypertension are major independent risk factors for cardiovascular and renal diseases; however, prevalence and characteristics of the coexistence in general population is not clear. Data from Thai National Health Examination Survey III were used to estimate the prevalence of coexistence of diabetes and hypertension, and to estimate the proportion of awareness, treatment and control of both conditions. A total of 36,877 (male 17,614 and female 19,263) participants were included in the study. The prevalence of people with diabetes and hypertension was 3.2% (male 2.8% and female 3.6%). Approximately half of the diabetes patients (49.0%, 95%CI 45.6, 52.5) had hypertension, and 14.4% (95%CI 13.0, 16.0) of hypertensive patients had diabetes. After controlling for covariates, factors associated with coexistence of diabetes and hypertension included; age ≥60 years (adjust odds ratio 1.38, 95%CI 1.14, 1.73), having education less than 6 years (1.83, 95%CI 1.03, 3.38) and abdominal obesity (2.49, 95%CI 2.00, 3.10). More than 80% were unaware of having both conditions. Target for control of both glucose and blood pressure among those treated was achieved in only 6.2%. In conclusion, patients with diabetes or hypertension should be promoted to have weight control and screening for the comorbidity.

  17. Prevalence, Awareness, Treatment and Control of Coexistence of Diabetes and Hypertension in Thai Population

    Directory of Open Access Journals (Sweden)

    Siriwat Tiptaradol

    2012-01-01

    Full Text Available Diabetes and hypertension are major independent risk factors for cardiovascular and renal diseases; however, prevalence and characteristics of the coexistence in general population is not clear. Data from Thai National Health Examination Survey III were used to estimate the prevalence of coexistence of diabetes and hypertension, and to estimate the proportion of awareness, treatment and control of both conditions. A total of 36,877 (male 17,614 and female 19,263 participants were included in the study. The prevalence of people with diabetes and hypertension was 3.2% (male 2.8% and female 3.6%. Approximately half of the diabetes patients (49.0%, 95%CI 45.6, 52.5 had hypertension, and 14.4% (95%CI 13.0, 16.0 of hypertensive patients had diabetes. After controlling for covariates, factors associated with coexistence of diabetes and hypertension included; age ≥60 years (adjust odds ratio 1.38, 95%CI 1.14, 1.73, having education less than 6 years (1.83, 95%CI 1.03, 3.38 and abdominal obesity (2.49, 95%CI 2.00, 3.10. More than 80% were unaware of having both conditions. Target for control of both glucose and blood pressure among those treated was achieved in only 6.2%. In conclusion, patients with diabetes or hypertension should be promoted to have weight control and screening for the comorbidity.

  18. Effects of nitroglycerin ointment on mastectomy flap necrosis in immediate breast reconstruction: a randomized controlled trial.

    Science.gov (United States)

    Gdalevitch, Perry; Van Laeken, Nancy; Bahng, Seokjae; Ho, Adelyn; Bovill, Esta; Lennox, Peter; Brasher, Penelope; Macadam, Sheina

    2015-06-01

    Mastectomy flap necrosis is a common complication of immediate breast reconstruction that impacts recovery time and reconstructive success. Nitroglycerin ointment is a topical vasodilator that has been shown to improve skin flap survival in an animal model. The objective of this study was to evaluate whether the application of nitroglycerin ointment to the breast skin after mastectomy and immediate reconstruction causes a decrease in the rate of mastectomy flap necrosis compared with placebo. This study was conducted as a randomized controlled trial and included patients aged 21 to 69 years undergoing mastectomy and immediate breast reconstruction at the University of British Columbia-affiliated hospitals (Vancouver, British Columbia, Canada). Patients with a medical history that precluded the administration of nitroglycerin were excluded from the study. The target sample size was 400 patients. Nitroglycerin ointment (45 mg) or a placebo was applied to the mastectomy skin at the time of surgical dressing. The trial was stopped at the first interim analysis after 165 patients had been randomized (85 to the treatment group and 80 to the placebo group). Mastectomy flap necrosis developed in 27 patients (33.8 percent) receiving placebo and in 13 patients (15.3 percent) receiving nitroglycerin ointment; the between-group difference was 18.5 percent (p = 0.006; 95 percent CI, 5.3 to 31.0 percent). Postoperative complications were similar in both groups [nitroglycerin, 22.4 percent (19 of 85); placebo, 28.8 percent (23 of 80)]. In patients undergoing mastectomy and immediate reconstruction, there was a marked reduction in mastectomy flap necrosis in patients who received nitroglycerin ointment. Nitroglycerin ointment application is a simple, safe, and effective way to help prevent mastectomy flap necrosis. Therapeutic, I.

  19. Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Jean Kaboré

    2017-03-01

    Discussion: CKD does not appear to amplify the risk of stroke and coronary events associated with aTRH in this older population. The reasons for excess cardiovascular mortality from other causes associated with controlled hypertension require further study.

  20. Safety of Temporary Discontinuation of Antihypertensive Medication in Patients with Difficult-to-Control Hypertension

    NARCIS (Netherlands)

    Beeftink, Martine M.A.; Van Der Sande, Nicolette G.C.; Bots, Michiel L.; Doevendans, Pieter A.; Blankestijn, Peter J.; Visseren, Frank L.J.; Voskuil, Michiel; Spiering, Wilko

    2017-01-01

    Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of

  1. Self-control and the effects of movie alcohol portrayals on immediate alcohol consumption in male college students

    NARCIS (Netherlands)

    Koordeman, R.; Anschutz, D.J.; Engels, R.C.M.E.

    2015-01-01

    Background: In movies, alcohol-related cues are frequently depicted and there is evidence for a link between movie alcohol cues and immediate alcohol consumption. Less is known about factors influencing immediate effects movie alcohol exposure on drinking. The exertion of self-control is thought to

  2. Self-control and the effects of movie alcohol portrayals on immediate alcohol consumption in male college students

    NARCIS (Netherlands)

    Koordeman, R.; Anschutz, D.J.; Engels, R.C.M.E.

    2015-01-01

    Background: In movies, alcohol-related cues are frequently depicted and there is evidence for a link between movie alcohol cues and immediate alcohol consumption. Less is known about factors influencing immediate effects movie alcohol exposure on drinking. The exertion of self-control is thought to

  3. The counseling african americans to control hypertension (caatch) trial: baseline demographic, clinical, psychosocial, and behavioral characteristics

    OpenAIRE

    Diaz-Gloster Marleny; Cassells Andrea; Tobin Jonathan N; Fernandez Senaida; Kalida Chamanara; Ogedegbe Gbenga

    2011-01-01

    Abstract Background Effectiveness of combined physician and patient-level interventions for blood pressure (BP) control in low-income, hypertensive African Americans with multiple co-morbid conditions remains largely untested in community-based primary care practices. Demographic, clinical, psychosocial, and behavioral characteristics of participants in the Counseling African American to Control Hypertension (CAATCH) Trial are described. CAATCH evaluates the effectiveness of a multi-level, mu...

  4. Prevalence, Risk Factors, Awareness, and Treatment and Control of Hypertension in Mafia Island, Tanzania

    Directory of Open Access Journals (Sweden)

    M. S. Muhamedhussein

    2016-01-01

    Full Text Available Introduction. The prevalence of hypertension in Africa ranges from 29.7% in Cameroon to 47% in South Africa. Only 10% receive treatment in Cameroon while 32% are on medications in Ghana. Control rates vary from 0.4% to 16.8%. This study was done to assess prevalence, risk factors, awareness, treatment, and control of hypertension in Mafia Island, Tanzania, which has never been documented before, so that necessary interventions can be undertaken accordingly. Methodology. Data was collected through questionnaires and anthropometric measurements were taken. Descriptive statistics were done and potential correlations were analyzed. Results. Out of 570 adults who were included in the study, 154 (27% were aged 41–50 and the male-to-female ratio was 1 : 1.05. Almost half (49.5% of the participants fit into the criteria of hypertension. Out of the 118 participants who were aware of having hypertension, 68 (57.6% were currently taking medication. From those taking medication, only 14 (20.6% had controlled hypertension. Conclusion. This study tried to show the extent of hypertension and find out risk factors which could explain the high prevalence of hypertension. This is very alarming and a dire need to raise awareness through health education, availability of screening, and treating and follow-up should be given priority.

  5. Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context.

    Science.gov (United States)

    Morenoff, Jeffrey D; House, James S; Hansen, Ben B; Williams, David R; Kaplan, George A; Hunte, Haslyn E

    2007-11-01

    The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension.

  6. Blood pressure control in resistant hypertension: new therapeutic options.

    Science.gov (United States)

    Grassi, Guido; Quarti-Trevano, Fosca; Brambilla, Gianmaria; Seravalle, Gino

    2010-11-01

    Resistant hypertension, namely the hypertensive state characterized by the inability of multiple antihypertensive drug interventions to lower blood pressure to goal levels, represents a condition frequently detected in clinical practice. Its main features are represented by its heterogeneous etiology as well as its very high cardiovascular risk. This latter peculiarity has implemented the research for new approaches to the treatment of the disease. This article will focus on two of them, namely carotid baroreceptor electric stimulation and the renal denervation procedure. Clinical studies and large-scale clinical trials are presently ongoing with the aim of defining the long-term efficacy and safety profile of the two interventions.

  7. The Growing Gap in Hypertension Control Between Insured and Uninsured Adults: NHANES 1988–2010

    Science.gov (United States)

    Egan, Brent M.; Li, Jiexiang; Small, James; Nietert, Paul J.; Sinopoli, Angelo

    2015-01-01

    Hypertension awareness, treatment and control are lower among uninsured than insured adults. Time trends in differences and underlying modifiable factors are important for informing strategies to improve health equity. National Health and Nutrition Examination Surveys 1988–1994, 1999–2004, 2005–2010 data in adults 18–64 years were analyzed to explore this opportunity. The proportion of adults with hypertension who were uninsured increased from 12.3% in 1988–1994 to 17.4% in 2005–2010. In 1988–1994, hypertension awareness, treatment and control to adults. By 2005–2010, the absolute gap in hypertension control between uninsured and insured adults of 21.9% (52.5% versus 30.6%, padults treated (75.2% versus 88.5%,and fewer treated adults controlled (63.1% versus 73.5% [all padults had similar income. Yet, hypertension control was similar across time periods in publicly and privately insured adults, despite lower income and education in the former. In multivariable analysis, hypertension control in 2005–2010 was associated with visit frequency (odds ratio 3.4, 95% confidence interval [2.4–4.8]), statin therapy (1.8 [1.4–2.3]) and healthcare insurance (1.6 [1.2–2.2]) but not poverty index (1.04 [0.96–1.12]). Public or private insurance linked to more frequent healthcare, greater awareness and effective treatment of hypertension, and appropriate statin use could reverse a long-term trend of growing inequity in hypertension control between insured and uninsured adults. PMID:25185135

  8. Inhaled iloprost for the control of pulmonary hypertension

    Science.gov (United States)

    Krug, Sabine; Sablotzki, Armin; Hammerschmidt, Stefan; Wirtz, Hubert; Seyfarth, Hans-Juergen

    2009-01-01

    Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by an elevated pulmonary arterial pressure and vascular resistance with a poor prognosis. Various pulmonary and extrapulmonary causes are now recognized to exist separately from the idiopathic form of pulmonary hypertension. An imbalance in the presence of vasoconstrictors and vasodilators plays an important role in the pathophysiology of the disease, one example being the lack of prostacyclin. Prostacyclin and its analogues are potent vasodilators with antithrombotic, antiproliferative and anti-inflammatory qualities, all of which are important factors in the pathogenesis of precapillary pulmonary hypertension. Iloprost is a stable prostacyclin analogue available for intravenous and aerosolized application. Due to the severe side effects of intravenous administration, the use of inhaled iloprost has become a mainstay in PAH therapy. However, owing to the necessity for 6 to 9 inhalations a day, oral treatment is often preferred as a first-line therapy. Numerous studies proving the efficacy and safety of inhaled iloprost have been performed. It is therefore available for a first-line therapy for PAH. The combination with endothelin-receptor antagonists or sildenafil has shown encouraging effects. Further studies with larger patient populations will have to demonstrate the use of combination therapy for long-term treatment of pulmonary hypertension. PMID:19475782

  9. Inhaled iloprost for the control of pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Sabine Krug

    2009-05-01

    Full Text Available Sabine Krug1, Armin Sablotzki2, Stefan Hammerschmidt1, Hubert Wirtz1, Hans-Juergen Seyfarth11University of Leipzig, Department of Respiratory Medicine, Germany; 2Klinikum St. Georg Leipzig, Clinics of Anaesthesiology, Critical Care and Pain Therapy, GermanyAbstract: Pulmonary arterial hypertension (PAH is a life-threatening disease characterized by an elevated pulmonary arterial pressure and vascular resistance with a poor prognosis. Various pulmonary and extrapulmonary causes are now recognized to exist separately from the idiopathic form of pulmonary hypertension. An imbalance in the presence of vasoconstrictors and vasodilators plays an important role in the pathophysiology of the disease, one example being the lack of prostacyclin. Prostacyclin and its analogues are potent vasodilators with antithrombotic, antiproliferative and anti-inflammatory qualities, all of which are important factors in the pathogenesis of precapillary pulmonary hypertension. Iloprost is a stable prostacyclin analogue available for intravenous and aerosolized application. Due to the severe side effects of intravenous administration, the use of inhaled iloprost has become a mainstay in PAH therapy. However, owing to the necessity for 6 to 9 inhalations a day, oral treatment is often preferred as a first-line therapy. Numerous studies proving the efficacy and safety of inhaled iloprost have been performed. It is therefore available for a first-line therapy for PAH. The combination with endothelin-receptor antagonists or sildenafil has shown encouraging effects. Further studies with larger patient populations will have to demonstrate the use of combination therapy for long-term treatment of pulmonary hypertension. Keywords: pulmonary arterial hypertension, prostacyclin, iloprost, inhaled

  10. Immediate and short-term pain relief by acute sciatic nerve press: a randomized controlled trial

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    Zhang Wenlong

    2007-05-01

    Full Text Available Abstract Background Despite much research, an immediately available, instantly effective and harmless pain relief technique has not been discovered. This study describes a new manipulation: a "2-minute sciatic nerve press", for rapid short-term relief of pain brought on by various dental and renal diseases. Methods This randomized, single-blind, placebo-controlled trial ran in three hospitals in Anhui Province, China, with an enrollment of 66 out of 111 solicited patients aged 16 to 74 years. Patients were recruited sequentially, by specific participating physicians at their clinic visits to three independent hospitals. The diseases in enrolled dental patients included dental caries, periodontal diseases and dental trauma. Renal diseases in recruits included kidney infections, stones and some other conditions. Patients were randomly assigned to receive the "2-minute sciatic nerve press" or the "placebo press". For the "2-minute sciatic nerve press", pressure was applied simultaneously to the sciatic nerves at the back of the thighs, using the fists while patients lay prone. For the "placebo press", pressure was applied simultaneously to a parallel spot on the front of the thighs, using the fists while patients lay supine. Each fist applied a pressure of 11 to 20 kg for 2 minutes, after which, patients arose to rate pain. Results The "2-minute sciatic nerve press" produced greater pain relief than the "placebo press". Within the first 10 minutes after sciatic pressure, immediate pain relief ratings averaged 66.4% (p Conclusion Two minutes of pressure on both sciatic nerves can produce immediate significant conduction analgesia, providing a convenient, safe and powerful way to overcome clinical pain brought on by dental diseases and renal diseases for short term purposes. Trial registration ACTR 12606000439549

  11. Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study

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    Clarita Silva de Souza

    2014-06-01

    Full Text Available Background: Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level. Objective: To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil. Methods: Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR with 95% confidence interval, Wald's χ2 test, and simple and multiple Poisson regression were used in the statistical analysis. Results: The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled. Conclusion: Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control.

  12. Sex differences in hypertension prevalence and control: Analysis of the 2010-2014 Korea National Health and Nutrition Examination Survey.

    Science.gov (United States)

    Choi, Hayon Michelle; Kim, Hyeon Chang; Kang, Dae Ryong

    2017-01-01

    Although not fully understood, sex may affect both the prevalence and control rate of hypertension. The present study was designed to investigate factors associated with hypertension prevalence and control among Korean adults. We analyzed 27,887 individuals (12,089 males and 15,798 females) aged 30 years or older who participated in the fifth (2010-2012) and sixth (2013-2014) Korea National Health and Nutrition Examination Survey. Multiple logistic regression models were applied to delineate factors associated with the prevalence and control of hypertension separately for men and women. Overall, the prevalence of hypertension was higher in men (34.6%) than in women (30.8%). However, after the age of 60 years, hypertension was more prevalent in females than in males. Regardless of sex, the older the participants were, the more likely they were to have hypertension. Factors positively associated with hypertension prevalence were old age, low education, and high BMI in women (pFactors decreasing hypertension control were white-collared women and young age, alcohol consumption in men. Sex differences in hypertension prevalence and control were discovered among Korean adults. After the age of 60, females were more likely to have hypertension and less likely to maintain hypertension control than males of the same age range. Accordingly, sex-specific approaches are recommended for effective blood pressure management.

  13. Body Mass Index, Smoking and Hypertensive Disorders during Pregnancy: A Population Based Case-Control Study.

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    Thuridur A Gudnadóttir

    Full Text Available While obesity is an indicated risk factor for hypertensive disorders of pregnancy, smoking during pregnancy has been shown to be inversely associated with the development of preeclampsia and gestational hypertension. The purpose of this study was to investigate the combined effects of high body mass index and smoking on hypertensive disorders during pregnancy. This was a case-control study based on national registers, nested within all pregnancies in Iceland 1989-2004, resulting in birth at the Landspitali University Hospital. Cases (n = 500 were matched 1:2 with women without a hypertensive diagnosis who gave birth in the same year. Body mass index (kg/m2 was based on height and weight at 10-15 weeks of pregnancy. We used logistic regression models to calculate odds ratios and corresponding 95% confidence intervals as measures of association, adjusting for potential confounders and tested for additive and multiplicative interactions of body mass index and smoking. Women's body mass index during early pregnancy was positively associated with each hypertensive outcome. Compared with normal weight women, the multivariable adjusted odds ratio for any hypertensive disorder was 1.8 (95% confidence interval, 1.3-2.3 for overweight women and 3.1 (95% confidence interval, 2.2-4.3 for obese women. The odds ratio for any hypertensive disorder with obesity was 3.9 (95% confidence interval 1.8-8.6 among smokers and 3.0 (95% confidence interval 2.1-4.3 among non-smokers. The effect estimates for hypertensive disorders with high body mass index appeared more pronounced among smokers than non-smokers, although the observed difference was not statistically significant. Our findings may help elucidate the complicated interplay of these lifestyle-related factors with the hypertensive disorders during pregnancy.

  14. Effect of Expectation of Care on Adherence to Antihypertensive Medications Among Hypertensive Blacks: Analysis of the Counseling African Americans to Control Hypertension (CAATCH) Trial.

    Science.gov (United States)

    Grant, Andrea Barnes; Seixas, Azizi; Frederickson, Keville; Butler, Mark; Tobin, Jonathan N; Jean-Louis, Girardin; Ogedegbe, Gbenga

    2016-07-01

    Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (PExpectation of care and social support are important factors for developing interventions to increase medication adherence among blacks.

  15. Effect of Expectation of Care on Adherence to Antihypertensive Medications Among Hypertensive Blacks: Analysis of the Counseling African Americans to Control Hypertension (CAATCH) Trial

    Science.gov (United States)

    Grant, Andrea Barnes; Seixas, Azizi; Frederickson, Keville; Butler, Mark; Tobin, Jonathan N.; Jean-Louis, Girardin; Ogedegbe, Gbenga

    2017-01-01

    Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (P<.05). Expectation of care and social support are important factors for developing interventions to increase medication adherence among blacks. PMID:26593105

  16. Press-coating of immediate release powders onto coated controlled release tablets with adhesives.

    Science.gov (United States)

    Waterman, Kenneth C; Fergione, Michael B

    2003-05-20

    A novel adhesive coating was developed that allows even small quantities of immediate-release (IR) powders to be press-coated onto controlled-release (CR), coated dosage forms without damaging the CR coating. The process was exemplified using a pseudoephedrine osmotic tablet (asymmetric membrane technology, AMT) where a powder weighing less than 25% of the core was pressed onto the osmotic tablet providing a final combination tablet with low friability. The dosage form with the adhesive plus the press-coated powder showed comparable sustained drug release rates to the untreated dosage form after an initial 2-h lag. The adhesive layer consisted of an approximately 100- microm coating of Eudragit RL, polyethylene glycol (PEG) and triethyl citrate (TEC) at a ratio of 5:3:1.2. This coating provides a practical balance between handleability before press-coating and good adhesion.

  17. Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia in 2 health systems.

    Science.gov (United States)

    Schroeder, Emily B; Hanratty, Rebecca; Beaty, Brenda L; Bayliss, Elizabeth A; Havranek, Edward P; Steiner, John F

    2012-09-01

    Many individuals with diabetes mellitus, hypertension, and hyperlipidemia have difficulty achieving control of all 3 conditions. We assessed the incidence and duration of simultaneous control of hyperglycemia, blood pressure, and low-density lipoprotein cholesterol in patients from 2 health care systems in Colorado. We performed a retrospective cohort study of adults at Denver Health and Kaiser Permanente Colorado with diabetes mellitus, hypertension, and hyperlipidemia from 2000 through 2008. Over a median of 4.0 and 4.4 years, 16% and 30% of individuals at Denver Health and Kaiser Permanente achieved the primary outcome (simultaneous control with a glycosylated hemoglobin (HbA(1c)) diabetes mellitus, hypertension, and hyperlipidemia was uncommon and generally transient. Less stringent goals had a relatively large effect on the proportion achieving simultaneous control. Individuals who simultaneously achieve multiple treatment goals may provide insight into self-care strategies for individuals with comorbid health conditions.

  18. The dynamics of hypertension prevalence, awareness, treatment, control and associated factors in Chinese adults: results from CHNS 1991-2011.

    Science.gov (United States)

    Guo, Jing; Zhu, Yin-Chao; Chen, Ya-Ping; Hu, Yu; Tang, Xue-Wen; Zhang, Bing

    2015-08-01

    To analyze the trends in blood pressure (BP), and the prevalence, awareness, treatment and control of hypertension and associated factors in Chinese adults from 1991 to 2011. On the basis of the longitudinal data of China Health and Nutrition Survey, 75 526 records of 24 410 adults were selected according to the eligibility criteria. The age-standardized levels of SBP, DBP, prevalence, awareness, treatment and control of hypertension were calculated by sex and age group within each year. Generalized estimating equation was employed to investigate the associations between demographic factors and status of hypertension, awareness, treatment and control. From 1991 to 2011, the BP level elevated (SBP 120.0-124.5 mmHg, DBP 76.7-79.3 mmHg) and the prevalence of hypertension increased from 23.4 to 28.6%. The increasing levels of BP and hypertension prevalence were more apparent among men and older patients. The rates of hypertension awareness, treatment and control also increased while kept at low levels. Factors such as age, sex, smoking habit, drinking habit, household income, health insurance, BMI, residential region, marital status, educational level and nationality were significantly associated with the status of hypertension, awareness, treatment and control. The BP level and hypertension prevalence have increased among Chinese adults in recent years. However, levels of hypertension awareness, treatment and control were quite low. To reduce the disease burden of the hypertension, improvements in health education programs, detection and treatment strategies are warranted.

  19. Prevalence, awareness, treatment, control and socio demographic determinants of hypertension in Malaysian adults.

    Science.gov (United States)

    Abdul-Razak, Suraya; Daher, Aqil Mohammad; Ramli, Anis Safura; Ariffin, Farnaza; Mazapuspavina, Md Yasin; Ambigga, Krishnapillai S; Miskan, Maizatullifah; Abdul-Hamid, Hasidah; Mat-Nasir, Nafiza; Nor-Ashikin, Mohamed Noor Khan; Ng, Kien Keat; Nawawi, Hapizah; Yusoff, Khalid

    2016-04-21

    Hypertension is the leading cardiovascular risk factor globally as well as in Malaysia. This study aimed to estimate the prevalence, awareness, treatment, control and the socio demographic determinants of hypertension among Malaysian adults. The analytic sample consisted of 11,288 adults aged ≥ 30 years recruited at baseline in 2007-2011 from the REDISCOVER Study which is an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. Socio-demographics, anti-hypertensive treatment details and an average of at least two blood pressure measurements were obtained. The age-adjusted prevalence was 42.0 % (CI: 40.9-43.2) and was higher in men [43.5 % (CI: 41.2-45.0)] than women [41.0 % (CI: 39.8-42.3)]. Participants from rural areas (APR: 1.12, CI: 1.04-1.20); aged at least 40-49 years (APR: 1.86, CI: 1.62-2.14); who were overweight (APR: 1.24, CI: 1.15-1.34) and obese (APR: 1.54, CI: 1.43-1.6) were more likely to have hypertension. The Indigenous ethnic group was less likely to be aware (APR: 0.81, CI: 0.69-0.92) and to be on treatment (APR: 0.66, CI: 0.55-0.79). Those in rural areas were less likely to have their hypertension controlled (APR: 0.61, CI: 0.49-0.75). On the other hand, control was more likely in females (APR: 1.25, CI: 1.01-1.54) and Indigenous group (APR: 1.64, CI: 1.19-2.25). Hypertension is common in the Malaysian adults. The control of hypertension has increased over the years but is still quite low. Public health measures, as well as individual interventions in primary care are crucial to reduce their risk of developing complications.

  20. Patient-related barriers to hypertension control in a Nigerian population

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    Okwuonu CG

    2014-07-01

    Full Text Available Chimezie Godswill Okwuonu,1 Nnamdi Ezekiel Ojimadu,2 Enajite Ibiene Okaka,3 Fatai Momodu Akemokwe41Nephrology Unit, Department of Internal Medicine, 2Department of Family Medicine, Federal Medical Center Umuahia, Abia State, 3Renal Unit, 4Neurology Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, NigeriaBackground: Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria.Methods: This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication.Results: A total of 252 participants were included in the survey, and comprised 143 males (56.7% and 109 females (43.3%. The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%, financial constraints (56.6%, high pill burden (22.5%, side effects of medication (17.3%, and low measured blood pressure (12.1%. Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants.Conclusion: Poor knowledge regarding hypertension, unrealistic

  1. A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

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    Rodrigo Ramos-Zúñiga

    2015-01-01

    Full Text Available Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma; and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

  2. Addition of lidocaine injection immediately before physiotherapy for frozen shoulder: a randomized controlled trial.

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    Wei-Chun Hsu

    Full Text Available The intraarticular injection of lidocaine immediately before a physiotherapy session may relieve pain during the stretching and mobilization of the affected joint in patients with a frozen shoulder, thus enhancing the treatment effect. To compare the effects of intraarticular injection of lidocaine plus physiotherapy to that of physiotherapy alone in the treatment of a frozen shoulder, a prospective randomized controlled trial was conducted in the rehabilitation department of a private teaching hospital. Patients with a frozen shoulder were randomized into the physiotherapy group or the lidocaine injection plus physiotherapy (INJPT group. The subjects in the INJPT group underwent injection of 3 ml of 1% lidocaine into the affected shoulder 10 to 20 minutes before each physiotherapy session. In each group, the treatment lasted 3 months. The primary outcome measures were the active and passive range of motion of the affected shoulder. The secondary outcome measures were the results of the Shoulder Disability Questionnaire, the Shoulder Pain and Disability Index, and the 36-item Short-Form Health Survey (SF-36. The outcome measures were evaluated before treatment and 1, 2, 3, 4, and 6 months after the start of treatment. The group comparisons showed significantly greater improvement in the INJPT group, mainly in active and passive shoulder range of motion in flexion and external rotation and improvements in pain and disability (P < 0.05; however, no significant group difference was seen in the SF-36 results. The intraarticular injection of lidocaine immediately before a physiotherapy session might be superior to physiotherapy alone in the treatment of a frozen shoulder. Trial registration: ClinicalTrials.gov NCT01817348.

  3. Determinants of Diabetes and Hypertension Control in Ambulatory Healthcare in Al Ain, United Arab Emirates

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    Latifa M. Baynouna

    2014-05-01

    Full Text Available bjectives: This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. Method: This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. Results: From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001, the number of chronic disease clinic visits (p=0.042 and triglyceride levels (p=0.007 predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001 for patients with hypertension was poor control of blood pressure in the year before. Conclusion: In this population, the healthcare system and the team played major roles as determinants in the control of patient’s diabetes and blood pressure more than any of the other factors examined.

  4. Sodium intake, dietary knowledge, and illness perceptions of controlled and uncontrolled rural hypertensive patients.

    Science.gov (United States)

    Kamran, Aziz; Azadbakht, Leila; Sharifirad, Gholamreza; Mahaki, Behzad; Sharghi, Afshan

    2014-01-01

    Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599 ± 258 mg/day and significantly greater than controlled group (2654 ± 540 mg/day) (P < 0.001). Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r = -0.66, P < 0.001 and r = -0.65, P < 0.001, resp.). Conclusion. Considering the fact that patients' nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients' information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients.

  5. Sodium Intake, Dietary Knowledge, and Illness Perceptions of Controlled and Uncontrolled Rural Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Aziz Kamran

    2014-01-01

    Full Text Available Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599±258 mg/day and significantly greater than controlled group (2654±540 mg/day (P<0.001. Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r=-0.66, P<0.001 and r=-0.65, P<0.001, resp.. Conclusion. Considering the fact that patients’ nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients’ information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients.

  6. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada

    National Research Council Canada - National Science Library

    Cléroux, J; Feldman, R D; Petrella, R J

    1999-01-01

    To provide updated, evidence-based recommendations for health care professionals concerning the effects of regular physical activity on the prevention and control of hypertension in otherwise healthy adults...

  7. EFFECT OF HIGH INTENSITY INTERVAL TRAINING ON ENDOTHELIAL FUNCTION IN POSTMENOPAUSAL HYPERTENSIVE PATIENTS RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Mona Mohamed Taha

    2016-02-01

    Full Text Available Background: Postmenopausal hypertension is the most common risk factor of cardiovascular morbidity and mortality. As the exercises training conveys benefits of the setting of secondary prevention of hypertension. High intensity interval training (HIIT emerged as a new form of physical training and presents as therapeutic alternative to patients and health care professionals. This study aimed to investigate the effect of high intensity interval training on endothelial function in postmenopausal hypertension. Methods: Forty six mildly hypertensive postmenopausal women, their ages ranged from (45-55 years old, were randomly allocated to two groups: HIIT group (group-I; n=23 performed a high intensity interval training 3 times a week for 10 weeks at an intensity of (80-85% HR max for 40 minutes and control group (group-II; n=23 remains sedentary during this period. Serum nitric oxide (NO, vascular endothelial growth factor levels (VEGF and blood pressures were measured before and after intervention. Results: A significant reduction in both systolic and diastolic blood pressure values by 9.5% and 7 % respectively, was seen after high intensity interval training which was accompanied by increase in NO and VEGF levels by 43.3% and 15.2 % respectively, while no significant change observed in the control group. Conclusion: High intensity interval training had obvious benefits in improving plasma No, VEGF concentrations and controlling hypertension in postmenopausal women.

  8. The role of diets, food, and nutrients in the prevention and control of hypertension and prehypertension.

    Science.gov (United States)

    Slimko, Michelle L; Mensah, George A

    2010-11-01

    Hypertension is the leading risk factor for death worldwide, even surpassing tobacco use, high blood glucose, high blood cholesterol, and obesity. Globally, the estimated prevalence of hypertension is nearly 1 billion persons with an annual mortality of almost 7.5 million deaths. In the United States, hypertension affects an estimated 65 million Americans, and is the leading risk-factor cause of death in women and only second to tobacco use as a contributory cause of death in men. Multiple sources of data from prospective observational, cohort, and randomized controlled clinical trials show that hypertension and its complications are highly preventable when the raised blood pressure is prevented, or treated and controlled. To promote positive behavior change and create a broader impact on public health, it has become necessary to leverage multilevel stakeholders such as all health care providers, researchers, policy makers, schools, the food industry, and the general public to drive policy changes and future innovation from research and development endeavors, and to emphasize the importance of diet-related lifestyle modifications to effectively prevent and control hypertension and prehypertension.

  9. Blood pressure control among hypertensives managed in a specialised health care setting in Nigeria.

    Science.gov (United States)

    Isezuo, A S; Njoku, C H

    2003-03-01

    In spite of the plethora of anti-hypertensives, hypertension remains an important cause of morbidity and mortality among Nigerian hypertensive population. To determine blood pressure control rate, defined as the proportion of treated hypertensive population with systolic and diastolic blood pressures less than 140 mmHg and 90 mmHg respec tively. One hundred and ten (110) treated adult Nigerian hypertensives aged 28-80 (mean 46.02 +/- 15.20) years with male: female ratio of 1:1.4 who have been commenced on treatment for at least 6 months were selected by simple random sampling for determination of blood pressure control rate and its determinant factors using clinic blood pressures. Blood pressure control rate was 42.70%. Pre-treatment mean blood pressure was significantly higher than the value at least 6 months post commencement of treatment: (170.09 +/- 15.20/108.98 +/- 15.85 mmHg versus 146.10 +/- 24.50/93.8 +/- 21.90 mmHg) (t=8.73; pmmHg in 42 (66.6%), rose by 10.50 +/- 1.0 mmHg in 8 (12.70%) and was unchanged in 13 (20.66%) patients. Diastolic blood pressure fell by 22.22 +/- 14.58 mmHg in 32 (50.8%), rose by 7.88 +/- 6.66 mmHg in 16 (25.40%) and was unchanged in 15 (23.80%) patients. Clinic compliance and family history of hypertension were associated with satisfactory blood pressure control. Blood pressure control rate among the study population was low. Compliance and family re-enforcement should be encouraged.

  10. Traditional Chinese Medicine, Food Therapy, and Hypertension Control: A Narrative Review of Chinese Literature.

    Science.gov (United States)

    Zou, Ping

    2016-01-01

    Despite the lack of English literature about Traditional Chinese Medicine (TCM) food therapy, there is abundant Chinese literature about the application of food therapy for hypertension control. This paper summarizes basic concepts of TCM, the principles of food therapy and its application for hypertension control according to Chinese literature. In TCM, food is conceptualized according to both nutritional and functional aspects, and can be used to treat illnesses. Four principles of TCM food therapy including light eating, balancing the "hot" and "cold" nature of food, the harmony of the five flavors of food, and consistency between dietary intake and different health conditions, can be used to facilitate hypertension control. Based on a statistical analysis of antihypertensive foods recommended in 20 books on the application of food therapy for hypertension control, the 38 most frequently recommended are celery, tomato, banana, hawthorn, garlic, onion, seaweed, apple, corn, green beans, persimmon, laver, kiwi, watermelon, eggplant, carrots, mushroom, peanut, soy products, sea cucumber, buckwheat, garland chrysanthemum, spinach, honey, dairy products, vinegar, black fungus, jellyfish, green onion, shepherd's purse, soybean, potato, pear, winter melon, bitter melon, oat, pea, and tea. Food therapy emphasizes the therapeutic effects of food, considering its nature, taste, and function on human balanced health, which leads to optimal blood pressure control. Current literature suggests that food therapy is effective in blood pressure control and can be incorporated into blood pressure self-management in the Chinese population.

  11. Non-pharmacological interventions in hypertension: A community-based cross-over randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hema Subramanian

    2011-01-01

    Full Text Available Background: Hypertension is the most prevalent non-communicable disease causing significant morbidity/mortality through cardiovascular, cerebrovascular, and renal complications. Objectives: This community-based study tested the efficacy of non-pharmacological interventions in preventing/controlling hypertension. Materials and Methods: This is a cross-over randomized controlled trial (RCT of the earlier RCT (2007 of non-pharmacological interventions in hypertension, conducted in the urban service area of our Institute. The subjects, prehypertensive and hypertensive young adults (98 subjects: 25, 23, 25, 25 in four groups were randomly allotted into a group that he/she had not belonged to in the earlier RCT: Control (New Group I, Physical Exercise (NG II-brisk walking for 50 to 60 minutes, three to four days/week, Salt Intake Reduction (NG III to at least half of their previous intake, Yoga (NG IV for 30 to 45 minutes/day, five days/week. Blood pressure was measured before and after eight weeks of intervention. Analysis was by ANOVA with a Games-Howell post hoc test. Results: Ninety-four participants (25, 23, 21, 25 completed the study. All three intervention groups showed significant reduction in BP (SBP/DBP mmHg: 5.3/6.0 in NG II, 2.5/2.0 in NG III, and 2.3/2.4 in NG IV, respectively, while the Control Group showed no significant difference. Persistence of significant reduction in BP in the three intervention groups after cross-over confirmed the biological plausibility of these non-pharmacological interventions. This study reconfirmed that physical exercise was more effective than Salt Reduction or Yoga. Salt Reduction, and Yoga were equally effective. Conclusion: Physical exercise, salt intake reduction, and yoga are effective non-pharmacological methods for reducing blood pressure in young pre-hypertensive and hypertensive adults.

  12. A framework for discussion on how to improve prevention, management, and control of hypertension in Canada.

    Science.gov (United States)

    Campbell, Norm; Young, Eric R; Drouin, Denis; Legowski, Barbara; Adams, Michael A; Farrell, Judi; Kaczorowski, Janusz; Lewanczuk, Richard; Moy Lum-Kwong, Margaret; Tobe, Sheldon

    2012-05-01

    Increased blood pressure is a leading risk for premature death and disability. The causes of increased blood pressure are intuitive and well known. However, the fundamental basis and means for improving blood pressure control are highly integrated into our complex societal structure both inside and outside our health system and hence require a comprehensive discussion of the pathway forward. A group of Canadian experts was appointed by Hypertension Canada with funding from Public Health Agency of Canada and the Heart and Stroke Foundation of Canada, Canadian Institute for Health Research (HSFC-CIHR) Chair in Hypertension Prevention and Control to draft a discussion Framework for prevention and control of hypertension. The report includes an environmental scan of past and current activities, proposals for key indicators, and targets to be achieved by 2020, and what changes are likely to be required in Canada to achieve the proposed targets. The key targets are to reduce the prevalence of hypertension to 13% of adults and improve control to 78% of those with hypertension. Broad changes in government policy, research, and health services delivery are required for these changes to occur. The Hypertension Framework process is designed to have 3 phases. The first includes the experts' report which is summarized in this report. The second phase is to gather input and priorities for action from individuals and organizations for revision of the Framework. It is hoped the Framework will stimulate discussion and input for its full intended lifespan 2011-2020. The third phase is to work with individuals and organizations on the priorities set in phase 2.

  13. Effect of psoriasis severity on hypertension control: a population-based study in the United Kingdom.

    Science.gov (United States)

    Takeshita, Junko; Wang, Shuwei; Shin, Daniel B; Mehta, Nehal N; Kimmel, Stephen E; Margolis, David J; Troxel, Andrea B; Gelfand, Joel M

    2015-02-01

    Hypertension is prevalent among patients with psoriasis. The effect of psoriasis and its severity on hypertension control is unknown. To determine the association between uncontrolled blood pressure and psoriasis, both overall and according to objectively measured psoriasis severity, among patients with diagnosed hypertension. Population-based cross-sectional study nested in a prospective cohort drawn from The Health Improvement Network (THIN), an electronic medical records database broadly representative of the general population in the United Kingdom. The study population included a random sample of patients with psoriasis (n = 1322) between the ages of 25 and 64 years in THIN who were included in the Incident Health Outcomes and Psoriasis Events prospective cohort and their age- and practice-matched controls without psoriasis (n = 11,977). All included patients had a diagnosis of hypertension; their psoriasis diagnosis was confirmed and disease severity was classified by their general practitioners. Uncontrolled hypertension was defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher based on the blood pressure recorded closest in time to the assessment of psoriasis severity. There was a significant positive dose-response relationship between uncontrolled hypertension and psoriasis severity as objectively determined by the affected body surface area in both unadjusted and adjusted analyses that controlled for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs (adjusted odds ratio [aOR], 0.97; 95% CI, 0.82-1.14 for mild psoriasis; aOR, 1.20; 95% CI, 0.99-1.45 for moderate psoriasis; and aOR, 1.48; 95% CI, 1.08-2.04 for severe psoriasis; P = .01 for trend). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, although not statistically

  14. Initial monotherapy and combination therapy and hypertension control the first year.

    Science.gov (United States)

    Egan, Brent M; Bandyopadhyay, Dipankar; Shaftman, Stephanie R; Wagner, C Shaun; Zhao, Yumin; Yu-Isenberg, Kristina S

    2012-06-01

    Initial antihypertensive therapy with single-pill combinations produced more rapid blood pressure control than initial monotherapy in clinical trials. Other studies reported better cardiovascular outcomes in patients achieving lower blood pressure during the first treatment year. We assessed the effectiveness of initial antihypertensive monotherapy, free combinations, and single-pill combinations in controlling untreated, uncontrolled hypertensives during their first treatment year. Electronic record data were obtained from 180 practice sites; 106 621 hypertensive patients seen from January 2004 to June 2009 had uncontrolled blood pressure, were untreated for ≥ 6 months before therapy, and had ≥ 1 one-year follow-up blood pressure data. Control was determined by the first follow-up visit with blood pressure blood pressure, body mass index, diabetes mellitus, chronic kidney disease, cardiovascular disease, initial therapy, final blood pressure medication number, and therapeutic inertia. Patients on initial single-pill combinations (N = 9194) were more likely to have stage 2 hypertension than those on free combinations (N = 18 328) or monotherapy (N = 79 099; all Phypertension control in the first year than free combinations (HR, 1.34; [95% CI, 1.31-1.37]) or monotherapy (reference) with benefits in black and white patients. Greater use of single-pill combinations as initial therapy may improve hypertension control and cardiovascular outcomes in the first treatment year.

  15. Hypertension Prevalence, Awareness, Treatment and Control, and Associated Factors: Results from a National Survey, Jordan

    Directory of Open Access Journals (Sweden)

    H. Y. Jaddou

    2011-01-01

    Full Text Available The study examined prevalence, awareness, treatment and control of hypertension (HTN, and associated factors and to evaluate the trend in hypertension between 2009 (period 2 and 1994–1998 (period 1. A national sample of 4117 adults aged 25 years and older was selected. Prevalence rate of HTN (SBP ≥ 140 or DBP ≥ 90 or on antihypertensive therapy was 32.3% and was higher than the 29.4% prevalence rate reported in period 1. Prevalence rate was significantly higher among males, older age groups, least educated, obese, and diabetics than their counterparts. The rate of awareness among hypertensives was 56.1% and was higher than the 38.8% rate reported form period 1 data. Awareness was positively associated with age, smoking, and diabetes for both men and women, and with level of education and body mass index for men. Rate of treatment for HTN among aware patients was 63.3% and was significantly higher than the 52.8% rate reported in period1. Control rate of HTN among treated hypertensives was 39.6%; significantly higher than the 27.9% control rate in period 1. Control of HTN was positively associated with age but only for women. In conclusion, HTN is still on the rise in Jordan, and levels of awareness and control are below the optimal levels.

  16. Awareness, treatment and control of hypertension among the elderly living in their home in Tunisia

    Directory of Open Access Journals (Sweden)

    Hammami Sonia

    2011-11-01

    Full Text Available Abstract Background Hypertension is a cardiovascular disorder rapidly emerging as a major public health problem in developing countries. However, the acknowledgement of the prevalence and the significant impact of hypertension in elderly are very important for health policy. The objective of the present investigation was to evaluate the prevalence, awareness and treatment of hypertension among the elderly living in their home in Tunisia at Monastir City. We also examined the impact of socio-demographic characteristics and known risk factors for high blood pressure. Methods A community based sample of 598 non-institutionalized elderly (age ≥ 65 years, was selected using probabilistic multistage cluster sampling. Results There was a predominance of female (66% and mean age was 72.3 ± 7.4 years. The prevalence of hypertension was 52% (n = 311, awareness (81%, n = 252, treatment (78.4%, n = 244 and only 30.7% (n = 75 are correctly treated. The prevalence of hypertension was higher for the female population (55.5% when compared to males (45%. No urban/rural differences were observed and no difference was observed by educational level. Multiple logistic regression analyses identified a higher body mass index, diabetes mellitus and disability as important correlates of the prevalence of hypertension. Conclusion These findings provide important information on the prevalence, awareness and control of hypertension in Monastir City and confirm their association with other cardio-vascular risk factors. Effective public health measures and strategies are needed to improve prevention, diagnosis and access to treatment of this elderly population.

  17. Trends and determinant factors in hypertension control in a population study with 25 years of follow-up

    DEFF Research Database (Denmark)

    Andersen, Ulla O; Jensen, Gorm B

    2010-01-01

    OBJECTIVE: The present study focused on trend in hypertension control and on determinant factors that may influence efficacy in antihypertensive therapy. Two measures of treatment efficacy were used: population blood pressure and the relative frequency of effectively treated patients (blood...... pressure hypertensive patients. The blood pressure measurement was fully standardized and measurement method was unchanged...... throughout the observation period. A questionnaire was completed by the participants and double-checked by the technicians. RESULTS: The number of treated hypertensive patients increased considerably and hypertension control increased from 21 to 26%. Pretreatment SBP was stable in the observation period...

  18. Prevalence, awareness, treatment and control of hypertension in adults with chronic kidney disease in Turkey: results from the CREDIT study.

    Science.gov (United States)

    Altun, Bülent; Süleymanlar, Gültekin; Utaş, Cengiz; Arınsoy, Turgay; Ateş, Kenan; Ecder, Tevfik; Camsarı, Taner; Serdengeçti, Kamil

    2012-01-01

    In the Chronic REnal Disease in Turkey-CREDIT Study, a large populationbased study on 10,748 adults, the prevalence of chronic kidney disease (CKD) and relationship between CKD and other cardiovascular risk factors had been studied. This report presents the results of CREDIT study on the prevalence, awareness, treatment, and control of hypertension among CKD patients. The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. Of the patients with hypertension, 31.5% were under treatment, and 16.4% had hypertension under control. Prevalence of CKD was 25.3% in patients with hypertension. Among CKD patients (15.7% of the CREDIT study population), 56.3% had hypertension. The prevalence of hypertension was 34.8% at stage 1, 79.8% at stage 3, and 92.3% at stage 5 CKD. Only 13.4% of patients with CKD have optimal blood pressure. Among CKD patients, 61.9% were aware of hypertension, and 44.2% were under treatment. Overall control rate of hypertension in subjects with CKD was 16.3% with the lowest rate at stage 1 (12.3%) and highest rate at stage 4 (40%). The control rate increased to 28.8% for CKD patients under treatment for hypertension. As a conclusion, hypertension is highly prevalent in subjects with CKD in Turkey with suboptimal awareness, treatment, and control rates. Appropriate health strategies should be implicated to improve prevention, early diagnosis, and treatment of hypertension, which is one of the leading causes of CKD. Copyright © 2012 S. Karger AG, Basel.

  19. Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial

    National Research Council Canada - National Science Library

    Vedanthan, Rajesh; Kamano, Jemima H; Naanyu, Violet; Delong, Allison K; Were, Martin C; Finkelstein, Eric A; Menya, Diana; Akwanalo, Constantine O; Bloomfield, Gerald S; Binanay, Cynthia A; Velazquez, Eric J; Hogan, Joseph W; Horowitz, Carol R; Inui, Thomas S; Kimaiyo, Sylvester; Fuster, Valentin

    2014-01-01

    .... This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive...

  20. Normotension, prehypertension, and hypertension in urban middle-class subjects in India: prevalence, awareness, treatment, and control.

    Science.gov (United States)

    Gupta, Rajeev; Deedwania, Prakash C; Achari, Vijay; Bhansali, Anil; Gupta, Bal Kishan; Gupta, Arvind; Mahanta, Tulika G; Asirvatham, Arthur J; Gupta, Sunil; Maheshwari, Anuj; Saboo, Banshi; Jali, Mallikarjuna V; Singh, Jitendra; Guptha, Soneil; Sharma, Krishna Kumar

    2013-01-01

    We conducted a multisite study to determine the prevalence and determinants of normotension, prehypertension, and hypertension, and awareness, treatment, and control of hypertension among urban middle-class subjects in India. We evaluated 6,106 middle-class urban subjects (men 3,371; women, 2,735; response rate, 62%) in 11 cities for sociodemographic and biological factors. The subjects were classified as having normotension (BP middle-class urban Asian Indians. Significant associations of hypertension were found with age, dietary fat, consumption of fruits and vegetables, smoking, and obesity. Normotensive individuals had a lower prevalence of cardiometabolic risk factors than did members of the prehypertensive or hypertensive groups. Half of the hypertensive group were aware of having hypertension, a third were receiving treatment for it, and quarter had a controlled BP.

  1. DIABETIC HYPERTENSIVE CONTROL AND TREATMENT: A DESCRIPTIVE REPORT FROM THE AUDIT

    Directory of Open Access Journals (Sweden)

    SYED ALWI SAR

    2010-01-01

    Full Text Available Introduction: Hypertension is a common co-morbidity in diabetes mellitus (DM that may lead to serious complications if notadequately controlled. Method: This is a descriptive study based on data from the Audit of Diabetes Control and Management (ADCM registry. This audit assessed the treatment and standard of control of hypertension in diabetic patients aged 18 years and above. Data were analysed using STATA version 9. Results: From a total of 20 646 cases, about two third of them, 13 417 (65% were reported to have hypertension. 19 484(94.4% had their blood pressure (BP recorded and out of these, 11 414 (58.5% were found to have BP >130/80 mmHg. 13601 cases (65.9% of the total sample were on antihypertensive drugs. 64.1% of those on antihypertensive drugs were prescribed angiotensin-converting enzyme inhibitors (ACEI or angiotensin II receptor blockers. 14.2% were on more than two types of antihypertensive drugs. Older patients and those with longer duration of DM were less likely to achieve the target BP of ≤130/80. In general, about 40% of diabetic cases registered in the ADCM project had their hypertension well controlled.

  2. Prevalence, treatment, and control of hypertension by sociodemographic factors among the Dutch elderly

    NARCIS (Netherlands)

    C.T.M. van Rossum (Caroline); H. van de Mheen (Dike); J.C.M. Witteman (Jacqueline); J.P. Mackenbach (Johan); D.E. Grobbee (Diederick); A. Hofman (Albert)

    2000-01-01

    textabstractThe study objective was to assess the prevalence, level of treatment, and control of hypertension in a general elderly population according to age and sociodemographic factors. We conducted a cross-sectional analysis of 7983 participants of the Rotterdam Stu

  3. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control

    OpenAIRE

    Lloyd-Sherlock, P; Beard, J.; Minicuci, N; Ebrahim, S; Chatterji, S.

    2014-01-01

    Background This study uses data from the World Health Organization’s Study on Global Ageing and Adult Health (SAGE) to examine patterns of hypertension prevalence, awareness, treatment and control for 15 people aged 50 years and over in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods The SAGE sample comprises of 35 125 people aged 50 years and older, selected randomly. Hypertension was defined as 5140mmHg (systolic blood pressure) or 590mmHg (diastolic blood pres...

  4. [Relationship between low-protein diet and hypertension control].

    Science.gov (United States)

    Cianciaruso, B

    2008-01-01

    Arterial hypertension is found in almost all patients with chronic kidney disease. The US Kidney Foundation guidelines recommend a pressure target for chronic kidney disease patients (130/80 mmHg) that may be difficult to reach because of the reduced sodium excretion in these patients and the widespread use of vasodilator drugs. Reducing the dietary protein intake may help to lower the dietary sodium load. The 130/80 mmHg target has been reached in 30% of stage 4 and 5 patients only after six months of a very low-protein diet supplemented with keto-analogues and essential amino acids. However, even moderate reductions of dietary sodium intake are useful in patients with compromised renal function, as was shown by Koomans et al more than 20 years ago. Blood pressure levels are lower in vegetarians, possibly also because of the reduced sodium content of potassium-rich vegetarian diets. Diets rich in unrefined cereals, vegetables, fruit and low-fat cheese may be useful in patients with chronic kidney disease. Commercial low-protein preparations may help to design diets that are both low in sodium, potassium and phosphorus and adequate for caloric needs.

  5. Association of statin therapy with blood pressure control in hypertensive hypercholesterolemic outpatients in clinical practice

    Science.gov (United States)

    Morgado, Manuel; Rolo, Sandra; Macedo, Ana Filipa; Castelo-Branco, Miguel

    2011-01-01

    Background: Some clinical evidence revealed that statins, apart from lowering cholesterol levels, also have an antihypertensive effect. Our aim was to evaluate the existence of a possible association of statin therapy with blood pressure (BP) control in clinical practice. Materials and Methods: Patients attending a hypertension/dyslipidemia clinic were prospectively evaluated. Those patients with a diagnosis of stage 1 hypertension and hypercholesterolemia who consented to participate were included in the study, either in the statin group (when taking a statin) or in the control group (when not taking a statin). Exclusion criteria included dementia, pregnancy, or breastfeeding, and history or evidence of stage 2 hypertension. Detailed clinical information was prospectively obtained from medical records. A total of 110 hypertensive patients were assigned to the study (82 in the statin group and 28 in the control group). Results: Although there were no significant differences (P > 0.05) in both groups concerning gender, body mass index, antihypertensive pharmacotherapy, and serum levels of high-density lipoprotein cholesterol and triglycerides, a higher BP control was observed in the statin group (P = 0.002). Significantly lower systolic BP (–6.7 mmHg, P = 0.020) and diastolic BP (–6.4 mmHg, P = 0.002) levels were reported in the statin group. Serum levels of low-density lipoprotein were also significantly lower in the statin group (P < 0.001). Conclusions: This observational study detected an association of statin therapy with BP control in hypertensive hypercholesterolemic patients in clinical practice. These findings raise the possibility that statin therapy may be useful for BP control in the studied population. PMID:21716752

  6. Trends in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension in Germany.

    Science.gov (United States)

    Sarganas, Giselle; Knopf, Hildtraud; Grams, Daniel; Neuhauser, Hannelore K

    2016-01-01

    Hypertension is a major risk factor for morbidity and mortality, therefore its control is of great importance. In this study we compare the use of antihypertensive medication among adults with hypertension in Germany 1998 and 2008-2011 and determine factors associated with use and control. Data from German Health Examination Surveys (GNHIES98 1998, n = 7,124 and DEGS1 2008-2011 n = 7,988, age 18-79 years) including standardized blood pressure (BP) measurements and Anatomical Therapeutic Chemical (ATC) medication codes were analyzed. The use of antihypertensive medication among adults with hypertension in Germany increased from 54% to 72% in 1 decade. In 2008-2011, 67% of users were treated with polytherapy. The most commonly used antihypertensive class in 1998 was diuretics (43%) and in 2008-2011 beta-blockers (54%). Ramipril and metoprolol are currently the most commonly used monotherapy agents, while ramipril in combination with hydrochlorothiazide is the most frequent polytherapy. Being a woman, older age, having statutory health insurance, diabetes, coronary heart disease (CHD), stroke, and obesity were positively associated with antihypertensive use. The control rate among treated increased from 42% to 72%. Young women (18-54 years) had better control compared to older women or to men. Having CHD or stroke was positively associated with BP control. Increased and improved antihypertensive use might be a main contributor to the decrease in BP observed in Germany in the last decade. However, there are still socio-demographic and health disparities in hypertension treatment and control. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. mRNA quality control is bypassed for immediate export of stress-responsive transcripts.

    Science.gov (United States)

    Zander, Gesa; Hackmann, Alexandra; Bender, Lysann; Becker, Daniel; Lingner, Thomas; Salinas, Gabriela; Krebber, Heike

    2016-12-12

    Cells grow well only in a narrow range of physiological conditions. Surviving extreme conditions requires the instantaneous expression of chaperones that help to overcome stressful situations. To ensure the preferential synthesis of these heat-shock proteins, cells inhibit transcription, pre-mRNA processing and nuclear export of non-heat-shock transcripts, while stress-specific mRNAs are exclusively exported and translated. How cells manage the selective retention of regular transcripts and the simultaneous rapid export of heat-shock mRNAs is largely unknown. In Saccharomyces cerevisiae, the shuttling RNA adaptor proteins Npl3, Gbp2, Hrb1 and Nab2 are loaded co-transcriptionally onto growing pre-mRNAs. For nuclear export, they recruit the export-receptor heterodimer Mex67-Mtr2 (TAP-p15 in humans). Here we show that cellular stress induces the dissociation of Mex67 and its adaptor proteins from regular mRNAs to prevent general mRNA export. At the same time, heat-shock mRNAs are rapidly exported in association with Mex67, without the need for adapters. The immediate co-transcriptional loading of Mex67 onto heat-shock mRNAs involves Hsf1, a heat-shock transcription factor that binds to heat-shock-promoter elements in stress-responsive genes. An important difference between the export modes is that adaptor-protein-bound mRNAs undergo quality control, whereas stress-specific transcripts do not. In fact, regular mRNAs are converted into uncontrolled stress-responsive transcripts if expressed under the control of a heat-shock promoter, suggesting that whether an mRNA undergoes quality control is encrypted therein. Under normal conditions, Mex67 adaptor proteins are recruited for RNA surveillance, with only quality-controlled mRNAs allowed to associate with Mex67 and leave the nucleus. Thus, at the cost of error-free mRNA formation, heat-shock mRNAs are exported and translated without delay, allowing cells to survive extreme situations.

  8. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control.

    Science.gov (United States)

    Lloyd-Sherlock, Peter; Beard, John; Minicuci, Nadia; Ebrahim, Shah; Chatterji, Somnath

    2014-02-01

    This study uses data from the World Health Organization's Study on Global Ageing and Adult Health (SAGE) to examine patterns of hypertension prevalence, awareness, treatment and control for people aged 50 years and over in China, Ghana, India, Mexico, the Russian Federation and South Africa. The SAGE sample comprises of 35 125 people aged 50 years and older, selected randomly. Hypertension was defined as ≥140 mmHg (systolic blood pressure) or ≥90 mmHg (diastolic blood pressure) or by currently taking antihypertensives. Control of hypertension was defined as blood pressure below 140/90 mmHg on treatment. A person was defined as aware if he/she was hypertensive and self-reported the condition. Prevalence rates in all countries are broadly comparable to those of developed countries (52.9%; range 32.3% in India to 77.9% in South Africa). Hypertension was associated with overweight/obesity and was more common in women, those in the lowest wealth quintile and in heavy alcohol consumers. Awareness was found to be low for all countries, albeit with substantial national variations (48.3%; range 23.3% in Ghana to 72.1% in the Russian Federation). This was also the case for control (10.2%; range 4.1% in Ghana to 14.1% India) and treatment efficacy (26.3%; range 17.4% in the Russian Federation to 55.2% in India). Awareness was associated with increasing age, being female and being overweight or obese. Effective control of hypertension was more likely in older people, women and in the richest quintile. Obesity was associated with poorer control. The high rates of hypertension in low- and middle-income countries are striking. Levels of treatment and control are inadequate despite half those sampled being aware of their condition. Since cardiovascular disease is by far the largest cause of years of life lost in these settings, these findings emphasize the need for new approaches towards control of this major risk factor.

  9. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial

    OpenAIRE

    Padwal, Raj; McAlister, Finlay Aleck; Wood, Peter William; Boulanger, Pierre; Fradette, Miriam; Klarenbach, Scott; Edwards, Alun L; Holroyd-Leduc, Jayna M; Alagiakrishnan, Kannayiram; Rabi, Doreen; Majumdar, Sumit Ranjan

    2016-01-01

    Background Diabetes and hypertension are devastating, deadly, and costly conditions that are very common in seniors. Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications. However, blood pressure (BP) must be lowered carefully because seniors are also susceptible to low BP and attendant harms. Achieving “optimal BP control” (ie, avoiding both undertreatment and overtreatment) is the ultimate therapeutic goal in such patients. Regular BP moni...

  10. Useful information for hypertension management reform in community health care: prevalence, awareness, treatment and control among Guangzhou adults.

    Science.gov (United States)

    Wu, Xueji; Pan, Bingying; Chen, Xiongfei; Zhuang, Xiaoxia; Zhu, Kaixing; Zeng, Lizhong; Dai, Liping; Dong, Xiaomei

    2014-01-01

    Objective data on hypertension prevalence and management in local areas are scarce. We assessed the prevalence of hypertension and its management in Guangzhou adult population. A stratified multistage cluster sampling with probability proportional to size method was used in this survey. Information on a total of 23 939 respondents, aged 15 years old or above, having a gender ratio of 0.997 (male versus female) with completed questionnaire and blood pressure measurement, was obtained. Hypertension was defined as having a mean SBP of at least 140 mm Hg, a DBP of at least 90 mm Hg, and/or the prescription of antihypertensive drugs. Information related to the history of hypertension and treatment of hypertension was collected through a questionnaire. The prevalence of hypertension was 11.8%. Among patients with hypertension, 54.4% were aware of their elevated BP, 49.3% had treatment, and 23.3% achieved targeted BP control. Among those who were aware of their hypertension, 90.4% underwent treatment, and among those who were treated, 43.6% were well controlled. Although the prevalence, awareness and treatment of hypertension varied significantly among adults with several social economics status, the control of hypertension did not show significant differences. Among treated patients, the control of hypertension showed significant differences among adults with education, occupation, insurance and income. It is the first time for Guangzhou to describe epidemic and management of hypertension. A baseline was established, which could provide useful information not only to policymakers but also to developing countries with a close urbanization and aging rate similar to Guangzhou.

  11. Spillover effects of community uninsurance on awareness, treatment, and control of hypertension among insured adults.

    Science.gov (United States)

    Escarce, José J; Edgington, Sarah E; Roan Gresenz, Carole

    2014-07-01

    Although studies have shown that a high rate of uninsurance in a community reduces access to and satisfaction with health care among the insured population, little is known about whether the community uninsurance rate also affects quality of care and clinical outcomes among the insured. To assess the spillover effects of the rate of uninsurance in a community on the awareness, treatment, and control of hypertension, a chronic condition responsible for substantial morbidity and mortality in the United States, among insured adults. NHANES III (1988-1994) and the 1999-2010 NHANES were linked to data from the Current Population Survey, Area Resource File, and InterStudy Competitive Edge. Multivariate probit regression models used 2 alternative estimation approaches: (1) maximum likelihood estimation, and (2) 2-stage residual inclusion estimation, an instrumental variables method. Six dichotomous outcomes included: awareness among all subjects with hypertension; treatment among all subjects with hypertension and among subjects who were aware of their condition; and control among all subjects with hypertension, among subjects who were aware of their condition, and among subjects receiving treatment. A 10 percentage point increase in the community uninsurance rate reduced the probability of receiving antihypertensive medications by 4.2 percentage points among insured hypertensive adults and by 5.5 percentage points among insured hypertensive adults who were aware of their hypertension. A 10 percentage point increase in the community uninsurance rate also resulted in a 6.8 percentage point decline in the probability of blood pressure control among insured hypertensive adults who were aware of their condition. Nationally, the Affordable Care Act is expected to reduce the number of uninsured by >30 million by 2016, although changes will be experienced by communities to a greater or lesser extent depending on the existing numbers and characteristics of the uninsured in the

  12. Blood Pressure Control in Smokers with Arterial Hypertension Who Switched to Electronic Cigarettes

    Directory of Open Access Journals (Sweden)

    Riccardo Polosa

    2016-11-01

    Full Text Available Electronic cigarettes (ECs are battery-operated devices designed to vaporise nicotine, which may help smokers with quitting or reducing their tobacco consumption. No data is available regarding the health effects of ECs use among smokers with arterial hypertension and whether regular use results in blood pressure (BP changes. We investigated long-term changes in resting BP and level of BP control in hypertensive smokers who quit or reduced substantially their tobacco consumption by switching to ECs. A medical records review of patients with hypertension was conducted to identify patients reporting regular daily use of ECs on at least two consecutive follow-up visits. Regularly smoking hypertensive patients were included as a reference group. A marked reduction in cigarette consumption was observed in ECs users (n = 43 though consumption remained unchanged in the control group (n = 46. Compared to baseline, at 12 months (follow-up visit 2 decline in cigarette consumption was associated with significant reductions in median (25th-, 75th-centile systolic BP (140 (134.5, 144 to 130 (123.5, 138.5 mmHg; p < 0.001 and diastolic BP (86 (78, 90 to 80 (74.5, 90 mmHg; p = 0.006. No significant changes were observed in the control group. As expected, decline in cigarette consumption in the ECs users was also associated with improved BP control. The study concludes that regular ECs use may aid smokers with arterial hypertension reduce or abstain from cigarette smoking, with only trivial post-cessation weight gain. This resulted in improvements in systolic and diastolic BP as well as better BP control.

  13. Blood Pressure Control in Smokers with Arterial Hypertension Who Switched to Electronic Cigarettes

    Science.gov (United States)

    Polosa, Riccardo; Morjaria, Jaymin B.; Caponnetto, Pasquale; Battaglia, Eliana; Russo, Cristina; Ciampi, Claudio; Adams, George; Bruno, Cosimo M.

    2016-01-01

    Electronic cigarettes (ECs) are battery-operated devices designed to vaporise nicotine, which may help smokers with quitting or reducing their tobacco consumption. No data is available regarding the health effects of ECs use among smokers with arterial hypertension and whether regular use results in blood pressure (BP) changes. We investigated long-term changes in resting BP and level of BP control in hypertensive smokers who quit or reduced substantially their tobacco consumption by switching to ECs. A medical records review of patients with hypertension was conducted to identify patients reporting regular daily use of ECs on at least two consecutive follow-up visits. Regularly smoking hypertensive patients were included as a reference group. A marked reduction in cigarette consumption was observed in ECs users (n = 43) though consumption remained unchanged in the control group (n = 46). Compared to baseline, at 12 months (follow-up visit 2) decline in cigarette consumption was associated with significant reductions in median (25th-, 75th-centile) systolic BP (140 (134.5, 144) to 130 (123.5, 138.5) mmHg; p < 0.001) and diastolic BP (86 (78, 90) to 80 (74.5, 90) mmHg; p = 0.006). No significant changes were observed in the control group. As expected, decline in cigarette consumption in the ECs users was also associated with improved BP control. The study concludes that regular ECs use may aid smokers with arterial hypertension reduce or abstain from cigarette smoking, with only trivial post-cessation weight gain. This resulted in improvements in systolic and diastolic BP as well as better BP control. PMID:27845734

  14. Hypertension control and antihypertensive therapy in patients with chronic kidney disease.

    Science.gov (United States)

    Unni, Sudhir; White, Kellee; Goodman, Michael; Ye, Xiangyang; Mavros, Panagiotis; Bash, Lori D; Brixner, Diana

    2015-06-01

    Hypertension is a major risk factor in the progression of chronic kidney disease (CKD). Although hypertension is more prevalent and treated more often among CKD patients, it is less likely to be controlled. Current guidelines recommend the use of multiple antihypertensive agents to achieve optimal blood pressure (BP) control. However, BP control attained by number and type of antihypertensive therapy according to CKD stage has not been examined thoroughly. Cross-sectional analysis of an electronic medical record (EMR) database. A total of 115,608 patients with CKD (Stages 1-4) and diagnosed or treated hypertension in General Electric Centricity EMR from 1996 to 2012. BP control, based on JNC 7 guidelines, was defined as less than 130/80 mm Hg. BP and antihypertensive therapy use was obtained from the EMR. The Cockcroft-Gault equation was used to calculate estimated glomerular filtration rate and classify CKD stage. Overall prevalence of BP control was 24.3%. BP control varied by CKD stage and number of antihypertensive therapy. In multivariable analysis, younger age was less likely to be associated with BP control, regardless of CKD stage. Multiple antihypertensive therapy use and BP control was strongest among CKD Stage 2 (odds ratio (OR): 1.41; 95% confidence interval (CI): 1.05, 1.90). Diuretic use was less likely to be associated with BP control among CKD Stage 1 (OR: 0.71; 95% CI: 0.59, 0.87) and 2 (OR: 0.78; 95% CI: 0.72, 0.85). Information on antihypertensive prescription fill data and adherence to medication regimens was unavailable. This study highlighted the need to pay closer attention to achieving BP treatment goals for younger individuals with CKD. More research is needed to assess the extent to which specific combinations of antihypertensive drugs leads to adequate BP control. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Prevalence, awareness, treatment and control of hypertension in Malaysia: a national study of 16,440 subjects.

    Science.gov (United States)

    Rampal, L; Rampal, S; Azhar, M Z; Rahman, A R

    2008-01-01

    A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure >140 mmHg, diastolic blood pressure >90 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged 30 years has increased from 32.9% in 1996 to 40.5% in 2004. In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians.

  16. Strategies for Better Hypertension Control in India and Other Lower Middle Income Countries.

    Science.gov (United States)

    Gupta, Rajeev; Khedar, Raghuvir Singh; Panwar, Raja Babu

    2016-09-01

    Hypertension is the most important cause of global burden of disease. It is highly prevalent in India and other low and lower-middle income countries. Prevalence of uncontrolled hypertension varies from 70-90% and is significantly greater in rural vs urban locations. Guidelines based treatment strategy has improved blood pressure (BP) control in high income countries but no context-specific guidelines exist in low and lower-middle income countries such as India. There are numerous barriers to proper BP control in these countries and include political apathy, bureaucratic inertia, weak health systems, overburdened healthcare providers and unempowered patients. Hypertension control can be improved in these countries by better political focus on social determinants of health such as education, development of health systems, proper healthcare financing, free or low-cost BP medicines, healthcare provider education for hypertension management, free primary care, task sharing with trained community health workers, patient empowerment and use of technological innovations. © Journal of the Association of Physicians of India 2011.

  17. Weight control behaviors in overweight/obese U.S. adults with diagnosed hypertension and diabetes

    Directory of Open Access Journals (Sweden)

    Li Chaoyang

    2009-03-01

    Full Text Available Abstract Background Obesity is a major risk factor for development and progression of hypertension and diabetes, which often coexist in obese patients. Losing weight by means of energy restriction and physical activity has been effective in preventing and managing these diseases. However, weight control behaviors among overweight/obese adults with these conditions are poorly understood. Methods Using self-reported data from 143,386 overweight/obese participants (aged ≥ 18 years in the 2003 Behavioral Risk Factor Surveillance System, we examined the proportion of overweight/obese adults who tried to lose weight and their weight control strategies by hypertension and/or diabetes status. Results Among all participants, 58% of those with hypertension, 60% of those with diabetes, and 72% of those with both diseases tried to lose weight, significantly higher than the 50% of those with neither condition (Bonferroni corrected P Conclusion The proportion of overweight/obese patients with diagnosed hypertension and/or diabetes who attempted to lose weight remains suboptimal and the weight control strategies varied significantly among these patients.

  18. The prevalence, awareness, and control of hypertension among workers in West Africa: a systematic review

    Directory of Open Access Journals (Sweden)

    William K. Bosu

    2015-01-01

    Full Text Available Background: Interventions in workplace settings are considered to be cost-effective in preventing cardiovascular diseases. A systematic review was conducted to assess the prevalence of hypertension and the level of awareness and control among workers in West Africa. Design: A systematic search for studies on formal and informal sector workers aged ≥15 years in West Africa published between 1980 and September 2014 was undertaken using the Ovid Medline, Embase, PubMed, and Google Scholar databases. Clinical and obstetric studies and studies that did not report prevalence were excluded. Data on study settings, characteristics of workers, blood pressure (BP levels, prevalence of hypertension, and associated demographic factors were extracted. Results: A total of 45 studies from six countries were identified involving 30,727 formal and informal sector workers. In 40 studies with a common definition of hypertension, the prevalence ranged from 12.0% among automobile garage workers to 68.9% among traditional chiefs. In 15 of these studies, the prevalence exceeded 30%. Typically sedentary workers such as traders, bank workers, civil servants, and chiefs were at high risk. Among health care workers, the prevalence ranged from 17.5 to 37.5%. The prevalence increased with age and was higher among males and workers with higher socio-economic status. Complications of hypertension, co-morbidities, and clustering of risk factors were common. The crude prevalence of hypertension increased progressively from 12.9% in studies published in the 1980s to 34.4% in those published in 2010–2014. The proportion of hypertensives who were previously aware of their diagnosis, were on treatment or had their BP controlled was 19.6–84.0%, 0–79.2%, and 0–12.7%, respectively. Hypertensive subjects, including health workers, rarely checked their BP except when they were ill. Conclusions: There is a high prevalence of hypertension among West Africa's workforce, of which

  19. Impact of corrective life style educational program on controlling stress, anxiety ,and depression in hypertensives

    OpenAIRE

    Fatemeh Samiei Siboni; Zainab Alimoradi; Tahereh Sadegi

    2013-01-01

    Background and Aim: Life style can cause stress and anxiety and consequently, hypertension. Regarding nurses' influencial role in implementing educational programs to increase patients’ self-control, the present research was designed to study the impact of a lifestyle promoting educational programs on controlling stress, anxiety, depression, and hypertewnsion in Qazvin Mino area in 2010. Materials and Methods: after the present study was a pre/post semi-experimental one conducted on 55 hyp...

  20. Hypertension treatment and control in a rural cohort in Thiruvallur, Tamil Nadu, India.

    Science.gov (United States)

    Kaur, Prabhdeep; Rao, Sudha Ramachandra; Venkatachalam, Ramachandran; Kaliaperumal, Kanagasabai

    2016-01-01

    Hypertension is a public health problem with low detection and treatment rates in India. We resurveyed 1284 patients with hypertension already identified in baseline survey of the cohort in Thiruvallur district, Tamil Nadu, India. The objective was to estimate the proportion of patients with drug treatment, hypertension control and lifestyle modification at follow-up (median follow-up 27 months). Overall, only 19.9% of the patients took drugs and 45.3% had blood pressure under control. Among 256 patients on drugs, 179 (69.9%) were on a single drug, 71 (27.7%) on two drugs, and six (2.3%) on three drugs. Commonly prescribed drugs based on the prescription review were beta blockers (50.4%), calcium channel blockers (36.7%), angiotensin-converting-enzyme inhibitor (18.4%), and diuretics (11.7%). Salt reduction was reported by 49.7% of the patients. There is a need for strengthening the health systems for effective management of hypertension and patient education to ensure active involvement in the long-term care.

  1. Effects of a Lifestyle Modification Program on Knowledge, Attitude and Practice of Hypertensive Patients with Angioplasty: A Randomized Controlled Clinical Trial

    Science.gov (United States)

    Jafari, Fahimeh; Shahriari, Mohsen; Sabouhi, Fakhri; Khosravi Farsani, Alireza; Eghbali Babadi, Maryam

    2016-01-01

    ABSTRACT Background: Lack of knowledge, attitude and practice are some of the barriers of having a healthy lifestyle and controlling high blood pressure. This study aimed to determine the effectiveness of a lifestyle modification program on knowledge, attitude and practice of hypertensive patients with angioplasty. Methods: This study was a randomized controlled clinical trial conducted from November to April 2014 on 60 hypertensive patients with angioplasty in Shahid Chamran hospital of Isfahan, Iran. The samples were randomly assigned to two equal groups. Data collection was performed in three stages by a researcher-made questionnaire. The intervention plan was 6 education sessions and then follow up were done by phone call. The gathered data were analyzed via SPSS (V.20), using t-test, Chi-square, repeated measurement, and post hoc LSD test and ANOVA statistics. Results: The mean score of knowledge, attitude and practice in the experimental group immediately after the intervention was 77.8±7.2, 88.3±6.4 and 86.2±6.5, respectively and one month after the intervention was 80.8±7.4, 91.1±3.5 and 92.5±2.2, respectively. But in the control group, the mean score of knowledge, attitude and practice immediately after the intervention (34.90±11.23, 61.11±6.28, and 38.64±7.15) and one month after the intervention was (38.64±7.15, 59.56±6.31 and 37.27±7.26. Conclusion: Lifestyle modification program can be effective in promoting the knowledge, attitude and practice of hypertensive patients with angioplasty. Nurses can use this program in their care provision programs for these patients. Trial Registration Number:IRCT2015062420912N3 PMID:27713892

  2. Controlling Hypertension (A Minute of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2013-04-04

    A recent study found an increase in self-reported high blood pressure among U.S. adults, and an increase in the use of medications to control high blood pressure. This podcast discusses the importance of controlling high blood pressure.  Created: 4/4/2013 by MMWR.   Date Released: 4/4/2013.

  3. Safety of Temporary Discontinuation of Antihypertensive Medication in Patients With Difficult-to-Control Hypertension.

    Science.gov (United States)

    Beeftink, Martine M A; van der Sande, Nicolette G C; Bots, Michiel L; Doevendans, Pieter A; Blankestijn, Peter J; Visseren, Frank L J; Voskuil, Michiel; Spiering, Wilko

    2017-05-01

    Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension. We assessed the occurrence of adverse cardiovascular and cerebrovascular events potentially attributable to temporary discontinuation of antihypertensive medication between February 2010 and March 2016 (n=604) in our Analysis of Complicated Hypertension screening program. A reference group (n=604) was extracted from the SMART study (Second Manifestations of Arterial Disease) cohort (comprising a similar cohort at our hospital in whom medication was not stopped) and individually matched for blood pressure, age, sex, and history of cardiovascular disease. Discontinuation of medication was well tolerated; 62% reported no complaints, 24% had mild discomfort that could be left untreated, and 14% experienced complaints that required prescription of antihypertensive escape medication. Three major adverse events were observed in the Analysis of Complicated Hypertension group between discontinuation of medication and 30 days after restart of medication (event rate=31.2 events per 1000 patient-year). In the reference cohort, 5 cardiovascular events were observed during a similar follow-up period (event rate=51.2 events per 1000 patient-year). In conclusion, discontinuation of antihypertensive medication for the diagnostic evaluation of hypertension does not increase the acute risk of cardiovascular events when performed in a well-controlled setting in specialized hospitals with appropriate protocols for monitoring safety. © 2017 American Heart Association, Inc.

  4. Factors associated with hypertension awareness, treatment and control among ethnic groups in Amsterdam, The Netherlands: The SUNSET study

    NARCIS (Netherlands)

    C. Agyemang; I. van Valkengoed; R. Koopmans; K. Stronks

    2006-01-01

    We sought to determine factors associated with hypertension awareness, pharmacological treatment and control among ethnic groups in Amsterdam, The Netherlands. We analysed data on hypertensive subjects ( Dutch n = 130, Hindustani n = 115 and African Surinamese n 225). After adjustments for important

  5. Community-based randomized controlled trial of non-pharmacological interventions in prevention and control of hypertension among young adults

    Directory of Open Access Journals (Sweden)

    Saptharishi L

    2009-01-01

    Full Text Available Context : Hypertension is a major chronic lifestyle disease. Several non-pharmacological interventions are effective in bringing down the blood pressure (BP. This study focuses on the effectiveness of such interventions among young adults. Aims : To measure the efficacy of physical exercise, reduction in salt intake, and yoga, in lowering BP among young (20-25 pre-hypertensives and hypertensives, and to compare their relative efficacies. Settings and Design: The study was done in the urban service area of JIPMER . Pre-hypertensives and hypertensives, identified from previous studies, constituted the universe. The participants were randomized into one control and three interventional groups. Materials and Methods: A total of 113 subjects: 30, 28, 28 and 27 in four groups respectively participated for eight weeks: control (I, physical exercise (II - brisk walking for 50-60 minutes, four days/week, salt intake reduction (III - to at least half of their previous intake, and practice of yoga (IV - for 30-45 minutes/day on at least five days/week. Statistical Analysis Used: Efficacy was assessed using paired t test and ANOVA with Games Howell post hoc test. An intention to treat analysis was also performed. Results : A total of 102 participants (29, 27, 25 and 21 in groups I, II, III and IV completed the study. All three intervention groups showed a significant reduction in BP (SBP/DBP: 5.3/6.0 in group II, 2.6/3.7 in III, and 2.0/2.6 mm Hg in IV respectively. There was no significant change (SBP/DBP: 0.2/0.5 mmHg of BP in control group (I. Physical exercise was most effective (considered individually; salt intake reduction and yoga were also effective. Conclusions : Physical exercise, salt intake reduction, and yoga are effective non-pharmacological interventions in significantly reducing BP among young hypertensives and pre-hypertensives. These can therefore be positively recommended for hypertensives. There is also a case to deploy these

  6. Association between Anthropometric Measures and Indicators for Hypertension Control among Kazakh-Chinese Hypertension Patients in Xinjiang, China: Results from a Cross-sectional Study

    Science.gov (United States)

    Zhang, Qinghua; Mahapatra, Tanmay; Huang, Feifei; Tang, Weiming; Guo, Yufang; Tang, Songyuan; Lei, Yang; Feng, Lei; Wang, Anni; Zhang, Liuyi; Zhang, Jingping

    2017-01-01

    Background Among Kazakh-Chinese population in Xinjiang province of China, prevalence of obesity and hypertension were 40.1% and 50.3% respectively, the highest across all ethnic groups residing in this pastureland. Despite this, there remained a dearth of information regarding the association between the anthropometric measures [body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), Waist-to-height ratio (WHtR) etc.] and indicators for hypertension control [achieved levels of systolic and diastolic blood pressures (SBP and DBP), pulse pressure index (PPI), ankle-brachial index (ABI) etc.] among them. Method A cross-sectional study was conducted in Xinjiang to determine the distribution and inter-relationships of the anthropometric measures and indicators for achieved BP control as well as their predictors among hypertension patients of Kazakh-Chinese ethnicity. Out of 550 randomly selected patients, 516 completed the interview, anthropometry and BP assessments. Results In the sample population, average SBP, DBP and PP were 156.26±24.40mmHg, 87.55±14.73mmHg and 68.71±19.39mmHg respectively. Bivariate analysis identified age, gender, education, duration of hypertension, WC and BMI being factors influencing the achieved levels of BP. Adjusted multiple linear regression models elicited positive associations of age (βa = 0.152, p = 0.001) and duration of hypertension (βa = 0.132, p = 0.003) with achieved level of SBP as well as BMI (βa = 0.135, p = 0.002) with DBP. Age (βa = 0.207, pAnthropometric measures and indicators for blood pressure control among Kazakh-Chinese patients were far beyond normal. Several anthropometric measures appeared useful for monitoring BP. Using them, regular screening and consequent targeted intervention were required urgently to control hypertension among Kazakh-Chinese. PMID:28129402

  7. The intervention effects ofa community-based hypertension control ...

    African Journals Online (AJOL)

    All white men and women aged 15 - 64 years were invited to participate in the ... recruited, trained registered nurses, were set up in the. 2 intervention towns. ... terol consumption, increased exercise, smoking control and stress management.

  8. Relationship between initial therapy and blood pressure control for high-risk hypertension patients in the UK: a retrospective cohort study from the THIN general practice database.

    Science.gov (United States)

    Weir, Sharada; Juhasz, Attila; Puelles, Jorge; Tierney, Travis S

    2017-07-28

    To examine the UK practice patterns in treating newly diagnosed hypertension and to determine whether subgroups of high-risk patients are more or less likely to follow particular therapeutic protocols and to reach blood pressure goals. Retrospective cohort study. This study examined adults in The Health Improvement Network (THIN) UK general practice medical records database who were initiated on medication for hypertension. 48 131 patients with essential hypertension diagnosed between 2008 and 2010 who were registered with a participating practice for a minimum of 13 months prior to, and 6 months following, initiation of therapy. We excluded patients with gestational hypertension or secondary hypertension. Patients were classified into risk groups based on blood pressure readings and comorbid conditions. Odds of receiving single versus fixed or free-drug combination therapy and odds of achieving blood pressure control were assessed using multivariable logistic regression. The vast majority of patients (95.8%) were initiated on single drug therapy. Patients with high cardiovascular risk (patients with grade 2-3 hypertension or those with high normal/grade 1 hypertension plus at least one cardiovascular condition pretreatment) had a statistically significant benefit of starting immediately on combination therapy when blood pressure control was the desired goal (OR: 1.23; 95% CI: 1.06 to 1.42) but, surprisingly, were less likely than patients with no risk factors to receive combination therapy (OR: 0.53; 95% CI: 0.47 to 0.59). Our results suggest that combination therapy may be indicated for patients with high cardiovascular risk, who accounted for 60.6% of our study population. The National Institute for Health and Care Excellence guideline CG34 of 2006 (in effect during the study period) recommended starting with single drug class therapy for most patients, and this advice does seem to have been followed even in cases where a more aggressive approach might

  9. Gender Specific Association of RAS Gene Polymorphism with Essential Hypertension: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Kh. Dhanachandra Singh

    2014-01-01

    Full Text Available Renin-angiotensin system (RAS polymorphisms have been studied as candidate risk factors for hypertension with inconsistent results, possibly due to heterogeneity among various genetic and environmental factors. A case-control association study was conducted to investigate a possible involvement of polymorphisms of three RAS genes: AGT M235T (rs699, ACE I/D (rs4340 and G2350A (rs4343, and AGTR1 A1166C (rs5186 in essential hypertensive patients. A total of 211 cases and 211 controls were recruited for this study. Genotyping was performed using PCR-RFLP method. The genotype and allele distribution of the M235T variant differed significantly in hypertensives and normotensives (OR-CI = 2.62 (1.24–5.76, P=0.006; OR-CI = 0.699 (0.518–0.943, P=0.018, respectively. When the samples were segregated based on sex, the 235TT genotype and T allele were predominant in the female patients (OR-CI = 5.68 (1.60-25.10, P=0.002; OR-CI = 0.522 (0.330–0.826, P=0.005 as compare to the male patients (OR-CI = 1.54 (1.24–5.76, P=0.34; OR-CI = 0.874 (0.330–0.826, P=0.506, respectively. For ACE DD variant, we found overrepresentation of “I”-allele (homozygous II and heterozygous ID in unaffected males which suggest its protective role in studied population (OR-CI = 0.401 (0.224–0.718; P=0.0009. The M235T variant of the AGT is significantly associated with female hypertensives and ACE DD variant could be a risk allele for essential hypertension in south India.

  10. Evidence of low dimensional chaos in renal blood flow control in genetic and experimental hypertension

    Science.gov (United States)

    Yip, K.-P.; Marsh, D. J.; Holstein-Rathlou, N.-H.

    1995-01-01

    We applied a surrogate data technique to test for nonlinear structure in spontaneous fluctuations of hydrostatic pressure in renal tubules of hypertensive rats. Tubular pressure oscillates at 0.03-0.05 Hz in animals with normal blood pressure, but the fluctuations become irregular with chronic hypertension. Using time series from rats with hypertension we produced surrogate data sets to test whether they represent linearly correlated noise or ‘static’ nonlinear transforms of a linear stochastic process. The correlation dimension and the forecasting error were used as discriminating statistics to compare surrogate with experimental data. The results show that the original experimental time series can be distinguished from both linearly and static nonlinearly correlated noise, indicating that the nonlinear behavior is due to the intrinsic dynamics of the system. Together with other evidence this strongly suggests that a low dimensional chaotic attractor governs renal hemodynamics in hypertension. This appears to be the first demonstration of a transition to chaotic dynamics in an integrated physiological control system occurring in association with a pathological condition.

  11. [Blood pressure control in a population of hypertensive diabetic patients treated in primary care: PRESCAP-Diabetes Study 2010].

    Science.gov (United States)

    Barquilla García, A; Llisterri Caro, J L; Prieto Díaz, M A; Alonso Moreno, F J; García Matarín, L; Galgo Nafría, A; Mediavilla Bravo, J J

    2015-01-01

    To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90mmHg was considered as good control of arterial hypertension. The percentages of patients withPrimaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  12. Effects of a Lifestyle Modification Program on Knowledge, Attitude and Practice of Hypertensive Patients with Angioplasty: A Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Fahimeh Jafari

    2016-10-01

    Full Text Available Background: Lack of knowledge, attitude and practice are some of the barriers of having a healthy lifestyle and controlling high blood pressure. This study aimed to determine the effectiveness of a lifestyle modification program on knowledge, attitude and practice of hypertensive patients with angioplasty. Methods: This study was a randomizedcontrolledclinical trial conducted from November to April 2014 on 60 hypertensive patients with angioplasty in ShahidChamran hospital of Isfahan, Iran. The samples were randomly assigned to two equal groups. Data collection was performed in three stages by a researcher-made questionnaire. The intervention plan was 6 education sessions and then follow up were done by phone call. The gathered data were analyzed via SPSS (V.20, using t-test, Chi-square, repeated measurement, and post hoc LSD test andANOVA statistics. Results: The mean score of knowledge, attitude and practice in the experimental group immediately after the intervention was 77.8±7.2, 88.3±6.4 and 86.2±6.5, respectively and one month after the intervention was 80.8±7.4, 91.1±3.5 and 92.5±2.2, respectively. But in the control group, the mean score of knowledge, attitude and practice immediately after the intervention (34.90±11.23, 61.11±6.28, and 38.64±7.15 and one month after the intervention was (38.64±7.15, 59.56±6.31 and 37.27±7.26. Conclusion: Lifestyle modification program can be effective in promoting the knowledge, attitude and practice of hypertensive patients with angioplasty. Nurses can use this program in their care provision programs for these patients.

  13. Family clustering of secondary chronic kidney disease with hypertension or diabetes mellitus. A case-control study.

    Science.gov (United States)

    de Almeida, Fernando Antonio; Ciambelli, Giuliano Serafino; Bertoco, André Luz; Jurado, Marcelo Mai; Siqueira, Guilherme Vasconcelos; Bernardo, Eder Augusto; Pavan, Maria Valeria; Gianini, Reinaldo José

    2015-02-01

    In Brazil hypertension and type 2 diabetes mellitus are responsible for 60% of cases of end-stage renal disease in renal replacement therapy. In the United States studies have identified family clustering of chronic kidney disease, predominantly in African-Americans. A single Brazilian study observed family clustering among patients with chronic kidney disease when compared with hospitalized patients with normal renal function. This article aims to assess whether there is family clustering of chronic kidney disease in relatives of individuals in renal replacement therapy caused by hypertension and/or diabetes mellitus. A case-control study with 336 patients in renal replacement therapy with diabetes mellitus or hypertension for at least 5 years (cases) and a control matched sample group of individuals with hypertension or diabetes mellitus and normal renal function (n = 389). Individuals in renal replacement therapy (cases) had a ratio of 2.35 (95% CI 1.42-3.89, p hypertension or diabetes mellitus).

  14. Trends and determinant factors in hypertension control in a population study with 25 years of follow-up

    DEFF Research Database (Denmark)

    Andersen, Ulla O; Jensen, Gorm B

    2010-01-01

    as compared with younger hypertensive patients. Obesity was associated with a high threshold SBP. The fourth factor was diagnosis. Patients with myocardial infarction were better treated in last surveys than patients from other diagnosis groups. Treated DBP was stable. CONCLUSION: Hypertension treatment...... efficacy is improving but still far from acceptable. The evaluation of determinant factors identified four areas that need special attention: men, elderly and obese hypertensive patients. The fourth factor is diagnosis. The results may indicate a beneficial effect of systematic control of hypertensive......OBJECTIVE: The present study focused on trend in hypertension control and on determinant factors that may influence efficacy in antihypertensive therapy. Two measures of treatment efficacy were used: population blood pressure and the relative frequency of effectively treated patients (blood...

  15. Is hypertension a risk factor for poor balance control in elderly adults?

    Science.gov (United States)

    Acar, Serap; Demırbüken, İlkşan; Algun, Candan; Malkoç, Mehtap; Tekın, Nil

    2015-03-01

    [Purpose] The aim of this study was to investigate whether hypertension negatively affects the postural balance control of elderly adults under different sensory conditions. [Subjects and Methods] Fifty-four healthy elderly adults who were residents in a Geriatric Home Care Center were recruited for this study. Height, weight, body mass index and age of the volunteers were recorded. After applying the exclusion criteria, the final study group included 16 hypertensive (HT) and the control group included 10 non-hypertensive (Non-HT) healthy elderly adults. To evaluate postural balance control objectively, the modified Clinical Test of Sensory Interaction on Balance (modified CTSIB) test was performed under four different conditions: 1) eyes open on a stable surface; 2) eyes closed on a stable surface; 3) eyes open on an unstable surface; and 4) eyes closed on an unstable surface. [Results] The postural balance scores (center of gravity sway) of the HT group were slightly higher than those of the Non-HT group under conditions 1 (HT group=0.3°/sec, Non-HT group=0.2°/sec), 2 (HT group=0.8°/sec, Non-HT group=0.4°/sec) and 4 (HT group=4.5°/sec, Non-HT group=3.5°/sec), but no statistically significant differences were found between the HT and Non-HT groups under any sensory condition. [Conclusion] The result of this study indicate that controlled hypertension in elderly adults is not a cause of worse balance performance than controls on stable or unstable surfaces with the eyes open or closed.

  16. Control of glomerular hypertension by insulin administration in diabetic rats.

    OpenAIRE

    Scholey, J.W.; Meyer, T W

    1989-01-01

    Micropuncture studies were performed in Munich Wistar rats made diabetic with streptozotocin and in normal control rats. Diabetic rats received daily ultralente insulin to maintain moderate hyperglycemia (approximately 300 mg/dl). Group 1 diabetic rats studied after routine micropuncture preparation exhibited elevation of the single nephron glomerular filtration rate (SNGFR) due to increases in the glomerular transcapillary hydraulic pressure difference and glomerular plasma flow rate. In gro...

  17. Safety and usefulness of Laghu shankha prakshalana in patients with essential hypertension: A self controlled clinical study

    Directory of Open Access Journals (Sweden)

    Prakash Mashyal

    2014-01-01

    Full Text Available Background: Yoga and Ayurveda texts emphasize the role of cleansing the bowel as an important component of management of hypertension (HTN. Observations during our clinical experience and pilot studies on Laghu shankha prakshalana kriya (LSP, a yogic bowel cleansing technique, appeared to be safe and complimentary. Objective: To test the safety and effectiveness of LSP in patients with essential hypertension. Materials and Methods: This self control study recruited 32 patients with mild to moderate essential HTN admitted for a week long residential integrated yoga therapy program at the integrative health home in Bengaluru. Patients had a daily routine of 6 hours of integrated approach of yoga therapy (IAYT module for HTN that included physical postures, relaxation sessions, pranayama and meditations. LSP, an additional practice, that involved drinking of luke-warm water (with or without a herbal combination, triphala followed by a set of specific yoga postures that activates defecation reflex, was administered on 2 nd (LSP without triphala and 5 th day (LSP with triphala. Assessments (sitting blood pressure and pulse rate were done just before and after both the sessions of LSP. Secondary outcome measures such as body mass index (BMI, symptom scores, medication scores, fatigue, state and trait anxiety, general health and quality of life were assessed on 1 st and 6 th day of IAYT intervention. Results: There was significant (P < 0.001, paired t test reduction in blood pressure (systolic and diastolic and pulse rate immediately after both the sessions (LSP with and without triphala. There were no adverse effects reported during or after LSP. There was no significant difference between the two techniques (P < 0.505, independent samples t test, although the percentage change appeared to be higher after triphala LSP session. The number of visits to clear the bowel during the procedure was significantly (P < 0.001, independent samples t test higher

  18. [Arterial hypertension and control in Brazzaville (Congo): role of ambulatory blood pressure monitoring (ABPM)].

    Science.gov (United States)

    Ikama, M S; Nsitou, B M; Makani, J; Nkalla-Lambi, M; Passi-Louamba, C

    2015-04-01

    To evaluate the rate control in the hypertensive patients and to identify the predictive factors of non-control. It was about a cross-sectional study with prospective collection of data over a period of 36 months. It has been held in Brazzaville, and included a consecutive series of 620 hypertensive patients known and treated for at least 6 weeks, having profited from an ambulatory blood pressure monitoring (ABPM) with therapeutic aiming. We used the TONOPORT V and the software Cardiosoft 6.51 of GE Health Care, respectively for the recording and the data analysis. The threshold fixed on the average of 24-hour was BP<130/80 mmHg, and the patients divided into two groups according to whether they were or not controlled. They were 352 men (56.8%) and 268 women (43.2%), old on average of 53.8 ± 9.7 years (ranges: 29 and 89 years). The standard of living of the patients was average in 330 cases (53.2%), weak in 132 cases (21.3%), and high in 71 cases (11.5%). The other associated risk factors were sedentariness in 275 cases (44.4%), overweight/obesity in 134 cases (21.6%), dyslipidemia in 121 cases (19.5%), diabetes mellitus in 90 cases (14.5%), and tobacco addiction in 25 cases (4%). The hypertension, old of 5.8 ± 5.7 years on average, was controlled among 215 patients (34.7%). The 24- hour BP average was 139 ± 14 mmHg for the SBP and 88.2 ± 10.2 mmHg for the DBP. The awake and asleep BP averages were respectively 141 ± 14 mmHg and 133 ± 16.2 mmHg for the SBP, 90.5 ± 10.5 and 81.2 ± 11.1 mmHg for the DBP. The antihypertensive protocol used was a monotherapy in 130 cases (21%), bitherapy in 287 cases (46.3%), tritherapy in 154 cases (24.8%), quadritherapy or more in 27 cases (4.3%). Prevalence of non-dipping was 43%. Age and male gender were the significant predictors of poor control. The rate control of hypertension in our study population remains low. Its improvement passes by the education of the hypertensive patients and the improvement of their living

  19. Dialysis-associated hypertension treated with Telmisartan--DiaTel: a pilot, placebo-controlled, cross-over, randomized trial

    National Research Council Canada - National Science Library

    Huber, Matthias; Treutler, Till; Martus, Peter; Kurzidim, Antje; Kreutz, Reinhold; Beige, Joachim

    2013-01-01

    .... We designed and conducted a randomised, placebo-controlled, double-blind and cross-over trial for treatment of dialysis-associated hypertension with telmisartan 80 mg once daily or placebo on top...

  20. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014.

    Science.gov (United States)

    Zhang, Yiyi; Moran, Andrew E

    2017-10-01

    Overall hypertension prevalence has not changed in the United States in recent decades although awareness, treatment, and control improved. However, hypertension epidemiology and its temporal trends may differ in younger adults compared with older adults. Our study included 41 331 participants ≥18 years of age from 8 National Health and Nutrition Examination Surveys (1999-2014) and estimated temporal trends of hypertension, awareness, treatment, and control among young adults (age, 18-39 years) compared with middle-age (age, 40-59 years) and older adults (age, ≥60 years). In 2013 to 2014, 7.3% of the US young adults had hypertension. During 1999 to 2014, young adults saw larger increases in hypertension awareness, treatment, and control than did older adults. However, all of these components of hypertension control were lower among young adults compared with middle-aged or older adults (74.7% younger versus 81.9% middle versus 88.4% older for awareness; 50.0% versus 70.3% versus 83.0% for treatment; and 40.2% versus 56.7% versus 54.4% for control). Worse hypertension awareness, treatment, and control in young adults overall were mostly driven by worse measures in young adult men compared with young adult women. More frequent healthcare visits by young adult women explained ≈28% of the sex-related difference in awareness, 60% of the difference in treatment, and 52% of the difference in control. These findings suggest that improved access to and engagement in medical care might improve hypertension control in young adults, particularly young adult men, and reduce life-time cardiovascular risk. © 2017 American Heart Association, Inc.

  1. Acupuncture for Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Clinical Trials

    Directory of Open Access Journals (Sweden)

    Dong-Ze Li

    2014-01-01

    Full Text Available Background. Acupuncture is frequently advocated as an adjunct treatment for essential hypertension. The aim of this review was to assess its adjunct effectiveness in treating hypertension. Methods. We searched PubMed, the Cochrane Library, EMBASE, and the Chinese databases Sino-Med, CNKI, WanFang, and VIP through November, 2012, for eligible randomized controlled trials that compared acupuncture with sham acupuncture. Outcome measures were changes in diastolic (DBP and systolic blood pressure (SBP. Results. A total of 4 randomized controlled trials were included. We found no evidence of an improvement with the fact that acupuncture relative to sham acupuncture in SBP change (n=386; mean difference = −3.80 mmHg, 95% CI = −10.03–2.44 mmHg; I2=99%, and an insignificant improvement in DBP change (n=386; mean difference = −2.82 mmHg, 95% CI = −5.22–(−0.43 mmHg; I2=97%. In subgroup analyses, acupuncture significantly improved both SBP and DBP in patients taking antihypertensive medications. Only minor acupuncture-related adverse events were reported. Conclusions. Our results are consistent with acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. We did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

  2. The effect of tiaprofenic acid on blood pressure control in treated hypertensive patients.

    Science.gov (United States)

    Smith, M D; Kupa, A; Weatherall, M; Henstridge, J D; Brooks, P M

    1985-01-01

    Eleven patients with osteoarthritis and mild hypertension completed an 8-week, double-blind crossover study in which 200 mg tiaprofenic acid 3-times daily or placebo were substituted for their normal non-steroidal anti-inflammatory therapy. Systolic blood pressure was significantly higher on tiaprofenic acid therapy than on placebo and plasma renin activity was significantly lower on active treatment. No significant changes were seen in biochemical parameters, though the weight of the patient was also higher on tiaprofenic acid than on placebo. Duration of morning stiffness was also lower on tiaprofenic acid than on placebo. Blood pressure on tiaprofenic acid was not different from baseline readings on other non-steroidal anti-inflammatory drug therapy. This study suggests that tiaprofenic acid, like other non-steroidal anti-inflammatory agents, may interfere with blood pressure control in treated hypertensive patients.

  3. Diagnosis and Control of Hypertension as Indicators of the Level of Awareness Among Relatives of Medical Students in Saudi Arabia.

    Science.gov (United States)

    Mirza, Ahmad A; Elmorsy, Soha A

    2016-06-01

    Patients' awareness plays an important role in the early diagnosis and control of many diseases including hypertension. To estimate the level of awareness among relatives of medical students by assessing the prevalence of undiagnosed and uncontrolled hypertension. A predefined group of medical students were recruited and properly instructed in order to conduct this cross-sectional study among their respective first-degree adult relatives whom their sociodemographic and medical history were obtained along with their blood pressure readings. According to the absence or presence of hypertension in their history, relatives with high blood pressure were considered as undiagnosed or uncontrolled hypertension, respectively; while those who had normal blood pressure were considered as normal or controlled hypertension, respectively. Comparative analysis of different parameters was carried out between these subgroups. We included 770 relatives of 82 (57.7 %) total students' participations. The prevalence of undiagnosed hypertension among the total study population was 14.4 % (111 cases). Among participants with previously diagnosed hypertension, 61.9 % were uncontrolled at the time of the study. Predictors for undiagnosed hypertension were age below 40 years, working at the present time in either governmental or private sectors, current smoking, absence of diabetes and cardiac diseases. None of the investigated factors showed to be a significant predictor for uncontrolled hypertension. There is insufficient level of awareness among family members of clinically oriented medical students, as demonstrated by the high prevalence of both undiagnosed and uncontrolled hypertension. The most frequent profile associated with the lowest awareness level is that of the young smoking employee with no history of diabetes or cardiac disease.

  4. Immune control of HIV-1 infection after therapy interruption: immediate versus deferred antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Bernaschi Massimo

    2009-10-01

    Full Text Available Abstract Background The optimal stage for initiating antiretroviral therapies in HIV-1 bearing patients is still a matter of debate. Methods We present computer simulations of HIV-1 infection aimed at identifying the pro et contra of immediate as compared to deferred Highly Active Antiretroviral Therapy (HAART. Results Our simulations highlight that a prompt specific CD8+ cytotoxic T lymphocytes response is detected when therapy is delayed. Compared to very early initiation of HAART, in deferred treated patients CD8+ T cells manage to mediate the decline of viremia in a shorter time and, at interruption of therapy, the virus experiences a stronger immune pressure. We also observe, however, that the immunological effects of the therapy fade with time in both therapeutic regimens. Thus, within one year from discontinuation, viral burden recovers to the value at which it would level off in the absence of therapy. In summary, simulations show that immediate therapy does not prolong the disease-free period and does not confer a survival benefit when compared to treatment started during the chronic infection phase. Conclusion Our conclusion is that, since there is no therapy to date that guarantees life-long protection, deferral of therapy should be preferred in order to minimize the risk of adverse effects, the occurrence of drug resistances and the costs of treatment.

  5. Can aerobic exercise complement antihypertensive drugs to achieve blood pressure control in individuals with essential hypertension?

    Science.gov (United States)

    Maruf, Fatai A; Salako, Babatunde L; Akinpelu, Aderonke O

    2014-06-01

    Achieving adequate blood pressure (BP) control with antihypertensive medication remains an elusive goal for many patients. The advances in knowledge of hypertension and the increasingly improved upon therapeutic strategies seem not to guarantee even sustainable control rates at the population level. In addition, patients who either discontinue their medications or are non-adherent to drug therapy run the risk of developing uncontrolled BP. Number of daily tablets more than two and number of daily drug administration at least three have been associated with poor adherence with drug therapy. However, BP control seems to go beyond adherence with drug therapy as there are other associated factors. Studies have demonstrated beneficial effect of aerobic exercise in the prevention and management of hypertension. It appears, however, that the majority of these studies failed to explore the possible additive or synergistic effect of aerobic exercise on antihypertensive drugs such that fewer drugs would be required to achieve BP control or that the BP control rate would be increased with the same number of drugs. This review presents the evidence for poor BP control in the general population, and the possible means and process of aerobic exercise complementing antihypertensive drug therapy in order to achieve higher BP control rates.

  6. Immediate postpartum versus 6-week postpartum intrauterine device insertion: a feasibility study of a randomized controlled trial.

    Science.gov (United States)

    Bryant, Amy G; Kamanga, Gift; Stuart, Gretchen S; Haddad, Lisa B; Meguid, Tarek; Mhango, Chisale

    2013-06-01

    This study aimed to evaluate the feasibility of conducting a randomized controlled trial of postpartum intrauterine device insertion and to demonstrate that the postpartum intrauterine device is acceptable to women. Women attending prenatal care at a maternity hospital in Lilongwe, Malawi were recruited into a trial comparing immediate (10 minutes to 48 hours) to 6 week postpartum insertion. Feasibility of recruiting and consenting 140 women and randomizing 70% of them was evaluated. Satisfaction with the intrauterine device was also assessed. One hundred fifteen women consented and 49 (61%) were randomized. Twenty-six women were assigned to immediate insertion, and 23 to insertion at 6 weeks postpartum. Thirty (24%) women received the device as part of the study protocol, and 28 (93%) had the device in place at 12 weeks postpartum. The intrauterine device is acceptable to some postpartum women in Malawi, but conducting a randomized clinical trial may not be feasible.

  7. The growing gap in hypertension control between insured and uninsured adults: National Health and Nutrition Examination Survey 1988 to 2010.

    Science.gov (United States)

    Egan, Brent M; Li, Jiexiang; Small, James; Nietert, Paul J; Sinopoli, Angelo

    2014-11-01

    Hypertension awareness, treatment, and control are lower among uninsured than insured adults. Time trends in differences and underlying modifiable factors are important for informing strategies to improve health equity. National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2004, and 2005 to 2010 data in adults aged 18 to 64 years were analyzed to explore this opportunity. The proportion of adults with hypertension who were uninsured increased from 12.3% in 1988 to 1994 to 17.4% in 2005 to 2010. In 1988 to 1994, hypertension awareness, treatment, and control to adults. By 2005 to 2010, the absolute gap in hypertension control between uninsured and insured adults of 21.9% (52.5% versus 30.6%; Padults treated (75.2% versus 88.5%), and fewer treated adults controlled (63.1% versus 73.5%; all Padults had similar income. Yet, hypertension control was similar across time periods in publicly and privately insured adults, despite lower income and education in the former. In multivariable analysis, hypertension control in 2005 to 2010 was associated with visit frequency (odds ratio, 3.4 [95% confidence interval, 2.4-4.8]), statin therapy (1.8 [1.4-2.3]), and healthcare insurance (1.6 [1.2-2.2]) but not poverty index (1.04 [0.96-1.12]). Public or private insurance linked to more frequent healthcare, greater awareness and effective treatment of hypertension, and appropriate statin use could reverse a long-term trend of growing inequity in hypertension control between insured and uninsured adults. © 2014 American Heart Association, Inc.

  8. Immediate vs. early loading of SLA implants in the posterior mandible: 5-year results of randomized controlled clinical trial.

    Science.gov (United States)

    Kokovic, Vladimir; Jung, Ronald; Feloutzis, Andreas; Todorovic, Vladimir S; Jurisic, Milan; Hämmerle, Christoph H F

    2014-02-01

    The aim of this study was to compare clinical results of immediate and early loading (EL) self-tapping implants placed in posterior mandibles. Twelve patients with bilateral edentulous posterior mandibular were randomly assigned to treatment either with immediate (test) or early loaded implants (control). Seventy-two self-tapping implants with SLA surface (Ø 4, 1/4, 8 mm; length 8 and 10 mm) were analyzed in this study. Test implants (36) were loaded on the day of surgery and control implants 6 weeks later. The measuring of implant stability quotient (ISQ) was performed on 0, 6th, 12th, and 52nd week after implant insertion. The bone resorption, modified plaque, and bleeding index were notified at 1 and 5 years later. After 5 years, survival in the both groups was 100%. The mean value of primary implant stability was 76.92 ± 0.79 ISQ. In the first 6 weeks, ISQ values significantly increased in the test group (77.92 ± 1.16 vs. 79.61 ± 0.90) as well as in the control group (7.92 ± 1.05 vs. 77.55 ± 0.99). A significant longitudinal increase in ISQ value was recorded in test and control group. The differences between immediate and early loaded implants were statistically insignificant (P > 0.05). At the 5 years, no statistically significant differences were found between immediate and early loaded implants with respect to mean crestal bone loss measurements (0.4 ± 0.24 vs. 0.8 ± 0.15 mm), mean bleeding index (0.22 ± 0.11 vs. 0.25 ± 0.11), and mean plaque index (0.17 ± 0.15 vs. 0.19 ± 0.20). Based on these results, the self-tapping implants inserted in posterior mandible can provide adequate primary stability value as the main factor for immediate and EL protocol. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  9. Hypertension Subtypes among Hypertensive Patients in Ibadan

    Directory of Open Access Journals (Sweden)

    Abiodun M. Adeoye

    2014-01-01

    Full Text Available Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH, isolated systolic hypertension (ISH, isolated diastolic hypertension (IDH, and systolic-diastolic hypertension (SDH. Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5% and IDH (4.9% versus 4.7% were more prevalent among females, ISH (10.1% versus 6.2% was higher among males (P=0.048. Female subjects were more obese (P<0.0001 and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations.

  10. The counseling african americans to control hypertension (caatch trial: baseline demographic, clinical, psychosocial, and behavioral characteristics

    Directory of Open Access Journals (Sweden)

    Diaz-Gloster Marleny

    2011-09-01

    Full Text Available Abstract Background Effectiveness of combined physician and patient-level interventions for blood pressure (BP control in low-income, hypertensive African Americans with multiple co-morbid conditions remains largely untested in community-based primary care practices. Demographic, clinical, psychosocial, and behavioral characteristics of participants in the Counseling African American to Control Hypertension (CAATCH Trial are described. CAATCH evaluates the effectiveness of a multi-level, multi-component, evidence-based intervention compared with usual care (UC in improving BP control among poorly controlled hypertensive African Americans who receive primary care in Community Health Centers (CHCs. Methods Participants included 1,039 hypertensive African Americans receiving care in 30 CHCs in the New York Metropolitan area. Baseline data on participant demographic, clinical (e.g., BP, anti-hypertensive medications, psychosocial (e.g., depression, medication adherence, self-efficacy, and behavioral (e.g., exercise, diet characteristics were gathered through direct observation, chart review, and interview. Results The sample was primarily female (71.6%, middle-aged (mean age = 56.9 ± 12.1 years, high school educated (62.4%, low-income (72.4% reporting less than $20,000/year income, and received Medicaid (35.9% or Medicare (12.6%. Mean systolic and diastolic BP were 150.7 ± 16.7 mm Hg and 91.0 ± 10.6 mm Hg, respectively. Participants were prescribed an average of 2.5 ± 1.9 antihypertensive medications; 54.8% were on a diuretic; 33.8% were on a beta blocker; 41.9% were on calcium channel blockers; 64.8% were on angiotensin converting enzyme (ACE inhibitors/angiotensin receptor blockers (ARBs. One-quarter (25.6% of the sample had resistant hypertension; one-half (55.7% reported medication non-adherence. Most (79.7% reported one or more co-morbid medical conditions. The majority of the patients had a Charlson Co-morbidity score ≥ 2. Diabetes

  11. Ocular Hypertension

    Science.gov (United States)

    ... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Written By: Kierstan Boyd Reviewed By: J Kevin ...

  12. The Effect of Lifestyle Changes on Blood Pressure Control among Hypertensive Patients.

    Science.gov (United States)

    Yang, Myung Hwa; Kang, Seo Young; Lee, Jung Ah; Kim, Young Sik; Sung, Eun Ju; Lee, Ka-Young; Kim, Jun-Su; Oh, Han Jin; Kang, Hee Chul; Lee, Sang Yeoup

    2017-07-01

    Hypertension is highly prevalent among patients who visit primary care clinics. Various factors and lifestyle behaviors are associated with effective blood pressure control. We aimed to identify factors and lifestyle modifications associated with blood pressure control among patients prescribed antihypertensive agents. This survey was conducted at 15 hospital-based family practices in Korea from July 2008 to June 2010. We prospectively recruited and retrospectively assessed 1,453 patients prescribed candesartan. An initial evaluation of patients' lifestyles was performed using individual questions. Follow-up questionnaires were administered at 4, 8, and 12 weeks. We defined successful blood pressure control as blood pressure pressures were included. In the univariate analysis of the change in performance index, weight gain (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.52 to 3.11; Ppressure control. Salt intake also showed a significant association. Multivariate ORs were calculated for age, sex, body mass index, education, income, alcohol consumption, smoking status, salt intake, comorbidity, and family history of hypertension. In the multivariate analysis, sex (OR, 3.55; 95% CI, 2.02 to 6.26; Ppressure control. Weight gain, physical inactivity, and high salt intake were associated with inadequate blood pressure control.

  13. Blood pressure control, hypertension, awareness, and treatment in adults with diabetes in the United States-Mexico border region.

    Science.gov (United States)

    Vijayaraghavan, Maya; He, Guozhong; Stoddard, Pamela; Schillinger, Dean

    2010-09-01

    To determine prevalence of blood pressure control, hypertension, hypertension awareness, and antihypertensive treatment among adults (> 18 years old) with diabetes living in the border region between the United States of America and Mexico, and to explore variation in those variables between all adults on the Mexican side of the border ("Mexicans") and three groups on the U.S. side of the border ("all U.S. adults," "U.S.-born Hispanics," and "Mexican immigrants"). Using data from Phase I (February 2001-October 2002) of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, age-adjusted prevalence of hypertension-related variables was calculated for the sample (n = 682) and differences between the border groups were examined through logistic regression. Less than one-third of the sample had controlled blood pressure (hypertension (≥140/90 mm Hg), and hypertension awareness and treatment were inadequate. After adjusting for demographics, body mass index, and access to health care, there were no differences in blood pressure control, hypertension, hypertension awareness, or treatment between Mexicans and both U.S. adults and Mexican immigrants. However, compared to Mexicans and Mexican immigrants, U.S.-born Hispanics, particularly younger individuals, had the lowest rates of blood pressure control (17.3%) and the highest rates of coexisting hypertension (54.8%). Compared to Mexicans, U.S.-born Hispanics had lower odds of controlled blood pressure (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.09-0.95) and greater odds of hypertension (OR 3.75, 95% CI 1.51-9.29) and hypertension awareness (OR 6.19, 95% CI 1.46-26.15). Co-occurrence of diabetes and hypertension is a major public health problem among U.S.-Mexico border residents. The low rate of blood pressure control among various border groups, especially younger U.S.-born Hispanics, suggests that initiatives should aggressively target blood

  14. The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

    Science.gov (United States)

    Ahmed, Rashid J.; Gafni, Amiram; Hu, Zheng Jing; Pullenayegum, Eleanor; von Dadelszen, Peter; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, J. Johanna; Ganzevoort, Wessel; Helewa, Michael; Lee, Shoo K.; Lee, Terry; Logan, Alexander G.; Moutquin, Jean-Marie; Singer, Joel; Thornton, Jim G.; Welch, Ross; Magee, Laura A.

    2016-01-01

    The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned “less tight” (target diastolic 100 mm Hg) and “tight” (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman–infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, −$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, −$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, −$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412. PMID:27550914

  15. The Effects of Sertraline in Controlling Refractory Hypertension in Women with Premenstrual Syndrome

    Directory of Open Access Journals (Sweden)

    Fatemeh Ranjbar

    2016-12-01

    Full Text Available Objective: The aim of this study was to evaluate the effect of Premenstrual Syndrome (PMS treatment with selective serotonin reuptake inhibitor (SSRI on treatment response of refractory hypertension of the patients.Method: This was a triple-blind randomized clinical trial conducted on female patients suffering from refractory hypertension and PMS at the same time. We obtained informed consent from 40 patients who had inclusion criteria and selected 20 patients for the intervention (sertraline 50 mg daily and 20 for the control groups. The study period was five weeks. The mean of systolic and diastolic blood pressure before and after intervention was measured separately for each individual in each group and the mean of blood pressure of the members of the two groups were compared with each other.Results: The mean age of the participants was 43.60 ± 4.57. In this study, systolic and diastolic blood pressure of both groups reduced after intervention. The mean of systolic blood pressure was reduced by 40.86 mmHg in the intervention group and this reduction was 16 mm Hg in control group after intervention (P<0.001. Comparing this reduction between the two groups, we found that reduction rate in systolic blood pressure of the two groups did not have a significant statistical difference before and after the intervention (P = 0.11. Mean of diastolic blood pressure also showed reduction of 9.17 mm Hg and that of control group showed 6.7-mmHg reduction. Reduction rate of diastolic blood pressure in the intervention group had a statistically significant difference with that of the control group (P<0.017.‎‎Conclusion: Administration of sertraline is more effective in controlling diastolic blood pressure in women suffering from refractory hypertension and comorbid PMS.

  16. Effect of Turkish classical music on blood pressure: a randomized controlled trial in hypertensive elderly patients.

    Science.gov (United States)

    Bekiroğlu, Tansel; Ovayolu, Nimet; Ergün, Yusuf; Ekerbiçer, Hasan Çetin

    2013-06-01

    Existing studies suggest that music therapy can have favorable effects on hypertension and anxiety. We therefore set out to investigate the effect of Turkish classical music. To investigate whether Turkish classical music has positive effects on blood pressures and anxiety levels in elderly patients. This was a randomized controlled trial performed on 60 hypertensive patients living in a local elderly home in Adana, Turkey. Following the completion of a socio-demographic form for each patient, Hamilton anxiety scale was applied. Thereafter, the subjects were randomly divided into two equal-size groups and were allowed to either listen to Turkish classical music (music therapy group) or have a resting period (control group) for 25 min. The primary and secondary outcome measures were blood pressure and Hamilton anxiety scale scores, respectively. The mean reduction in systolic blood pressure was 13.00 mmHg in the music therapy group and 6.50 mmHg in the control group. The baseline adjusted between treatment group difference was not statistically significant (95% CI 6.80-9.36). The median reductions in diastolic blood pressures were 10 mmHg both in the music therapy and control groups. The between treatment group difference was not statistically significant (Mann-Whitney U test, P = 0.839). The mean reduction in HAMA-A was 1.63 in the music therapy group and 0.77 in the control group. The baseline adjusted between treatment group difference was not statistically significant (95% CI 0.82-1.92). The study demonstrated that both Turkish classical music and resting alone have positive effects on blood pressure in patients with hypertension. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Glycemic and blood pressure control in older patients with hypertension and diabetes: association with carotid atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    Hong-Wei Du; Jia-Yue Li; Yao He

    2011-01-01

    Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp)control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes.However, few studies have compared the relative importance of glycemic vs.Bp control in patients with diabetes and hypertension.We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes.Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke.Subjects were categorized by their systolic blood pressure: tight control, < 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, > 140 mmHg,and by their hemoglobin Alc (HbAlc) level: tight control, < 6.5%; usual control, 6.5%-7.5%; or uncontrolled, ≥ 7.5%, respectively.Results The mean CIMT was 8.20 ± 0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects.Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥1.1 mm).The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 mm, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis.Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1

  18. Mineral factors controlling essential hypertension--a study in the Chandigarh, India population.

    Science.gov (United States)

    Taneja, Satish Kumar; Mandal, Reshu

    2007-01-01

    Essential hypertension (EH) is a major public health problem world over and in India. Recent data on EH in the population of Chandigarh (Union Territory and capital of Punjab and Haryana States of India) revealed that the prevalence of EH has become double in the last 30 years in the residents of Chandigarh (26.9 to 45.80% in the year 1968 and 2002). Zinc (Zn), copper (Cu), magnesium (Mg), and manganese (Mn) in the serum are considered important in maintaining the human hypertension. The high Zn intake was considered to increase the blood pressure (BP) and to affect the other mineral status in the body. Recent survey on the trace metal status of different vegetables in the State of Punjab around Chandigarh (India) revealed that Zn level is significantly higher (40 mg/kg or more in above ground vegetables and 120 mg/kg or above in underground vegetables) in underground water-irrigated vegetables, but the levels of Cu and Mg are within prescribed limit. The present study was conducted on Chandigarh population to evaluate the levels of Zn, Cu, Mg, and Mn in the blood and urine of normotensive (NT) control and hypertensive (HT) subjects matched with number, age and sex. Atomic absorption spectrophotometer studies reevaluated that the levels of serum Zn, Mg, and Mn were significantly higher (p < 0.001), but the level of Cu was low in the HT subjects (BP = 160/93) compared to NT control (BP = 140/83). Higher levels of urinary Zn, Cu, Mg, and Mn were observed in the HT subject vs NT control (p < 0.001). Positive correlations were evaluated between the levels of serum Zn, Mg, and Mn vs systolic and diastolic pressures (DP and SP), respectively (r = 0.928, 0.863, 0.876, 0.808, 0.404, 0.326, p < 0.01), but negative and positive nonsignificant correlations between the serum Cu with SP and DP were recorded (r = -0.032, r = 0.024). Positive correlations were also evaluated between urinary levels of Zn, Cu, Mg, and Mn vs SP and DP (r = 0.718, 0.657, 0.750, 0.681, 0.630, 0.578, 0

  19. Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Muntner, Paul; Anderson, Amanda; Charleston, Jeanne; Chen, Zhen; Ford, Virginia; Makos, Gail; O’Connor, Andrew; Perumal, Kalyani; Rahman, Mahboob; Steigerwalt, Susan; Teal, Valerie; Townsend, Raymond; Weir, Matthew; Wright, Jackson T

    2010-01-01

    Background A low rate of blood pressure control has been reported among patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness. Study Design Cross-sectional Setting & Participants Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) study (n=3612) were analyzed. Participants with an estimated glomerular filtration rate of 20 to 70 ml/min/1.73m2 were identified from physician offices and review of laboratory databases. Outcomes Prevalence and awareness of hypertension, treatment patterns, control rates and factors associated with hypertension control. Measurements Following a standardized protocol, blood pressure was measured three times by trained staff and hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported antihypertensive medication use. Patients’ awareness and treatment of hypertension were defined using self-report and two levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 mmHg and <130/80 mmHg. Results The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis, 98.3% were treated with medications while 67.1% and 46.1% had their hypertension controlled to <140/90 mmHg and <130/80 mmHg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26% and 32% were taking one, two, three and four or more antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, those with higher urinary albumin excretion were less likely while participants taking ACE-inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 mmHg and <130/80 mmHg. Limitations Data were derived from a single study visit. Conclusions Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of

  20. Integrated control of hypertension by olmesartan medoxomil and hydrochlorothiazide and rationale for combination

    Directory of Open Access Journals (Sweden)

    Punzi HA

    2011-12-01

    Full Text Available Henry A PunziTrinity Hypertension and Metabolic Research Institute, Punzi Medical Center, Carrollton, TX, USA; Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USAAbstract: Hypertension affects nearly one-third of all individuals in the US, yet one-half of all treated patients achieve blood pressure (BP controlled to recommended goals. The percentage of patients with uncontrolled BP is likely to be much higher when considering the number of patients who are not even aware of their hypertensive state. Elevated BP is associated with increased risks of cardiovascular events and end-organ damage. Antihypertensive monotherapy is not always sufficient to achieve BP goals, and thus more aggressive treatment regimens need to be considered. Antihypertensive combination therapy, which may improve tolerability, offers the benefit of targeting different mechanisms of action. Numerous outcomes studies support the use of a renin–angiotensin system inhibitor as a first-line choice in antihypertensive therapy. This review discusses the benefits of combination therapy with the angiotensin type II receptor blocker olmesartan medoxomil (OM paired with the thiazide diuretic hydrochlorothiazide (HCTZ. The pharmacokinetic properties of OM will be reviewed in addition to efficacy studies that support OM + HCTZ combination therapy over other possible antihypertensive combinations. Finally, a rationale for choosing HCTZ over another diuretic, chlorthalidone, will also be discussed based on pharmacokinetic differences, clinical concerns, and trends in use.Keywords: antihypertensives, blood pressure, combination therapy, HCTZ

  1. Randomised controlled trial of qigong in the treatment of mild essential hypertension.

    Science.gov (United States)

    Cheung, B M Y; Lo, J L F; Fong, D Y T; Chan, M Y; Wong, S H T; Wong, V C W; Lam, K S L; Lau, C P; Karlberg, J P E

    2005-09-01

    Exercise and relaxation decrease blood pressure. Qigong is a traditional Chinese exercise consisting of breathing and gentle movements. We conducted a randomised controlled trial to study the effect of Guolin qigong on blood pressure. In all, 88 patients with mild essential hypertension were recruited from the community and randomised to Goulin qigong or conventional exercise for 16 weeks. The main outcome measurements were blood pressure, health status (SF-36 scores), Beck Anxiety and Depression Inventory scores. In the qigong group, blood pressure decreased significantly from 146.3+/-7.8/93.0+/-4.1 mmHg at baseline to 135.5+/-10.0/87.1+/-7.7 mmHg at week 16. In the exercise group, blood pressure also decreased significantly from 140.9+/-10.9/93.1+/-3.5 mmHg to 129.7+/-11.1/86.0+/-7.0 mmHg. Heart rate, weight, BMI, waist circumference, total cholesterol, renin and 24 h urinary albumin excretion significantly decreased in both groups after 16 weeks. General health, bodily pain, social functioning and depression also improved in both groups. No significant differences between qigong and conventional exercise were found. In conclusion, Guolin qigong and conventional exercise have similar effects on blood pressure in patients with mild hypertension. While no additional benefits were identified, it is nevertheless an alternative to conventional exercise in the nondrug treatment of hypertension.

  2. Smartphone Applications for Hypertension Management: a Potential Game-Changer That Needs More Control.

    Science.gov (United States)

    Parati, Gianfranco; Torlasco, Camilla; Omboni, Stefano; Pellegrini, Dario

    2017-06-01

    This review article will summarize available data on mobile applications for the management of hypertension, by highlighting their potential for clinical use, the current limitations and the yet pending issues to be addressed in future studies. The number of available applications related to arterial hypertension and their usage by smartphone owners is constantly increasing. However, most applications lack standardization and scientific validation, and security flaws could be an important, yet still underrated, issue. Small studies showed that treatment strategies based on telemonitoring of home blood pressure with mobile applications could improve blood pressure control, but there are no data on strong outcomes and the high heterogeneity of available studies severely limits the possibility of reaching a definitive conclusion on the impact of such strategies. Smartphone applications for arterial hypertension represent a great chance to improve management of this condition. Results from small studies are promising, but there is a strong need for large, long-term, well-designed clinical trials, before these potential solutions might be reliably applied in real-life patients' care.

  3. Factors associated with blood pressure control amongst adults with hypertension in Yaounde, Cameroon: a cross-sectional study

    Science.gov (United States)

    Menanga, Alain; Edie, Sandrine; Boombhi, Jérôme; Musa, Ahmadou Jingi; Mfeukeu, Liliane Kuate; Kingue, Samuel

    2016-01-01

    Background Hypertension is associated with considerable morbidity and mortality. Improvement of its management to reduce adverse cardiovascular outcomes will require an understanding of the patient characteristics and treatment factors associated with uncontrolled blood pressure. Factors that affect blood pressure control have not been sufficiently described in Cameroon. The main goal of our study was to determine the predictors of blood pressure control in patients with hypertension in an urban city in Cameroon. Methods This was descriptive cross-sectional study from five outpatient hypertension consultation units in Hospitals in Yaoundé. Controlled hypertension was defined as blood pressure ≤140/90 mmHg. Logistic regression was used to determine factors associated with blood pressure control. Results Among the 440 patients enrolled in the survey, 280 (63.6%) were females. The mean age was 61 (SD ±11) years. Mean systolic blood pressure (SBP) was 147 mmHg and mean diastolic blood pressure (DBP) was 88 mmHg. Only 36.8% of patients had their mean blood pressure controlled (BP ≤140/90 mmHg). Multivariable logistic regression analysis revealed good adherence to anti-hypertensive medications (OR= 3.99; 95% CI: 2.20–7.23; Plifestyle changes (OR =1.5; 95% CI: 0.53–2.49; P=0.031) to be factors independently associated with controlled hypertension. Conclusions Only one out of three patients has their blood pressure controlled. The results of our study suggest that good adherence to treatment are important factors for tight blood pressure control in primary care. Further identification of patients at risk of non-adherence to treatment and poor blood pressure control can lead to targeted interventions to reduce hypertension related morbidity and mortality in this setting. PMID:27747167

  4. Chronic baroreflex activation restores spontaneous baroreflex control and variability of heart rate in obesity-induced hypertension

    OpenAIRE

    Iliescu, Radu; Tudorancea, Ionut; Irwin, Eric D; Lohmeier, Thomas E.

    2013-01-01

    The sensitivity of baroreflex control of heart rate is depressed in subjects with obesity hypertension, which increases the risk for cardiac arrhythmias. The mechanisms are not fully known, and there are no therapies to improve this dysfunction. To determine the cardiovascular dynamic effects of progressive increases in body weight leading to obesity and hypertension in dogs fed a high-fat diet, 24-h continuous recordings of spontaneous fluctuations in blood pressure and heart rate were analy...

  5. Relationship between brain atrophy estimated by a longitudinal computed tomography study and blood pressure control in patients with essential hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Yamano, Shigeru; Sawai, Fuyuki; Yamamoto, Yuta [Nara Medical Univ., Kashihara (Japan)] [and others

    1999-01-01

    To evaluate the relationship between blood pressure control and the progression of brain atrophy in the elderly, patients with essential hypertension and brain atrophy were longitudinally evaluated using computerized tomography (CT). The study evaluated 48 patients with essential hypertension aged 46-78 years, and 30 sex- and age-matched normotensive control subjects. The extent of brain atrophy as determined by caudate head index (CHI), the inverse cella media index (iCMI), and Evans` ratio (ER) was estimated twice at an interval of 5-9 years (mean, 6.9 years). The mean annual increases in CHI ({Delta}CHI), iCMI ({Delta}iCMI), and ER ({Delta}ER) were evaluated. Mean blood volume in the common carotid artery (BF) and the decrease in BF per year ({Delta}BF) were also determined. The {Delta}CHI, {Delta}iCMI, and {Delta}ER increased with age in the hypertensive subjects as well as the control group across all age groups evaluated. The {Delta}CHI, {Delta}iCMI, and {Delta}ER were significantly greater in the patients with essential hypertension in their 50s as compared with the controls. In patients with essential hypertension aged 65 years or older, the {Delta}CHI, {Delta}iCMI, and {Delta}ER were significantly lower in the group in whom the blood pressure was controlled within the range of borderline hypertension than the groups in which it was controlled in the range of normal or mild hypertension. In the younger patients under the age of 65 with essential hypertension, blood pressure control did not affect the {Delta}CHI, {Delta}iCMI, and {Delta}ER. The {Delta}CHI, {Delta}iCMI, and {Delta}ER were significantly correlated with {Delta}BF in both groups. These findings indicate that control of systolic blood pressure within the range of borderline hypertension may delay the progression of brain atrophy in elderly patients with essential hypertension. (author)

  6. Immediate effect of passive and active stretching on hamstrings flexibility: a single-blinded randomized control trial.

    Science.gov (United States)

    Nishikawa, Yuichi; Aizawa, Junya; Kanemura, Naohiko; Takahashi, Tetsuya; Hosomi, Naohisa; Maruyama, Hirofumi; Kimura, Hiroaki; Matsumoto, Masayasu; Takayanagi, Kiyomi

    2015-10-01

    [Purpose] This study compared the efficacy of passive and active stretching techniques on hamstring flexibility. [Subjects] Fifty-four healthy young subjects were randomly assigned to one of three groups (2 treatment groups and 1 control group). [Methods] Subjects in the passive stretching group had their knees extended by an examiner while lying supine 90° of hip flexion. In the same position, subjects in the active stretching group extended their knees. The groups performed 3 sets of the assigned stretch, with each stretch held for 10 seconds at the point where tightness in the hamstring muscles was felt. Subjects in the control group did not perform stretching. Before and immediately after stretching, hamstring flexibility was assessed by a blinded assessor, using the active knee-extension test. [Results] After stretching, there was a significant improvement in the hamstring flexibilities of the active and passive stretching groups compared with the control group. Furthermore, the passive stretching group showed significantly greater improvement in hamstring flexibility than the active stretching group. [Conclusion] Improvement in hamstring flexibility measured by the active knee-extension test was achieved by both stretching techniques; however, passive stretching was more effective than active stretching at achieving an immediate increase in hamstring flexibility.

  7. Closing the gap in hypertension control between younger and older adults: National Health and Nutrition Examination Survey (NHANES) 1988 to 2010.

    Science.gov (United States)

    Egan, Brent M; Li, Jiexiang; Shatat, Ibrahim F; Fuller, J Michael; Sinopoli, Angelo

    2014-05-20

    Joint National Committee goal blood pressure for all adults was Adults aged ≥60 years (older) have mainly isolated systolic hypertension, with major trials attaining systolic blood pressure hypertension control to adults and adults aged ≥18 years. From 1988 to 1994 to 2005 to 2010, hypertension control to hypertension control reflected increased percentages of older (55.6% to 77.5%) and younger (34.6% to 54.7%) patients on treatment and treated older (45.7% to 64.9%) and younger (56.8% to 73.4%) patients controlled (all Padults. Antihypertensive medication number and percentages on ≥3 medications increased in both age groups but increased more in older patients (Phypertension control to hypertension predominates, controlling 70% to hypertension control in all adults. © 2014 American Heart Association, Inc.

  8. Hypertension Prevalence, Awareness and Blood Pressure Control in Matao, Brazil: A Pilot Study in Partnership With the Brazilian Family Health Strategy Program.

    Science.gov (United States)

    Minelli, Cesar; Borin, Lucileni Aparecida; Trovo, Mayra de Cassia; Dos Reis, Geraldo Cassio

    2016-07-01

    Around 30% of Brazilian population is hypertensive. Brazilian's Family Health Strategy (FHS) is a community-based approach to provide primary health care and control chronic disease as hypertension. The aims of this pilot study were to study hypertension prevalence and awareness and to analyze the feasibility of FHS program with community healthy agents (CHA) to collect data about hypertensive subjects in Matao, Brazil. A cross-sectional study was conducted in subjects equal or older than 40 years old in a neighborhood belonging to FHS program. CHA were trained to collect data and to assess blood pressure (BP) with an automated device. Hypertension diagnosis was defined if systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg or subject had previous use of hypertensive drug. Chi-square test and univariate logistic regression analysis were applied with significance level of 5% and a confidence interval of 95%. In 625 subjects, hypertension prevalence was 68.8% and women (71.9%) were more hypertensive than men (63.2%) (P = 0.02). Prevalence of hypertension increased with age group, from 46.3% (40 - 49 years) to 82.5% (70 - 79 years) (P < 0.001). The overall prevalence of pre-hypertension was 40.1%: stage 1, 25.7% and stage 2, 17.0%. Hypertension awareness was 81.8% and 79.8% reported use of anti-hypertensive drugs. BP was not controlled in 61.8% and 67.7% of them was using anti-hypertensive drugs. CHA reported no difficulties to collect data and BP assessment with the automated device. We observed a high hypertension prevalence rate, awareness, and subjects with uncontrolled hypertension even with use of anti-hypertensive drugs. CHA from FHS program are a feasible option to BP control in future studies involving larger populations.

  9. A multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2

    Directory of Open Access Journals (Sweden)

    Sierink Joanne C

    2012-03-01

    Full Text Available Abstract Background Computed tomography (CT scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients. Methods/design The REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED. All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness. Discussion The REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning

  10. The Counseling Older Adults to Control Hypertension (COACH) trial: design and methodology of a group-based lifestyle intervention for hypertensive minority older adults.

    Science.gov (United States)

    Ogedegbe, Gbenga; Fernandez, Senaida; Fournier, Leanne; Silver, Stephanie A; Kong, Jian; Gallagher, Sara; de la Calle, Franze; Plumhoff, Jordan; Sethi, Sheba; Choudhury, Evelyn; Teresi, Jeanne A

    2013-05-01

    The disproportionately high prevalence of hypertension and its associated mortality and morbidity in minority older adults is a major public health concern in the United States. Despite compelling evidence supporting the beneficial effects of therapeutic lifestyle changes on blood pressure reduction, these approaches remain largely untested among minority elders in community-based settings. The Counseling Older Adults to Control Hypertension trial is a two-arm randomized controlled trial of 250 African-American and Latino seniors, 60 years and older with uncontrolled hypertension, who attend senior centers. The goal of the trial is to evaluate the effect of a therapeutic lifestyle intervention delivered via group classes and individual motivational interviewing sessions versus health education, on blood pressure reduction. The primary outcome is change in systolic and diastolic blood pressure from baseline to 12 months. The secondary outcomes are blood pressure control at 12 months; changes in levels of physical activity; body mass index; and number of daily servings of fruits and vegetables from baseline to 12 months. The intervention group will receive 12 weekly group classes followed by individual motivational interviewing sessions. The health education group will receive an individual counseling session on healthy lifestyle changes and standard hypertension education materials. Findings from this study will provide needed information on the effectiveness of lifestyle interventions delivered in senior centers. Such information is crucial in order to develop implementation strategies for translation of evidence-based lifestyle interventions to senior centers, where many minority elders spend their time, making the centers a salient point of dissemination.

  11. Prevalence, awareness, treatment, and control of hypertension in elderly adults with chronic kidney disease: results from the survey of Prevalence, Awareness, and Treatment Rates in Chronic Kidney Disease Patients with Hypertension in China.

    Science.gov (United States)

    Cai, Guangyan; Zheng, Ying; Sun, Xuefeng; Chen, Xiangmei

    2013-12-01

    Data regarding hypertension in elderly adults with chronic kidney disease (CKD) remains limited. This study aimed to assess the epidemiological characteristics of hypertension in elderly adults with CKD using data from a nationwide survey. A nationwide, multicenter, cross-sectional study with a large sample. The Survey of Prevalence, Awareness, and Treatment Rates in Chronic Kidney Disease Patients with Hypertension in China (PATRIOTIC). Participants in PATRIOTIC (aged≥60; n=2,414). Trained physicians measured blood pressure (BP) using a standard protocol with a mercury sphygmomanometer at the time of admission. The prevalence, awareness, and treatment of hypertension in elderly adults with CKD were 82.0%, 90.7%, and 87.3%, respectively. The control of hypertension at BP less than 140/90 mmHg was 29.6% and at BP less than 130/80 mmHg it was 12.1%. No significant differences were noted in the prevalence, awareness, treatment, or control of hypertension in individuals with CKD divided into the age groups of 60 to 69, 70 to 79, and 80 and older (P>.05). With increasing age, the proportion of isolated systolic hypertension in elderly adults with CKD with uncontrolled hypertension increased (P=.02). Obesity (P=.01), CKD Stages 4 and 5 (Phypertension in elderly adults with CKD, using the goal of BP less than 140/90 mmHg. The prevalence of hypertension in elderly adults in China with CKD is high, and its control is poor. Most elderly adults with CKD with uncontrolled hypertension have systolic hypertension. Obesity, CKD Stages 4 and 5, and diabetes mellitus were adversely associated with greater uncontrolled hypertension in elderly adults with CKD. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  12. Immediate vs. delayed insertion of intrauterine contraception after second trimester abortion: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Soon Judith A

    2011-06-01

    Full Text Available Abstract Background We describe the rationale and protocol for a randomized controlled trial (RCT to assess whether intrauterine contraception placed immediately after a second trimester abortion will result in fewer pregnancies than current recommended practice of intended placement at 4 weeks post-abortion. Decision analysis suggests the novel strategy could substantially reduce subsequent unintended pregnancies and abortions. This paper highlights considerations of design, implementation and evaluation of a trial expected to provide rigorous evidence for appropriate insertion timing and health economics of intrauterine contraception after second trimester abortion. Methods/Design Consenting women choosing to use intrauterine contraception after abortion for a pregnancy of 12 to 24 weeks will be randomized to insertion timing groups either immediately (experimental intervention or four weeks (recommended care post abortion. Primary outcome measure is pregnancy rate at one year. Secondary outcomes include: cumulative pregnancy rates over five year follow-up period, comprehensive health economic analyses comparing immediate and delayed insertion groups, and device retention rates, complication rates (infection, expulsion and, contraceptive method satisfaction. Web-based Contraception Satisfaction Questionnaires, clinical records and British Columbia linked health databases will be used to assess primary and secondary outcomes. Enrolment at all clinics in the province performing second trimester abortions began in May 2010 and is expected to complete in late 2011. Data on one year outcomes will be available for analysis in 2014. Discussion The RCT design combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry and hospital records, offers a unique opportunity to evaluate such an approach by determining pregnancy rate at one

  13. Actions to control high blood pressure among hypertensive adults in Texas counties along the Mexico border: Texas BRFSS, 2007.

    Science.gov (United States)

    Ayala, Carma; Fang, Jing; Escobedo, Luis; Pan, Stephen; Balcazar, Hector G; Wang, Guijing; Merritt, Robert

    2012-01-01

    We examined the prevalence of actions taken to control blood pressure as measured by taking antihypertensive medication or making lifestyle modifications among hypertensive adults residing along the Texas/Mexico border. We used self-reported data from the 2007 Texas Behavioral Risk Factor Surveillance System, with oversampling of border counties. We calculated the age-standardized prevalence of actions taken to control hypertension by selected characteristics. In analyses that combined ethnicity with predominant language spoken, those least likely to take any action to control their blood pressure--either by taking an antihypertensive medication or by making any of four lifestyle modifications--were Spanish-speaking Hispanic people (83.2% ± 2.7% standard error [SE]), with English-speaking non-Hispanic people (88.9% ± 0.8% SE) having the highest prevalence of taking action to control blood pressure. When analyzed by type of medical category, uninsured Hispanic people (63.8% ± 4.8% SE) had the lowest prevalence of taking action to control their blood pressure compared with uninsured non-Hispanic people (75.4% ± 4.7% SE). Nonborder Texas residents with hypertension were more likely to take antihypertensive medications (78.4% ± 1.0% SE) than border county residents with hypertension (70.7% ± 2.0% SE). Public health efforts must be undertaken to improve the control of hypertension among residents of Texas counties along the Mexico border, particularly for uninsured Hispanic people.

  14. Blood pressure control in hypertension. Pros and cons of available treatment strategies.

    Science.gov (United States)

    Mancia, Giuseppe; Rea, Federico; Cuspidi, Cesare; Grassi, Guido; Corrao, Giovanni

    2017-02-01

    The low rate of blood pressure (BP) control that characterizes the hypertensive population in real life is traditionally associated to factors such as low adherence of patients to the prescribed treatment regimen, physicians' therapeutic inertia, and deficiencies of the healthcare systems. This study will focus on a fourth factor that may also be importantly involved, i.e. reluctance to adopt drug treatment strategies that more effectively reduce an elevated BP. The point will be made that, vis-à-vis strategies based on patients' persistence in monotherapy, drug combinations are accompanied by a much more frequent BP control. In particular, it will be argued that compared with the administration of additional drugs after initial monotherapy, use of combination treatment from the beginning may carry important advantages, such as a faster BP control, and thus an earlier protection in patients at a high cardiovascular risk and a better adherence to the prescribed drugs and thus a more frequent long-term achievement of target BP values, possibly also with a more effective cardiovascular protection. This may justify a more clear support of this treatment strategy by future guidelines, in the attempt to lessen the contribution of hypertension to cardiovascular disease and death.

  15. Full-dose Perindopril/Indapamide in the Treatment of Difficult-to-Control Hypertension: The FORTISSIMO Study.

    Science.gov (United States)

    Karpov, Yuri Aleksandrovich

    2017-02-01

    Blood pressure (BP) control in hypertensive patients remains poor worldwide, particularly in high-risk patients with hypertension and diabetes. Guidelines recommend that such patients receive prompt pharmacological therapy at maximal doses to rapidly control BP. We aimed to evaluate efficacy and safety of single-pill combination (SPC) perindopril/indapamide (PER/IND) at full dose (10/2.5 mg) in hypertensive patients, including diabetics, with BP uncontrolled by previous medication. Twelve-week prospective, observational study in patients with uncontrolled hypertension (≥160-200 mmHg systolic BP [SBP] and hypertensive patients were enrolled, including 307 with type 2 diabetes. Two weeks after substitution, SBP significantly decreased from 171.0 ± 13.3 to 148.6 ± 13.4 mmHg, and DBP from 98.6 ± 8.3 to 88.8 ± 7.9 mmHg (both p hypertension, including difficult-to-treat patients with diabetes.

  16. [Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project].

    Science.gov (United States)

    Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, María Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

    2017-06-08

    Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

  17. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

    Science.gov (United States)

    Cléroux, J; Feldman, R D; Petrella, R J

    1999-05-04

    To provide updated, evidence-based recommendations for health care professionals concerning the effects of regular physical activity on the prevention and control of hypertension in otherwise healthy adults. People may engage in no, sporadic or regular physical activity that may be of low, moderate or vigorous intensity. For sedentary people with hypertension, the options are to undertake or maintain regular physical activity and to avoid or moderate medication use; to use another lifestyle modification technique; to commence or continue antihypertensive medication; or to take no action and remain at increased risk of cardiovascular disease. The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. A MEDLINE search was conducted for the period 1966-1997 with the terms exercise, exertion, physical activity, hypertension and blood pressure. Both reports of trials and review articles were obtained. Other relevant evidence was obtained from the reference lists of these articles, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. A high value was placed on avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. Physical activity of moderate intensity involving rhythmic movements with the lower limbs for 50-60 minutes, 3 or 4 times per week, reduces blood pressure and appears to be more effective than vigorous exercise. Harm is uncommon and is generally restricted to the musculoskeletal injuries that may occur with any repetitive activity. Injury occurs more often with jogging than with walking, cycling or swimming. The costs include the costs of appropriate shoes, garments and equipment, but these were not specifically measured. (1) People with mild hypertension should engage in 50-60 minutes

  18. Blood pressure control in hypertensive patients within Family Health Program versus at Primary Healthcare Units: analytical cross-sectional study.

    Science.gov (United States)

    Martins, Telma Lima; Atallah, Alvaro Nagib; Silva, Edina Mariko Koga da

    2012-01-01

    Hypertension is a public health problem due to its high prevalence and long-term cardiovascular complications. In Brazil in 2005, cardiovascular diseases were responsible for 28% of all deaths. Efforts are being made within primary care to achieve adequate hypertension control. The Family Health Program (FHP) has the aims of promoting quality of life and intervening in factors that put this at risk. The objective of this study was to evaluate the rate of blood pressure control among patients followed up at FHP units compared with those at primary healthcare units (PHUs). Analytical cross-sectional study in the municipality of Petrópolis, Rio de Janeiro, from January to December 2005. Five hundred patients with a diagnosis of hypertension were included: 250 were being followed up at two FHP units and 250 at two PHUs. The diagnosis of hypertension was based on the Fourth Brazilian Hypertension Consensus, and the patients needed to have been under follow-up at the units for at least 12 months. Patients' blood pressure was considered to be under control if it was less than 140/90 mmHg at the last consultation. Blood pressure was under control in 29.2% (n = 73) at FHP units and 39.23% (n = 98) at PHUs (odds ratio = 0.64; confidence interval = 0.44-0.93; P = 0.024). Blood pressure control was better among patients followed up at PHUs than among those followed up at FHP units.

  19. Effectiveness of B vitamins on the control of hypertension and stroke events of SHRSP rats.

    Science.gov (United States)

    França, Camille Feitoza; Vianna, Lucia Marques

    2010-03-01

    The spontaneously hypertensive stroke-prone rat (SHRSP) is a recognized animal model for the study of severe hypertension and stroke, being characterized by presenting an elevated tissue levels of free radicals. Therefore, this study has the main goal to identify the effect of B vitamins, closely associated to the control of oxidative stress, on SHRSP rats. After 10 days (baseline period), the animals, 18 SHRSP rats at 18 weeks of age, were divided into three groups with six rats treated with riboflavin (B2), six treated with pyridoxine (B6) plus folic acid (B9), and control. Body weight, water and food intake, diuresis, sensory-motor responses, and systolic blood pressure of all the rats were determined daily. Physical aspects of whole body (i.e., distribution and coloring of hair, skin and mucosa, and an eventual presence of bleeding, stains, cracks, or opacification) and behavior were equally monitored. The data were evaluated by ANOVA two-way and p thought as one of the alternative therapies to prevent the occurrence of stroke.

  20. Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial.

    Science.gov (United States)

    Noronha Neto C, Carlos; Maia, Sabina S B; Katz, Leila; Coutinho, Isabela C; Souza, Alex R; Amorim, Melania M

    2017-01-01

    Changes during the puerperium are still unclear, particularly in women with hypertension. The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, also requires further elucidation. Currently, there are no clear data to guide the decision for the choice of postpartum antihypertensives. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effect. The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension. A randomized, drug-controlled, triple-blind clinical trial evaluating postpartum women receiving captopril or clonidine. Inclusion criteria consisted of: women with hypertensive disorders of pregnancy systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥110 mmHg], requiring magnesium sulfate. Exclusion criteria were: heart disease, smoking, illicit drug use, contraindications to captopril, clonidine or oral medication, and having used captopril/clonidine previously. The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit. A total of 90 postpartum women met the study inclusion criteria, with 45 randomized to each group. There were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7, p = 0.08), greater percentage reduction in SBP (14.0% ± 8.6% vs. 10.8% ± 8.8%, p = 0.08) and fewer women requiring sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02-1.39; p = 0.06) in the clonidine group compared to the captopril group; however, these differences were not significant. The groups were similar regarding daily mean SBP or DBP; however, on the third postpartum day, mean SBP was lower in

  1. Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial

    Science.gov (United States)

    Noronha Neto C, Carlos; Katz, Leila; Coutinho, Isabela C.; Souza, Alex R.; Amorim, Melania M.

    2017-01-01

    Background Changes during the puerperium are still unclear, particularly in women with hypertension. The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, also requires further elucidation. Currently, there are no clear data to guide the decision for the choice of postpartum antihypertensives. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effect. The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension. Methods and findings A randomized, drug-controlled, triple-blind clinical trial evaluating postpartum women receiving captopril or clonidine. Inclusion criteria consisted of: women with hypertensive disorders of pregnancy systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥110 mmHg], requiring magnesium sulfate. Exclusion criteria were: heart disease, smoking, illicit drug use, contraindications to captopril, clonidine or oral medication, and having used captopril/clonidine previously. The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit. A total of 90 postpartum women met the study inclusion criteria, with 45 randomized to each group. There were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7, p = 0.08), greater percentage reduction in SBP (14.0% ± 8.6% vs. 10.8% ± 8.8%, p = 0.08) and fewer women requiring sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02–1.39; p = 0.06) in the clonidine group compared to the captopril group; however, these differences were not significant. The groups were similar regarding daily mean SBP or DBP; however, on the third

  2. Trends in hypertension prevalence, awareness, treatment, and control among US adults 80 years and older, 1988-2010.

    Science.gov (United States)

    Bromfield, Samantha G; Bowling, C Barrett; Tanner, Rikki M; Peralta, Carmen A; Odden, Michelle C; Oparil, Suzanne; Muntner, Paul

    2014-04-01

    The authors examined trends in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the prevalence, awareness, treatment, and control of hypertension in 1988-1994 (n=1164), 1999-2004 (n=1,026), and 2005-2010 (n=1048) among US adults 80 years and older in serial National Health and Nutrition Examination Surveys. Hypertension was defined as SBP ≥140 mm Hg, DBP ≥90 mm Hg, or use of antihypertensive medication. Awareness and treatment were defined by self-report and control as SBP/DBP1988-1994 and 2005-2010. The prevalence, awareness, and treatment of hypertension each increased over time. Controlled hypertension increased from 30.4% in 1988-1994 to 53.1% in 2005-2010. The proportion of patients taking 3 classes of antihypertensive medication increased from 7.0% to 30.9% between 1988-1994 and 2005-2010. Increases in awareness, treatment, and control of hypertension and antihypertensive polypharmacy have been observed among very old US adults.

  3. Onset of hypertension during pregnancy is associated with long-term worse blood pressure control and adverse cardiac remodeling.

    Science.gov (United States)

    Mesquita, Roberto F; Reis, Muriel; Beppler, Ana Paula; Bellinazzi, Vera Regina; Mattos, Sandra S; Lima-Filho, José L; Cipolli, José A; Coelho-Filho, Otavio R; Pio-Magalhães, José A; Sposito, Andrei C; Matos-Souza, José R; Nadruz, Wilson

    2014-11-01

    Up to 20% of women with hypertensive pregnancy disorders might persist with chronic hypertension. This study compared clinical and echocardiographic features between women whose hypertension began as hypertensive pregnancy disorders (PH group) and women whose diagnosis of hypertension did not occur during pregnancy (NPH group). Fifty PH and 100 NPH women were cross-sectionally evaluated by clinical, laboratory, and echocardiography analysis, and the groups were matched by duration of hypertension. PH exhibited lower age (46.6 ± 1.4 vs. 65.3 ± 1.1 years; P < .001), but higher systolic (159.8 ± 3.9 vs. 148.0 ± 2.5 mm Hg; P = .009) and diastolic (97.1 ± 2.4 vs. 80.9 ± 1.3 mm Hg; P < .001) blood pressure than NPH, although used more antihypertensive classes (3.4 ± 0.2 vs. 2.6 ± 0.1; P < .001). Furthermore, PH showed higher left ventricular wall thickness and increased prevalence of concentric hypertrophy than NPH after adjusting for age and blood pressure. In conclusion, this study showed that PH may exhibit worse blood pressure control and adverse left ventricular remodeling compared with NPH.

  4. A randomised controlled trial for the evaluation of risk for type 2 diabetes in hypertensive patients receiving thiazide diuretics: Diuretics In the Management of Essential hypertension (DIME) study.

    Science.gov (United States)

    Ueda, Shinichiro; Morimoto, Takeshi; Ando, Shin-Ichi; Takishita, Shu-Ichi; Kawano, Yuhei; Shimamoto, Kazuaki; Ogihara, Toshio; Saruta, Takao

    2014-07-16

    Thiazide diuretics are one of the first choice antihypertensives but not optimally utilised because of concerns regarding their adverse effects on glucose metabolism. The Diuretics In the Management of Essential hypertension (DIME) study was designed, for the first time, to assess the risk for type 2 diabetes mellitus in patients with essential hypertension during antihypertensive treatment with low-dose thiazide diuretics compared to those not treated with diuretics. Multicentre, unblinded, pragmatic, randomised, controlled trial with blinded assessment of end points and intention-to-treat analysis that was started in 2004 and finished in 2012. Hypertension clinics at 106 sites in Japan, including general practitioners' offices and teaching hospitals. Non-diabetic patients with essential hypertension. Antihypertensive treatment with low-dose thiazide diuretics at 12.5 mg/day of hydrochlorothiazide or equivalent (Diuretics group) or that without thiazide diuretics (No-diuretics group). The primary outcome was new onset of type 2 diabetes diagnosed according to WHO criteria and the criteria of Japanese Society of Diabetes. 1130 patients were allocated to Diuretics (n=544) or No-diuretics group (n=586). Complete end point information was collected for 1049 participants after a median follow-up of 4.4 years. Diabetes developed in 25 (4.6%) participants in the Diuretics group, as compared with 29 (4.9%) in the No-diuretics group (HR 0.93; 95% CI 0.55 to 1.58; p=0.800). Antihypertensive treatment with thiazide diuretics at low doses may not be associated with an increased risk for new onset of type 2 diabetes. This result might suggest safety of use of low doses of thiazide diuretics. ClinicalTrials.gov NCT00131846. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. A randomised controlled trial for the evaluation of risk for type 2 diabetes in hypertensive patients receiving thiazide diuretics: Diuretics In the Management of Essential hypertension (DIME) study

    Science.gov (United States)

    Ueda, Shinichiro; Morimoto, Takeshi; Ando, Shin-ichi; Takishita, Shu-ichi; Kawano, Yuhei; Shimamoto, Kazuaki; Ogihara, Toshio; Saruta, Takao

    2014-01-01

    Objectives Thiazide diuretics are one of the first choice antihypertensives but not optimally utilised because of concerns regarding their adverse effects on glucose metabolism. The Diuretics In the Management of Essential hypertension (DIME) study was designed, for the first time, to assess the risk for type 2 diabetes mellitus in patients with essential hypertension during antihypertensive treatment with low-dose thiazide diuretics compared to those not treated with diuretics. Design Multicentre, unblinded, pragmatic, randomised, controlled trial with blinded assessment of end points and intention-to-treat analysis that was started in 2004 and finished in 2012. Setting Hypertension clinics at 106 sites in Japan, including general practitioners’ offices and teaching hospitals. Participants Non-diabetic patients with essential hypertension. Interventions Antihypertensive treatment with low-dose thiazide diuretics at 12.5 mg/day of hydrochlorothiazide or equivalent (Diuretics group) or that without thiazide diuretics (No-diuretics group). Main outcome The primary outcome was new onset of type 2 diabetes diagnosed according to WHO criteria and the criteria of Japanese Society of Diabetes. Results 1130 patients were allocated to Diuretics (n=544) or No-diuretics group (n=586). Complete end point information was collected for 1049 participants after a median follow-up of 4.4 years. Diabetes developed in 25 (4.6%) participants in the Diuretics group, as compared with 29 (4.9%) in the No-diuretics group (HR 0.93; 95% CI 0.55 to 1.58; p=0.800). Conclusions Antihypertensive treatment with thiazide diuretics at low doses may not be associated with an increased risk for new onset of type 2 diabetes. This result might suggest safety of use of low doses of thiazide diuretics. Trial registration number ClinicalTrials.gov NCT00131846. PMID:25031188

  6. Psychological treatment of essential hypertension: a controlled comparison of meditation and meditation plus biofeedback.

    Science.gov (United States)

    Hafner, R J

    1982-09-01

    Twenty-one patients with essential hypertension were randomly allocated to eight 1-hour sessions of meditation training, meditation plus biofeedback-aided relaxation, or a no-treatment control group. Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs, although overall reductions in blood pressure were not significantly greater in either program than in the control group. Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone. All patients practiced mediation regularly between training sessions: The amount of practice did not correlate with the amount of blood pressure reduction after training. On questionnaire measures of psychological symptoms and personality, sex differences emerged, with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms. In females, outward-directed hostility fell significantly and assertiveness increased after training, but in males, somatopsychic symptoms were unchanged.

  7. EVALUATION OF QUALITY OF ARTERIAL HYPERTENSION CONTROL IN POPULATION OF VOLOGDA REGION

    Directory of Open Access Journals (Sweden)

    A. I. Popugaev

    2008-01-01

    Full Text Available Aim. To study results of registration, calculation and evaluation of quality of arterial hypertension (HT control (HT Register in Vologda Region (VR.Material and methods. HT Register system is developed and legislatively introduced in the VR. Blood pressure registration in every visitor of out-patient clinics is the basic principle of HT Register. The algorithm of HT diagnosis in primary medical care of rural public health services was developed. Analysis of results of HT Register implementation in VR during 2004-2007 is presented.Results. Patients with HT stage 1 seek medical help more often in cities while patients with HT stage 3 seek medical help more often in villages. Patients with HT in villages take antihypertensive drugs more often, but they have more risk factors and associate conditions.Conclusion. Improvement of HT pharmacotherapy was observed in urban and rural districts of VR. At the same time non pharmacologic HT control has to be developed.

  8. Adolescents' perception of self and of immediate environment by parental marital status: a controlled study.

    Science.gov (United States)

    Saucier, J F; Ambert, A M

    1986-08-01

    Most studies on children of "broken families" are based on small and unrepresentative samples, are limited to children of divorce and do not control for basic demographic variables. In order to do a survey with fewer methodological deficiencies, we managed to obtain a completely representative sample of a Francophone urban population attending High School I, II and III, with the reasonable sample size of 1519 subjects and including 72 subjects from widowed families in addition to 174 children of divorce; furthermore, we were able to control for the following eight demographic variables: father's and mother's occupation, mother's work, respondent's, father's and mother's age, family size, and respondent's rank of birth. When comparing children from legally intact, widowed, and divorced families, on a wide range of psychosocial variables, we found that on the average, divorce is associated with the greatest disadvantage in children, followed by widowhood; children belonging to intact families show the least disadvantage. Besides, when comparing girls and boys, we did not find striking differences between them in divorced families, but, on the other hand, we found striking differences in widowed families, boys being at much more disadvantage than girls. It is concluded that on the average a family breakup should be considered as a serious risk factor for teenagers and that clinicians would be well advised to monitor the situation carefully when aware of an impending family breakup.

  9. Why is control of hypertension in sub-Saharan Africa poor?

    Science.gov (United States)

    Seedat, Y K

    2015-01-01

    In sub-Saharan Africa (SSA) in 2010, hypertension (defined as systolic blood pressure ≥ 115 mmHg) was the leading cause of death, increasing 67% since 1990. It was also the sixth leading cause of disability, contributing more than 11 million adjusted life years. In SSA, stroke was the main outcome of uncontrolled hypertension. Poverty is the major underlying factor for hypertension and cardiovascular disease. This article analyses the causes of poor compliance in the treatment of hypertension in SSA and provides suggestions on the treatment of hypertension in a poverty-stricken continent.

  10. Blood Pressure Profile and Hypertensive Organ Damage in COPD Patients and Matched Controls. The RETAPOC Study.

    Directory of Open Access Journals (Sweden)

    Rafael Golpe

    Full Text Available Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases.Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed.classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05. There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01 and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001.Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.

  11. Simultaneous parasympathetic and sympathetic activation reveals altered autonomic control of heart rate, vascular tension and epinephrine release in anaesthetized hypertensive rats

    Directory of Open Access Journals (Sweden)

    Torill eBerg

    2011-11-01

    Full Text Available Sympathetic hyperactivity and parasympathetic insufficiency characterize blood pressure control in genetic hypertension, but is difficult to demonstrate experimentally in anesthetized rats. Here we present a pharmacological approach to activate sympathetic and parasympathetic nerves simultaneously, and identify their contribution. Anaesthetized normotensive (WKY and spontaneously hypertensive rats (SHR were injected i.v. with 4-aminopyridine (4-AP, a voltage-sensitive K+ channel inhibitor. Blood pressure was recorded through a femoral artery catheter, cardiac output and heart rate (HR through an ascending aorta flow probe. Total peripheral vascular resistance (TPVR was calculated. 4-AP induced an immediate, atropine- and hexamethonium-sensitive bradycardia in WKY, and in strains, a subsequent, sustained tachycardia, and norepinephrine but not epinephrine release. The tachycardia was eliminated by reserpine, nadolol or right vagal nerve stimulation, but not adrenalectomy, scopolamine or hexamethonium. 4-AP-induced, atropine-sensitive bradycardia was observed in reserpinized or nadolol-treated SHR, where atropine also increased the late HR-response. 4-AP increased TPVR, transiently in WKY but sustained in SHR. Yohimbine but not phentolamine prevented TPVR down-regulation in WKY. Reserpine, phentolamine and prazosin eliminated the late vasoconstriction in SHR. Plasma epinephrine overflow increased in nadolol-treated SHR. Conclusions: 4-AP activated parasympathetic ganglion transmission and peripheral, sympathetic nerve norepinephrine release. The sympathetic component dominated the HR-response to 4-AP in SHR. α2-adrenceptor-dependent vasodilatation opposed norepinephrine-induced α1-adrenergic vasoconstriction in WKY, but not in SHR. A βAR-activated, probably vagal afferent mechanism, hampered adrenal epinephrine secretion in SHR. Thus, 4-AP exposed mechanisms, which contribute to hypertension, and may allow identification of the factors

  12. Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Aged ≥18 Years - Los Angeles County, 1999-2006 and 2007-2014.

    Science.gov (United States)

    Hales, Craig M; Carroll, Margaret D; Simon, Paul A; Kuo, Tony; Ogden, Cynthia L

    2017-08-18

    Hypertension is an important and common risk factor for heart disease and stroke, two of the leading causes of death in adults in the United States. Despite considerable improvement in increasing the awareness, treatment, and control of hypertension, undiagnosed and uncontrolled hypertension remain public health challenges (1). Data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension, as well as awareness, treatment, and control of hypertension among adults aged ≥18 years in Los Angeles County compared with adults aged ≥18 years in the United States during 1999-2006 and 2007-2014. During 2007-2014, the prevalence of hypertension was 23.1% among adults in Los Angeles County, lower than the prevalence of 29.6% among all U.S. adults. Among adults with hypertension in Los Angeles County, substantial improvements from 1999-2006 to 2007-2014 were found in hypertension awareness (increase from 73.8% to 84.6%), treatment (61.3% to 77.2%), and control (28.5% to 48.3%). Similar improvements were also seen among all U.S. adults. Although the prevalence of hypertension among adults in Los Angeles County meets the Healthy People 2020 (https://www.healthypeople.gov/) goal of ≤26.9%, continued progress is needed to meet the Healthy People 2020 goal of ≥61.2% for control of hypertension.

  13. Obesity indices and haemodynamic response to exercise in obese diabetic hypertensive patients: Randomized controlled trial.

    Science.gov (United States)

    Abdelaal, Ashraf Abdelaal Mohamed; Mohamad, Mohamad Ali

    2015-01-01

    Obesity, diabetes and hypertension are major worldwide interconnected problems. The aim of this study was to investigate body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP and DPB) responses to circuit weight training (CWT) or aerobic exercise training (AET) in obese diabetic hypertensive patients (ODHP). Fifty-nine ODHP were randomly assigned into CWT, AET and control groups. Either CWT or AET was performed thrice weekly for 12 weeks. Variables were evaluated pre-training (evaluation-1), after 3 months (evaluation-2) and 1 month post-training cessation (evaluation-3). At evaluation-2, BMI, WC, SBP, DBP mean values and percentages of decrease were 31.56±1.48 (9.23%), 104±5.97 (6.2%), 141±2.2 (3.09%), 91.2±1.24 (2.98%) and 32.09±1.21 (7.11%), 107.66±3.92 (3.07%), 138.3±1.17 (4.79%), 88.05±1.05 (6.02%) for CWT and AET groups respectively (Pobesity indices, AET is still the best intervention to lower blood pressure in ODHP, for a more extended period of time. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  14. Creatine kinase inhibition lowers systemic arterial blood pressure in spontaneously hypertensive rats: a randomized controlled trial.

    Science.gov (United States)

    Karamat, Fares A; Oudman, Inge; Haan, Yentl C; van Kuilenburg, Andre B P; Leen, Rene; Danser, Jan A H; Leijten, Frank P J; Ris-Stalpers, Carrie; van Montfrans, Gert A; Clark, Joseph F; Brewster, Lizzy M

    2016-12-01

    Creatine kinase is reported to be a main predictor of blood pressure (BP) in the general population, with a strong correlation between resistance artery creatine kinase expression and clinical BP in humans. The enzyme rapidly regenerates ATP near cytoplasmic ATPases involved in pressor responses, including resistance artery contractility and renal sodium retention. Therefore, we assessed whether creatine kinase inhibition reduces BP. We implemented the 'Animal Research: Reporting of In Vivo Experiments' guideline. In a 4-week randomized controlled trial, male 16-week-old spontaneously hypertensive rats (N = 16) were randomly assigned to the specific competitive creatine kinase inhibitor beta-guanidinopropionic acid (3%)-supplemented chow vs. standard chow. BP measured by the tail-cuff method was the main outcome. Other outcomes included vasodilation in isolated arteries and renal renin expression. Creatine kinase inhibition reduced BP safely and reversibly. Mean baseline BP of, respectively, 191.5 (standard error 4.3) mmHg SBP and 143.1 (4.1) mmHg DBP was reduced by, respectively, 42.7 (5.5) mmHg SBP and 35.6 (5.0) mmHg DBP (P creatine kinase inhibition. Our data indicate that modulation of the creatine kinase system is a potential novel treatment target for hypertension.

  15. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial.

    LENUS (Irish Health Repository)

    Lobo, Melvin D

    2015-01-22

    Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension.

  16. Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices

    Directory of Open Access Journals (Sweden)

    Gágyor Ildikó

    2012-06-01

    Full Text Available Abstract Background Uncomplicated urinary tract infections (UTI are usually treated with antibiotics as recommended by primary care guidelines. Antibiotic treatment supports clinical cure in individual patients but also leads to emerging resistance rates in the population. We designed a comparative effectiveness study to investigate whether the use of antibiotics for uncomplicated UTI could be reduced by initial treatment with ibuprofen, reserving antibiotic treatment to patients who return due to ongoing or recurrent symptoms. Methods/design This is a randomized-controlled, double-blind, double dummy multicentre trial assessing the comparative effectiveness of immediate vs. conditional antibiotic therapy in uncomplicated UTI. Women > 18 and  Discussion This study aims at investigating whether the use of antibiotics for uncomplicated UTI could be reduced by initial treatment with ibuprofen. The comparative effectiveness design was chosen to prove the effectiveness of two therapeutic strategies instead of the pure drug efficacy. Trial registration Clinicaltrials.Gov: NCT01488955

  17. Acute and chronic effects of aerobic exercise on blood pressure in resistant hypertension: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Nascimento, L S; Santos, A C; Lucena, Jms; Silva, Lgo; Almeida, Aem; Brasileiro-Santos, M S

    2017-06-02

    Resistant hypertension is a specific condition that affects approximately 10% of subjects with hypertension, and is characterized by persistently high blood pressure levels even using therapy of three or more antihypertensive agents or with blood pressure control using therapy with four or more antihypertensive agents. Changes in lifestyle, such as physical exercise, are indicated for controlling blood pressure. However, investigating studies about this therapy in individuals with resistant hypertension are few. This is a randomized controlled clinical trial. Forty-eight patients with resistant hypertension will be submitted to perform four short-term interventions: aerobic exercise sessions (mild-, moderate- and high-intensity) and control session, in random order and on separate days. After the short-term sessions, the patients will be randomly allocated into four groups for 8 weeks of follow-up: mild-, moderate- and high-intensity aerobic exercise, and a control group. The primary outcome is the occurrence of blood pressure reduction (office and ambulatory analysis, and acute and chronic effects). Secondary outcomes are autonomic and hemodynamic mechanisms: cardiac and vasomotor autonomic modulation, spontaneous baroreflex sensitivity, forearm blood flow and vascular resistance. The importance of exercise for hypertension has been known for decades, but little is known about the effects on patients with resistant hypertension. This study will help to understand whether different aerobic exercise intensities can induce different responses, as well as by what mechanisms adjustments in blood pressure levels may occur. ClinicalTrials.gov, ID: NCT02670681 . Registered on 28 January 2016 (first version); Brazilian Registry Platform Clinical Trials: protocol RBR-5q24zh . Registered on 24 June 2015.

  18. Efficacy of moxibustion for pre- or stage I hypertension: study protocol for a pilot randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Shin Kyung-Min

    2012-10-01

    Full Text Available Abstract Background Hypertension is a risk factor for cardiovascular disease, and the prevalence of hypertension tends to increase with age. Current treatments for hypertension have adverse side effects and poor adherence. The purpose of this study is to evaluate the effects of moxibustion on blood pressure in individuals with pre- or stage I hypertension. Methods/design Forty-five subjects with pre- or stage I hypertension will be randomized into three groups: treatment group A (2 times/week, treatment group B (3 times/week, and the control group (non-treated group. The inclusion criteria will be as follows: (1 aged between 19 and 65 years; (2 prehypertension or stage I hypertension (JNC 7, Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; (3 the participants are volunteers and written consent obtained. The participants in the treatment group A will undergo indirect moxibustion 2 times per week for 4 weeks, and the participants in the treatment group B will undergo indirect moxibustion 3 times per week for 4 weeks. The participants in the control group (non-treated group will maintain their current lifestyle, including diet and exercise. The use of antihypertensive medication is not permitted. The primary endpoint will be a change in patient blood pressure. The secondary endpoints will be the body mass index, lipid profile, EuroQol and Heart Rate Variability. The data will be analyzed with the Student’s t-test and analysis of variance (ANOVA (p Discussion The results of this study will help to establish the optimal approach for the care of adults with pre- or stage I hypertension. Trial registration Clinical Research Information Service KCT0000469

  19. Prevalence, awareness, medication, control, and risk factors associated with hypertension in Bai ethnic group in rural China: the Yunnan Minority Eye Study.

    Directory of Open Access Journals (Sweden)

    Jinman Zhang

    Full Text Available PURPOSE: This study aimed to assess the prevalence, awareness, treatment, and control of hypertension and their associated factors among Bai ethnic population in the rural China. METHODS: A population-based survey was conducted in 2010 with a randomly cluster sampling in rural communities in Dali, southwest China. A total of 2133 adults aged 50 or above were interviewed, and their blood pressure, height, weight and waist circumference were measured. Hypertension was defined as a mean SBP≥140 mmHg and/or DBP≥90 mmHg, and/or current use of antihypertensive medications. RESULTS: The prevalence of hypertension was 42.1% (899/2133, and the age- and gender-adjusted prevalence was 40.0%. Among the hypertensive participants, 28.4% (255/899were aware of their condition, while 24.6% (221/899 took antihypertensive medications, with only 7.5% (67/899 of those achieving blood pressure control (<140/90 mmHg. Risk factors for hypertension were older age, smoking, alcohol drinking, family history of HBP, overweight, and obesity, while protective factors included being lean, and having finished senior high school or above. CONCLUSIONS: Hypertension prevalence is high among the population of Bai ethnic group in China, while the associated risk factors of hypertension include overweight/obesity, cigarette smoking, history of hypertension, and older age. The percentages of hypertensive participants aware of their hypertension and those taking antihypertensive medications were low with an incredibly low proportion of hypertensive patients who kept their hypertension under control. It is suggested that health education and hypertension screening programs be carried out in the area for the high blood pressure prevention and control.

  20. A Concept Mapping Study of Physicians’ Perceptions of Factors Influencing Management and Control of Hypertension in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Juliet Iwelunmor

    2015-01-01

    Full Text Available Hypertension, once a rare problem in Sub-Saharan Africa (SSA, is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians’ perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management.

  1. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

    Directory of Open Access Journals (Sweden)

    Dongfeng Gu

    2015-08-01

    Full Text Available Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg. Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015 were considered cost-effective. Treating hypertensive adults with prior

  2. The immediate effect of unilateral lumbar Z-joint mobilisation on posterior chain neurodynamics: a randomised controlled study.

    Science.gov (United States)

    Szlezak, Adam Michael; Georgilopoulos, Peter; Bullock-Saxton, Joanne Elizabeth; Steele, Michael Craig

    2011-12-01

    Hamstring strain (HS) is a common musculoskeletal condition and abnormal neurodynamics has been shown to influence HS and delay recovery. The efficacy of stretching for preventing and treating HS remains uncertain despite extensive research and wide-spread use. The effects of cervical spine mobilisation on peripheral nervous system function, neurodynamics and muscle force in the upper limb have been reported. Very few studies have reported effects of lumbar spine mobilisation on these variables in the lower limb. This study aimed to determine immediate effects of either a unilateral zygopophyseal joint posteroanterior mobilisation or a static posterior chain muscle stretch on the range of passive straight leg raise (SLR) in comparison to a non-treatment control. Using a single-blinded, randomised controlled study design, 36 healthy participants were allocated into one of three groups (control; mobilisation; static posterior chain muscle stretch). Measures of SLR were taken before and after intervention for each group on the day of testing. A General Linear Model (GLM) and a paired sample t-test showed a significant difference between base line and post-intervention for the mobilisation group only (p neurodynamics.

  3. Studies on Renin Stimulation in Normal Controls and in Patients with Essential Hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Chang Soon; Choe, Kang Won; Lee, Hong Kyu; Lee, Jung Sang [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1978-03-15

    To find out a convenient and reliable method of detecting low renin status, we employed intravenous furosemide injection as a stimulatory maneuver. The results thus obtained were compared with those from the postural stimuli and basal plasma renin activity (PRA) in relation to sodium excretion. Intravenous furosemide test was performed in 66 control subjects and 44 patients with essential hypertension. The results were as follow; 1) Mean PRA in control subjects rose from 2.5+-1.95 ng/ml/hr (basal) to 4.5+-2.51, 5.2+-2.49 and 4.2+-2.44 ng/ml/hr at 1, 2 and 3 hrs after IV injection. One-hour response is more convenient in clinical practice. 2) Postural stimuli by assuming an upright posture for 3 hrs gave rise to considerable increase in PRA (4.0+-2.92 from 2.4+-1.85), but we found it less convenient than stimulation with furosemide. 3) The increase in PRA was much less marked in patients with essential hypertension as a whole (2.9+-2.75). Hyporesponsiveness to furosemide stimuli was found in 34.1%. Of these hyporesponders, a third had a normal basal PRA, indicating the need for this kind stimulatory procedure. 4) Younger age group showed greater renin responsiveness than older age group after furosemide stimuli. Likewise mean age of low renin patients (52.9+-5.38 years old) was significantly higher than that of high and normal renin patients (44.1+-13.78 years old).

  4. Prevalence, awareness, medication, control, and risk factors associated with hypertension in Yi ethnic group aged 50 years and over in rural China: the Yunnan minority eye study.

    Science.gov (United States)

    Chen, Lixing; Zong, Yuan; Wei, Tao; Sheng, Xun; Shen, Wei; Li, Jun; Niu, Zhiqiang; Zhou, Hua; Zhang, Yang; Yuan, Yuansheng; Chen, Qin; Zhong, Hua

    2015-04-15

    Hypertension is an important public health issue in China, but there are few studies examining hypertension in ethnic groups in Yunnan, China. This study, Yunnan Minority Eye Study (YMES), was initially designed to determine the prevalence and impact of eye diseases, including hypertension and diabetes mellitus. As a part of YMES, the prevalence, awareness, treatment, and control of hypertension and the associated risk factors among the Yi ethnic population in rural China are reported. A population-based survey was conducted in 2012 with adult participants over 50 from rural communities in Shilin Yi Autonomous County, Yunnan Province, located in southwest China. A random cluster sampling method was used to select a representative sample. The participants' blood pressure, height, weight, and waist circumference were measured. Hypertension was defined as mean systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of antihypertensive medications. A total of 2208 adults were assessed. The prevalence of hypertension was 38.5%, and the age- and gender-adjusted prevalence was 37.0%. The proportion of patients who were aware of their hypertension among those diagnosed with hypertension was 24.8%. Of those aware of having hypertension, 23.6% took antihypertensive drugs. Among all hypertensive patients, only 7.2% had controlled their hypertension (ethnic group in China. The ratio of awareness, treatment, and control of hypertension were considerately low. Hypertension education and screening programs in rural China are recommended to improve the health status of this population.

  5. Trends in hypertension prevalence, awareness, treatment and control in an adult type 2 diabetes Spanish population between 2003 and 2009.

    Directory of Open Access Journals (Sweden)

    Carmen de Burgos-Lunar

    Full Text Available In patients with type 2 diabetes, the prevalence of hypertension is higher than in non-diabetic subjects. Despite the high cardiovascular risk involving hypertension in these patients, its prevalence and control are not well known. The aims of this study were: to estimate the hypertension prevalence, awareness, treatment and control in Spanish adults with type 2 diabetes attended in Primary Care; and to analyse its time trend from 2003 to 2009. A serial cross-sectional study from 2003 to 2009 was performed in 21 Primary Care Centres in Madrid. The study population comprised all patients with diagnosed type 2 diabetes in their computerised medical history. Overall annual prevalence during the period 2003-2009 was calculated from and according to sex and age groups. Linear trend tests, regression lines and coefficients of determination were used. In 2003 89.78% (CI 87.92-91.64 of patients with type 2 diabetes suffered hypertension and 94.76% (CI: 92.85-96.67 in 2009. This percentage was greater for women and for patients over 65 years old. 30% of patients suffered previously undiagnosed hypertension in 2003 and 23.1% in 2009. 97% of diagnosed patients received pharmacological treatment and 28.79% reached the blood pressure objective in 2009. The average number of antihypertensive drugs taken was 2.72 in 2003 and 3.27 in 2009. Only 5.2% of patients with type 2 diabetes show blood pressure levels below 130/80 mmHg. Although significant improvements have been achieved in the diagnosis and control of hypertension in people with type 2 diabetes, these continue to remain far from optimum.

  6. Prevalence, Awareness, Treatment and Control of Hypertension in Indonesian Adults Aged ≥40 Years: Findings from the Indonesia Family Life Survey (IFLS).

    Science.gov (United States)

    Hussain, Mohammad Akhtar; Mamun, Abdullah Al; Reid, Christopher; Huxley, Rachel R

    2016-01-01

    Hypertension is the major driver of the cardiovascular epidemic facing Indonesia in the 21st century. Understanding the socioeconomic inequalities associated with hypertension is essential for designing effective intervention strategies. The aim of the current study was to use sub-nationally representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indonesian adults. We investigated factors associated with hypertension prevalence, diagnosis, treatment and control using data on self-reported diagnosis and treatment, and blood pressure measurements, collected from 9755 respondents aged 40 years and up in the 2007 Indonesian Family Life Survey (IFLS 4). Age-standardized prevalence of hypertension among the study participants was 47.8% (95% CI: 46.8, 48.9), of which almost 70% were undiagnosed. Hypertension was significantly higher in women than men (52.3% versus 43.1%, p-valuehypertension increased significantly with ageing (Pfor trend hypertension cases were uncontrolled. Gender, education and socioeconomic status had differential impact on the diagnosis of hypertension and in receiving treatment. Overall, less than a third were aware of their hypertension and a quarter of those on medication had their blood pressure effectively controlled. Men and those of younger age were more vulnerable to have undiagnosed and untreated hypertension. Substantial effort should be given to improve awareness about the condition and making provision for early diagnosis and treatment.

  7. Kidney flow and function in hypertension: protective effects of pycnogenol in hypertensive participants--a controlled study.

    Science.gov (United States)

    Cesarone, Maria Rosaria; Belcaro, Gianni; Stuard, Stefano; Schönlau, Frank; Di Renzo, Andrea; Grossi, Maria Giovanna; Dugall, Mark; Cornelli, Umberto; Cacchio, Marisa; Gizzi, Giuseppe; Pellegrini, Luciano

    2010-03-01

    This study evaluated the effects of Pycnogenol as an adjunct to angiotensin-converting enzyme (ACE)-inhibitor ramipril treatment of hypertensive patients presenting with early signs of renal function problems. One group of 26 patients was medicated with 10 mg ramipril per day only; a second group of 29 patients took Pycnogenol in addition to the ACE inhibitor over a period of 6 months. At trial end, a lowered systolic and diastolic blood pressure was found in both groups, with a significant further reduction of diastolic pressure in the group given Pycnogenol in addition to ramipril. The major aim of this study was the investigation of kidney-protective effects of Pycnogenol. Urinary albumin decreased from 87 +/- 23 to 64 +/- 16 mg/d with ramipril only. Additional Pycnogenol lowered albumin significantly better from 91 +/- 25 to 39 +/- 13 mg/day (P Pycnogenol combination; the latter reached statistical significance. Kidney cortical flow velocity was investigated by Doppler color duplex ultrasonography. Both systolic and diastolic flow velocities increased significantly after 6 months medication with ramipril. The addition of Pycnogenol to the regimen statistically significantly further enhanced kidney cortical flow velocities, by 8% for diastolic flow and 12% for systolic flow, relative to values found for the group taking ramipril only. The protective effects of Pycnogenol for initial kidney damage found in this study warrant further research with a larger number of patients and over a longer period of time.

  8. Comparison of magnesium and methyldopa for the control of blood pressure in pregnancies complicated with hypertension

    DEFF Research Database (Denmark)

    Rudnicki, M; Frølich, A; Pilsgaard, K;

    2000-01-01

    OBJECTIVES: Although magnesium is now the drug of choice for the prevention of eclamptic seizures only few studies have evaluated whether magnesium may reduce blood pressure in pregnancies complicated with hypertension. METHODS: A total of 33 patients with pregnancy-induced hypertension were...... demonstrates that magnesium treatment lowers blood pressure in pregnancies complicated with hypertension. The effect is without any adverse effect on maternal and neonatal well-being....

  9. Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case-control study

    NARCIS (Netherlands)

    Gelder, M.M.H.J. van; Bennekom, C.M. Van; Louik, C.; Werler, M.M.; Roeleveld, N.; Mitchell, A.A.

    2015-01-01

    OBJECTIVE: To study previously identified associations between specific maternal hypertensive disorders and/or prenatal exposure to antihypertensive medication and birth defects. DESIGN: Case-control study. SETTING: Slone Birth Defects Study, 1998-2010. POPULATION: A total of 5568 cases with birth

  10. Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case-control study

    NARCIS (Netherlands)

    Gelder, M.M.H.J. van; Bennekom, C.M. Van; Louik, C.; Werler, M.M.; Roeleveld, N.; Mitchell, A.A.

    2015-01-01

    OBJECTIVE: To study previously identified associations between specific maternal hypertensive disorders and/or prenatal exposure to antihypertensive medication and birth defects. DESIGN: Case-control study. SETTING: Slone Birth Defects Study, 1998-2010. POPULATION: A total of 5568 cases with birth d

  11. Endothelial apoptosis in pulmonary hypertension is controlled by a microRNA/programmed cell death 4/caspase-3 axis

    NARCIS (Netherlands)

    White, Kevin; Dempsie, Yvonne; Caruso, Paola; Wallace, Emma; McDonald, Robert A; Stevens, Hannah; Hatley, Mark E; Van Rooij, Eva; Morrell, Nicholas W; MacLean, Margaret R; Baker, Andrew H

    2014-01-01

    Pulmonary endothelial cell apoptosis is a transient, yet defining pathogenic event integral to the onset of many pulmonary vascular diseases such as pulmonary hypertension (PH). However, there is a paucity of information concerning the molecular pathway(s) that control pulmonary arterial endothelial

  12. Hypertension control in the very old people in China: what we learn from the Chinese subgroup analysis in the Hypertension in the Very Elderly Trial?

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2008-01-01

    @@ Hypertension is a prevalent disorder and accounts for a large proportion of cardiovascular morbidity and mortality worldweide.1 In china,hypertension appears to be a big burden of public health issues.

  13. Reward-based hypertension control by a synthetic brain-dopamine interface.

    Science.gov (United States)

    Rössger, Katrin; Charpin-El Hamri, Ghislaine; Fussenegger, Martin

    2013-11-05

    Synthetic biology has significantly advanced the design of synthetic trigger-controlled devices that can reprogram mammalian cells to interface with complex metabolic activities. In the brain, the neurotransmitter dopamine coordinates communication with target neurons via a set of dopamine receptors that control behavior associated with reward-driven learning. This dopamine transmission has recently been suggested to increase central sympathetic outflow, resulting in plasma dopamine levels that correlate with corresponding brain activities. By functionally rewiring the human dopamine receptor D1 (DRD1) via the second messenger cyclic adenosine monophosphate (cAMP) to synthetic promoters containing cAMP response element-binding protein 1(CREB1)-specific cAMP-responsive operator modules, we have designed a synthetic dopamine-sensitive transcription controller that reversibly fine-tunes specific target gene expression at physiologically relevant brain-derived plasma dopamine levels. Following implantation of circuit-transgenic human cell lines insulated by semipermeable immunoprotective microcontainers into mice, the designer device interfaced with dopamine-specific brain activities and produced a systemic expression response when the animal's reward system was stimulated by food, sexual arousal, or addictive drugs. Reward-triggered brain activities were able to remotely program peripheral therapeutic implants to produce sufficient amounts of the atrial natriuretic peptide, which reduced the blood pressure of hypertensive mice to the normal physiologic range. Seamless control of therapeutic transgenes by subconscious behavior may provide opportunities for treatment strategies of the future.

  14. Prevalence, awareness, treatment and control of hypertension and salt intake in some rural areas of Sisak – Moslavina county, Croatia

    OpenAIRE

    Sović, Slavica; Vitale, Ksenija; Keranović, Adis; Dražić, Ivanka; Džakula, Aleksandar; Jelaković, Bojan

    2011-01-01

    Background and Purpose: High salt intake through food rich in salt is one of the important risk factors for hypertension, and even modest reduction in salt intake lowers the blood pressure (BP). In Croatia 91.6 % of the total territory is classified as rural and 47.6% of population live in rural regions. The study was conducted in order to determine salt intake and awareness on harmful effect of salt on BP, prevalence, treatment and control of hypertension in rural part of Sisak – Mosla...

  15. Haplotype-based case-control study of the human AGTR1 gene and essential hypertension in Han Chinese subjects.

    Science.gov (United States)

    Nie, Sheng-jie; Wen-ru, Tang; Bi-feng, Chen; Jin, Li; Wen, Zhang; Sheng-jun, Luo; Wei-wei, Li; Hai-jing, Yu; Chun-jie, Xiao

    2010-02-01

    Essential hypertension is considered to be a multifactorial trait resulting from the combined influence of environmental and genetic determinants. The aim of the study is to assess the association between the human AGTR1 gene and essential hypertension (EH) using a haplotype-based case-control study in Han Chinese subjects. Seven tag SNPs and the A1166C polymorphism of the AGTR1 gene were genotyped in 510 hypertension subjects and 510 normotensive subjects using PCR-RFLP method. Single SNP analyses indicated that the rs12695895 was significantly associated with hypertension, adjusted for covariates. Compared with the other haplotypes, Hap4 (AGGACTT) which carry the susceptible rs12695895 A allele was found to significantly increase the risk of EH with odds ratios equal to 1.84 (p=0.0002). The present results indicate that rs12695895 might be a genetic marker for EH and Hap4 (AGGACTT) was associated with hypertension in Han Chinese population. (c) 2009 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  16. Immediate effects of a controllable knee ankle foot orthosis for functional compensation of gait in patients with proximal leg weakness.

    Science.gov (United States)

    Moreno, Juan C; Brunetti, Fernando; Rocon, Eduardo; Pons, José L

    2008-01-01

    Application of intermittent control of the knee joint stiffness in a knee ankle foot orthosis (KAFO) during gait is proposed. The approach combines inertial sensors and an actuator system in order to apply compensation in quadriceps weakness with a wearable device. Two methods, segment-angular rotation based and segment-angular velocity based, are analysed for the control of the knee joint state (intermittent stiffness) based on the inertial sensors signals. Protocolled tests are developed with two post-polio syndrome patients (PPS). In this study, the cases of gait with free-swinging leg and safe stance with the orthotic system are presented in terms of quantified kinematics (average peak angle of knee flexion of 50 degrees ) and evidences of reduction of frequent compensations (e.g. leg lateral movement) in post-polio syndrome patients. The results from immediate inspection indicate an important improvement of the gait patterns in two patients with proximal leg weakness by means of compensations applied by the wearable orthosis.

  17. Hypertensive Encephalopathy

    Directory of Open Access Journals (Sweden)

    Mostafa SHARIFIAN

    2012-09-01

    Full Text Available How to cite this article: Sharifian M. Hypertensive Encephalopathy. Iran J Child Neurol 2012; 6(3:1-7.Hypertension is called the silent killer and vital organs such as the brain, eyes,kidneys and the heart are the targets. Seizure, central nervous system (CNShemorrhage, and cerebrovascular accident (CVA, blindness and heart attacksare the end points.The prevalence of hypertension in children is much less than adults, but evidencereveals that the source of hypertension in adulthood goes back to childhood. In70-80% of cases hypertension is due to renal diseases. In children, hypertensiveencephalopathy (HE may be the first manifestation of renal diseases. Seizure isone of the most common manifestations of HE.In this article, definitions, etiology, pathophysiology and finally the acute andchronic managements of HE will be discussed.ReferencesSawicka K, Szczyrek M, Jastrzębska I, Prasal M, ZwolakA, Jadwiga D. Hypertension – The silent killer. J Pre-Clin Clin Res 2011;5(2:43-6.Croix B, Feig DI. Childhood hypertension is not a silent disease. Pediatr Nephrol 2006 Apr;21(4:527-32.Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med 2004 Nov;351(22:2310-7.Krzesinski JM, Cohen EP.Hypertension and the kidney.Acta Clin Belg 2007 Jan-Feb;62(1:5-14.Report of the Second Task Force on Blood Pressure Control in Children – 1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 1987Jan;79(1:1-25.Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 1996 Oct;98(4 Pt1:649-58.Ataei N, Aghamohammadi A, Yousefi E, Hosseini M, Nourijelyani K, Tayebi M, et al. Blood pressure nomograms for school children in Iran. Pediatr Nephrol 2004 Feb;19

  18. Hypertension and hypertensive encephalopathy.

    Science.gov (United States)

    Price, Raymond S; Kasner, Scott E

    2014-01-01

    The definition of hypertension has continuously evolved over the last 50 years. Hypertension is currently defined as a blood pressure greater than 140/90mmHg. One in every four people in the US has been diagnosed with hypertension. The prevalence of hypertension increases further with age, affecting 75% of people over the age of 70. Hypertension is by far the most common risk factor identified in stroke patients. Hypertension causes pathologic changes in the walls of small (diameter<300 microns) arteries and arterioles usually at short branches of major arteries, which may result in either ischemic stroke or intracerebral hemorrhage. Reduction of blood pressure with diuretics, β-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors have all been shown to markedly reduce the incidence of stroke. Hypertensive emergency is defined as a blood pressure greater than 180/120mmHg with end organ dysfunction, such as chest pain, shortness of breath, encephalopathy, or focal neurologic deficits. Hypertensive encephalopathy is believed to be caused by acute failure of cerebrovascular autoregulation. Hypertensive emergency is treated with intravenous antihypertensive agents to reduce blood pressure by 25% within the first hour. Selective inhibition of cerebrovascular blood vessel permeability for the treatment of hypertensive emergency is beginning early clinical trials. © 2014 Elsevier B.V. All rights reserved.

  19. Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension.

    Science.gov (United States)

    Rendina, Domenico; Ippolito, Renato; De Filippo, Gianpaolo; Muscariello, Riccardo; De Palma, Daniela; De Bonis, Silvana; Schiano di Cola, Michele; Benvenuto, Domenico; Galderisi, Maurizio; Strazzullo, Pasquale; Galletti, Ferruccio

    2017-03-01

    Silent myocardial ischemia (SMI) is frequently observed in patients with essential hypertension (EH). The major risk factor for SMI is uncontrolled blood pressure (BP), but SMI is also observed in patients with well-controlled BP. To evaluate the prevalence of SMI and the factors associated with SMI in EH patients with well-controlled BP. The medical records of 859 EH patients who underwent simultaneous 24-h ambulatory blood pressure monitoring (ABPM) and 24-h ambulatory electrocardiogram recording (AECG) were retrospectively evaluated. Each SMI episode was characterized by: (a) ST segment depression ≥0.5 mm; (b) duration of ST segment depression >60 s; and (c) reversibility of the ST segment depression. Overall 126 EH patients (14.7 %) had at least one episode of SMI. The SMI events were more frequent among patients with poorly controlled compared to those with well-controlled BP [86/479 (17.95 %) vs. 40/380 (10.52 %), p < 0.01]. Among EH patients with well-controlled BP, current and past smoking as well as the presence of an additional metabolic syndrome (MetS) constitutive element (obesity, impaired fasting glucose level or dyslipidemia) were significantly associated with the occurrence of SMI. In all EH patients with well-controlled BP and AECG evidence of SMI, there were one or more coronary artery stenotic lesions greater than 50 % found at coronary angiography. In EH patients who are current smokers, or have one or more additional components of a MetS there is markedly reduced benefit associated with good BP control with regard to the occurrence of myocardial ischemia: in this patient category, an AECG may help detect this condition.

  20. Hypertension Prevalence, Awareness, Treatment, and Control and Sodium Intake in Shandong Province, China: Baseline Results From Shandong–Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011

    Science.gov (United States)

    Bi, Zhenqiang; Liang, Xiaofeng; Xu, Aiqiang; Wang, Linghong; Shi, Xiaoming; Zhao, Wenhua; Ma, Jixiang; Guo, Xiaolei; Zhang, Xiaofei; Zhang, Jiyu; Ren, Jie; Yan, Liuxia; Lu, Zilong; Wang, Huicheng; Tang, Junli; Cai, Xiaoning; Dong, Jing; Zhang, Juan; Chu, Jie; Engelgau, Michael; Yang, Quanhe; Hong, Yuling

    2014-01-01

    Introduction In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. Methods Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. Results Overall, 23.4% (95% confidence interval [CI], 20.9%–26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg–6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg–4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg–5,683 mg). Conclusion Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China. PMID:24854239

  1. EFFICACY AND SAFETY OF GINKGO BILOBA IN ELDERLY PATIENTS WITH CONTROLLED ARTERIAL HYPERTENSION AND CIRCULATORY ENCEPHALOPATHY

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    V. V. Jakusevich

    2008-01-01

    Full Text Available Aim. To study effects of Ginkgo biloba based drug (Memoplant, Dr Willar Schwabe, Germany on haemorheological and clinical status in elderly patients with circulatory encephalopathy and controlled arterial hypertension.Material and methods. 80 patients (>60 y.o. were involved in the study. Patients were randomized (3:1 on Memoplant (240 mg/daily treatment group and control group. Duration of observation was 16 weeks. The changes of neurological complaints, neuropsychological and life quality test results were estimated during the study. The rheological indicators (blood, plasma and erythrocyte suspension viscosity; aggregative activity and plasticity of erythrocytes also were studied.Results. Reduction (by 50-90% of neurological complaints (headache, giddiness, tinnitus, unsteadiness walking were founded in patients receiving Memoplant. Cognitive abilities according to mental status scale, frontal tests battery, 5 words test, watch drawing test and quality of a life according to QOLI-NS scale improved in patients treated with Memoplant. Decrease of blood viscosity (by 19,3%, р<0,01 , erythrocytes rigidity index (by 15,6%, р<0,05 and erythrocyte aggregation (degree of aggregation by 45,6%; average aggregate size by 25,9%, р<0,05 > <0,05 was observed. Tissue oxygen supply was increased by 23,3% (р<0,05 in comparison with initial state. Changes of haemorheological indicators were not founded in control group.Conclusion. Memoplant increases brain oxygenation due to improvement of microcirculatory blood flow.

  2. The Contrast Study on Serum Collagen Metabolism between Essential Hypertension and Normal Control

    Institute of Scientific and Technical Information of China (English)

    梁茜; 杨希立; 林爱珍

    2003-01-01

    Objectives To investigate serum concentration of procollagen type Icarboxyterminal peptide (PⅠP), type Ⅲ aminopeptide (PⅢP) and type Icollagen telopeptide (ICTP) in essential hypertension (EH). Methods Serum levels of PⅠP, PⅢP and ICTP in 42 EH patients and 30 healthy control were measured by radioimmunoassays. Results In EH patients,serum concentration of PⅠP, PⅢP was significantly higher than that in 30 healthy control. Although EH patients did tend to exhibit a higher serum ICTP concentration than normal control subjects, the difference was not statistically significant. EH patients with left ventricular hypertrophy exhibited higher values of PⅠP (P < 0. 05 )and lower values of ICTP (P < 0.05) than EH patients without left ventricular hypertrophy. No significant difference was noted between the serum PⅢP of the EH patients with and without left ventricular hypertrophy (P >0.05). Conclusions The results suggest that PⅠP and P Ⅲ P are sensitive serum markers of myocardial collagen synthesis. Myocardial fibrosis may be due to the excessive synthesis and insufficient degradation of collagen. PⅠP, PⅢP and ICTP may be indirect markers of myocardial fibrosis.

  3. Therapeutic embolization of renal artery to control severe hypertension due to renal trauma

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    Cotroneo, A.R.; Patane, D.; De Cinque, M.; Falappa, P.; Doglietto, G.

    1987-05-01

    In a young patient with a post-traumatic renal hematoma, severe systemic hypertension, secondary to the activation of the renin-angiotensin axis, developed. Because of persistent hypertension, after 3 months of drug therapy, selective percutaneous embolization of the damaged vessels was performed. One year after procedure, the patient is normotensive without drugs.

  4. Associations of MTHFR gene polymorphisms with hypertension and hypertension in pregnancy: a meta-analysis from 114 studies with 15411 cases and 21970 controls.

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    Boyi Yang

    Full Text Available BACKGROUND: Several epidemiological studies have investigated the associations of methylenetetrahydrofolate reductase (MTHFR C677T and A1298C polymorphisms with hypertension (H or hypertension in pregnancy (HIP. However, the results were controversial. We therefore performed a comprehensive meta-analysis to provide empirical evidences on the associations. METHODOLOGIES: The English and Chinese databases were systematically searched to identify relevant studies. Odds ratios (ORs and 95% confidence intervals (CIs were calculated to evaluate the strength of the associations. Meta-regression, subgroup analysis, sensitivity analysis, cumulative meta-analysis and assessment of publication bias were performed in our study. PRINCIPAL FINDINGS: A total of 114 studies with 15411 cases and 21970 controls were included, 111 studies with 15094 cases and 21633 controls for the C677T polymorphism and 21 with 2533 cases and 2976 controls for the A1298C polymorphism. Overall, the C677T polymorphism was significantly associated with H and HIP (H & HIP: OR = 1.26, 95% CI = 1.17-1.34; H: OR = 1.36, 95% CI = 1.20-1.53; HIP: OR = 1.21, 95% CI = 1.08-1.32. Stratified analysis by ethnicity revealed a significant association among East Asians and Caucasians, but not among Latinos, Black Africans, and Indians and Sri Lankans. In the stratified analyses according to source of controls, genotyping method, sample size and study quality, significant associations were observed in all the subgroups, with the exception of population based subgroup in H studies and large sample size and "others" genotyping method subgroups in HIP studies. For the A1298C polymorphism, no significant association was observed either in overall or subgroup analysis under all genetic models. CONCLUSIONS: This meta-analysis suggests that the MTHFR C677T rather than A1298C polymorphism may be associated with H & HIP, especially among East Asians and Caucasians.

  5. Effects of Massage on Blood Pressure in Patients With Hypertension and Prehypertension: A Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Liao, I-Chen; Chen, Shiah-Lian; Wang, Mei-Yeh; Tsai, Pei-Shan

    2016-01-01

    Massage may help reduce blood pressure; previous studies on the effect of massage on blood pressure have presented conflicting findings. In addition, no systematic review is available. The aim of this study was to evaluate the evidence concerning the effect of massage on blood pressure in patients with hypertension or prehypertension. A search was performed on electronic database records up to October 31, 2013, based on the following medical subject headings or keywords: hypertension, massage, chiropractic, manipulation, and blood pressure. The methodological quality of randomized controlled trials was assessed based on the Cochrane collaboration tool. A meta-analysis was performed to evaluate the effect of massage on hypertension. The study selection, data extraction, and validation were performed independently by 2 reviewers. Nine randomized controlled trials met our inclusion criteria. The results of this study show that massage contributes to significantly enhanced reduction in both systolic blood pressure (SBP) (mean difference, -7.39 mm Hg) and diastolic blood pressure (DBP) (mean difference, -5.04 mm Hg) as compared with control treatments in patients with hypertension and prehypertension. The effect size (Hedges g) for SBP and DBP was -0.728 (95% confidence interval, -1.182 to -0.274; P = .002) and -0.334 (95% confidence interval, -0.560 to -0.107; P = .004), respectively. This systematic review found a medium effect of massage on SBP and a small effect on DBP in patients with hypertension or prehypertension. High-quality randomized controlled trials are urgently required to confirm these results, although the findings of this study can be used to guide future research.

  6. The impact of educational intervention on self-care behaviors in overweight hypertensive women: A randomized control trial.

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    Daniali, Seyedeh Shahrbanoo; Eslami, Ahmad Ali; Maracy, Mohammad Reza; Shahabi, Javad; Mostafavi-Darani, Firoozeh

    2017-01-01

    The improper control of self-care in hypertension imposes a lot of financial burden on the health-care system. On the other hand, the importance of participatory care and high effectiveness of self-management programs have been confirmed. This study was aimed to examine the effect of an educational intervention on self-efficacy, self-care behaviors and blood pressure (BP) of hypertensive obese or overweight women in the primary health-care setting in Isfahan, Iran. This randomized controlled trial was an educational intervention program. It was performed among 146 hypertensive women of 30-65 age range who referred to 6 health care centers of Isfahan that randomly assigned to a control and intervention groups. The interventional group participated in the 6 weekly sessions including exercises, weight control, medication adherence, and home self-monitoring based on goal setting, and promotion of self-efficacy. The control group received routine care from health-care center and any special intervention has been done for the control group. Output variables were analyzed after intervention, and 6-month follow-up. There are no significant differences between age, weight, body mass index and BP and biochemical variables except lipids as well as behavioral factors at the baseline. After 6 months intervention self-efficacy (control group. After 6 months, there was a significant reduction in systolic (P self-care to control disease. Furthermore, since adherence to the treatment of hypertensive patients in our society is low, organizing such courses can teach essential knowledge and skills to lifestyle change and prevention of complications. Performing these courses is recommended for other chronic disease patients in health-care centers to assess self-management programs on self-care behavior.

  7. ASSOCIATION OF HYPERTENSION AND CORONARY HEART DISEASE WITH STROKE: A HOSPITAL BASED CASE CONTROL STUDY FROM KISHANGANJ, BIHAR

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    Anuj Kumar

    2016-06-01

    Full Text Available Stroke is a major cause of mortality and morbidity worldwide and commonly occurs amongst elderly. Every year, 15 million people worldwide suffer from stroke. Hypertension is the most powerful and important modifiable risk factor for all stroke subtypes. Approximately 30-40% stroke risk reduction can be achieved with lowering of blood pressure only. Heart disease is also a strong risk factor for stroke, although only for one type of stroke, ischemic strokes. MATERIALS AND METHODS This was a retrospective, cross-sectional, case-control study conducted from Jan-2015 to March-2015 (3 months. Study was done among stroke patients aged 20 years and above, hospitalized in M.G.M Medical College and L.S.K Hospital, Kishanganj. Age and gender matched control subjects were selected among neurologically healthy people who were admitted for other ailments in this hospital. Sample size was 312 people, containing 156 cases and 156 controls. Statistical analysis was done using Med Calc Version 12.7.5.0 software. Chi-square test was used as test of significance and p value less than 0.05 was considered as significant. OBSERVATION Male:Female ratio among the cases and control was 1.51:1. Mean age of cases and controls were 51.30±11.13 and 51.93±14.60. Out of 156 cases, 97 (62.18 % cases were having history of hypertension, while only 33 (21.15% controls had hypertension. P value was 0.0001, which is significant. Coronary heart disease was present in 21 (13.46% of cases and 6 (3.85% of controls. P value was significant. CONCLUSION To conclude in the present hospital-based case control study, systemic hypertension (p<0.001 and coronary heart diseases were significant risk factors in patients with stroke. Thus, our present study is a step towards determination of risk factors of stroke.

  8. Auricular acupuncture for prehypertension and stage 1 hypertension: study protocol for a pilot multicentre randomised controlled trial.

    Science.gov (United States)

    Kim, Joo-Hee; Jung, Hyun Jung; Kim, Tae-Hun; Lee, Seunghoon; Kim, Jung-Eun; Kang, Kyung-Won; Jung, So-Young; Kim, Ae-Ran; Park, Hyo-Ju; Shin, Mi-Suk; Shin, Kyung-Min; Jung, Hee-Jung; Lee, Seung-Deok; Hong, Kwon-Eui; Choi, Sun-Mi

    2013-09-22

    Hypertension, a worldwide public health problem, is a major risk factor for cardiovascular and kidney disease, and the medical and economic burden of hypertension is increasing. Auricular acupuncture has been used to treat various diseases, including hypertension. Several studies have shown that auricular acupuncture treatment decreases blood pressure in patients with hypertension; however, the scientific evidence is still insufficient. Therefore, we aimed to perform a randomised controlled clinical trial in patients with prehypertension and stage 1 hypertension to evaluate the effect and safety of auricular acupuncture. This on-going study is a two parallel arm, assessor-blinded, randomised controlled trial. Sixty participants with prehypertension and stage 1 hypertension will be recruited and randomly allocated into two groups in a 1:1 ratio. Participants in the auricular acupuncture group will receive auricular acupuncture treatment two times per week for 4 weeks. Participants in the usual care group will not receive any acupuncture treatment during the study period. All participants in both groups will be provided with verbal and written educational materials regarding the dietary and physical activity habits for controlling high blood pressure, and they will self-manage their lifestyle, including diet and exercise, during the study. The primary outcome is the 24-h average systolic and diastolic blood pressure, as measured with an ambulatory monitor. The secondary outcomes are the mean change in the average systolic and diastolic blood pressure during day- and night-time, the circadian rhythm of blood pressure, the mean arterial pressure, the change in blood pressure before and after auricular acupuncture treatment, the EuroQOL-5D (EQ-5D), heart rate variability (HRV), body mass index (BMI) and laboratory examination, including lipid profile and high sensitivity C-reactive protein (hs-CRP). Safety will be assessed at every visit. This pilot multicentre

  9. Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis

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    Otelio Randall

    2013-01-01

    Full Text Available Pulse pressure (PP, a marker of arterial system properties, has been linked to cardiovascular (CV complications. We examined (a association between unit changes of PP and (i composite CV outcomes and (ii development of left-ventricular hypertrophy (LVH and (b effect of mean arterial pressure (MAP control on rate of change in PP. We studied 1094 nondiabetics with nephrosclerosis in the African American Study of Kidney Disease and Hypertension. Subjects were randomly assigned to usual MAP goal (102–107 mmHg or a lower MAP goal (≤92 mmHg and randomized to beta-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker. After covariate adjustment, a higher PP was associated with increased risk of CV outcome (RR = 1.28, CI = 1.11–1.47, P<0.01 and new LVH (RR = 1.26, CI = 1.04–1.54, P=0.02. PP increased at a greater rate in the usual than in lower MAP groups (slope ± SE: 1.08 ± 0.15 versus 0.42 ± 0.15 mmHg/year, P=0.002, but not by the antihypertensive treatment assignment. Observations indicate that control to a lower MAP slows the progression of PP, a correlate of cardiovascular remodeling and complications, and may be beneficial to CV health.

  10. Controlled Release Inhalable Polymeric Microspheres for Treatment of Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Saigal, Aparna; Ng, Wai Kiong; Tan, Reginald B H; Chan, Sui Yung

    2015-01-01

    Pulmonary arterial hypertension (PAH) is a chronic ailment of the lungs, exhibiting elevated arterial pressure and vascular resistance; with a mean arterial pressure above 25 mmHg at rest and above 30 mmHg during exercise. It is associated with poor prognosis, and its prevalence is estimated to be 15 cases per one million. The current treatment options for PAH are discussed with the prostanoid class of drugs being the most effective. The latter drugs act by dilating systemic and pulmonary arterial vascular beds and, with sustained long-term usage, altering pulmonary remodelling. They are administered as IV infusions or inhalation solutions. Despite their clinical effectiveness, prostanoids have short half-lives requiring frequent administration of 6-9 times daily and thus suffer from poor compliance. Controlled release inhalation delivery systems for treatment of PAH, ranging from liposomes, biodegradable nano- and microparticles, formation of co-precipitates and complexation with cyclodextrins, are explored. Arising from these formulation strategies, we developed novel polymeric microspheres for inhalation to reduce dosing frequency and improve medication compliance. These microspheres are designed with release modifiers, to reside in the lung which is the site of drug action for a longer duration so as to release the drug slowly and consistently over a prolonged period. This could lead to the development of the first commercially available controlled release inhalation product.

  11. Awareness, treatment, and control of hypertension is low among adults in Aksum town, northern Ethiopia: A sequential quantitative-qualitative study.

    Science.gov (United States)

    Gebrihet, Teklay Aredehey; Mesgna, Kebede Haile; Gebregiorgis, Yosef Sibhatu; Kahsay, Alemayehu Bayray; Weldehaweria, Negassie Berhe; Weldu, Meresa Gebremedhin

    2017-01-01

    Hypertension is a major risk factor of cardiovascular diseases which are the leading causes of deaths from chronic non-communicable diseases in Ethiopia. However, little is documented in the issue. Therefore, this study aimed to assess the prevalence, associated factors, awareness, treatment and control of hypertension among adults 18 years old or above in Aksum town, Tigray region, North Ethiopia. A sequential quantitative-qualitative study was conducted among adults aged 18 years and above in Aksum town. A multi stage sampling procedure was used to select the study participants for the quantitative study whilst convenience sampling technique was used for the qualitative part. A pre-tested and structured questionnaire was used to collect quantitative data, and an interview guide was used to collect the qualitative data. The logistic regression model was fitted to identify factors independently associated with hypertension using SPSS Version 20. P-values of qualitative data, iterative hearing of the discussions verbatim interpretation was followed by categorizing similar ideas into themes and finally triangulated with the quantitative results. The overall prevalence of hypertension was 16.5% (95% CI: 13.4, 20.0). Awareness, treatment and control of hypertension were 43%, 2.1% and 18.2%, respectively. Being unable to read and write [AOR = 4.73, 95% CI:1.11, 20.23], not consuming fruit [AOR = 4.31, 95% CI:1.74, 10.66], being physically inactive [AOR = 20.11, 95% CI:8.75, 6.20], not knowing physical inactivity is a risk factor of hypertension [AOR = 3.57, 95% CI: 1.69, 7.69] and being overweight/obese [AOR = 9.2, 95% CI:4.54, 18.67] were significantly associated with hypertension. Remarkably, all identified hypertensive cases were linked to the nearby hospital for confirmation of diagnosis, care and follow-up and all of them were found to be hypertensive. This suggests that implementing primary health care approach integrated with the urban health extension package

  12. Efficacy of bone substitute material in preserving volume when placing a maxillary immediate complete denture: study protocol for the PANORAMIX randomized controlled trial.

    Science.gov (United States)

    Rignon-Bret, Christophe; Hadida, Alain; Aidan, Alexis; Nguyen, Thien-Huong; Pasquet, Gerard; Fron-Chabouis, Helene; Wulfman, Claudine

    2016-05-20

    Bone preservation is an essential issue in the context of last teeth extraction and complete edentulism. The intended treatment, whether a complete denture or an implant placement, is facilitated with a voluminous residual ridge. Bone resorption after multiple extractions has not been as well studied as the bone resorption that occurs after the extraction of a single tooth. Recent advances in bone substitute materials have revived this issue. The purpose of this study is to evaluate the interest in using bone substitute material to fill the socket after last teeth extraction in a maxillary immediate complete denture procedure compared with the conventional protocol without socket filling. A randomized, controlled, clinical trial was designed. The 34 participants eligible for maxillary immediate complete denture were divided into two groups. Complete dentures were prepared despite persistence of the last anterior teeth. The control group received a conventional treatment including denture placement immediately after extractions. In the experimental group, in addition to the immediate denture placement, a xenograft bone-substitute material (Bio-Oss Collagen®) was placed in the fresh sockets. The primary outcome of the study is to compare mean bone ridge height loss 1 year after maxillary immediate complete denture placement, with or without bone-substitute material, in incisor and canine sockets. The secondary outcomes are to compare the average bone ridge height and width loss for each extraction site. An original quantitative evaluation method using cone beam computed tomography was designed for reproducible measurements, with a radio-opaque denture duplicate. Two independent operators perform the radiologic measurements. The immediate complete denture technique limits bone resorption in multiple extraction situations and thus allows better denture retention and better options for implant placement. To compare the benefit of using any bone socket-filling material

  13. Prevalence, awareness, treatment, and control of hypertension and associated risk factors among adults in Xi'an, China: A cross-sectional study.

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    Hu, Meiqin; Wan, Yi; Yu, Lifen; Yuan, Jing; Ma, Yonghong; Hou, Bin; Jiang, Xun; Shang, Lei

    2016-08-01

    To investigate the prevalence, awareness, treatment, and control of hypertension, and the associated risk factors among adults in Xi'an, China.From October to December 2013, participants in Xi'an, China were recruited for the study by using a multiple-stage sampling method. A self-developed questionnaire with an additional health examination was used to collect data on the history of hypertension diagnosis and antihypertensive medication. The status on prevalence, awareness, treatment, and control of hypertension were analyzed and related risk factors were identified by using logistic regression analysis.A total of 8193 participants were included with an overall prevalence of hypertension of 20.4%. Among the hypertensive participants, 63.7% were aware of their conditions, 47.3% took antihypertensive medication, and 17.8% had their blood pressure (BP) controlled within 140/90 mm Hg. More complications and less frequent BP measurements were associated with hypertension. Older participants, non-drinkers, and those with more complications and more frequent BP measurements were more aware of their hypertension. Being older, living in an urban area, and having more frequent BP measurements were all factors for better treatment. Participants who were women, living in an urban area, with a higher educational level and who were not obese were more likely to have their hypertension controlled.The prevalence of hypertension among adults in Xi'an is high with suboptimal low awareness, treatment, and control rates. Further comprehensive integrated strategies based on these risk factors should be taken into account in order to improve the prevention, awareness, treatment, and control of hypertension.

  14. Hypertension in developing countries.

    Science.gov (United States)

    Tibazarwa, Kemi B; Damasceno, Albertino A

    2014-05-01

    The past 2 decades have seen a considerable global increase in cardiovascular disease, with hypertension remaining by far the most common. More than one-third of adults in Africa are hypertensive; as in the urban populations of most developing countries. Being a condition that occurs with relatively few symptoms, hypertension remains underdetected in many countries; especially in developing countries where routine screening at any point of health care is grossly underutilized. Because hypertension is directly related to cardiovascular disease, this has led to hypertension being the leading cause of adverse cardiovascular outcomes, as a result of patients living, often unknowingly, with uncontrolled hypertension for prolonged periods of time. In Africa, hypertension is the leading cause of heart failure; whereas at global levels, hypertension is responsible for more than half of deaths from stroke, just less than half of deaths from coronary artery disease, and for more than one-tenth of all global deaths. In this review, we discuss the escalating occurrence of hypertension in developing countries, before exploring the strengths and weaknesses of different measures to control hypertension, and the challenges of adopting these measures in developing countries. On a broad level, these include steps to curb the ripple effect of urbanization on the health and disease profile of developing societies, and suggestions to improve loopholes in various aspects of health care delivery that affect surveillance and management of hypertension. Furthermore, we consider how the industrial sectors' contributions toward the burden of hypertension can also be the source of the solution.

  15. Chronic baroreflex activation restores spontaneous baroreflex control and variability of heart rate in obesity-induced hypertension.

    Science.gov (United States)

    Iliescu, Radu; Tudorancea, Ionut; Irwin, Eric D; Lohmeier, Thomas E

    2013-10-01

    The sensitivity of baroreflex control of heart rate is depressed in subjects with obesity hypertension, which increases the risk for cardiac arrhythmias. The mechanisms are not fully known, and there are no therapies to improve this dysfunction. To determine the cardiovascular dynamic effects of progressive increases in body weight leading to obesity and hypertension in dogs fed a high-fat diet, 24-h continuous recordings of spontaneous fluctuations in blood pressure and heart rate were analyzed in the time and frequency domains. Furthermore, we investigated whether autonomic mechanisms stimulated by chronic baroreflex activation and renal denervation-current therapies in patients with resistant hypertension, who are commonly obese-restore cardiovascular dynamic control. Increases in body weight to ∼150% of control led to a gradual increase in mean arterial pressure to 17 ± 3 mmHg above control (100 ± 2 mmHg) after 4 wk on the high-fat diet. In contrast to the gradual increase in arterial pressure, tachycardia, attenuated chronotropic baroreflex responses, and reduced heart rate variability were manifest within 1-4 days on high-fat intake, reaching 130 ± 4 beats per minute (bpm) (control = 86 ± 3 bpm) and ∼45% and therapy may reduce the risk factors for cardiac arrhythmias as well as lower arterial pressure.

  16. Effectiveness of interventions for hypertension care in the community – a meta-analysis of controlled studies in China

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    Lu Zuxun

    2012-07-01

    Full Text Available Abstract Background Hypertension is a serious public health problem in China and in other developing countries. Our aim is to conduct a systematic review of studies on the effectiveness of community interventions for hypertension management in China. Methods China National Knowledge Infrastructure, PubMed, and references of retrieved articles were searched to identify randomised or quasi-randomised controlled studies that evaluated community hypertension care in mainland China. One reviewer extracted and a second reviewer checked data from the included studies. Results We included 94 studies, 93 of which were in Chinese language, that evaluated the following interventions: health education, improved monitoring, family-support, self-management, healthcare management changes and training of providers. The study quality was generally poor, with high risk of biased outcome reporting and significant heterogeneity between studies. When reported, the vast majority of the included studies reported statistically significantly improved outcomes in the intervention group. By assuming zero treatment effects for missing outcomes, the weighted reduction in the intervention group was 6∙9 (95% CI: 4∙9 to 8∙9 mm Hg for systolic BP, and 3∙8 (95% CI: 2∙6 to 5∙0 mm Hg for diastolic BP. Exploratory subgroup analyses found no significant differences between different interventions. Conclusions After taking account of possible reporting biases, a wide range of community interventions for hypertension care remain effective. The findings have implications for China and other low and middle income countries facing similar challenges. Because of significant heterogeneity and high risk of bias in the available studies, further well designed studies should be conducted in China to provide high quality evidence to inform policy decisions on hypertension control.

  17. Factors associated with multimorbidity and its link with poor blood pressure control among 223,286 hypertensive patients.

    Science.gov (United States)

    Wong, Martin C S; Wang, Harry H X; Cheung, Clement S K; Tong, Ellen L H; Sek, Antonio C H; Cheung, N T; Yan, Bryan P Y; Yu, Cheuk-Man; Griffiths, Sian M; Coats, Andrew J S

    2014-11-15

    Multimorbidity has become the norm worldwide as populations age. It remains, however, infrequently researched. This study evaluated factors associated with multimorbidity in a predominantly Chinese hypertensive population. We included all adult patients prescribed their first antihypertensive agents in the entire public sector in Hong Kong from a validated database. Multimorbidity was defined as having one or more medical conditions (cardiovascular diseases; respiratory diseases; diabetes or impaired fasting glucose; renal disease) in addition to hypertension. We studied the prevalence of multimorbidity and performed multinomial regression analyses to evaluate factors independently associated with multimorbidity. 223,286 hypertensive patients (average age of 59.9 years, SD 17.6) were included. The prevalence of having 0, 1 and ≥ 2 additional conditions was 59.6%, 32.8% and 7.5%, respectively. The most common conditions were cardiovascular disease (24.2%) and diabetes (23.0%), followed by respiratory disorders (14.6%) and renal disease (10.9%). Older age (>50 years), male sex, lower household income, receipt of social security allowance and suboptimal blood pressure control (>140 mmHg or >90 mmHg; >130 mmHg or >80 mmHg for diabetes patients; AOR = 3.38-4.49) were significantly associated with multimorbidity. There exists a synergistic effect among these variables as older (≥ 70 years), male patients receiving security allowance had substantially higher prevalence of multimorbidity (19.9% vs 7.5% among all patients). Multimorbidity is very common in hypertensive patients and its prevalence increased markedly with the presence of risk factors identified in this study. Hypertensive patients with multimorbidities should receive more meticulous clinical care as their blood pressure control tends to be poorer.

  18. Salinity in drinking water and the risk of (preeclampsia and gestational hypertension in coastal Bangladesh: a case-control study.

    Directory of Open Access Journals (Sweden)

    Aneire Ehmar Khan

    Full Text Available BACKGROUND: Hypertensive disorders in pregnancy are among the leading causes of maternal and perinatal death in low-income countries, but the aetiology remains unclear. We investigated the relationship between salinity in drinking water and the risk of (preeclampsia and gestational hypertension in a coastal community. METHODS: A population-based case-control study was conducted in Dacope, Bangladesh among 202 pregnant women with (preeclampsia or gestational hypertension, enrolled from the community served by the Upazilla Health Complex, Dacope and 1,006 matched controls from the same area. Epidemiological and clinical data were obtained from all participants. Urinary sodium and sodium levels in drinking water were measured. Logistic regression was used to calculate odds ratios, and 95% confidence intervals. FINDINGS: Drinking water sources had exceptionally high sodium levels (mean 516.6 mg/L, S.D 524.2. Women consuming tube-well (groundwater were at a higher disease risk than rainwater users (p900.01 mg/L, compared to <300 mg/L in drinking water (ORs 3.30 [95% CI 2.00-5.51], 4.40 [2.70-7.25] and 5.48 [3.30-9.11] (p-trend<0.001. Significant associations were seen for both (preeclampsia and gestational hypertension separately. INTERPRETATION: Salinity in drinking water is associated with increased risk of (preeclampsia and gestational hypertension in this population. Given that coastal populations in countries such as Bangladesh are confronted with high salinity exposure, which is predicted to further increase as a result of sea level rise and other environmental influences, it is imperative to develop and evaluate affordable approaches to providing water with low salt content.

  19. Hypertension prevalence, awareness, treatment and control among older people in Latin America, India and China: a 10/66 cross-sectional population-based survey.

    Science.gov (United States)

    Prince, Martin J; Ebrahim, Shah; Acosta, Daisy; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Jacob, K S; Jimenez-Velazquez, Ivonne Z; Rodriguez, Juan L; Salas, Aquiles; Sosa, Ana L; Williams, Joseph D; Gonzalez-Viruet, Maribella; Jotheeswaran, Amuthavilli T; Liu, Zhaorui

    2012-01-01

    To estimate the prevalence, social patterning, treatment and control of hypertension among older people in the 10/66 Dementia Research Group developing country sites. Cross-sectional surveys of SBP, hypertension, and hypertension awareness, treatment and control among 17 014 people aged 65 years and over in eight urban and four rural sites in Latin America, India and China. Hypertension prevalence was higher in urban (range 52.6-79.8%) than rural sites (range 42.6-56.9%), and lower in men than women [pooled prevalence ratio 0.89, 95% confidence interval (CI) 0.85-0.93]. Educational attainment was positively associated with hypertension in rural and least-developed sites. Age-standardized morbidity ratios, compared to USA (100), were higher in urban sites in Cuba (105), Dominican Republic (109), and Venezuela (107), similar in Puerto Rico (105), urban Mexico (99) and urban India (101), and lower in urban (75) and rural (61) Peru, rural Mexico (81), urban (91) and rural (84) China and rural India (65). In most Latin American centres, and urban China just over one-third of those with hypertension were controlled (BP hypertension is common among older people in developing countries, and may rise further during the demographic and health transitions. It is a major determinant of population SBP level. Strengthening primary care to improve hypertension management is necessary for primary prevention.

  20. Immediate effect of mind sound resonance technique on state anxiety and cognitive functions in patients suffering from generalized anxiety disorder: A self-controlled pilot study

    Directory of Open Access Journals (Sweden)

    Vipin Dhansoia

    2015-01-01

    Conclusion: This pilot study suggests that MSRT may have a potential role in reducing state anxiety and enhancing psychomotor performance in patients suffering from GAD immediately after the practice. These findings need confirmation from studies with a larger sample size and randomized controlled design, which are implicated in the future.

  1. The influence of health systems on hypertension awareness, treatment, and control: a systematic literature review.

    Directory of Open Access Journals (Sweden)

    Will Maimaris

    Full Text Available BACKGROUND: Hypertension (HT affects an estimated one billion people worldwide, nearly three-quarters of whom live in low- or middle-income countries (LMICs. In both developed and developing countries, only a minority of individuals with HT are adequately treated. The reasons are many but, as with other chronic diseases, they include weaknesses in health systems. We conducted a systematic review of the influence of national or regional health systems on HT awareness, treatment, and control. METHODS AND FINDINGS: Eligible studies were those that analyzed the impact of health systems arrangements at the regional or national level on HT awareness, treatment, control, or antihypertensive medication adherence. The following databases were searched on 13th May 2013: Medline, Embase, Global Health, LILACS, Africa-Wide Information, IMSEAR, IMEMR, and WPRIM. There were no date or language restrictions. Two authors independently assessed papers for inclusion, extracted data, and assessed risk of bias. A narrative synthesis of the findings was conducted. Meta-analysis was not conducted due to substantial methodological heterogeneity in included studies. 53 studies were included, 11 of which were carried out in LMICs. Most studies evaluated health system financing and only four evaluated the effect of either human, physical, social, or intellectual resources on HT outcomes. Reduced medication co-payments were associated with improved HT control and treatment adherence, mainly evaluated in US settings. On balance, health insurance coverage was associated with improved outcomes of HT care in US settings. Having a routine place of care or physician was associated with improved HT care. CONCLUSIONS: This review supports the minimization of medication co-payments in health insurance plans, and although studies were largely conducted in the US, the principle is likely to apply more generally. Studies that identify and analyze complexities and links between health

  2. Intrauterine administration of hCG immediately after oocyte retrieval and the outcome of ICSI: a randomized controlled trial.

    Science.gov (United States)

    Navali, N; Gassemzadeh, A; Farzadi, L; Abdollahi, S; Nouri, M; Hamdi, K; Mallah, F; Jalilvand, F

    2016-11-01

    Does the intrauterine administration of hCG immediately after oocyte retrieval in antagonist cycles with ICSI and fresh embryo transfer (ET) influence the implantation rate or chemical and clinical pregnancy rates? The intrauterine administration of hCG after oocyte retrieval increases the implantation rate and chemical and clinical pregnancy rates. Over half of IVF/ICSI cycles fail due to implantation failure. Intrauterine administration of hCG, a few minutes before ET, increased the implantation and pregnancy rates in most but not in all studies. The effect of intrauterine administration of hCG, after oocyte retrieval, has not yet been studied. The study was a parallel, triple-blind randomized clinical trial (RCT) performed from September 2015 to February 2016, in a university hospital. We recruited women undergoing antagonist ovarian stimulation, ICSI and ET. For an effect size of 0.2, power of 80% at a significance level of 0.05, we needed 150 participants. Accounting for a 7% dropout rate, a total of 160 women was considered appropriate. A computer-generated randomization list with a block size of 4, with 1:1 allocation was used. The treatment allocation was placed in a sealed, opaque, envelope and picked up consecutively. Immediately after oocyte retrieval, patients in the intervention and control groups were treated with intrauterine injection of hCG and saline, respectively. Participants underwent ET on Day 3. A beta-hCG test was done at 2 weeks. If positive, three transvaginal-ultrasonographies (TVSs) were done at 3, 4 and 10 weeks after ET. The participants were called up thereafter and questioned about the continuity of their pregnancy. Of 1990 women attending the infertility clinic of our university hospital, 508 were IVF/ICSI candidates during the study period, and 245 of the patients on an antagonist cycle met the criteria to be invited into our trial. Inclusion criteria were normal ovarian reserve, age ≤41, undergoing ICSI, and fresh ET and normal

  3. Autonomic control of heart rate and blood pressure in spontaneously hypertensive rats during aversive classical conditioning.

    Science.gov (United States)

    Hatton, D C; Buchholz, R A; Fitzgerald, R D

    1981-12-01

    An examination was made of the heart rate (HR) and blood pressure (BP) responses of 7-9-wk-old spontaneously hypertensive rats (SHR) and genetical control Wistar/Kyoto (WKY) rats during aversive classical conditioning. Subsequent to the development of conditioned responding (CRs), assessments were made of the effects of selective autonomic blockade by methyl atropine (10 mg/kg), phentolamine (2 mg/kg), and propranolol (2 mg/kg). The CR complex in the two strains consisted of pressor BP CRs in conjunction with vagally mediated decelerative HR CRs in the SHR strain and sympathetically mediated accelerative HR CRs in the WKY strain. The decelerative SHR HR CR did not appear to be secondary to baroreceptor reflex activity, although such activity did appear to be involved in the pressor BP and decelerative HR orienting response (OR) and unconditioned response (UR) complex of the SHRs on the initial application of the CS and the US, respectively. Augmented pressor BP ORs, CRs, and URs in the SHRs relative to the WKYs and differential drug effects on BP and HR baselines of the two strains suggested the presence of enhanced sympathetic activity in the SHRs that was not reflected in the SHR decelerative HR CR. Phentolamine unmasked evidence of reflex beta 2-vasodilation deficiency in the SHRs that could have contributed to the enhancement of their BP OR and CR.

  4. Acute effects of aerosolized iloprost in COPD related pulmonary hypertension - a randomized controlled crossover trial.

    Science.gov (United States)

    Boeck, Lucas; Tamm, Michael; Grendelmeier, Peter; Stolz, Daiana

    2012-01-01

    Inhaled iloprost potentially improves hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease (COPD) and secondary pulmonary hypertension (PH). To evaluate acute effects of aerosolized iloprost in patients with COPD-associated PH. A randomized, double blind, crossover study was conducted in 16 COPD patients with invasively confirmed PH in a single tertiary care center. Each patient received a single dose of 10 µg iloprost (low dose), 20 µg iloprost (high dose) and placebo during distinct study-visits. The primary end-point of the study was exercise capacity as assessed by the six minute walking distance. Both iloprost doses failed to improve six-minute walking distance (p = 0.36). Low dose iloprost (estimated difference of the means -1.0%, p = 0.035) as well as high dose iloprost (-2.2%, piloprost was associated with reduced peak oxygen consumption (-76 ml/min, p = 0.002), elevated partial pressure of carbon dioxide (0.27 kPa, p = 0.040) and impaired ventilation during exercise (-3.0l/min, piloprost inhalation in patients with COPD-associated mild to moderate PH is very unlikely. Controlled-Trials.com ISRCTN61661881.

  5. Refractory nausea and vomiting in the setting of well-controlled idiopathic intracranial hypertension.

    Science.gov (United States)

    Barnett, Dennis L; Rosenbaum, Rachel A; Diaz, Jonathan R

    2014-06-03

    Summary A 27-year-old woman with a history of recurrent nausea and vomiting in the setting of idiopathic intracranial hypertension (IIH) was admitted for control of unremitting nausea and vomiting. Initial antiemetic therapy included optimisation of IIH therapy by titrating acetazolamide, in addition to using ondansetron and metoclopramide as needed, with minimal relief. She was ultimately treated with palonosetron with complete resolution of her acute nausea. Nausea, often treated with 5-hydroxytryptamine (5-HT3) receptor antagonists, approved for perioperative and chemotherapy-induced nausea, are used off-label to treat nausea and vomiting outside of those settings. The efficacy of different regimens has been compared in the literature and continues to remain controversial. When choosing from different 5-HT3 antagonists there are other considerations, in addition to efficacy to consider: dosing schedule, half-life, time of onset, duration and cost-to-benefit ratio, and although one 5-HT3 antagonist may not have been effective, another one may be. In our case palonosetron, with a significantly longer half-life than other 5-HT3 antagonists, was effective in resolving nausea when compared with the more commonly used ondansetron.

  6. The MicroRNA-130/301 Family Controls Vasoconstriction in Pulmonary Hypertension*

    Science.gov (United States)

    Bertero, Thomas; Cottrill, Katherine; Krauszman, Adrienn; Lu, Yu; Annis, Sofia; Hale, Andrew; Bhat, Balkrishen; Waxman, Aaron B.; Chau, B. Nelson; Kuebler, Wolfgang M.; Chan, Stephen Y.

    2015-01-01

    Pulmonary hypertension (PH) is a complex disorder, spanning several known vascular cell types. Recently, we identified the microRNA-130/301 (miR-130/301) family as a regulator of multiple pro-proliferative pathways in PH, but the true breadth of influence of the miR-130/301 family across cell types in PH may be even more extensive. Here, we employed targeted network theory to identify additional pathogenic pathways regulated by miR-130/301, including those involving vasomotor tone. Guided by these predictions, we demonstrated, via gain- and loss-of-function experimentation in vitro and in vivo, that miR-130/301-specific control of the peroxisome proliferator-activated receptor γ regulates a panel of vasoactive factors communicating between diseased pulmonary vascular endothelial and smooth muscle cells. Of these, the vasoconstrictive factor endothelin-1 serves as an integral point of communication between the miR-130/301-peroxisome proliferator-activated receptor γ axis in endothelial cells and contractile function in smooth muscle cells. Thus, resulting from an in silico analysis of the architecture of the PH disease gene network coupled with molecular experimentation in vivo, these findings clarify the expanded role of the miR-130/301 family in the global regulation of PH. They further emphasize the importance of molecular cross-talk among the diverse cellular populations involved in PH. PMID:25505270

  7. Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol

    Directory of Open Access Journals (Sweden)

    Lutschg Meghan Z

    2011-10-01

    Full Text Available Abstract Background Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens. Methods/design This randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-recommended care for hypertension into clinical practice and improve blood pressure (BP control in the primary care setting. Using constrained randomization, we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms: physician-level incentive; group-level incentive; combination of physician and group incentives; and no incentives (control. All participants at the hospital (cluster were assigned to the same study arm. We enrolled 83 full-time primary care physicians and 42 non-physician personnel. The intervention consisted of an educational session about guideline-recommended care for hypertension, five audit and feedback reports, and five disbursements of incentive payments. Incentive payments rewarded participants for chart-documented use of guideline-recommended antihypertensive medications, BP control, and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention. To identify potential unintended consequences of the incentives, the study team interviewed study participants, as well as non-participant primary care personnel and leadership at study sites. Chart reviews included data collection on quality measures not related to hypertension. To evaluate the persistence of the effect of the incentives, the study design includes a washout period. Discussion We briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful

  8. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention.

    Science.gov (United States)

    Singh, R B; Suh, I L; Singh, V P; Chaithiraphan, S; Laothavorn, P; Sy, R G; Babilonia, N A; Rahman, A R; Sheikh, S; Tomlinson, B; Sarraf-Zadigan, N

    2000-01-01

    Reliable statistics related to the prevalence, incidence and mortality of hypertension and stroke are not available from Asia. The data may be in national or institutional reports or journals published in the local language only. The mortality rate for stroke has been on the decline since the mid 1960s in the developed countries of Asia, such as Australia, New Zealand, and Japan, with some improvement in Singapore, Taiwan and Hong Kong, some areas of China and Malaysia about 15 years later. In India, China, Philippines, Thailand, Sri Lanka, Iran, Pakistan, Nepal, there has been a rapid increase in stroke mortality and prevalence of hypertension. The prevalence of hypertension according to new criteria (>140/90 mm Hg) varies between 15-35% in urban adult populations of Asia. In rural populations, the prevalence is two to three times lower than in urban subjects. Hypertension and stroke occur at a relatively younger age in Asians and the risk of hypertension increases at lower levels of body mass index of 23-25 kg/m2. Overweight, sedentary behaviour, alcohol, higher social class, salt intake, diabetes mellitus and smoking are risk factors for hypertension in most of the countries of Asia. In Australia, New Zealand and Japan, lower social class is a risk factor for hypertension and stroke. Population-based long-term follow-up studies are urgently needed to demonstrate the association of risk factors with hypertension in Asia. However prevention programmes should be started based on cross-sectional surveys and case studies without waiting for the cohort studies.

  9. Immediate versus delayed initiation of the levonorgestrel-releasing intrauterine system following medical termination of pregnancy - 1 year continuation rates: a randomised controlled trial.

    Science.gov (United States)

    Korjamo, R; Mentula, M; Heikinheimo, O

    2017-06-26

    To assess the 1-year continuation rates and new pregnancies following immediate versus delayed insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS) after medical termination of pregnancy (MTOP) up to 20 weeks of gestation. A randomised controlled trial. Helsinki University Hospital, Finland, January 2013 to December 2014. A total of 267 women requesting MTOP and planning LNG-IUS for post-MTOP contraception. Insertion of LNG-IUS occurred immediately (0-3 days) or after a delay (2-4 weeks) following MTOP. Follow-up visits were at 3 months and 1 year after MTOP. LNG-IUS use at 1 year after MTOP. Women were randomised to immediate (n = 134) or delayed (n = 133) insertion of the LNG-IUS, and 133 and 131 were analysed; 127 (95.5%) women received immediate insertion and 111 (84.7%) women had delayed insertion of the LNG-IUS (risk ratio [RR] 1.13, 95% CI 1.04-1.22). The verified numbers of women continuing the LNG-IUS use at 1 year were 83 (62.4%) and 52 (39.7%) (RR 1.57, 95% CI 1.23-2.02). The numbers of new pregnancies were 6 (4.5%) and 16 (12.2%) (RR 0.37, 95% CI 0.15-0.91), and numbers of subsequent TOPs were 4 (3.0%) and 5 (3.8%) (RR 0.79, 95% CI 0.22-2.87). Immediate insertion of the LNG-IUS following MTOP resulted in higher 1-year continuation rates compared with delayed insertion. In addition, those receiving immediate insertion demonstrated a decreased new pregnancy rate, but no difference in the numbers of another TOP. Immediate LNG-IUS insertion after MTOP results in a higher 1-year continuation compared with delayed insertion. © 2017 Royal College of Obstetricians and Gynaecologists.

  10. Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial.

    Science.gov (United States)

    Lopes, Susana; Correia, Christophe; Félix, Gonçalo; Lopes, Mário; Cruz, Ana; Ribeiro, Fernando

    2017-10-01

    Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. Controlled laboratory design. Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. At baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5±3.4 to 9.7±2.7cm(2), p=0.002 and CoP velocity: 2.8±0.6 to 2.3±0.5cm/s, pPilates group. Pilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study.

    Science.gov (United States)

    Basu, Sanjay; Millett, Christopher

    2013-07-01

    Large-scale hypertension screening campaigns have been recommended for middle-income countries. We sought to identify sociodemographic predictors of hypertension prevalence, diagnosis, treatment, and control among middle-income countries. We analyzed data from 47 443 adults in all 6 middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) sampled in nationally representative household assessments from 2007 to 2010 as part of the World Health Organization Study on Global Aging and Adult Health. We estimated regression models accounting for age, sex, urban/rural location, nutrition, and obesity, as well as hypothesized covariates of healthcare access, such as income and insurance. Hypertension prevalence varied from 23% (India) to 52% (Russia), with between 30% (Russia) and 83% (Ghana) of hypertensives undiagnosed before the survey and between 35% (Russia) and 87% (Ghana) untreated. Although the risk of hypertension significantly increased with age (odds ratio, 4.6; 95% confidence interval, 3.0-7.1; among aged, 60-79 versus income quintile (13% obesity). Insurance status and income also emerged as significant correlates to diagnosis and treatment probability, respectively. More than 90% of hypertension cases were uncontrolled, with men having 3 times the odds as women of being uncontrolled. Overall, the social epidemiology of hypertension in middle-income countries seems to be correlated to increasing obesity prevalence, and hypertension control rates are particularly low for adult men across distinct cultures.

  12. Prevalence of Atherogenic Dyslipidemia in Spanish Hypertensive Patients and Its Relationship With Blood Pressure Control and Silent Organ Damage.

    Science.gov (United States)

    de la Sierra, Alejandro; Gorostidi, Manuel; Aranda, Pedro; Corbella, Emili; Pintó, Xavier

    2015-07-01

    To assess the prevalence of atherogenic dyslipidemia in hypertensive patients and its relationship with risk profile and blood pressure control. The study included 24 351 hypertensive patients from the Spanish Ambulatory Blood Pressure Monitoring Registry. Atherogenic dyslipidemia was defined as the presence of hypertriglyceridemia (> 150mg/dL) and low levels of high-density lipoprotein cholesterol (< 40mg/dL in men and < 46mg/dL in women). Blood pressure control was assessed by office and ambulatory monitoring. Atherogenic dyslipidemia was present in 2705 patients (11.1%). Of these, 30% had hypertriglyceridemia and 21.7% had low levels of high-density lipoprotein cholesterol. Compared with patients without these risk factors, the former group were more often male (60% vs 52%), younger (57 years vs 59 years), had other risk factors and organ damage (microalbuminuria, reduced estimated glomerular filtration rate, and left ventricular hypertrophy), worse office, diurnal, and nocturnal blood pressure values (odds ratio 1.09, 1.06, and 1.10, respectively), and the lowest nocturnal blood pressure reduction (odds ratio=1.07), despite the greater use of antihypertensive drugs. Atherogenic dyslipidemia is present in more than 10% of hypertensive patients and is associated with other risk factors, organ damage, and poorer blood pressure control. Greater therapeutic effort is needed to reduce overall risk in these patients. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Telemonitoring and/or self-monitoring of blood pressure in hypertension (TASMINH4): protocol for a randomised controlled trial.

    Science.gov (United States)

    Franssen, Marloes; Farmer, Andrew; Grant, Sabrina; Greenfield, Sheila; Heneghan, Carl; Hobbs, Richard; Hodgkinson, James; Jowett, Susan; Mant, Jonathan; Martin, Una; Milner, Siobhan; Monahan, Mark; Ogburn, Emma; Perera-Salazar, Rafael; Schwartz, Claire; Yu, Ly-Mee; McManus, Richard J

    2017-02-13

    Self-monitoring of hypertension is associated with lower systolic blood pressure (SBP). However, evidence for the use of self-monitoring to titrate antihypertensive medication by physicians is equivocal. Furthermore, there is some evidence for the efficacy of telemonitoring in the management of hypertension but it is not clear what this adds over and above self-monitoring. This trial aims to evaluate whether GP led antihypertensive titration using self-monitoring results in lower SBP compared to usual care and whether telemonitoring adds anything to self-monitoring alone. This will be a pragmatic primary care based, unblinded, randomised controlled trial of self-monitoring of BP with or without telemonitoring compared to usual care. Eligible patients will have poorly controlled hypertension (>140/90 mmHg) and will be recruited from primary care. Participants will be individually randomised to either usual care, self-monitoring alone, or self-monitoring with telemonitoring. The primary outcome of the trial will be difference in clinic SBP between intervention and control groups at 12 months adjusted for baseline SBP, gender, BP target and practice. At least 1110 patients will be sufficient to detect a difference in SBP between self-monitoring with or without telemonitoring and usual care of 5 mmHg with 90% power with an adjusted alpha of 0.017 (2-sided) to adjust for all three pairwise comparisons. Other outcomes will include adherence of anti-hypertensive medication, lifestyle behaviours, health-related quality of life, and adverse events. An economic analysis will consider both within trial costs and a model extrapolating the results thereafter. A qualitative sub study will gain insights into the views, experiences and decision making processes of patients and health care professionals focusing on the acceptability of self-monitoring and telemonitoring in the routine management of hypertension. The results of the trial will be directly applicable to primary

  14. Inhaled iloprost for the control of acute pulmonary hypertension in children: a systematic review.

    Science.gov (United States)

    Mulligan, Claire; Beghetti, Maurice

    2012-07-01

    Inhaled iloprost is attracting growing interest as a potential alternative and/or adjuvant to inhaled nitric oxide in the management of pediatric pulmonary hypertension in the acute and intensive care settings. However, there are currently no formal evidence-based guidelines regarding the use of inhaled iloprost in children with pulmonary hypertension. The aim of this systematic review is to assess the literature concerning the use of inhaled iloprost in children with pulmonary hypertension in the acute setting. Studies were identified from PubMed and Embase. Internal literature databases and recent congress abstracts (2009 onward) were also searched for relevant publications. Studies were included if they examined the use of inhaled iloprost in children with pulmonary hypertension in an acute or intensive care setting. Twenty-eight studies were included in the review. The majority were case studies or case series (n = 17), and in total, the 28 studies represented the treatment of 195 children with iloprost. Iloprost was most frequently studied in children undergoing cardiac surgery (as a bridge to surgery and postoperatively), in children undergoing acute pulmonary vasoreactivity testing, and in neonates with persistent pulmonary hypertension of the newborn. The results of the included studies suggested that inhaled iloprost may have a diverse role in the acute treatment of pediatric pulmonary hypertension and that its acute effects are similar to those of inhaled nitric oxide. However, the iloprost dose was not consistently reported and varied greatly between studies, and several different administration devices were used. Inhaled iloprost may be useful in the acute treatment of children and neonates with pulmonary hypertension, but clinical data are scarce, and the appropriate dosing of iloprost in different scenarios is uncertain. Well-designed prospective clinical trials are needed.

  15. Mitochondrial DNA copy number in peripheral blood cell and hypertension risk among mining workers: a case-control study in Chinese coal miners.

    Science.gov (United States)

    Lei, L; Guo, J; Shi, X; Zhang, G; Kang, H; Sun, C; Huang, J; Wang, T

    2017-09-01

    Alteration of mitochondrial DNA (mtDNA) copy number, which reflects oxidant-induced cell damage, has been observed in a wide range of human diseases. However, whether it correlates with hypertension has not been elucidated. We aimed to explore the association between mtDNA copy number and the risk of hypertension in Chinese coal miners. A case-control study was performed with 378 hypertension patients and 325 healthy controls in a large coal mining group located in North China. Face-to-face interviews were conducted by trained staffs with necessary medical knowledge. The mtDNA copy number was measured by a quantitative real-time PCR assay using DNA extracted from peripheral blood. No significant differences in mtDNA copy number were observed between hypertension patients and healthy controls. However, in both case and control groups, the mtDNA copy number was statistically significantly lower in the elder population (≥45 years old) compared with the younger subjects (copy number could be found in hypertension patients consuming alcohol regularly compared with no alcohol consumption patients (7.09 vs 6.69); mtDNA copy number was also positively correlated with age and alcohol consumption. Hypertension was found significantly correlated with factors such as age, work duration, monthly family income and drinking status. Our results suggest that the mtDNA copy number is not associated with hypertension in coal miners.

  16. Insulin Resistance and Hypertension

    Institute of Scientific and Technical Information of China (English)

    张建华; 张春秀

    2002-01-01

    Summary: The insulin sensitivity in hypertensive patients with normal glucose tolerance (NGT),impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM) and the insulin resistance(IR) under the disorder of glucose metabolism and hypertension were studied. By glucose toler-ance test and insulin release test, insulin sensitivity index (ISI) and the ratio of area under glucosetolerance curve (AUCG) to area under insulin release curve (AUC1) were calculated and analyzed.The results showed that ISI was decreased to varying degrees in the patients with hypertension,the mildest in the group of NGT with hypertension, followed by the group of IGT without hyper-tension, the group of IGT with hypertension and DM (P=0). There was very significant differ-ence in the ratio of AUCG/AUC1 between the hypertensive patients with NGT and controls (P=0). It was concluded that a significant IR existed during the development of IGT both in hyperten-sion and nonhypertension. The increase of total insulin secretion (AUC1) was associated with non-hypertension simultaneously. IR of the hypertensive patients even existed in NGT and was wors-ened with the deterioration of glucose metabolism disorder, but the AUC1 in the HT groupchanged slightly. A relative deficiency of insulin secretion or dysfunction of β-cell of islet existed inIGT and DM of the hypertensive patients.

  17. Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome: a randomized, placebo-controlled trial

    Institute of Scientific and Technical Information of China (English)

    Yi Chen; De-yu Fu; Yu Chen; Yan-ming He; Xiao-dong Fu; Yan-qiu Xu; Yi Liu

    2013-01-01

    BACKGROUND:Patients with hypertension coupled with metabolic syndrome (MetS) are among the high risk population in cardiovascular and cerebrovascular diseases.To reduce the prevalence of cardiovascular and cerebrovascular diseases,it is essential to appropriately control blood pressure together with other cardiovascular risk factors.OBJECTIVE:The current study was designed to investigate the therapeutic effects on blood pressure,blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula,a compound traditional Chinese herbal medicine,in addition to routine treatment to hypertensive patients coupled with MetS.DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS:A total of 43 patients with hypertension coupled with MetS were recruited into this study.The enrolled patients were randomly divided into the Chinese herbal formula group (anti-hypertensive drugs plus Yiqi Huaju Formula,CHF) and the control group (anti-hypertensive drugs plus placebo).The CHF group enrolled 22 patients while the control group received 21 cases.Treatments were given for 12 weeks in both groups.MAIN OUTCOME MEASURES:Parameters examined include 24-hour ambulatory blood pressure monitoring,body mass index,waist circumference,waist-to-hip ratio,homeostatic model assessment for insulin resistance (HOMA-IR),fasting glycosylated hemoglobin (HbA1c),fasting plasma glucose,2-hour postprandial plasma glucose (PPG),fasting plasma insulin,serum lipid,etc.RESULTS:Compared with the control group,the CHF group had significant improvement (P<0.01) in anthropometric parameters,FPG,HOMA-IR,blood pressure amplitude,blood pressure variability and blood pressure load.CONCLUSION:This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors.The mechanism of controlling of blood pressure may be associated with the improvement of insulin sensitivity due to the Yiqi

  18. Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam: a cluster-randomized controlled feasibility trial

    National Research Council Canada - National Science Library

    Hoa L Nguyen; Jeroan J Allison; Duc A Ha; German Chiriboga; Ha N Ly; Hanh T Tran; Cuong K Nguyen; Diem M Dang; Ngoc T Phan; Nguyen C Vu; Quang P Nguyen; Robert J Goldberg

    2017-01-01

    ...,” and a didactic intervention. Methods The storytelling intervention included stories about strategies for coping with hypertension, with patients speaking in their own words, and didactic content about the importance of healthy...

  19. Comparing exercise interventions to increase persistence with physical exercise and sporting activity among people with hypertension or high normal blood pressure: study protocol for a randomised controlled trial

    National Research Council Canada - National Science Library

    Fife-Schaw, Chris; de Lusignan, Simon; Wainwright, Joe; Sprake, Hannah; Laver, Suzannah; Heald, Victoria; Orton, Julian; Prescott, Matt; Carr, Helen; O'Neill, Mark

    2014-01-01

    .... Four-arm randomised controlled trial. The study tests two types of intervention that are intended to increase physical activity among currently inactive 18- to 74-year-old people with hypertension or high-normal blood pressure...

  20. Dialysis-Associated Hypertension Treated with Telmisartan - DiaTel: A Pilot, Placebo-Controlled, Cross-Over, Randomized Trial: e79322

    National Research Council Canada - National Science Library

    Matthias Huber; Till Treutler; Peter Martus; Antje Kurzidim; Reinhold Kreutz; Joachim Beige

    2013-01-01

    .... We designed and conducted a randomised, placebo-controlled, double-blind and cross-over trial for treatment of dialysis-associated hypertension with telmisartan 80 mg once daily or placebo on top...

  1. The effectiveness and safety of L-amlodipine besylate for blood pressure control in patients with mild to moderate essential hypertension

    Institute of Scientific and Technical Information of China (English)

    贾坦

    2013-01-01

    Objective To evaluate the effectiveness and safety of L-amlodipine besylate for blood pressure control in patients with mild to moderate essential hypertension.Methods A total of 1051 mild to moderate essential

  2. Immediate Single-Tooth Implant Placement in Bony Defects in the Esthetic Zone : A 1-Year Randomized Controlled Trial

    NARCIS (Netherlands)

    Slagter, Kirsten W.; Meijer, Henny J. A.; Bakker, Nicolaas A.; Vissink, Arjan; Raghoebar, Gerry M.

    2016-01-01

    Background: This study aims to assess, with regard to marginal bone level (MBL), whether the outcome of immediate implant placement in bony defects in the esthetic zone was non-inferior to delayed implant placement after 1 year. Methods: Forty patients with a failing tooth in the esthetic zone and a

  3. Review of inhaled iloprost for the control of pulmonary artery hypertension in children

    Directory of Open Access Journals (Sweden)

    Cecile Tissot

    2009-04-01

    Full Text Available Cecile Tissot, Maurice BeghettiPediatric Cardiology Unit, Department of the Child and Adolescent, University Hospital of Geneva, SwitzerlandAbstract: In the pediatric population, pulmonary hypertension may present as an acute event in the setting of lung or cardiac pathology or as a chronic disease, mainly as idiopathic pulmonary hypertension or associated with congenital heart disease. Recently, new pharmacologic approaches have demonstrated significant efficacy in the management of adults with pulmonary arterial hypertension; these include intravenous epoprostenol, prostacyclin analogs, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors. The same treatment strategies are currently used in children. There are only few reports of the use of inhaled iloprost in pediatrics, only one of which reported the use of chronic inhaled iloprost in a significant number of children. This report showed that 1 the acute pulmonary vasodilator response to inhaled iloprost is equivalent to that of inhaled nitric oxide; 2 acute inhalation of iloprost can induce bronchoconstriction 3 the addition of inhaled iloprost can reduce the need for intravenous prostanoid therapy in some patients; 4 most children tolerated the combination of inhaled iloprost and endothelin receptor antagonist or phosphodiesterase inhibitors; 5 Several patients had clinical deterioration during chronic inhaled iloprost therapy and required rescue therapy with intravenous prostanoids. In this review we will discuss the role of inhaled iloprost in acute and chronic pulmonary hypertension in children.Keywords: pulmonary hypertension, children, iloprost

  4. Clinical Effectiveness Of Dynamic Out-Patient Control Technology Over Hypertensive Patients Based On Computer System And Mobile Phone Connection

    Directory of Open Access Journals (Sweden)

    O.M. Posnenkova

    2009-09-01

    Full Text Available A new follow-up technology of dynamic out-patient control based on system of mobile monitoring of patients with arterial hypertension (SMMAH has been created in Saratov Scientific Research Institute of Cardiology. SMMAH is based on exchange of information between patient and doctor with the help of Internet and standard short mobile messages. The aim of the present work is to study the effectiveness of SMMAH for follow-up control of hypertensive patients for the period of 12 months. 79 patients with hypertension aged 49±11 were included in the investigation. Control period lasted 12 months. Control visits were made in the 1st, 6th and 12th months. The number of patients became out of control, its causes, percentage of patients who achieved and maintained target blood pressure (BP were analyzed after each visit. Data were presented as M (95% confidence interval. As a result in 1 month period of investigation 88,6% of patients regularly used mobile messages, 11% of patients were out of control. In 6 months period 68,4% of participants were under control, 31,6% of patients dropped out. In 12 months period — 67% and 33% of patients accordingly. Target BP was maintained in 87% (77%-96% of patients in 1 month period, in 78% (66%-90% of patients in 6 months period and in 68% of patients (53%-84% in 12 months period. High clinical effectiveness of SMMAH has been proved during the study: 67% of patients have followed prescribed therapy after the investigation period and 68% of them have maintained target BP level.

  5. Acute effects of aerosolized iloprost in COPD related pulmonary hypertension - a randomized controlled crossover trial.

    Directory of Open Access Journals (Sweden)

    Lucas Boeck

    Full Text Available BACKGROUND: Inhaled iloprost potentially improves hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease (COPD and secondary pulmonary hypertension (PH. OBJECTIVES: To evaluate acute effects of aerosolized iloprost in patients with COPD-associated PH. METHODS: A randomized, double blind, crossover study was conducted in 16 COPD patients with invasively confirmed PH in a single tertiary care center. Each patient received a single dose of 10 µg iloprost (low dose, 20 µg iloprost (high dose and placebo during distinct study-visits. The primary end-point of the study was exercise capacity as assessed by the six minute walking distance. RESULTS: Both iloprost doses failed to improve six-minute walking distance (p = 0.36. Low dose iloprost (estimated difference of the means -1.0%, p = 0.035 as well as high dose iloprost (-2.2%, p<0.001 significantly impaired oxygenation at rest. Peak oxygen consumption and carbon dioxide production differed significantly over the three study days (p = 0.002 and p = 0.003, accordingly. As compared to placebo, low dose iloprost was associated with reduced peak oxygen consumption (-76 ml/min, p = 0.002, elevated partial pressure of carbon dioxide (0.27 kPa, p = 0.040 and impaired ventilation during exercise (-3.0l/min, p<0.001. CONCLUSIONS: Improvement of the exercise capacity after iloprost inhalation in patients with COPD-associated mild to moderate PH is very unlikely. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN61661881.

  6. Hypertension with unsatisfactory sleep health (HUSH): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Levenson, Jessica C; Rollman, Bruce L; Ritterband, Lee M; Strollo, Patrick J; Smith, Kenneth J; Yabes, Jonathan G; Moore, Charity G; Harvey, Allison G; Buysse, Daniel J

    2017-06-06

    Insomnia is common in primary care medical practices. Although behavioral treatments for insomnia are safe, efficacious, and recommended in practice guidelines, they are not widely-available, and their effects on comorbid medical conditions remain uncertain. We are conducting a pragmatic clinical trial to test the efficacy of two cognitive behavioral treatments for insomnia (Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi)) versus an enhanced usual care condition (EUC). The study is a three-arm, parallel group, randomized controlled trial. Participants include 625 adults with hypertension and insomnia, recruited via electronic health records from primary care practices affiliated with a large academic medical center. After screening and baseline assessments, participants are randomized to treatment. BBTI is delivered individually with a live therapist via web-interface/telehealth sessions, while SHUTi is a self-guided, automated, interactive, web-based form of cognitive behavioral therapy for insomnia. Participants in EUC receive an individualized sleep report, educational resources, and an online educational video. Treatment outcomes are measured at 9 weeks, 6 months, and 12 months. The primary outcome is patient-reported sleep disturbances. Secondary outcomes include other self-reported sleep measures, home blood pressure, body mass index, quality of life, health functioning, healthcare utilization, and side effects. This randomized clinical trial compares two efficacious insomnia interventions to EUC, and provides a cost-effective and efficient examination of their similarities and differences. The pragmatic orientation of this trial may impact sleep treatment delivery in real world clinical settings and advance the dissemination and implementation of behavioral sleep interventions. ClinicalTrials.gov (Identifier: NCT02508129 ; Date Registered: July 21, 2015).

  7. Trends in blood pressure control and medication use during 20 years in a hypertension clinic in Japan.

    Science.gov (United States)

    Kansui, Yasuo; Ibaraki, Ai; Goto, Kenichi; Haga, Yoshie; Seki, Takunori; Takiguchi, Tomohiro; Ohtsubo, Toshio; Kitazono, Takanari; Matsumura, Kiyoshi

    2016-01-01

    Guidelines for the management of hypertension have recommended strict control of blood pressure to help prevent cardiovascular disease. The aim of the present study was to evaluate the current status of blood pressure control and trends over the past two decades. Four hundred patients treated for hypertension at Kyushu University Hospital were included in the present study. Blood pressure levels and prescribed antihypertensive drugs were examined in 2011. The average blood pressure was 129/74 mmHg, and the number of prescribed antihypertensive drugs was 2.2. Angiotensin II receptor antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, alpha-blockers, and beta-blockers were prescribed in 66%, 5%, 78%, 21%, 12%, and 27% of the cases, respectively. Systolic blood pressure was significantly higher, and diastolic blood pressure was significantly lower in patients aged 80 years or older compared with the younger patients (drugs was similar between the two groups. Sixty-five patients were continuously treated for 20 years. The average blood pressure of these patients significantly decreased from 142/87 mmHg in 1991 to 128/71 mmHg in 2011, accompanied with an increase in the number of antihypertensive drugs from 1.6 in 1991 to 2.7 in 2011. These findings suggest that the revised guidelines for the management of hypertension may have contributed to increased awareness and better management of blood pressure levels.

  8. Systemic and renal oxidative stress in the pathogenesis of hypertension: modulation of long-term control of arterial blood pressure by resveratrol.

    Directory of Open Access Journals (Sweden)

    Shereen M Hamza

    2014-08-01

    Full Text Available Hypertension affects over 25% of the global population and is associated with grave and often fatal complications that affect many organ systems. Although great advancements have been made in the clinical assessment and treatment of hypertension, the cause of hypertension in over 90% of these patients are unknown, which hampers the development of targeted and more effective treatment. The etiology of hypertension involves multiple pathological processes and organ systems, however one unifying feature of all of these contributing factors is oxidative stress. Once the body’s natural anti-oxidant defense mechanisms are overwhelmed, reactive oxygen species (ROS begin to accumulate in the tissues. ROS play important roles in normal regulation of many physiological processes, however in excess they are detrimental and cause widespread cell and tissue damage as well as derangements in many physiological processes. Thus, control of oxidative stress has become an attractive target for pharmacotherapy to prevent and manage hypertension. Resveratrol (trans-3,5,4'-Trihydroxystilbene is a naturally occurring polyphenol which has anti-oxidant effects in vivo. Many studies have shown anti-hypertensive effects of resveratrol in different pre-clinical models of hypertension, via a multitude of mechanisms that include its function as an anti-oxidant. However, results have been mixed and may be due to the heavy emphasis on peripheral vasodilator effects of resveratrol with virtually no investigation of its potential renal effects. This is troubling in the arena of hypertension, where it is accepted that the kidney plays an essential role in the long term regulation of arterial pressure and a vital role in the development and maintenance of chronic hypertension. Thus the focus of this review is to discuss the potential of resveratrol as an anti-hypertensive treatment via amelioration of oxidative stress within the framework of physiological principles of blood

  9. 2012 consensus document of the Italian Society of Hypertension (SIIA): strategies to improve blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy.

    Science.gov (United States)

    Volpe, Massimo; Rosei, Enrico Agabiti; Ambrosioni, Ettore; Cottone, Santina; Cuspidi, Cesare; Borghi, Claudio; De Luca, Nicola; Fallo, Francesco; Ferri, Claudio; Morganti, Alberto; Muiesan, Maria Lorenza; Sarzani, Riccardo; Sechi, Leonardo; Virdis, Agostino; Tocci, Giuliano; Trimarco, Bruno; Filippi, Alessandro; Mancia, Giuseppe

    2013-03-01

    Observational clinical studies have demonstrated that only 30-40% of patients with arterial hypertension achieve the recommended blood pressure goals (below 140/90 mmHg). In contrast, interventional trials consistently showed that it is possible to achieve effective blood pressure targets in about 70% of treated hypertensive patients with different cardiovascular risk profiles, especially through the use of rational, effective and well tolerated combination therapies. In order to bridge the gap between current and desired blood pressure control and to achieve more effective prevention of cardiovascular diseases, the Italian Society of Hypertension (SIIA) has developed an interventional strategy aimed at reaching nearly 70% of treated controlled hypertensive patients by 2015. This ambitious goal can be realistically achieved by a more rational use of modern tools and supports, and also through the use of combination therapy in hypertension in daily clinical practice, especially if this approach can be simplified into a single pill (fixed combination therapy), which is a therapeutic option now also available in Italy. Since about 70-80% of treated hypertensive patients require a combination therapy based on at least two classes of drugs in order to achieve the recommended blood pressure goals, it is of key importance to implement this strategy in routine clinical practice. Amongst the various combination therapies currently available for hypertension treatment and control, the use of those strategies based on drugs that antagonize the renin-angiotensin system, such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and ACE inhibitors, in combination with diuretics and/or calcium channel blockers, has been shown to significantly reduce the risk of major cardiovascular events and to improve patient compliance to treatment, resulting in a greater antihypertensive efficacy and better tolerability compared with monotherapy. The present document

  10. Case-control study of risk of Parkinson's disease in relation to hypertension, hypercholesterolemia, and diabetes in Japan.

    Science.gov (United States)

    Miyake, Yoshihiro; Tanaka, Keiko; Fukushima, Wakaba; Sasaki, Satoshi; Kiyohara, Chikako; Tsuboi, Yoshio; Yamada, Tatsuo; Oeda, Tomoko; Miki, Takami; Kawamura, Nobutoshi; Sakae, Nobutaka; Fukuyama, Hidenao; Hirota, Yoshio; Nagai, Masaki

    2010-06-15

    This case-control study investigated the associations of a history of hypertension, hypercholesterolemia, and diabetes mellitus with the risk of Parkinson's disease (PD) in Japan. Included were 249 cases within 6 years of onset of PD. Controls were 368 inpatients and outpatients without a neurodegenerative disease. Data on the vascular risk factors and confounders were obtained from a self-administered questionnaire. The vascular risk factors were defined based on drug treatment. Adjustment was made for sex, age, region of residence, pack-years of smoking, years of education, leisure-time exercise, body mass index, dietary intake of energy, cholesterol, vitamin E, alcohol, and coffee and the dietary glycemic index. The proportions of hypertension, hypercholesterolemia, and diabetes mellitus prior to the onset of PD were 23.7%, 9.6%, and 4.0%, respectively, in cases. Hypertension, hypercholesterolemia, and diabetes mellitus were significantly associated with a decreased risk of PD: the adjusted ORs were 0.43 (95% CI: 0.29-0.64), 0.58 (95% CI: 0.33-0.97), and 0.38 (95% CI: 0.17-0.79), respectively. No significant differences were observed in the association of vascular risk factors with the risk of PD between men and women. We found evidence of significant inverse associations of hypertension, hypercholesterolemia, and diabetes mellitus with the risk of PD in Japan. Further well-designed investigations of the association of vascular risk factors with the risk of PD are needed, particularly large-scale prospective studies in Asia.

  11. Clinical management of patients with hypertension and high cardiovascular risk: main results of an Italian survey on blood pressure control.

    Science.gov (United States)

    Tocci, Giuliano; Borghi, Claudio; Volpe, Massimo

    2014-06-01

    Hypertension management and control still represents a major clinical challenge for physicians, as well as for National Health Care Systems, since high blood pressure (BP) levels in treated uncontrolled outpatients are related to a persistently increased risk of cardiovascular (CV) events. The Italian Society of Hypertension (SIIA) has prompted several educational interventions for improving BP control in Italy. To evaluate clinical attitudes and preferences of large community sample of both specialized physicians and general practitioners, included in an educational program, endorsed by SIIA and aimed at improving interventions for achieving better BP control in Italy. A predefined questionnaire, which included a main body with 17 questions and 15 specific items (3-4 questions for each item), was anonymously administered to a large community sample of physicians who have practice in managing outpatients with hypertension and high CV risk profile. Both specialized physicians and general practitioners, distributed throughout the whole Italian territory, have been included in this educational program. Data were reported into a computerised spreadsheet and centrally analysed. Confidentiality of the data were guaranteed during each phase of the study. From a total of 64 questions, 557 physicians (478 male, mean age 54.2 ± 7.1 years, average age of medical activity 28.0 ± 8.1 years), among which 261 (46.9 %) specialised physicians and 296 (53.1 %) general practitioners, provided 60,713 answers to the survey questionnaire. Physicians devote time and effort for achieving the recommended BP targets (high risk subgroups), yet they reported a very high rate of BP control (about 70 %). Concomitant presence of diabetes, cardiac and renal organ damage (35-50 %), as well as comorbidities (20-35 %), is reported to be high and able to impact on antihypertensive treatment's efficacy. Appropriate BP assessment is also viewed as a key tool for verifying effectiveness of a given

  12. Urinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study

    Directory of Open Access Journals (Sweden)

    Saint-Remy Annie

    2012-09-01

    Full Text Available Abstract Background In kidney transplant (Kt recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP control is therefore mandatory. Office BP (OBP remains frequently used for clinical decisions, however home BP (HBP have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in Kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods The BP control defined by OBP 30. Results Using an agreement between OBP and HBP, we identified controlled (21% and uncontrolled recipients (49%. Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 ± 93 vs 162 ± 88 mmol/24 h but uncontrolled patients excreted less potassium (68 ± 14 vs 54 ± 20 mmol/24 h; P = 0.029 and had significantly lower potassium intakes (3279 ± 753 vs 2208 ± 720 mg/24 h; P = 0.009, associated with a higher urinary Na+/K + ratio. Systolic HBP was inversely and significantly correlated to urinary potassium (r = −0.48; P = 0.002, a positive but non significant relation was observed with urinary sodium (r = 0,30;P = 0.074. Conclusions Half of the treated hypertensive Kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control.

  13. The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Su, Tin Tin; Majid, Hazreen Abdul; Nahar, Azmi Mohamed; Azizan, Nurul Ain; Hairi, Farizah Mohd; Thangiah, Nithiah; Dahlui, Maznah; Bulgiba, Awang; Murray, Liam J

    2014-01-01

    Death rates due to hypertension in low and middle income countries are higher compared to high income countries. The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries. The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. Two housing complexes will be assigned to the intervention group and the other two housing complexes will be allocated in the control group. Based on power analysis, 320 participants will be recruited. The participants in the intervention group (n = 160) will undergo three main components in the intervention which are the peer support for home blood pressure monitoring, face to face health coaching on healthy diet and demonstration and training for indoor home based exercise activities while the control group will receive a pamphlet containing information on hypertension. The primary outcomes are systolic and diastolic blood pressure. Secondary outcome measures include practice of self-blood pressure monitoring, dietary intake, level of physical activity and physical fitness. The present study will evaluate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, during a 6 month intervention period. Moreover, the study aims to assess whether these effects can be sustainable more than six months after the intervention has ended.

  14. The blockade of renin-angiotensin-aldosterone system in hemodialysis patients to control hypertension and prevent cardiovascular disease: optimal pharmacotherapy.

    Science.gov (United States)

    Morishita, Yoshiyuki; Kusano, Eiji

    2011-10-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in hemodialysis (HD) patients. Hypertension (HT) is a major risk factor for CVD. The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of HT in HD patients. Previous studies suggested that the blockade of RAAS may be effective to control blood pressure (BP) and to prevent CVD in HD patients. A certain level of preventive effects against CVD by RAAS blockade in HD patients has been reported independently from a BP lowering effect. This review focuses on the effect of blocking RAAS in HD patients for the control of HT and the prevention of CVD.

  15. Immunologic and infectious consequences of immediate versus delayed umbilical cord clamping in premature infants: a prospective, randomized, controlled study.

    Science.gov (United States)

    Kugelman, Amir; Borenstein-Levin, Liron; Kessel, Aharon; Riskin, Arieh; Toubi, Elias; Bader, David

    2009-01-01

    To evaluate the immunologic and infectious consequences of delayed versus immediate cord clamping in premature infants (cord clamping (ICC) at 5-10 s and 30 infants to delayed cord clamping (DCC), at 30-45 s (14 and 15 infants in each group were cord clamping did not affect the immunologic or the infectious status of infants born at <35 weeks during the neonatal period.

  16. Prevalence, awareness, treatment, control and risk factors related to hypertension among urban adults in Inner Mongolia 2014: differences between Mongolian and Han populations.

    Science.gov (United States)

    Li, Guoju; Wang, Hailing; Wang, Ke; Wang, Wenrui; Dong, Fen; Qian, Yonggang; Gong, Haiying; Xu, Guodong; Li, Yanlong; Pan, Li; Wang, Bin; Zhu, Guangjin; Shan, Guangliang

    2016-04-01

    Han and Mongolian populations constitute approximately 96% of the population of Inner Mongolia Autonomous Region, and the two ethnic groups have different genetic backgrounds and lifestyle. We aim to assess the prevalence, awareness, treatment, control, and related risk factors of hypertension among urban adults in Inner Mongolia, with the comparison of the differences between Mongolian and Han populations in this respect. Three thousand two hundred fifty-one individuals aged 20-80 years (2326 Han and 925 Mongolian) were selected using a multistage cluster sampling method from Inner Mongolia in 2014. The adjusted prevalence, awareness, treatment and control of hypertension were evaluated by the Logistic regression. In addition, possible interactions were also tested. When interactions were found significant, strata-specific analysis were performed. Multivariate logistic regression was used for estimating independent associations between risk factors and hypertension. The prevalence of hypertension was 27.47% for Han population, 31.46% for Mongolian population. The adjusted prevalence, awareness, treatment and control of hypertension were 26.45, 65.43, 78.24 and 48.28% in Han, and 31.30, 68.22, 85.57 and 50.55% in Mongolian, respectively. There was no significant difference in the adjusted awareness, treatment and control of hypertension among Mongolian and Han adult residents (all P >0.05). Lower prevalence of hypertension was associated with younger age and healthy weight in both Mongolian and Han adults. Within Han adults, high education, moderate physical activity and non-alcohol drinkers were additionally associated with lower prevalence of hypertension, whereas within Mongolian adults, lower prevalence was associated with being female. Among residents with medium education level, nondrinkers had 0.60 times lower odds of having hypertension than current drinkers (OR = 0.60, 95% CI: 0.44-0.82); among residents with high education level, nondrinkers has 0

  17. Clinical and Radiographic Evaluation of Immediate Loaded Dental Implants With Local Application of Melatonin: A Preliminary Randomized Controlled Clinical Trial.

    Science.gov (United States)

    El-Gammal, Mona Y; Salem, Ahmed S; Anees, Mohamed M; Tawfik, Mohamed A

    2016-04-01

    Immediate loading of dental implants in situations where low bone density exist, such as the posterior maxillary region, became possible recently after the introduction of biomimetic agents. This 1-year preliminary clinical trial was carried out to clinically and radiographically evaluate immediate-loaded 1-piece implants with local application of melatonin in the osteotomy site as a biomimetic material. 14 patients with missing maxillary premolars were randomized to receive 14 implants of 1-piece type that were subjected to immediate loading after 2 weeks of initial placement. Group I included 7 implants with acid-etched surface while group II included 7 implants with acid-etched surface combined with local application of melatonin gel at the osteotomy site. Patients were recalled for follow up at 1, 3, 6, and 12 months after loading. All implants were considered successful after 12 months of follow-up. Significant difference (P implant loading when considering the implant stability. At 1 and 3 months there were significant differences in the marginal bone level between the 2 groups. These results suggest that the local application of melatonin at the osteotomy site is associated with good stability and minimal bone resorption. However, more studies for longer follow-up periods are required to confirm the effect of melatonin hormone on osseointegration of dental implants.

  18. Pharmacologic Management of Pediatric Hypertension.

    Science.gov (United States)

    Misurac, Jason; Nichols, Kristen R; Wilson, Amy C

    2016-02-01

    Hypertension in children is common, and the prevalence of primary hypertension is increasing with the obesity epidemic and changing dietary choices. Careful measurement of blood pressure is important to correctly diagnose hypertension, as many factors can lead to inaccurate blood pressure measurement. Hypertension is diagnosed based on comparison of age-, sex-, and height-based norms with the average systolic and diastolic blood pressures on three separate occasions. In the absence of hypertensive target organ damage (TOD), stage I hypertension is managed first by diet and exercise, with the addition of drug therapy if this fails. First-line treatment of stage I hypertension with TOD and stage II hypertension includes both lifestyle changes and medications. First-line agents include angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics, and calcium-channel blockers. Hypertensive emergency with end-organ effects requires immediate modest blood pressure reduction to alleviate symptoms. This is usually accomplished with IV medications. Long-term reduction in blood pressure to normal levels is accomplished gradually. Specific medication choice for outpatient hypertension management is determined by the underlying cause of hypertension and the comparative adverse effect profiles, along with practical considerations such as cost and frequency of administration. Antihypertensive medication is initiated at a starting dose and can be gradually increased to effect. If ineffective at the recommended maximum dose, an additional medication with a complementary mechanism of action can be added.

  19. Serum nitric oxide metabolite (NO(x)) levels in hypertensive patients at rest: a comparison of age, gender, blood pressure and complications using normotensive controls.

    Science.gov (United States)

    Higashino, Hideaki; Miya, Hirohisa; Mukai, Hidenori; Miya, Yoshihisa

    2007-08-01

    1. Hypertensive patients have pathophysiological changes such as atherosclerosis, endothelial dysfunction and inflammations. The patients' serum nitric oxide metabolite (nitrate/nitrite; NO(x)) levels were measured in peripheral blood using normotensive controls for comparison. 2. The NO(x) levels in 175 hypertensive patients with or without comorbid diseases (aged 37-95 years; average 50.6 +/- 0.8 years) were compared with those in 80 normotensive controls (aged 25-73 years; average 37.1 +/- 1.8 years). 3. The NO(x) levels increased with age in both the normotensive and hypertensive women, but not in men. No difference was noted in the NO(x) levels between the normotensive and hypertensive patients without comorbid diseases. The mean value of NO(x) in male hypertensive patients aged under 50 years was close to that of female patients aged 51-60 years. Hypertensive males aged 61-70 years showed almost the same NO(x) levels as those of female patients aged over 81 years. A male group of hypertensive patients with diabetes, hyperlipaemia and renal disorder had a significantly higher NO(x) level compared with a normotensive control group. However, in female groups, only hypertensive patients with hyperlipaemia showed higher serum NO(x) values compared with the normotensive group. 4. These findings suggest that: (i) the occurrence of NO(x) in the serum is not solely the outcome of high blood pressure; (ii) higher serum NO(x) levels in older women are because of an oestrogen deficiency-induced cardiovascular disease; (iii) ageing effects on the circulation system are more apparent in men than in women; and (iv) measurement of NO(x) levels in the serum is helpful for understanding the pathological progress in male hypertensive patients with diseases such as diabetes mellitus, hyperlipaemia and renal disorder.

  20. Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial.

    Science.gov (United States)

    Schwartz, Mark D; Jensen, Ashley; Wang, Binhuan; Bennett, Katelyn; Dembitzer, Anne; Strauss, Shiela; Schoenthaler, Antoinette; Gillespie, Colleen; Sherman, Scott

    2015-07-01

    Panel Management can expand prevention and chronic illness management beyond the office visit, but there is limited evidence for its effectiveness or guidance on how best to incorporate it into practice. We aimed to test the effectiveness of incorporating panel management into clinical practice by incorporating Panel Management Assistants (PMAs) into primary care teams with and without panel management education. We conducted an 8-month cluster-randomized controlled trial of panel management for improving hypertension and smoking cessation outcomes among veterans. Twenty primary care teams from the Veterans Affairs New York Harbor were randomized to control, panel management support, or panel management support plus education groups. Teams included 69 clinical staff serving 8,153 hypertensive and/or smoking veterans. Teams assigned to the intervention groups worked with non-clinical Panel Management Assistants (PMAs) who monitored care gaps and conducted proactive patient outreach, including referrals, mail reminders and motivational interviewing by telephone. Measurements included mean systolic and diastolic blood pressure, proportion of patients with controlled blood pressure, self-reported quit attempts, nicotine replacement therapy (NRT) prescriptions, and referrals to disease management services. Change in mean blood pressure, blood pressure control, and smoking quit rates were similar across study groups. Patients on intervention teams were more likely to receive NRT (OR = 1.4; 95% CI 1.2-1.6) and enroll in the disease management services MOVE! (OR = 1.2; 95% CI 1.1-1.6) and Telehealth (OR = 1.7, 95% CI 1.4-2.1) than patients on control teams. Panel Management support for primary care teams improved process, but not outcome variables among veterans with hypertension and smoking. Incorporating PMAs into teams was feasible and highly valued by the clinical staff, but clinical impact may require a longer intervention.

  1. Sympathetic predominance is associated with impaired endothelial progenitor cells and tunneling nanotubes in controlled-hypertensive patients.

    Science.gov (United States)

    de Cavanagh, Elena M V; González, Sergio A; Inserra, Felipe; Forcada, Pedro; Castellaro, Carlos; Chiabaut-Svane, Jorge; Obregón, Sebastián; Casarini, María Jesús; Kempny, Pablo; Kotliar, Carol

    2014-07-15

    Early endothelial progenitor cells (early EPC) and late EPC are involved in endothelial repair and can rescue damaged endothelial cells by transferring organelles through tunneling nanotubes (TNT). In rodents, EPC mobilization from the bone marrow depends on sympathetic nervous system activity. Indirect evidence suggests a relation between autonomic derangements and human EPC mobilization. We aimed at testing whether hypertension-related autonomic imbalances are associated with EPC impairment. Thirty controlled-essential hypertensive patients [systolic blood pressure/diastolic blood pressure = 130(120-137)/85(61-88) mmHg; 81.8% male] and 20 healthy normotensive subjects [114(107-119)/75(64-79) mmHg; 80% male] were studied. Mononuclear cells were cultured on fibronectin- and collagen-coated dishes for early EPC and late EPC, respectively. Low (LF)- and high (HF)-frequency components of short-term heart rate variability were analyzed during a 5-min rest, an expiration/inspiration maneuver, and a Stroop color-word test. Modulations of cardiac sympathetic and parasympathetic activities were evaluated by LF/HF (%) and HF power (ms(2)), respectively. In controlled-hypertensive patients, the numbers of early EPC, early EPC that emitted TNT, late EPC, and late EPC that emitted TNT were 41, 77, 50, and 88% lower than in normotensive subjects (P hypertensive patients, late EPC number was positively associated with cardiac parasympathetic reserve during the expiration/inspiration maneuver (rho = 0.45, P = 0.031) and early EPC with brachial flow-mediated dilation (rho = 0.655; P = 0.049); also, late TNT number was inversely related to cardiac sympathetic response during the stress test (rho = -0.426, P = 0.045). EPC exposure to epinephrine or norepinephrine showed negative dose-response relationships on cell adhesion to fibronectin and collagen; both catecholamines stimulated early EPC growth, but epinephrine inhibited late EPC growth. In controlled-hypertensive patients

  2. Is a targeted intensive intervention effective for improvements in hypertension control?

    DEFF Research Database (Denmark)

    Reuther, Lene Ørskov; Paulsen, Maja Skov; Andersen, Morten

    2012-01-01

    BACKGROUND: High blood pressure (BP) is one of the most important risk factors for stroke, and antihypertensive therapy significantly reduces the risk of cardiovascular morbidity and mortality. However, achieving a regulated BP in hypertensive patients is still a challenge. OBJECTIVE: To evaluate...

  3. Review of inhaled iloprost for the control of pulmonary artery hypertension in children

    Science.gov (United States)

    Tissot, Cecile; Beghetti, Maurice

    2009-01-01

    In the pediatric population, pulmonary hypertension may present as an acute event in the setting of lung or cardiac pathology or as a chronic disease, mainly as idiopathic pulmonary hypertension or associated with congenital heart disease. Recently, new pharmacologic approaches have demonstrated significant efficacy in the management of adults with pulmonary arterial hypertension; these include intravenous epoprostenol, prostacyclin analogs, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors. The same treatment strategies are currently used in children. There are only few reports of the use of inhaled iloprost in pediatrics, only one of which reported the use of chronic inhaled iloprost in a significant number of children. This report showed that 1) the acute pulmonary vasodilator response to inhaled iloprost is equivalent to that of inhaled nitric oxide; 2) acute inhalation of iloprost can induce bronchoconstriction 3) the addition of inhaled iloprost can reduce the need for intravenous prostanoid therapy in some patients; 4) most children tolerated the combination of inhaled iloprost and endothelin receptor antagonist or phosphodiesterase inhibitors; 5) Several patients had clinical deterioration during chronic inhaled iloprost therapy and required rescue therapy with intravenous prostanoids. In this review we will discuss the role of inhaled iloprost in acute and chronic pulmonary hypertension in children. PMID:19436672

  4. Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease.

    Science.gov (United States)

    Reboldi, Gianpaolo; Angeli, Fabio; de Simone, Giovanni; Staessen, Jan A; Verdecchia, Paolo

    2014-03-01

    An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target hypertension and without established cardiovascular disease.

  5. A multicentre randomized controlled trial of moderate hypothermia to prevent intracranial hypertension in acute liver failure

    DEFF Research Database (Denmark)

    Bernal, William; Murphy, Nicholas; Brown, Sarah

    2016-01-01

    BACKGROUND & AIMS: Animal models and human case series of acute liver failure (ALF) suggest moderate hypothermia (MH) to have protective effects against cerebral oedema (CO) development and intracranial hypertension (ICH). However, the optimum temperature for patient management is unknown. In a p...

  6. [Effects of body mass index on blood pressure control rate in elderly coronary heart disease outpatients with hypertension].

    Science.gov (United States)

    Liang, D L; Li, X Y; Wang, L; Xu, H; Tuo, X P; Jian, Z J

    2016-09-20

    Objective: To explore the influences of body mass index (BMI) on blood pressure control rate in elderly coronary heart disease (CHD) outpatients with hypertension. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients with hypertension aged 60 years or over were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011, and 5 140 cases of elderly CHD patients with hypertension were finally included into the study. The cases were divided into low BMI group (n=130 cases), normal body mass index (BMI) group (n=1 390 cases), overweight (n=2 418 cases), obesity group (n=662 cases) according to the different levels of BMI. Clinical data and blood pressure control rate were compared among the groups, and relationships of different BMI levels with blood pressure control rate were analyzed by the binary classification unconditioned Logistic regression equation. Results: There was a statistically significant difference in blood pressure control rate of general population, men and women patients among low BMI group, normal BMI group, overweight and obesity group (χ(2)=66.346, 58.995, 26.044, respectively, Ppressure failure rate in obesity group (73.7%) was higher than that in overweight group (65.8%) and normal BMI group (57.5%) (Pgroup was also higher than normal BMI group (Ppressure failure rate in obesity men was higher than that in normal BMI and low BMI group (Pgroup was higher than normal BMI group (Ppressure failure rate in obesity women was higher than that in normal BMI and low BMI group (Ppressure control rate of different age groups (60-70, 71-80, >80 years old) among low BMI group, normal BMI group, overweight and obesity group (χ(2)=37.729, 20.007, 15.538, respectively, Ppressure failure rate in obesity patients with 60-70 years old was higher than that in overweight and normal BMI group (Ppressure failure rates in obesity and overweight patients with 71-80 and

  7. Systemic and renal oxidative stress in the pathogenesis of hypertension: modulation of long-term control of arterial blood pressure by resveratrol.

    Science.gov (United States)

    Hamza, Shereen M; Dyck, Jason R B

    2014-01-01

    Hypertension affects over 25% of the global population and is associated with grave and often fatal complications that affect many organ systems. Although great advancements have been made in the clinical assessment and treatment of hypertension, the cause of hypertension in over 90% of these patients is unknown, which hampers the development of targeted and more effective treatment. The etiology of hypertension involves multiple pathological processes and organ systems, however one unifying feature of all of these contributing factors is oxidative stress. Once the body's natural anti-oxidant defense mechanisms are overwhelmed, reactive oxygen species (ROS) begin to accumulate in the tissues. ROS play important roles in normal regulation of many physiological processes, however in excess they are detrimental and cause widespread cell and tissue damage as well as derangements in many physiological processes. Thus, control of oxidative stress has become an attractive target for pharmacotherapy to prevent and manage hypertension. Resveratrol (trans-3,5,4'-Trihydroxystilbene) is a naturally occurring polyphenol which has anti-oxidant effects in vivo. Many studies have shown anti-hypertensive effects of resveratrol in different pre-clinical models of hypertension, via a multitude of mechanisms that include its function as an anti-oxidant. However, results have been mixed and in some cases resveratrol has no effect on blood pressure. This may be due to the heavy emphasis on peripheral vasodilator effects of resveratrol and virtually no investigation of its potential renal effects. This is particularly troubling in the arena of hypertension, where it is well known and accepted that the kidney plays an essential role in the long term regulation of arterial pressure and a vital role in the initiation, development and maintenance of chronic hypertension. It is thus the focus of this review to discuss the potential of resveratrol as an anti-hypertensive treatment via

  8. A randomized controlled trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension.

    Science.gov (United States)

    Hagins, Marshall; Rundle, Andrew; Consedine, Nathan S; Khalsa, Sat Bir S

    2014-01-01

    The purpose of this study was to compare the effects of yoga with an active control (nonaerobic exercise) in individuals with prehypertension and stage 1 hypertension. A randomized clinical trial was performed using two arms: (1) yoga and (2) active control. Primary outcomes were 24-hour day and night ambulatory systolic and diastolic blood pressures. Within-group and between-group analyses were performed using paired t tests and repeated-measures analysis of variance (time × group), respectively. Eighty-four participants enrolled, with 68 participants completing the trial. Within-group analyses found 24-hour diastolic, night diastolic, and mean arterial pressure all significantly reduced in the yoga group (-3.93, -4.7, -4.23 mm Hg, respectively) but no significant within-group changes in the active control group. Direct comparisons of the yoga intervention with the control group found a single blood pressure variable (diastolic night) to be significantly different (P=.038). This study has demonstrated that a yoga intervention can lower blood pressure in patients with mild hypertension. Although this study was not adequately powered to show between-group differences, the size of the yoga-induced blood pressure reduction appears to justify performing a definitive trial of this intervention to test whether it can provide meaningful therapeutic value for the management of hypertension.

  9. IPP-rich milk protein hydrolysate lowers blood pressure in subjects with stage 1 hypertension, a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kloek Joris

    2010-11-01

    Full Text Available Abstract Background Milk derived peptides have been identified as potential antihypertensive agents. The primary objective was to investigate the effectiveness of IPP-rich milk protein hydrolysates (MPH on reducing blood pressure (BP as well as to investigate safety parameters and tolerability. The secondary objective was to confirm or falsify ACE inhibition as the mechanism underlying BP reductions by measuring plasma renin activity and angiotensin I and II. Methods We conducted a randomized, placebo-controlled, double blind, crossover study including 70 Caucasian subjects with prehypertension or stage 1 hypertension. Study treatments consisted of daily consumption of two capsules MPH1 (each containing 7.5 mg Isoleucine-Proline-Proline; IPP, MPH2 (each containing 6.6 mg Methionine-Alanine-Proline, 2.3 mg Leucine-Proline-Proline, 1.8 mg IPP, or placebo (containing cellulose for 4 weeks. Results In subjects with stage 1 hypertension, MPH1 lowered systolic BP by 3.8 mm Hg (P = 0.0080 and diastolic BP by 2.3 mm Hg (P = 0.0065 compared with placebo. In prehypertensive subjects, the differences in BP between MPH1 and placebo were not significant. MPH2 did not change BP significantly compared with placebo in stage I hypertensive or prehypertensive subjects. Intake of MPHs was well tolerated and safe. No treatment differences in hematology, clinical laboratory parameters or adverse effects were observed. No significant differences between MPHs and placebo were found in plasma renin activity, or angiotensin I and II. Conclusions MPH1, containing IPP and no minerals, exerts clinically relevant BP lowering effects in subjects with stage 1 hypertension. It may be included in lifestyle changes aiming to prevent or reduce high BP. Trial registration ClinicalTrials.gov NCT00471263

  10. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and non-resistant hypertension

    Science.gov (United States)

    Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; Reynolds, Kristi; Calhoun, David A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

    2015-01-01

    We sought to compare the risk of end stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was sub-categorized into 2 groups; 23,104 patients with cRH (controlled on 4 or more medicines) and 37,223 patients with uRH (uncontrolled on 3 or more medicines) in a 5 year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and co-morbidities. Resistant hypertension (cRH and uRH) compared to non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27–1.37), 1.24 (1.20–1.28), 1.46 (1.40–1.52), 1.14 (1.10–1.19), and 1.06 (1.03–1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH to cRH had hazard ratios of 1.25 (1.18–1.33), 1.04 (0.99–1.10), 0.94 (0.89–1.01), 1.23 (1.14–1.31), and 1.01 (0.97–1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Males and Hispanics had greater risk for ESRD within all 3 cohorts. Resistant hypertension had greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA and were 25% and 23% greater, respectively, in uRH compared to cRH supporting the linkage between blood pressure and both outcomes. PMID:25945406

  11. A randomised controlled trial for the evaluation of risk for type 2 diabetes in hypertensive patients receiving thiazide diuretics: Diuretics In the Management of Essential hypertension (DIME) study

    OpenAIRE

    Ueda, Shinichiro; Morimoto, Takeshi; Ando, Shin-ichi; Takishita, Shu-ichi; Kawano, Yuhei; Shimamoto, Kazuaki; Ogihara, Toshio; Saruta, Takao

    2014-01-01

    Objectives Thiazide diuretics are one of the first choice antihypertensives but not optimally utilised because of concerns regarding their adverse effects on glucose metabolism. The Diuretics In the Management of Essential hypertension (DIME) study was designed, for the first time, to assess the risk for type 2 diabetes mellitus in patients with essential hypertension during antihypertensive treatment with low-dose thiazide diuretics compared to those not treated with diuretics. Design Multic...

  12. Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study.

    Science.gov (United States)

    Gyamfi, Joyce; Plange-Rhule, Jacob; Iwelunmor, Juliet; Lee, Debbie; Blackstone, Sarah R; Mitchell, Alicia; Ntim, Michael; Apusiga, Kingsley; Tayo, Bamidele; Yeboah-Awudzi, Kwasi; Cooper, Richard; Ogedegbe, Gbenga

    2017-02-02

    Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses' knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH). A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses' satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management. A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses' knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention. Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana. Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013.

  13. Comparison of Azelnidipine and Trichlormethiazide in Japanese Type 2 Diabetic Patients with Hypertension: The COAT Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Masahiro Takihata

    Full Text Available This study compared the efficacy and safety of azelnidipine with that of trichlormethiazide in Japanese type 2 diabetic patients with hypertension.In a multicenter, open-label trial, 240 patients with adequately controlled diabetes (HbA1c ≤ 7.0% under lifestyle modification and/or administration of hypoglycemic agents and inadequately controlled hypertension (systolic blood pressure [sBP] ≥ 130 mmHg or diastolic blood pressure [dBP] ≥ 80 mmHg who were being treated with olmesartan were enrolled. Participants were randomly assigned to an azelnidipine group or a trichlormethiazide group and were followed up for 48 weeks. Main outcome measure was the difference in the change in HbA1c levels from the baseline values at 48 weeks between these two groups.Of the 240 subjects that were enrolled, 209 subjects (azelnidipine group: 103 patients, trichlormethiazide group: 106 patients completed this trial. At 48 weeks, the following changes were observed in the azelnidipine and trichlormethiazide groups, respectively: HbA1c levels, 0.19 ± 0.52% and 0.19 ± 0.54%; sBP/dBP, -10.7 ± 9.6/-6.6 ± 6.6 mmHg and -7.1 ± 7.7/-3.3 ± 6.1 mmHg (P < 0.001 for both sBP and dBP. In both groups, dizziness (12 patients [11.7%] and 16 patients [15.1%] and edema (16 patients [15.5%] and 7 patients [6.6%], P = 0.047 were observed during the 48-week follow-up period.Azelnidipine was more effective for controlling blood pressure than trichlormethiazide in Japanese type 2 diabetes patients, whereas trichlormethiazide was more effective for reducing albuminuria than azelnidipine. Both of these agents, however, similarly exacerbated glycemic control in type 2 diabetic patients with hypertension.UMIN 000006081.

  14. Quantifying the economic benefits of prevention in a healthcare setting with severe financial constraints: the case of hypertension control.

    Science.gov (United States)

    Athanasakis, Kostas; Kyriopoulos, Ilias-Ioannis; Boubouchairopoulou, Nadia; Stergiou, George S; Kyriopoulos, John

    2015-01-01

    Hypertension significantly contributes to the increased cardiovascular morbidity and mortality, thus leading to rising healthcare costs. The objective of this study was to quantify the clinical and economic benefits of optimal systolic blood pressure (SBP), in a setting under severe financial constraints, as in the case of Greece. Hence, a Markov model projecting 10-year outcomes and costs was adopted, in order to compare two scenarios. The first one depicted the "current setting", where all hypertensives in Greece presented an average SBP of 164 mmHg, while the second scenario namely "optimal SBP control" represented a hypothesis in which the whole population of hypertensives would achieve optimal SBP (i.e. <140 mmHg). Cardiovascular events' occurrence was estimated for four sub-models (according to gender and smoking status). Costs were calculated from the Greek healthcare system's perspective (discounted at a 3% annual rate). Findings showed that compared to the "current setting", universal "optimal SBP control" could, within a 10-year period, reduce the occurrence of non-fatal events and deaths, by 80 and 61 cases/1000 male smokers; 59 and 37 cases/1000 men non-smokers; whereas the respective figures for women were 69 and 57 cases/1000 women smokers; and accordingly, 52 and 28 cases/1000 women non-smokers. Considering health expenditures, they could be reduced by approximately €83 million per year. Therefore, prevention of cardiovascular events through BP control could result in reduced morbidity, thereby in substantial cost savings. Based on clinical and economic outcomes, interventions that promote BP control should be a health policy priority.

  15. Resistant hypertension.

    Science.gov (United States)

    Armario, P; Oliveras, A; de la Sierra, A

    2013-11-01

    A 53 year old woman with hypercholesterolemia treated with statins, with no history of cardiovascular disease, was referred to the Hypertension and Vascular Risk Unit for management of hypertension resistant to 4 antihypertensive agents at full doses. The patient had obesity, with a body mass index of 36.3kg/m(2) and office blood pressure 162/102mm Hg. Physical examination showed no data of interest. glucose 120mg/dl, glycated Hb: 6.4%, albuminuria 68mg/g, kidney function and study of the renin angiotensin system and other biochemical parameters were normal. Echocardiography: left ventricular mass, 131g/m(2) (normal, <110g/m(2)). True resistant hypertension was confirmed by ambulatory monitoring of blood pressure during 24h (153/89mm Hg). Spironolactone treatment (25mg/day) was added and was well tolerated, with no change in renal function and kaliemia within normal (4.1mmol/l) following the treatment. After 8 weeks, blood pressure was well controlled: office blood pressure 132/86mm Hg and 24h-ambulatory blood pressure: 128/79mm Hg. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  16. [Hypertensive crisis in kidney patients].

    Science.gov (United States)

    Scrivano, Jacopo; Giuliani, Anna; Pettorini, Laura; Punzo, Giorgio; Mene', Paolo; Pirozzi, Nicola

    2011-01-01

    The classification and management of hypertensive crisis have been recently reviewed in the context of both European and American guidelines. The key points for proper blood pressure control in severe arterial hypertension are: 1 - Distinction between urgent intervention and emergencies 2 - Choice of the best drug(s) 3 - Choice of the correct route of administration. In patients with renal disease, beside the common causes of hypertension/ hypertensive crises, kidney-specific causes should be taken into account such as renal parenchymal hypertension, renovascular hypertension, sclerodermic crises, and preeclampsia.

  17. Hypertension after clonidine withdrawal.

    Science.gov (United States)

    Husserl, F E; deCarvalho, J G; Batson, H M; Frohlich, E D

    1978-05-01

    Rebound hypertension occurred in two patients upon clonidine withdrawal. Treatment of the hypertensive crisis consists of both alpha- and beta-adrenergic receptor blockade, reserpine, or the reintroduction of clonidine. With effective control of pressure during the crisis, long-term antihypertensive therapy must be resumed.

  18. Antioxidant effect of immediate- versus sustained-release melatonin in type 2 diabetes mellitus and healthy controls.

    Science.gov (United States)

    Rybka, Joanna; Kędziora-Kornatowska, Kornelia; Kupczyk, Daria; Muszalik, Marta; Kornatowski, Maciej; Kędziora, Józef

    2016-01-01

    Oxidative damage has been suggested as the primary cause of aging and age-associated diseases including type 2-dependent diabetes mellitus (T2DM) and therefore there is a growing interest in exploring therapeutic potential of antioxidant agents including melatonin. In the present study, we analyzed red blood cell antioxidants and lipid peroxidation after 5 mg/daily immediate-release melatonin treatment of elderly T2DM patients and healthy elderly subjects in comparison with 2 mg/daily sustained-release melatonin treatment of elderly T2DM patients and healthy elderly subjects, to determine the antioxidant effect of different doses and formulations of melatonin in these groups. Our study revealed that there was no significant difference in antioxidant status of red blood cells measured by glutathione concentration and activities of GPx-1, CAT, GR, SOD-1 and MDA levels, after supplementation with 2 mg-sustained release melatonin or with 5 mg-immediate release melatonin, either in T2DM or in healthy elderly subjects. These results suggest that both preparations may exert similar therapeutic effect related to melatonin's action on antioxidant defense system.

  19. Chaos in blood flow control in genetic and renovascular hypertensive rats

    DEFF Research Database (Denmark)

    Yip, K P; Holstein-Rathlou, N H; Marsh, D J

    1991-01-01

    Hydrostatic pressure and flow in renal proximal tubules oscillate at 30-40 mHz in normotensive rats anesthetized with halothane. The oscillations originate in tubuloglomerular feedback, a mechanism that provides local blood flow regulation. Instead of oscillations, spontaneously hypertensive rats...... with time after the application of the renal artery clip. Statistical measures of deterministic chaos were applied to tubular pressure data. The correlation dimension, a measure of the dimension of the phase space attractor generating the time series, indicated the presence of a low-dimension strange...... (SHR) have aperiodic tubular pressure fluctuations; the pattern is suggestive of deterministic chaos. Normal rats made hypertensive by clipping one renal artery had similar aperiodic tubular pressure fluctuations in the unclipped kidney, and the fraction of rats with irregular fluctuations increased...

  20. Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid

    OpenAIRE

    2010-01-01

    Elevated blood pressure can lead to serious patient morbidity and mortality. The aim of the study was to evaluate the implementation of a tailored multifaceted program, administered by care managers in a Medicaid setting to improve hypertension medication adherence. The program enrolled 558 Medicaid patients. Patients had at least one phone call by care managers. The individually tailored program focused on improving lifestyle and medication adherence. The primary outcome was the medication p...

  1. Home and Office Blood Pressure Control among Treated Hypertensive Patients in Japan: Findings from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME Study

    Directory of Open Access Journals (Sweden)

    Nariyasu Mano

    2010-02-01

    Full Text Available Appropriate control of blood pressure (BP is essential for prevention of future cardiovascular events. However, BP control among treated hypertensive patients has been insufficient. Recently, the usefulness of self-measured BP at home (home BP measurement for the management of hypertension has been reported in many studies. We evaluated BP control both at home and in the office among treated hypertensive patients in primary care settings in Japan (the J-HOME study. We found poor control of home and office BPs and clarified some factors affecting control. We also examined factors associated with the magnitude of the white-coat effect, the morning–evening BP difference, and home heart rate in this J-HOME study.

  2. [Hypertension control and related factors at primary care located in the west side of the city of São Paulo, Brazil].

    Science.gov (United States)

    Pierin, Angela Maria Geraldo; Marroni, Sandra Nara; Taveira, Luzi Aparecida Faleiros; Benseñor, Isabela Judith Martins

    2011-01-01

    The objective of this study was to characterize blood pressure control of 440 hypertensive patients. The subjects were interviewed and had their blood pressure measurement by means of an automatic device. The results showed that 45.5% had an adequate blood pressure control. People under control were different (psadness. The multivariate analysis revealed a statistically significant association of uncontrolled hypertension with previous treatment (OR = 2.26; IC 95%, 1.4-3.6), no family history of cardiovascular diseases (OR = 2.2; IC 95%, 1.3 3.5) and unaware of the importance of physical activities for blood pressure control (OR = 3.5; IC 95%, 1.1 10.8). Blood pressure control was associated with biological variables, behavior and information about hypertension as a risk factor and its treatment.

  3. DB 02-2 STRICT CONTROL OF HYPERTENSION IN THE FRAIL ELDERLY: IS IT BENEFICIAL? (CON).

    Science.gov (United States)

    Rakugi, Hiromi

    2016-09-01

    European guidelines (ESH-ESC2013) for the elderly have discussed well about treatment blood pressure (BP) levels and targeting BP levels. In general, elderly patients with systolic BP (SBP) ≥160 mmHg including individuals older than 80 years in good physical and mental conditions are recommended reducing SBP to between 150 and 140 mmHg. Furthermore, fit elderly patients elderly patients are recommended to leave decisions on antihypertensive therapy to the treating physician, and based on monitoring of the clinical effects of treatment. NICE guidelines at 2011 and guidelines by the American Society of Hypertension and the International Society of Hypertension at 2013 indicate similar target BP with ESH-ESC2013 on principle, although patients aged less than 80 years old are recommended elderly, such as subjects who are unable to accomplish 6 m walking. Regarding target BP, patients aged 65-74 years old are recommended reducing BPpeople including the elderly is elderly, or patients with LV hypertrophy, systolic or diastolic LV dysfunction, diabetes mellitus or chronic kidney disease depending on the results of randomized clinical trials (eg, Systolic Blood Pressure Intervention Trial [SPRINT]). SPRINT showed significant evidence that targeting SBP elderly and frail hypertensive patients.

  4. Arterial hypertension and skin allergy are risk factors for progression from dengue to dengue hemorrhagic fever: a case control study.

    Science.gov (United States)

    Teixeira, Maria Glória; Paixão, Enny S; Costa, Maria da Conceição N; Cunha, Rivaldo V; Pamplona, Luciano; Dias, Juarez P; Figueiredo, Camila A; Figueiredo, Maria Aparecida A; Blanton, Ronald; Morato, Vanessa; Barreto, Maurício L; Rodrigues, Laura C

    2015-05-01

    Currently, knowledge does not allow early prediction of which cases of dengue fever (DF) will progress to dengue hemorrhagic fever (DHF), to allow early intervention to prevent progression or to limit severity. The objective of this study is to investigate the hypothesis that some specific comorbidities increase the likelihood of a DF case progressing to DHF. A concurrent case-control study, conducted during dengue epidemics, from 2009 to 2012. Cases were patients with dengue fever that progressed to DHF, and controls were patients of dengue fever who did not progress to DHF. Logistic regression was used to estimate the association between DHF and comorbidities. There were 490 cases of DHF and 1,316 controls. Among adults, progression to DHF was associated with self-reported hypertension (OR = 1.6; 95% CI 1.1-2.1) and skin allergy (OR = 1.8; 95% CI 1.1-3.2) with DHF after adjusting for ethnicity and socio-economic variables. There was no statistically significant association between any chronic disease and progression to DHF in those younger than 15 years. Physicians attending patients with dengue fever should keep those with hypertension or skin allergies in health units to monitor progression for early intervention. This would reduce mortality by dengue.

  5. [Hypertension in women].

    Science.gov (United States)

    Tagle, Rodrigo; Tagle V, Rodrigo; Acevedo, Mónica; Valdés, Gloria

    2013-02-01

    The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.

  6. INVESTIGATION AND ANALYSIS OF OUTPATIENT HYPERTENSION CONTROL AND MANAGEMENT%门诊高血压控制情况调查分析和管理

    Institute of Scientific and Technical Information of China (English)

    姚晨平

    2011-01-01

    [目的]探讨我院门诊高血压的降压治疗现状、控制率及血压控制不良原因.[方法]采用自制的调查表,在患者知情同意原则下,对1 450例门诊就医商血压病患者进行了调查研究,经过1年的随访观察血压控制情况.[结果]高血压总控制率为63.24%(917/1450),不同性别高血压患者血压控制率差异无统计学意义(P>0.05).但不同类型高血压控制率却有统计学差异(P 0.05). However, different types of hypertension control rate were significantly different (P < 0.05) , hypertension control rate of type I was up to 93.44% (456/ 488), and Ⅲ hypertension control rate was as low as 44.66% (184/412). In this study, 533 cases of poor blood pressure control in hypertensive patients were mainly due to: poor compliance, few monitoring of blood pressure, taking short-acting anti-hypertensive drugs, refractory hypertension and economic reasons. [Conclusion] Through the integrated management of hypertensive patients, early diagnosis, effective treatment, sustained drug laws, regular monitoring of blood pressure drugs should be adjusted to effectively control blood pressure.

  7. Awareness, Treatment, and Control of Hypertension in Primary Health Care and Secondary Referral Medical Outpatient Clinic Settings at Enugu, Southeast Nigeria

    Directory of Open Access Journals (Sweden)

    Chioli Chijioke

    2016-01-01

    Full Text Available Essential hypertension is the most common noncommunicable disease (NCD, affecting more than half the adult population in many countries and being the major NCD contributor to the double burden of disease in developing countries. We undertook a survey of the hypertension awareness, treatment, and control in primary and secondary referral health care clinics in Enugu, Nigeria, and compared these data with those obtained in local community surveys. The prevalence of hypertension in the primary care clinic (9.2% was lower than in a previously reported community survey (42.2%, while, in the referral clinic, 70.3% of patients attending were hypertensive. Hypertension awareness rates were 91.9%, 29.4%, and 93.2% in these respective health care settings. Treatment and control rates (89.9% and 72.9% were better in the secondary care clinic than in the primary care centre (87.7% and 46.0%. (Chi-square analysis confirmed statistically significant differences between these rates (p<0.05. These data may form a useful index of health care system effectiveness in Nigeria. Possible reasons for the differences observed and effective strategies to address the waxing pandemic of hypertension are discussed.

  8. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Iso, Hiroyasu; Brown, David F M; Hasegawa, Kohei

    2017-08-23

    Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). In this population-based study of

  9. No immediate changes on neural and muscular mechanosensitivity after first rib manipulation in subjects with cervical whiplash: A randomized controlled trial.

    Science.gov (United States)

    Peña-Salinas, Marta; Oliva-Pascual-Vaca, Jesús; Heredia-Rizo, Alberto Marcos; Rodriguez-Blanco, Cleofás; Ricard, François; Oliva-Pascual-Vaca, Ángel

    2017-01-01

    Upper rib manipulative therapy appears to be effective on primary complaint of shoulder pain, but its efficacy has not been evaluated in subjects with whiplash-associated disorders. To assess the immediate changes on neural and muscular mechanosensitivity after first-rib manipulation in patients with neck or cervicobrachial pain secondary to cervical whiplash (CW). A single-blind (evaluators were blinded to subject allocation) randomized trial was conducted. Fifty-three (N = 53) subjects, 34.7 (SD 10.8 years; 56.6% females), with cervical or cervicobrachial pain following CW, were distributed into two groups. The experimental group (n = 27) underwent a single first-rib high-velocity low-amplitude manipulation technique, while the control group (n = 26) received a sham placebo intervention. Outcome measures were taken at baseline and immediately after intervention, of the pressure pain threshold over the trigeminal, median and ulnar nerves, and over the area described for the location of tense bands in the upper trapezius, masseter, biceps brachii and triceps brachii muscles. No significant differences in mechanosensitivity values were observed after intervention in the between-groups comparison (p > 0.05). The use of a sole first-rib thrust technique has no immediate effect on neural or muscular mechanosensitivity, when compared to placebo, in subjects with cervical or cervicobrachial pain after CW.

  10. [The matched case-control study of the risk factors associated with edema-proteinuria hypertension syndrome (EPHS)].

    Science.gov (United States)

    Guo, Z C

    1992-12-01

    This paper conducted a matched case-control study to determine the possible risk factors associated with EPHS. 208 cases and 208 matched controls were selected from two affiliated hospitals of Tianjin Medical College between 1 Dec. 1986 and 30 Oct. 1987. The conditional logistic regression analysis showed that basic diastolic blood pressure, the history of hypertension TH Time Hurry) +CH (Competition and Hostility) scores and quetelet index were the major risk factors. The odds ratio (OR) and 95% confidence of OR for these factors were 1.08 (1.04-1.12), 3.58 (1.88-6.83), 1.05 (1.03-1.09), 1.17 (1.05-1.31), respectively. Compared with Type B behavior, OR for Type A behavior is 3.06 (2.24-4.19). OR for women with history of hypertension of her father is 2.5 (1.49-4.20). The lower the average family income, education level, the higher the risk of EPHS. Basic systolic blood Pressure and body weight were positively related to EPHS. Did not find relationship between fetal sex, maternal age, parity, age of menarche, rest period during pregnancy and EPHS.

  11. The Role of Colour Doppler And Spectral Flow Analysis In Pregnancy Induced Hypertension: A Case Control Study

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    Hinal Bhagat

    2015-03-01

    Full Text Available Background: The use of Doppler ultrasound to study blood flow in Obstetrics is of major importance because fetal inaccessibility precludes many other methods of study of fetal circulation. This study was undertaken to assess the role of Doppler in management of Pregnancy induced Hypertension. Methodology: The present case-control study was conducted in the department of Radiology, Govt. Medical College and New Civil Hospital, Surat. Details of obstetric history, age, last menstrual date and underlying risk factor, Doppler study of umbilical artery, fetal middle cerebral artery, both maternal uterine arteries and Ductus venosus was done. Parameters in form of Resistive index (RI, Pulsatility index (PI and systolic/diastolic ratio (S/D of all four arteries were taken. Results: It was observed that 55% cases with pregnancy induced hypertension developed IUGR fetuses while 2% of the IUGR fetus was present in control group. There were 41 (54% cases with IUGR fetuses. Out of which 28 (68% cases with IUGR had fetoplacental Doppler abnormality. 13 cases had abnormally low PI of MCA with normal umbilical arterial Doppler indices, out of which 12 patients had abnormal fetal outcome. Conclusion: By examining the maternal vessels using Doppler ultrasound it is possible to determine, the risk of complication developing in the course of pregnancy long before clinical signs of preeclampsia appear so that therapeutic measures may be undertaken early. [Natl J Med Res 2015; 5(1.000: 57-60

  12. Effects of exercise on kidney function among non-diabetic patients with hypertension and renal disease: randomized controlled trial

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    Barcellos Franklin C

    2012-08-01

    Full Text Available Abstract Background Chronic kidney disease is an important public health threat. Such patients present high morbidity and mortality due to cardiovascular disease, with low quality of life and survival, and also high expenditure resulting from the treatment. Arterial hypertension is both a cause and a complication of kidney disease; also, arterial hypertension is a risk factor for cardiovascular disease among patients with kidney diseases. There is some evidence that exercise interventions may be beneficial to chronic kidney disease patients, but previous studies included only end-stage patients, i.e. those undergoing dialysis. This study aims to evaluate the effect of exercise on kidney function, quality of life and other risk factors for cardiovascular disease among non-diabetic chronic hypertensive kidney disease patients who are not undergoing dialysis. Methods The participants will be located through screening hypertensive patients attended within the public healthcare network in Pelotas, a city in south of Brazil. Eligible individuals will be those with glomerular filtration rate between 15 and 59 ml/min x 1.73 m2. The randomization will be done in fixed-size blocks of six individuals such that 75 participants will be allocated to each group. At baseline, information on demographic, socioeconomic, behavioral, anthropometric, blood pressure and quality-of-life variables will be collected, and laboratory tests will be performed. The intervention will consist of three weekly physical exercise sessions lasting 60–75 minutes each, with a total duration of 16 weeks. The outcomes will be the kidney function progression rate, quality of life, blood pressure, lipid profile, hemoglobin level, ultrasensitive C-reactive protein level, and ankle-arm index. The patients in both groups (intervention and control will be reassessed and compared partway through the study (8th week, at the end of the intervention (16th week and in the 8th week after

  13. Effect of "no added salt diet" on blood pressure control and 24 hour urinary sodium excretion in mild to moderate hypertension

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    Rahimi Rahim

    2007-11-01

    Full Text Available Abstract Background The incidence of Hypertension as a major cardiovascular threat is increasing. The best known diet for hypertensives is 'no added salt diet'. In this study we evaluated the effect of 'no added salt diet' on a hypertensive population with high dietary sodium intake by measuring 24 hour urinary sodium excretion. Methods In this single center randomized study 80 patients (60 cases and 20 controls not on any drug therapy for hypertension with mild to moderate hypertension were enrolled. 24 hour holter monitoring of BP and 24 hour urinary sodium excretion were measured before and after 6 weeks of 'no added salt diet'. Results There was no statistically significant difference between age, weight, sex, Hyperlipidemia, family history of hypertension, mean systolic and diastolic BP during the day and at night and mean urinary sodium excretion in 24 hour urine of case and control groups. Seventy eight percent of all patients had moderate to high salt intake. After 6 week of 'no added salt diet' systolic and diastolic BP significantly decreased during the day (mean decrease: 12.1/6.8 mmhg and at night (mean decrease: 11.1/5.9 mmhg which is statistically significant in comparison to control group (P 0.001 and 0.01. Urinary sodium excretion of 24 hour urine decreased by 37.1 meq/d ± 39,67 mg/dl in case group which is statistically significant in comparison to control group (p: 0.001. Only 36% of the patients, after no added salt diet, reached the pretreatment goal of 24 hour urinary sodium excretion of below 100 meq/dl (P:0.001. Conclusion Despite modest effect on dietary sodium restriction, no added salt diet significantly decreased systolic and diastolic BP and so it should be advised to every hypertensive patient. Trial Registration Clinicaltrial.govnumber NCT00491881

  14. From hypertension control to global cardiovascular risk management: an educational intervention in a cluster-randomised controlled trial.

    Science.gov (United States)

    Mortsiefer, Achim; Meysen, Tobias; Schumacher, Martin; Abholz, Heinz-Harald; Wegscheider, Karl; In der Schmitten, Jürgen

    2015-05-07

    Guidelines on hypertension management recommend adjusting therapeutic efforts in accordance with global cardiovascular risk (CVR) rather than by blood pressure levels alone. However, this paradigm change has not yet arrived in German General Practice. We have evaluated the effect of an educational outreach visit with general practitioners (GPs), encouraging them to consider CVR in treatment decisions for patients with hypertension. Prospective cluster-randomised trial comprising 3443 patients with known hypertension treated by 87 GPs. Practices were randomly assigned to complex (A) or simple (B) intervention. Both groups received a guideline by mail; group A also received complex peer intervention promoting the concept of global CVR. Clinical data were collected at baseline and 6-9 months after intervention. Main outcome was improvement of calculated CVR in the predefined subpopulation of patients with a high CVR (10-year mortality ≥5%), but no manifest cardiovascular disease. Adjusted for baseline the follow-up CVR were 13.1% (95% CI 12.6%-13.6%) (A) and 12.6% (95% CI 12.2%-13.1%) (B) with a group difference (A vs. B) of 0.5% (-0.2%-1.1%), p = 0.179. The group difference was -0.05% in patients of GPs familiar with global CVR and 1.1% in patients of GPs not familiar with with global CVR. However, this effect modification was not significant (p = 0.165). Pooled over groups, the absolute CVR reduction from baseline was 1.0%, p educational intervention, including a clinical outreach visit, had no significant effect on CVR of patients with known hypertension at high risk compared to a simple postal intervention. ISRCTN44478543 .

  15. Auricular acupuncture for prehypertension and stage 1 hypertension: study protocol for a pilot multicentre randomised controlled trial

    OpenAIRE

    Kim, Joo-Hee; Jung, Hyun Jung; Kim, Tae-Hun; Lee, Seunghoon; Kim, Jung-Eun; Kang, Kyung-Won; Jung, So-Young; Kim, Ae-Ran; Park, Hyo-Ju; Shin, Mi-Suk; Shin, Kyung-Min; Jung, Hee-Jung; Lee, Seung-Deok; Hong, Kwon-Eui; Choi, Sun-Mi

    2013-01-01

    Background Hypertension, a worldwide public health problem, is a major risk factor for cardiovascular and kidney disease, and the medical and economic burden of hypertension is increasing. Auricular acupuncture has been used to treat various diseases, including hypertension. Several studies have shown that auricular acupuncture treatment decreases blood pressure in patients with hypertension; however, the scientific evidence is still insufficient. Therefore, we aimed to perform a randomised c...

  16. Hypertension self-control with a portable feedback unit or meditation-relaxation.

    Science.gov (United States)

    Hager, J L; Surwit, R S

    1978-09-01

    Thirty borderline essential hypertensives were randomly assigned to a portable constant-cuff blood pressure feedback technique or meditation-relaxation. Each technique was taught in the laboratory, then practiced twice daily at home for four weeks. Subjects mailed daily records of their progress. Seven feedback and ten meditation-relaxation subjects completed the program. Both techniques produced significant systolic and diastolic reductions within practice sessions and diastolic reductions over weeks of training. Neither technique improved reductions nor reduced initial systolic pressure levels over the four weeks. Differences between biofeedback and meditation-relaxation in within-session pressure reductions were not significant.

  17. Hypertensive Crisis

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Hypertensive Crisis: When You Should Call 9-1-1 for ... 18,2017 Know the two types of HBP crisis to watch for A hypertensive ( high blood pressure ) ...

  18. Portal Hypertension

    Science.gov (United States)

    ... Obesity to Liver Cancer Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD, Thomas Jefferson ... Liver Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension (See also Overview of Liver Disease .) Portal ...

  19. Predictors of hyperkalemia risk after hypertension control with aldosterone blockade according to the presence or absence of chronic kidney disease.

    Science.gov (United States)

    Gwoo, Sangeon; Kim, Ye Na; Shin, Ho Sik; Jung, Yeon Soon; Rim, Hark

    2014-01-01

    Aldosterone antagonists have been proven to be efficient in the management of hypertension and the reduction of proteinuria; however, they are not widely used because of the risk of hyperkalemia. We assessed the predictors of hyperkalemia risk following hypertension control using aldosterone blockade in the presence or absence of chronic kidney disease (CKD). A total of 6,575 patients with hypertension treated between January 1, 2000, and November 30, 2012, were evaluated for the safety of an aldosterone-blocking agent (spironolactone) added to preexisting blood pressure-lowering regimens. Hyperkalemia was defined as a serum potassium level ≥5.0 mEq/l. All patients used 3 mechanistically complementary antihypertensive agents, including a diuretic and a RAAS blocker. Patients were evaluated after 4 and 8 weeks of treatment. The incidence of hyperkalemia, significant renal dysfunction [a reduction of the estimated glomerular filtration rate (eGFR) ≥30%], and adverse effects was assessed. The incidence of hyperkalemia in the presence or absence of CKD was 50.4 and 42.6% after 4 weeks (p = 0.001) and 3.8 and 3.0% after 8 weeks, respectively (p = 0.371). A logistic regression analysis revealed that medication, CKD, basal hyperkalemia, reduction in eGFR, and diabetes were all predictive of a hyperkalemia risk following spironolactone use. Spironolactone was well tolerated by selected CKD patients. The risk of serious hyperkalemia or a significant reduction of eGFR appears to be low. Strict monitoring over the first month of treatment followed by standard surveillance for angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers is suggested. © 2015 S. Karger AG, Basel.

  20. Improved glycemic control by acarbose therapy in hypertensive diabetic patients: effects on blood pressure and hormonal parameters

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    Rosenbaum P.

    2002-01-01

    Full Text Available A double-blind, randomized, placebo-controlled study was carried out on 44 hypertensive type 2 diabetic subjects previously treated by diet associated or not with sulfonylurea to assess the effects of acarbose-induced glycemic control on blood pressure (BP and hormonal parameters. Before randomization and after a 22-week treatment period (100 to 300 mg/day, the subjects were submitted to a standard meal test and to 24-h ambulatory BP monitoring (ABPM and had plasma glucose, glycosylated hemoglobin, lipid profile, insulin, proinsulin and leptin levels determined. Weight loss was found only in the acarbose-treated group (75.1 ± 11.6 to 73.1 ± 11.6 kg, P<0.01. Glycosylated hemoglobin decreased only in the acarbose group (6.4 ± 1.7 to 5.6 ± 1.9%, P<0.05. Fasting proinsulin decreased only in the acarbose group (23.4 ± 19.3 to 14.3 ± 13.6 pmol/l, P<0.05, while leptin decreased in both (placebo group: 26.3 ± 6.1 to 23.3 ± 9.4 and acarbose group: 25.0 ± 5.5 to 22.7 ± 7.9 ng/ml, P<0.05. When the subset of acarbose-treated patients who improved glycemic control was considered, significant reductions in diurnal systolic, diastolic and mean BP (102.3 ± 6.0 to 99.0 ± 6.6 mmHg, P<0.05 were found. Acarbose monotherapy or combined with sulfonylurea was effective in improving glycemic control in hypertensive diabetic patients. Acarbose-induced improvement in metabolic control may reduce BP in these patients. Our data did not suggest a direct action of acarbose on insulin resistance or leptin levels.

  1. The angiotensin II receptor antagonist telmisartan reduces urinary albumin excretion in patients with isolated systolic hypertension: results of a randomized, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Vogt, Liffert; Navis, Gerjan; Koester, Juergen; Manolis, Athanasios J.; Reid, John L.; de Zeeuw, Dick

    2005-01-01

    Objective To examine the effect of telmisartan or hydrochlorothiazide on the control of urinary albumin excretion (UAE) in patients with isolated systolic hypertension (ISH) unselected for albuminuria in a pre-planned substudy of a large, multicentre, double-blind, placebo-controlled, randomized

  2. The angiotensin II receptor antagonist telmisartan reduces urinary albumin excretion in patients with isolated systolic hypertension : results of a randomized, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Vogt, Liffert; Navis, Gerjan; Koester, Juergen; Manolis, Athanasios J.; Reid, John L.; de Zeeuw, Dick

    2005-01-01

    Objective To examine the effect of telmisartan or hydrochlorothiazide on the control of urinary albumin excretion (UAE) in patients with isolated systolic hypertension (ISH) unselected for albuminuria in a pre-planned substudy of a large, multicentre, double-blind, placebo-controlled, randomized stu

  3. The angiotensin II receptor antagonist telmisartan reduces urinary albumin excretion in patients with isolated systolic hypertension: results of a randomized, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Vogt, Liffert; Navis, Gerjan; Koester, Juergen; Manolis, Athanasios J.; Reid, John L.; de Zeeuw, Dick

    2005-01-01

    Objective To examine the effect of telmisartan or hydrochlorothiazide on the control of urinary albumin excretion (UAE) in patients with isolated systolic hypertension (ISH) unselected for albuminuria in a pre-planned substudy of a large, multicentre, double-blind, placebo-controlled, randomized stu

  4. Health locus of control as a psychological factor in improving treatment results in adolescents with primary hypertension and diabetes

    Directory of Open Access Journals (Sweden)

    Marta Anna Biernacka

    2016-10-01

    Full Text Available Background The belief that an individual can influence and control the course of events is a factor which enables a person to overcome difficulties. Some studies, however, have questioned the universality of this statement. This study aims to investigate and explore the relationship between the self-health locus of control and the effectiveness of cooperation in the treatment process in adolescents with chronic diseases. Participants and procedure One hundred and sixty-four adolescent patients suffering from chronic diseases (61 girls and 103 boys ranging from 11 to 17 years old participated in the study. Eighty-seven had primary hypertension and 77 had type 1 diabetes. To investigate their sense of health control we used the Health Locus of Control Scale (HLC. Cooperation in the treatment process was assessed using a 4-item scale completed by a doctor. Results Better results in the treatment were positively correlated with a better internal health locus of control. A negative correlation between the chance health locus of control and results in the treatment was found. Differences in the health locus of control proved to be dependent on gender, age and different clinical groups. Conclusions Health locus of control in patients with chronic diseases seems to be a crucial factor in determining the results of the treatment process in such patients.

  5. Family history of hypertension increases risk of preeclampsia in pregnant women: a case-control study

    Directory of Open Access Journals (Sweden)

    Mulualem Endeshaw

    2016-12-01

    Advanced maternal age (AOR=4.79;95% CI 1.031-22.18, family history of hypertension (AOR=11.16;95% CI 5.41-41.43, history of diabetes mellitus (AOR=6.17;95% CI 2.11-20.33, UTI in the current pregnancy (AOR=6.58;95% CI 2.93-14.73, failure to comply with iron and folic acid supplement during pregnancy (AOR=8.32;95% CI 3.35-20.62, lack of exercise (AOR=3.33;95% CI 1.35-8.17, multiple pregnancy (AOR=4.05;95% CI 1.57-12.27, anemia (AOR=4.19;95% CI 1.27-13.92, and periodontal disease or gingivitis (AOR =3.51;95% CI 1.14-10.83 were associated with preeclampsia. Conclusion Family history of hypertension was the most dominant risk factor for preeclampsia in pregnant women. Encouraging pregnant women to have health seeking behavior during pregnancy would provide a chance to diagnose preeclampsia as early as possible.

  6. Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study

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    Pietro A. Modesti

    2017-01-01

    Full Text Available Data on health needs of Chinese living in the South of Europe are lacking. To compare prevalence, awareness, treatment, control, and risk factors for hypertension between Chinese migrants and Italian adults, a sample of 1200 first-generation Chinese migrants and 291 native Italians aged 35–59 years living in Prato (Italy was recruited in a community-based participatory cross-sectional survey. Primary outcome measure was hypertension, diagnosed for blood pressure values ≥ 140/90 mmHg or current use of antihypertensive medications. Associations with exposures (including age, gender, body mass index, waist, education level, total cholesterol, and triglycerides were examined using logistic regression. When compared with Italians, Chinese had higher hypertension prevalence (27.2% versus 21.3%, p<0.01, with comparable levels of awareness (57.4% and 48.4% but lower treatment rates (70.6% and 90.0%, resp.. In both ethnic groups age and parental history of hypertension were predictors of awareness and treatment, body mass index being predictor of hypertension diagnosis. In Chinese participants, where the optimum cut-off point for body mass index was ≥23.9 kg/m2, the sensibility and specificity prediction for hypertension were 61.7% and 59.8%, respectively (area under the ROC curve = 0.629. Implementation of specific, culturally adapted health programs for the Chinese community is now needed.

  7. Immediate loading of dental implants.

    Science.gov (United States)

    Henry, P J; Liddelow, G J

    2008-06-01

    The purpose of this review is to explore the concept of immediate loading as it pertains to dental implants and the indications for clinical practice. The definition of immediate loading will be considered together with a review of the relevant literature in an attempt to provide evidence-based guidelines for successful implementation into practice. A search of electronic databases including Medline, PubMed and the Cochrane Database of Systematic Reviews was undertaken using the terms "immediate loading'', "dental implants'', "immediate function'', "early loading'', "oral implants'', "immediate restoration'' and "systematic review''. This was supplemented by handsearching in peer-reviewed journals and cross-referenced with the articles accessed. Emphasis was given to systematic reviews and controlled clinical trials. A definition of immediate loading was suggested pertinent to the realities of logistics in clinical practice with respect to application and time frame. The literature was evaluated and shown to be limited with significant shortcomings. Guidelines and recommendations for clinical protocols were suggested and illustrated by examples of case types with a minimum of 1-3 years follow-up. A list of additional references for further reading was provided. Within the limitations of this review, there is evidence to suggest that immediate loading protocols have demonstrated high implant survival rates and may be cautiously recommended for certain clinical situations. However, more high level evidence studies, preferably randomized controlled trials (RCTs), over a long time frame are required to show a clear benefit over more conventional loading protocols.

  8. Heart Disease, Hypertension, Gestational Diabetes Mellitus, and Preeclampsia/Eclampsia in Mothers With Juvenile Arthritis: A Nested Case-Control Study.

    Science.gov (United States)

    Feldman, Debbie E; Vinet, Évelyne; Bérard, Anick; Duffy, Ciarán; Hazel, Beth; Meshefedjian, Garbis; Sylvestre, Marie-Pierre; Bernatsky, Sasha

    2017-02-01

    To determine whether women with a history of juvenile arthritis are at higher risk for heart disease and hypertension and for developing adverse maternal outcomes: gestational diabetes mellitus, maternal hypertension, and preeclampsia/eclampsia. We designed a nested case-control study from a cohort of first-time mothers with prior physician billing codes suggesting juvenile arthritis, and a matched comparison group without juvenile arthritis. For the nested case-control design, we selected 3 controls for each case for the outcomes of heart disease (n = 403), prepregnancy hypertension (n = 66), gestational diabetes mellitus (n = 285), maternal hypertension (n = 561), and preeclampsia/eclampsia (n = 236). We used conditional logistic regression, adjusting for maternal age and education. Having juvenile arthritis was associated with heart disease (odds ratio [OR] 2.44 [95% confidence interval (95% CI) 1.15-5.15]) but not with gestational hypertension, diabetes mellitus, or preeclampsia/eclampsia. All 66 cases of prepregnancy hypertension had juvenile arthritis. Having prepregnancy hypertension was strongly associated with preeclampsia/eclampsia (OR 8.05 [95% CI 2.69-24.07]). Women with a history of juvenile arthritis had a higher risk of heart disease. This risk signals the potential importance of cardiac prevention strategies in juvenile arthritis. As this was a retrospective study, it was not possible to correct for some relevant potential confounders. Further studies should assess the impact of medications, disease severity, and other factors (e.g., obesity) on cardiac outcomes in juvenile arthritis. © 2016, American College of Rheumatology.

  9. A trial for the use of qigong in the treatment of pre and mild essential hypertension: a study protocol for a randomized controlled trial

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    Park Ji-Eun

    2011-11-01

    Full Text Available Abstract Background Hypertension is a risk factor for cardiovascular disease, and the prevalence of hypertension tends to increase with age. Current treatments for hypertension have side effects and poor adherence. Qigong has been studied as an alternative therapy for hypertension; however, the types of qigong used in those studies were diverse, and there have not been many well-designed randomized controlled trials. Our objectives are the following: 1 To evaluate the effects of qigong on blood pressure, health status and hormone levels for pre- or mild hypertension. 2 To test the methodological appropriateness of this clinical trial and calculate a sample size for future randomized trials. Methods Forty subjects with pre- or mild hypertension will be randomized to either the qigong exercise group or the non-treated group. Participants in the qigong group will conduct qigong exercises 5 times per week for 8 weeks, and participants in the non-treated group will maintain their current lifestyle, including diet and exercise. The use of antihypertensive medication is not permitted. The primary endpoint is a change in patient blood pressure. Secondary endpoints are patient health status (as measured by the SF-36 and the MYMOP2 questionnaires and changes in hormone levels, including norepinephrine, epinephrine, and cortisol. Discussion This study will be the first randomized trial to investigate the effectiveness of qigong exercises for the treatment of pre- and mild hypertension. The results of this study will help to establish the optimal approach for the care of adults with pre- or mild hypertension. Trial registration Clinical Research Information Service KCT0000140

  10. Higher Prevalence and Awareness, but Lower Control Rate of Hypertension in Patients with Diabetes than General Population: The Fifth Korean National Health and Nutrition Examination Survey in 2011

    Science.gov (United States)

    Ko, Seung-Hyun; Kwon, Hyuk-Sang; Kim, Dae Jung; Kim, Jae Hyeon; Kim, Nan Hee; Kim, Chul Sik; Song, Kee-Ho; Won, Jong Chul; Lim, Soo; Choi, Sung Hee; Han, Kyungdo

    2014-01-01

    Background We investigated the prevalence, awareness, treatment, and control rate of hypertension in Korean adults with diabetes using nationally representative data. Methods Using data of 5,105 adults from the fifth Korea National Health and Nutrition Examination Survey in 2011 (4,389 nondiabetes mellitus [non-DM]), 242 newly diagnosed with DM (new-DM), and 474 previously diagnosed with DM (known-DM), we analyzed the prevalence of hypertension (mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication) and control rate of hypertension (blood pressure [BP] <130/80 mm Hg). Results The prevalence of hypertension in diabetic adults was 54.6% (44.4% in new-DM and 62.6% in known-DM, P<0.0001 and P<0.0001, respectively) compared with non-DM adults (26.2%). Compared to non-DM, awareness (85.7%, P<0.001) and treatment (97.0%, P=0.020) rates were higher in known-DM, whereas no differences were found between new-DM and non-DM. Control rate among all hypertensive subjects was lower in new-DM (14.9%), compared to non-DM (35.1%, P<0.001) and known-DM (33.3%, P=0.004). Control rate among treated subjects was also lower in new-DM (25.2%), compared to non-DM (68.4%, P<0.0001) and known-DM (39.9%, P<0.0001). Conclusion Higher prevalence and low control rate of hypertension in adults with diabetes suggest that stringent efforts are needed to control BP in patients with diabetes, particularly in newly diagnosed diabetic patients. PMID:24627828

  11. Higher Prevalence and Awareness, but Lower Control Rate of Hypertension in Patients with Diabetes than General Population: The Fifth Korean National Health and Nutrition Examination Survey in 2011

    Directory of Open Access Journals (Sweden)

    Seung-Hyun Ko

    2014-02-01

    Full Text Available BackgroundWe investigated the prevalence, awareness, treatment, and control rate of hypertension in Korean adults with diabetes using nationally representative data.MethodsUsing data of 5,105 adults from the fifth Korea National Health and Nutrition Examination Survey in 2011 (4,389 nondiabetes mellitus [non-DM], 242 newly diagnosed with DM (new-DM, and 474 previously diagnosed with DM (known-DM, we analyzed the prevalence of hypertension (mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication and control rate of hypertension (blood pressure [BP] <130/80 mm Hg.ResultsThe prevalence of hypertension in diabetic adults was 54.6% (44.4% in new-DM and 62.6% in known-DM, P<0.0001 and P<0.0001, respectively compared with non-DM adults (26.2%. Compared to non-DM, awareness (85.7%, P<0.001 and treatment (97.0%, P=0.020 rates were higher in known-DM, whereas no differences were found between new-DM and non-DM. Control rate among all hypertensive subjects was lower in new-DM (14.9%, compared to non-DM (35.1%, P<0.001 and known-DM (33.3%, P=0.004. Control rate among treated subjects was also lower in new-DM (25.2%, compared to non-DM (68.4%, P<0.0001 and known-DM (39.9%, P<0.0001.ConclusionHigher prevalence and low control rate of hypertension in adults with diabetes suggest that stringent efforts are needed to control BP in patients with diabetes, particularly in newly diagnosed diabetic patients.

  12. Correlative research between homocysteine,cystatin C and patients with essential hypertension and hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    孙屿

    2014-01-01

    Objective To investigate the correlation between homocysteine(Hcy),cystatin C(Cys C)and patients with essential hypertension and hypertensive intracerebral hemorrhage.Methods Subjects were divided into hypertensive intracerebral hemorrhage group(108 cases),essential hypertension group(100 cases)and control group(100 cases),and their cystatin C,homocysteine and total cholesterol(TC)and triglycerides(TG)were surveyed.Results The patients with hypertensive intracerebral hemorrhage and essential hypertension had higher

  13. Influence of food intake and eating habits on hypertension control among outpatients at a government health clinic in the Klang Valley, Malaysia.

    Science.gov (United States)

    Suzana, S; Azlinda, A; Hin, S L; Khor, W H; Zahara, Z; Sa'ida, Munira J; Norliza, M

    2011-08-01

    In Malaysia, hypertension prevalence has increased from 13% in 1996 to 43% in 2006 based on the Third National Health and Morbidity Survey. Recognising the importance of hypertension control to prevent cardiovascular morbidity and mortality, a cross-sectional study was carried out to assess factors influencing blood pressure among 74 hypertensive adults (22 men, 52 women, mean age 61.1 +/- 8.8 years old) attending an outpatient clinic of a government health clinic in Klang Valley. Subjects were interviewed to obtain information on social and health, physical activity level and food intake using Diet History Questionnaire (DHQ) and Food Frequency Questionnaire (FFQ). Anthropometric measurements including weight, height, waist circumference and percentage of body fat were also conducted. The majority of the subjects (71.6%) had poor hypertension control as determined using blood pressure. Women aged 30-59 years old had a higher mean diastolic blood pressure (87.3 +/- 11.6 mmHg) than women aged 60 years old (78.5 +/- 9.5 mmHg) (p food intake and eating habits including high salt diet, coffee consumption and inadequate milk intake were unsatisfactory. There is a need to implement a nutrition intervention programme based on MNT to achieve good hypertensive control among subjects.

  14. Fatalism and hypertension prevalence, awareness, treatment and control in US Hispanics/Latinos: results from HCHS/SOL Sociocultural Ancillary Study.

    Science.gov (United States)

    Gutierrez, Angela P; McCurley, Jessica L; Roesch, Scott C; Gonzalez, Patricia; Castañeda, Sheila F; Penedo, Frank J; Gallo, Linda C

    2016-08-08

    Compared with non-Hispanic whites, US Hispanics/Latinos display similar hypertension prevalence, but lower awareness, treatment, and control. Sociocultural factors may affect these patterns. Fatalism, the belief that health is predetermined by fate, relates to poorer adoption of risk reducing health behaviors. We examined the association of fatalism with hypertension prevalence, awareness, treatment, and control among 5313 Hispanics/Latinos, ages 18-74, who were enrolled from four US communities in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. After accounting for socioeconomic status and acculturation in logistic regression analyses, higher fatalism was associated with increased odds of hypertension (OR 1.14, 95 % CI 1.02, 1.28). This association was non-significant when diabetes and other health-related covariates were statistically adjusted. Fatalism was not associated with hypertension awareness, treatment, or control. Findings suggest that the association of fatalism with hypertension may be due largely to its association with SES, acculturation, or related health conditions.

  15. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial.

    Science.gov (United States)

    Padwal, Raj; McAlister, Finlay Aleck; Wood, Peter William; Boulanger, Pierre; Fradette, Miriam; Klarenbach, Scott; Edwards, Alun L; Holroyd-Leduc, Jayna M; Alagiakrishnan, Kannayiram; Rabi, Doreen; Majumdar, Sumit Ranjan

    2016-06-24

    Diabetes and hypertension are devastating, deadly, and costly conditions that are very common in seniors. Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications. However, blood pressure (BP) must be lowered carefully because seniors are also susceptible to low BP and attendant harms. Achieving "optimal BP control" (ie, avoiding both undertreatment and overtreatment) is the ultimate therapeutic goal in such patients. Regular BP monitoring is required to achieve this goal. BP monitoring at home is cheap, convenient, widely used, and guideline endorsed. However, major barriers prevent proper use. These may be overcome through use of BP telemonitoring-the secure teletransmission of BP readings to a health portal, where BP data are summarized for provider and patient use, with or without protocolized case management. To examine the incremental effectiveness, safety, cost-effectiveness, usability, and acceptability of home BP telemonitoring, used with or without protocolized case management, compared with "enhanced usual care" in community-dwelling seniors with diabetes and hypertension. A 300-patient, 3-arm, pragmatic randomized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors' residences in greater Edmonton. Consenting patients will be randomized to usual care, home BP telemonitoring alone, or home BP telemonitoring plus protocolized pharmacist case management. Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data. In both telemonitored arms, providers will receive telemonitored BP data summaries. In the case management arm, pharmacist case managers will be responsible for reviewing teletransmitted data and initiating guideline-concordant and protocolized changes in BP management. Outcomes will be ascertained at 6 and 12 months. Within-study-arm change

  16. Effect of Baduanjin exercise for hypertension: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Xiong, Xingjiang; Wang, Pengqian; Li, Shengjie; Zhang, Yuqing; Li, Xiaoke

    2015-04-01

    This study aims to evaluate the efficacy of Baduanjin exercise for hypertension. Cochrane Library, PubMed, EMBASE, CNKI, VIP, CBM and Wanfang databases were searched. Eight randomized controlled trials (RCTs) were identified. Baduanjin significantly lowered systolic blood pressure (SBP) (WMD=-13.00 mmHg; 95% CI: -21.24 to -4.77; P=0.002), diastolic blood pressure (DBP) (WMD=-6.13 mmHg; 95% CI: -11.20 to -1.07; P=0.02), body mass index, blood glucose, triglyceride, and low-density lipoprotein-cholesterol, and improved high-density lipoprotein-cholesterol and quality of life compared to no intervention. No significant difference between Baduanjin and antihypertensive drugs on SBP (WMD=1.05 mmHg; 95% CI: -2.07 to 4.17; P=0.51) or DBP (WMD=1.90 mmHg; 95% CI: -1.22 to 5.02; P=0.23) was identified. Baduanjin plus antihypertensive drugs significantly reduced SBP (WMD=-7.49 mmHg; 95% CI: -11.39 to -3.59; P=0.0002), DBP (WMD=-3.55 mmHg; 95% CI: -5.25 to -1.85; P<0.0001), blood glucose, and total cholesterol compared to antihypertensive drugs. Baduanjin is an effective therapy for hypertension. However, further rigorously designed RCTs are still warranted.

  17. Protocol of randomized control trial for effectiveness of angiotensin receptor blockers on blood pressure control among euvolemic hypertensive hemodialysis patients.

    Science.gov (United States)

    Aftab, Raja Ahsan; Khan, Amer Hayat; Syed Sulaiman, Syed Azhar; Khan, Tahir Mehmood; Adnan, Azreen Syazril

    2017-04-01

    Volume overload and the renin-aldosterone-angiotensin system (RAAS) are 2 major factors contributing to hypertension (HTN) among hemodialysis (HD) patients. Although volume-dependent components of HTN can be corrected by appropriate volume removal, a proportion of HD patients experience elevated blood pressure (BP) despite achieving euvolemic and ideal dry weight. A single center, prospective, randomized, parallel design, single-blind trial will be conducted in the Malaysian state of Kelantan among postdialysis euvolemic hypertensive patients that are on regular dialysis at least 3 times a week. The primary outcome of the trial will be to note the effectiveness of losartan (RAAS inhibitor) in reducing systolic BP look at all causes of mortality. A body composition monitor (BCM) will be used to assess postdialysis volume and dry weight. Postdialysis euvolemic patients that have systolic BP > 140 mm Hg will be randomized using Covariate Adaptive Randomization to standard or treatment arm. Participants in the treatment arm will be given 50 mg of losartan once daily except on dialysis days, whereas the standard arm patients will be prescribed non-RAAS antihypertensive agents. The study participants will be followed for a period of 12 months. A Wilcoxon statistical test will be performed to note the difference in BP from baseline up to 12 months using Statistical Package for the Social Sciences (SPSS) 20. The study protocols are approved from the Ethical and Research Committee of the Universiti Sains Malaysia (USM/JEPeM/15050173). The trial is registered under the Australia New Zealand Clinical Trial Registry (ACTRN12615001322527). The trial was registered on 2/12/2015 and the 1st patient was enrolled on 10/12/2015. The trial was formally initiated on 16/02/2016. Management of HTN among HD patients requires understanding the primary cause of HTN and treating accordingly. The current trial is an attempt to reduce BP among postdialysis euvolemic but

  18. Blood pressure (BP) control and perceived family support in patients with essential hypertension seen at a primary care clinic in Western Nigeria.

    Science.gov (United States)

    Ojo, Oluwaseun S; Malomo, Sunday O; Sogunle, Peter T

    2016-01-01

    Nonadherence to therapeutic plans has been reported among hypertensive patients. Researchers have also shown that adherence to therapeutic plans improves if motivation in the form of social support is provided. There is a dearth of local studies that explore the influence of family support on treatment outcomes of hypertensive patients. The aim of the study was to determine the relationship between BP control and perceived family support in patients with essential hypertension seen at a primary care setting in Western Nigeria. This was a cross-sectional hospital-based study. Systematic random sampling technique was used in selecting 360 hypertensive respondents between April and July 2013. Data were collected through a pretested interviewer-administered questionnaire and a standardized tool, Perceived Social Support Family Scale, which measured the respondents' level of perceived family support. Statistical Package for Social Sciences (SPSS) version 17.0 was used to analyze data. The majority of the respondents were middle-aged (61.1%) and female (59.4%). Blood pressure (BP) was controlled in 46.4% of the respondents. Most of the respondents (79.4%) had "strong" perceived family support. Strong perceived family support (odds ratio [OR] 4.778, 95% confidence interval [CI] =2.569-8.887) and female gender (OR 1.838, 95% CI = 1.177-2.869) were independent predictors of controlled BP. The proportion of hypertensive patients with optimal BP control is low in this practice setting. The positive association between BP control and perceived family support emphasizes the need for physicians to reflect on the available family support when managing hypertensive patients.

  19. Balance and Gait in People with Multiple Sclerosis: A Comparison with Healthy Controls and the Immediate Change after an Intervention based on the Bobath Concept.

    Science.gov (United States)

    Ilett, P; Lythgo, N; Martin, C; Brock, K

    2016-06-01

    The objective of this study is to compare the balance and gait of 11 people with multiple sclerosis (MS) to 11 healthy controls and to investigate the immediate change after a single intervention based on the Bobath concept on these activities in the MS group. Balance was assessed by ground reaction forces (GRF) and centre of pressure movements during single limb standing (SLS), the Lateral Reach Test (LRT) and the Four Square Step Test (FSST). Gait was evaluated by GRF, ankle kinematics and spatiotemporal measures. Baseline measures in the MS group showed significantly greater vertical GRF variability (p = 0.008) during SLS reached less distance on the LRT (p = 0.001) and were slower completing the FSST (p Bobath concept delivered to the most impaired foot and ankle. After the intervention, the MS group had significant changes towards the control group values with reduced mediolateral (p = 0.002) and vertical (p = 0.016) GRF variability in the SLS task, faster FSST time (p = 0.006) and increased ankle PF during gait (p = 0.002). This study provides further evidence of balance and gait limitations in people with MS and indicates that a single treatment based on principles of the Bobath concept to the foot and ankle can result in immediate improvements in balance and ankle PF during gait in people with MS. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Hypertensive Disorders of Pregnancy.

    Science.gov (United States)

    Leeman, Lawrence; Dresang, Lee T; Fontaine, Patricia

    2016-01-15

    Elevated blood pressure in pregnancy may represent chronic hypertension (occurring before 20 weeks' gestation or persisting longer than 12 weeks after delivery), gestational hypertension (occurring after 20 weeks' gestation), preeclampsia, or preeclampsia superimposed on chronic hypertension. Preeclampsia is defined as hypertension and either proteinuria or thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. Proteinuria is not essential for the diagnosis and does not correlate with outcomes. Severe features of preeclampsia include a systolic blood pressure of at least 160 mm Hg or a diastolic blood pressure of at least 110 mm Hg, platelet count less than 100 × 103 per µL, liver transaminase levels two times the upper limit of normal, a doubling of the serum creatinine level or level greater than 1.1 mg per dL, severe persistent right upper-quadrant pain, pulmonary edema, or new-onset cerebral or visual disturbances. Preeclampsia without severe features can be managed with twice-weekly blood pressure monitoring, antenatal testing for fetal well-being and disease progression, and delivery by 37 weeks' gestation. Preeclampsia with any severe feature requires immediate stabilization and inpatient treatment with magnesium sulfate, antihypertensive drugs, corticosteroids for fetal lung maturity if less than 34 weeks' gestation, and delivery plans. Preeclampsia can worsen or initially present after delivery. Women with hypertensive disorders should be monitored as inpatients or closely at home for 72 hours postpartum.

  1. Efficacy and safety of LCI699 for hypertension: a meta-analysis of randomized controlled trials and systematic review.

    Science.gov (United States)

    Wang, H-Z; Tian, J-B; Yang, K H

    2015-01-01

    This study reviews the available data from randomized controlled trials on efficacy and safety of LCI699, a novel inhibitor of aldosterone synthase, as treatment of hypertension. We performed a meta-analysis of phase II randomized, controlled trials comparing the efficacy/safety of LCI699 with placebo in hypertension patients. For this purpose, PubMed, Embase, Cochrane Library database, ISI-Science Citation Index, and the Chinese Biomedicine Literature Database were searched until August 2013. The available data on mean sitting systolic blood pressure (MSSBP), mean sitting diastolic blood pressure (MSDBP), adverse effects, renin-angiotensin-aldosterone system biomarkers (RAASB) and adrenocorticotropic hormone-stimulated cortisol concentration (AHSC) were collected. All data were analyzed using Review Manager, version 5.2. The present study finally included three randomized controlled trials, comprising of 623 patients in total. The daily use of ≥ 1 mg LCI699 was associated with a significant reduction of MSSBP (Weighted mean difference/WMD = -8.80, 95% CI: -11.31 to -5.68, p risk of side effects compared with placebo (RR = 0.90; 95% CI: 0.68 to 1.18, p = 0.43, I2 = 0%). Suppression of plasma aldosterone was measured at all doses of LCI699 treatment groups. LCI699 suppressed the ACTH-stimulated cortisol response in a dose- and time-dependent manner. Current evidence indicates that the novel aldosterone inhibitor LCI699 is an effective and well-tolerated antihypertensive agent that lowers plasma aldosterone concentration and produces a mild ACTH-stimulated cortisol response suppressive effect.

  2. Hypertension, a health economics perspective.

    Science.gov (United States)

    Alcocer, Luis; Cueto, Liliana

    2008-06-01

    The economic aspects of hypertension are critical to modern medicine. The medical, economic, and human costs of untreated and inadequately controlled hypertension are enormous. Hypertension is distributed unequally and with iniquity in different countries and regions of the world. Treatment of hypertension requires an investment over many years to prolong disease-free quality years of life. The high prevalence and high cost of the disease impacts on the microeconomics and macroeconomics of countries and regions. The criteria used for inclusion in clinical guidelines for hypertension impact on the cost and cost/utility of diagnosis or treatment.

  3. A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: a randomized controlled trial.

    Science.gov (United States)

    Migneault, Jeffrey P; Dedier, Julien J; Wright, Julie A; Heeren, Timothy; Campbell, Marci Kramish; Morisky, Donald E; Rudd, Peter; Friedman, Robert H

    2012-02-01

    Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking. We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity. We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling. The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.

  4. Review of pathogenesis and diagnostic methods of immediate relevance for epidemiology and control of Salmonella Dublin in cattle

    DEFF Research Database (Denmark)

    Nielsen, Liza Rosenbaum

    2013-01-01

    and diagnosis of immediate relevance for epidemiology and control of S. Dublin at animal and herd level. Relatively few in vivo studies on S. Dublin pathogenesis in cattle included more than a few animals and often showed varying result. It makes it difficult to draw conclusions about mechanisms that affect...... dissemination in cattle and that might be targets for control methods directed towards improving resistance against the bacteria, e.g. new vaccines. It is recommended to perform larger studies to elucidate dose-response relationships and age- and genetic effects of immunity. Furthermore, it is recommended...... to attempt to develop faster and more sensitive methods for detection of S. Dublin for diagnosis of infectious animals....

  5. Immediate implant placement and provisionalization in the aesthetic zone using a flapless or a flap-involving approach: a randomized controlled trial.

    Science.gov (United States)

    Stoupel, Janet; Lee, Chun-Teh; Glick, Jaclyn; Sanz-Miralles, Elena; Chiuzan, Cody; Papapanou, Panos N

    2016-12-01

    We conducted a randomized controlled trial to compare the effect of flapless (FLS) or flap-involving (F) immediate placement and provisionalization of single-tooth implants in the aesthetic zone. Thirty-nine patients were randomized following extraction of a non-restorable tooth to a FLS or F group. All implants were immediately placed and provisionalized. We monitored prospectively changes in the peri-implant mucosal margin, the interproximal bone and buccal horizontal ridge at 3, 6 and 12 months. At 3 months post-surgery, the mean ± SD [median (interquartile range)] mesiobuccal peri-implant gingival margin recession from the pre-surgical soft tissue position amounted to 0.11 ± 0.32 mm [0 (0, 0.5)] in the FLS treatment arm versus 0.43 ± 37 mm [0.5 (0, 0.5)] in the F treatment arm (p = 0.02); corresponding values at the distobuccal surface were 0.11 ± 32 mm [0 (0, 0)] in the FLS arm versus 0.48 ± 0.44 mm [0.5 (0, 1)] in the F arm (p = 0.01). No other significant differences in soft or hard tissue remodelling between the treatment arms were observed at 3, 6 or 12 months. Flapless and a flap-involving immediate implant placement and provisionalization in the aesthetic zone resulted in comparable remodelling of the peri-implant mucosa, interproximal bone and buccal ridge at 6 and 12 months. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Hypertension: physiology and pathophysiology.

    Science.gov (United States)

    Hall, John E; Granger, Joey P; do Carmo, Jussara M; da Silva, Alexandre A; Dubinion, John; George, Eric; Hamza, Shereen; Speed, Joshua; Hall, Michael E

    2012-10-01

    Despite major advances in understanding the pathophysiology of hypertension and availability of effective and safe antihypertensive drugs, suboptimal blood pressure (BP) control is still the most important risk factor for cardiovascular mortality and is globally responsible for more than 7 million deaths annually. Short-term and long-term BP regulation involve the integrated actions of multiple cardiovascular, renal, neural, endocrine, and local tissue control systems. Clinical and experimental observations strongly support a central role for the kidneys in the long-term regulation of BP, and abnormal renal-pressure natriuresis is present in all forms of chronic hypertension. Impaired renal-pressure natriuresis and chronic hypertension can be caused by intrarenal or extrarenal factors that reduce glomerular filtration rate or increase renal tubular reabsorption of salt and water; these factors include excessive activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, increased formation of reactive oxygen species, endothelin, and inflammatory cytokines, or decreased synthesis of nitric oxide and various natriuretic factors. In human primary (essential) hypertension, the precise causes of impaired renal function are not completely understood, although excessive weight gain and dietary factors appear to play a major role since hypertension is rare in nonobese hunter-gathers living in nonindustrialized societies. Recent advances in genetics offer opportunities to discover gene-environment interactions that may also contribute to hypertension, although success thus far has been limited mainly to identification of rare monogenic forms of hypertension. © 2012 American Physiological Society

  7. Effects of moxonidine vs. metoprolol on blood pressure and metabolic control in hypertensive subjects with type 2 diabetes.

    Science.gov (United States)

    Jacob, S; Klimm, H-J; Rett, K; Helsberg, K; Häring, H-U; Gödicke, J

    2004-06-01

    Subjects with type 2 diabetes experience an increased cardiovascular morbidity and mortality, related to a high prevalence of hypertension, dyslipidemia, and obesity. Antihypertensive treatment with beta-adrenergic receptor blockers may have deleterious metabolic consequences, including worsening of lipid profiles and insulin sensitivity. The centrally-acting sympatholytic agent moxonidine may improve these variables. In this randomised, double-blind multicenter study, the effects of two widely used antihypertensive agents--moxonidine (MOX) and the beta (1)-selective adrenergic receptor blocker metoprolol (MET)--on blood pressure and metabolic control were directly compared in hypertensive subjects with type 2 diabetes. Patients received either MOX (0.2 - 0.6 mg/d) or MET (50 - 150 mg/d) for 12 weeks, intending comparable blood pressure control. In total 200 patients were randomized. Here we report results from the per protocol population consisting of 127 patients (MOX 66, MET 61) but similar results were found in the ITT population. Reductions in systolic (SBP) and diastolic (DBP) blood pressures after 12 weeks were similar in both groups: In the MOX group, mean SBP (+/- SD) decreased from 154 +/- 12 to 142 +/- 17 mmHg and mean DBP from 91 +/- 9 to 83 +/- 9 mmHg. In the MET group, mean SBP decreased from 152 +/- 13 to 140 +/- 15 mmHg, and mean DBP from 90 +/- 8 to 84 +/- 10 mmHg. Mean HbA (1C) values did not differ between groups after 12 weeks (MOX 8.1 +/- 1.4 Hb%, MET 8.1 +/- 1.5 Hb%, intention-to-treat population). However, fasting plasma glucose decreased in the MOX group (median change - 5 mg/dl), but increased in the MET group (+ 16 mg/dl; p IR)) were + 0.56 micro IU x mol/L (2) in the MET group, and - 0.27 micro IU x mol/L (2) in the MOX group. Correspondingly, fasting triglycerides increased with a median change of + 29.5 mg/dL in the MET group, but decreased in the MOX group (- 27.5 mg/dl; p < 0.05). These results indicate that MOX, unlike MET, may

  8. Dialysis-associated hypertension treated with Telmisartan--DiaTel: a pilot, placebo-controlled, cross-over, randomized trial.

    Directory of Open Access Journals (Sweden)

    Matthias Huber

    Full Text Available Treatment of hypertension in hemodialysis (HD patients is characterised by lack of evidence for both the blood pressure (BP target goal and the recommended drug class to use. Telmisartan, an Angiotensin receptor blocker (ARB that is metabolised in the liver and not excreted via HD extracorporeal circuit might be particularly suitable for HD patients. We designed and conducted a randomised, placebo-controlled, double-blind and cross-over trial for treatment of dialysis-associated hypertension with telmisartan 80 mg once daily or placebo on top of standard antihypertensive treatment excluding other Renin-Angiotensin-System (RAS blockers. In 29 patients after randomization we analysed BP after a treatment period of 8 weeks, while 13 started with telmisartan and 16 with placebo; after 8 weeks 11 continued with telmisartan and 12 with placebo after cross-over, respectively. Patients exhibited a significant reduction of systolic pre-HD BP from 141.9±21.8 before to 131.3±17.3 mmHg after the first treatment period with telmisartan or placebo. However, no average significant influence of telmisartan was observed compared to placebo. The latter may be due to a large inter-individual variability of BP responses reaching from a 40 mmHg decrease under placebo to 40 mmHg increase under telmisartan. Antihypertensive co-medication was changed for clinical reasons in 7 out of 21 patients with no significant difference between telmisartan and placebo groups. Our starting hypothesis, that telmisartan on top of standard therapy lowers systolic office BP in HD patients could not be confirmed. In conclusion, this small trial indicates that testing antihypertensive drug efficacy in HD patients is challenging due to complicated standardization of concomitant medication and other confounding factors, e.g. volume status, salt load and neurohormonal activation, that influence BP control in HD patients.Clinicaltrialsregister.eu 2005-005021-60.

  9. Hypertension--forekomst og behandling

    DEFF Research Database (Denmark)

    Ibsen, Hans; Jørgensen, Torben; Jensen, Gorm B;

    2009-01-01

    Hypertension is the most important modifiable risk factor for cardiovascular disease. However, less than half of all hypertensives have their blood pressure reduced to relevant goals. The prevalence of hypertension in Denmark was found to be between 26% and 40% of the adult population. Just over ...... half were aware of the diagnosis, but less than half were in treatment. Blood pressure control in patients who are undergoing treatment has improved during recent years, but there is still a gap to achievable control rates....

  10. Hypertension--forekomst og behandling

    DEFF Research Database (Denmark)

    Ibsen, Hans; Jørgensen, Torben; Jensen, Gorm B

    2009-01-01

    Hypertension is the most important modifiable risk factor for cardiovascular disease. However, less than half of all hypertensives have their blood pressure reduced to relevant goals. The prevalence of hypertension in Denmark was found to be between 26% and 40% of the adult population. Just over ...... half were aware of the diagnosis, but less than half were in treatment. Blood pressure control in patients who are undergoing treatment has improved during recent years, but there is still a gap to achievable control rates....

  11. A randomized controlled trial comparing interim acrylic prostheses with and without cast metal base for immediate loading of dental implants in the edentulous mandible.

    Science.gov (United States)

    Thomé, Eloana; Lee, Hyung Joo; Sartori, Ivete Aparecida de Mattias; Trevisan, Roseli Latenek; Luiz, Jaques; Tiossi, Rodrigo

    2015-12-01

    This randomized controlled trial used resonance frequency analysis (RFA) to assess the effects of the presence or absence of a cast rigid bar splinting multiple implants in the stability of immediately loaded implants. Twenty-nine edentulous patients were randomly divided into two groups: G1 with full-arch implant-fixed prostheses and G2 with multiple implant splinting via acrylic resin denture bases. All implants were immediately loaded. RFA measurements assessed implant stability at three different times (T0--at baseline, T1--4 months, and T2--8 months. Wilcoxon and Friedman tests and a multivariate model with repeated measures for longitudinal data were used for statistical comparison (α = 0.05). Twenty-nine patients were assessed (G1 = 15 and G2 = 14). Implant and prostheses survival rates were 100% for both groups after the 8-month observation period and no significant differences in the mean ISQ values were found at the different implant stability assessment times (P > 0.05). The different splinting protocols did not appear to affect implant stability during the 8-month observation period. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Methamphetamine Use and Pulmonary Hypertension

    Science.gov (United States)

    ... other problems, diagnosing a case of pulmonary hyper- tension can be difficult and may require a specialist. Once pulmonary hyperten- sion is diagnosed, however, treatment can begin immediately. One form of PH is called pulmonary arterial hypertension (PAH). In PAH, the blood vessels that ...

  13. Recall initiation strategies must be controlled in training studies that use immediate free recall tasks to measure the components of working memory capacity across time.

    Science.gov (United States)

    Gibson, Bradley S; Gondoli, Dawn M; Johnson, Ann C; Robison, Matthew K

    2014-01-01

    There has been great interest in using working memory (WM) training regimens as an alternative treatment for ADHD, but it has recently been concluded that existing training regimens may not be optimally designed because they target the primary memory component but not the secondary component of WM capacity. This conclusion requires the ability to accurately measure changes in primary and secondary memory abilities over time. The immediate free recall task has been used in previous studies to measure these changes; however, one concern with these tasks is that the recall order required on training exercises may influence the recall strategy used during free recall, which may in turn influence the relative number of items recalled from primary and secondary memory. To address this issue, previous training studies have explicitly controlled recall strategy before and after training. However, the necessity of controlling for recall strategies has not been explicitly tested. The present study investigated the effects of forward-serial-order training on free recall performance under conditions in which recall strategy was not controlled using a sample of adolescents with ADHD. Unlike when recall order was controlled, the main findings showed selective improvement of the secondary memory component (as opposed to the primary memory component) when recall order was uncontrolled. This finding advances our understanding of WM training by highlighting the importance of controlling for recall strategies when free recall tasks are used to measure changes in the primary and secondary components of WM across time.

  14. Review article: putting immediate-release proton-pump inhibitors into clinical practice--improving nocturnal acid control and avoiding the possible complications of excessive acid exposure.

    Science.gov (United States)

    Katz, P O

    2005-12-01

    Nocturnal gastro-oesphageal reflux is an under-appreciated clinical challenge. This condition may cause symptoms such as nocturnal heartburn, or it may be asymptomatic. In addition, patients may experience sleep disturbances that can potentially lead to complications such as erosive oesophagitis and Barrett's oesophagus, and may be a risk factor for development of oesophageal adenocarcinoma. Delayed-release proton-pump inhibitors (PPIs) have traditionally been effective in treating both daytime and night-time reflux symptoms, but are limited in control of nocturnal acidity by their pharmacodynamic characteristics. This narrative review addresses the prevalence, impact and pharmacologic approaches used to control nocturnal acidity. Methods to optimize nocturnal acid control include careful attention to dosing schedule, using higher doses of PPIs, adding an histamine H2-receptor antagonist at bedtime to once or twice daily delayed-release PPI, or using immediate-release omeprazole (Zegerid powder for oral suspension; Santarus, Inc., San Diego, CA, USA). This new formulation appears to provide sustained control of intragastric pH at steady state, and when dosed at bedtime, and may be effective in improving control of nocturnal pH and treating night-time GERD.

  15. Tianma Gouteng Yin as Adjunctive Treatment for Essential Hypertension: A Systematic Review of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Jie Wang

    2013-01-01

    Full Text Available Background. Tianma Gouteng Yin (TGY is widely used for essential hypertension (EH as adjunctive treatment. Many randomized clinical trials (RCTs of TGY for EH have been published. However, it has not been evaluated to justify their clinical use and recommendation based on TCM zheng classification. Objectives. To assess the current clinical evidence of TGY as adjunctive treatment for EH with liver yang hyperactivity syndrome (LYHS and liver-kidney yin deficiency syndrome (LKYDS. Search Strategy. 7 electronic databases were searched until November 20, 2012. Inclusion Criteria. RCTs testing TGY combined with antihypertensive drugs versus antihypertensive drugs were included. Data Extraction and Analyses. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. Results. 22 RCTs were included. Methodological quality was generally low. Except diuretics treatment group, blood pressure was improved in the other 5 subgroups; zheng was improved in angiotensin converting enzyme inhibitors (ACEIs, calcium channel blockers (CCBs, and “CCB + ACEI” treatment groups. The safety of TGY is still uncertain. Conclusions. No confirmed conclusion about the effectiveness and safety of TGY as adjunctive treatment for EH with LYHS and LKYDS could be made. More rigorous trials are needed to confirm the results.

  16. Aliskiren improves blood pressure control and prevents cardiac damage in high-risk hypertensive subjects.

    Science.gov (United States)

    Mazza, A; Montemurro, D; Zuin, M; Schiavon, L; Zorzan, S; Chondrogiannis, S; Ferretti, A; Ramazzina, E; Rubello, D

    2013-08-01

    Longitudinal study aimed to evaluate the antihypertensive efficacy, safety and the effect on cardiac damage of Aliskiren, administered to a group of high-risk hypertensive patients with mild impairment of renal function and uncontrolled blood pressure (BP) despite a two-drug antihypertensive treatment. One hundred and six patients (56 men and 50 females) aged 61.9±12.7 years, were assigned to receive Aliskiren 150-300 mg once-daily for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while biochemical tests, estimated glomerular filtration rate (eGFR), 24-hours ambulatory BP measurements (ABMP) and echocardiography were evaluated at baseline and at the end of follow-up. Analysis of variance for repeated measures compared BP, left ventricular mass index (LVMI) and eGFR values changes. A significant reduction (all P0.05). Putative adverse events caused withdrawal of 7 subjects (6 for gastrointestinal disturbances, 1 for alopecia). Aliskiren was effective in decreasing both clinical and ABPM values and in reducing LVMI in both genders without any influence on eGFR. The treatment resulted safe, even in combination with ACE-inhibitors and angiotensin II receptor blockers. A significant reduction in the use of concomitant antihypertensive drugs was observed.

  17. Systolic and diastolic short-term blood pressure variability and its determinants in patients with controlled and uncontrolled hypertension: a retrospective cohort study.

    Science.gov (United States)

    Pengo, Martino F; Rossitto, Giacomo; Bisogni, Valeria; Piazza, Daniele; Frigo, Anna Chiara; Seccia, Teresa Maria; Maiolino, Giuseppe; Rossi, Gian Paolo; Pessina, Achille C; Calò, Lorenzo A

    2015-04-01

    Absolute blood pressure (BP) values are not the only causes of adverse cardiovascular consequences. BP variability (BPV) has also been demonstrated to be a predictor of mortality for cardiovascular events; however, its determinants are still unknown. This study considers 426 subjects with ambulatory BP monitoring (ABPM) measuring 24-h, diurnal and nocturnal absolute BP values and their standard deviations of the mean, along with nocturnal fall, age, sex and current treatment. Patients were divided in two subgroups, controlled and uncontrolled BP, and BPV of patients with "true" and "false" resistant hypertension was also analyzed. Nocturnal and 24-h BPV were higher in the group with uncontrolled hypertension. Multiple regression analysis showed that absolute BP, age, nocturnal fall, but not sex predicted BPV. Patients with "true" resistant hypertension had greater BPV than "false" resistant hypertension patients. Absolute BP resulted as the main determinant of 24-h and nocturnal BPV but not daytime BPV. Also nocturnal BP fall and age resulted as predictors of BPV in treated and untreated patients. Patients with "true" resistant hypertension have a higher BPV, suggesting a higher sympathetic activation. Evidence is still limited regarding the importance of short-term BPV as a prognostic factor and assessment of BPV cannot yet represent a parameter for routine use in clinical practice. Future prospective trials are necessary to define which targets of BPV can be achieved with antihypertensive drugs and whether treatment-induced reduction in BPV is accompanied by a corresponding reduction in cardiovascular events.

  18. Risk factor control in hypertensive and diabetic subjects attended by the Family Health Strategy in the State of Pernambuco, Brazil: the SERVIDIAH study.

    Science.gov (United States)

    Fontbonne, Annick; Cesse, Eduarda Ângela Pessoa; Sousa, Islândia Maria Carvalho de; Souza, Wayner Vieira de; Chaves, Vera Lúcia de Vasconcelos; Bezerra, Adriana Falangola Benjamin; Carvalho, Eduardo Freese de

    2013-06-01

    The SERVIDIAH study (Evaluation of Health Services for Diabetic and Hypertensive Subjects) was conducted in 2010 in the State of Pernambuco, Brazil. A multi-stage random sample of 785 hypertensive and 823 diabetic patients was drawn from 208 Family Health Strategy (FHS) units selected throughout 35 municipalities. Patients underwent a structured interview and weight, height, blood pressure and HbA1c levels (for diabetic patients) were measured. Mean age was approximately 60 years, and women were overrepresented in the sample (70%). 43.7% of hypertensive subjects and 25.8% of diabetic subjects achieved adequate blood pressure control and 30.5% of diabetic subjects had HbA1c levels below 7%. Despite 70% of the patients being overweight or obese, few had adhered to a weight-loss diet. The study of this representative sample of hypertensive and diabetic patients attended by the FHS in the State of Pernambuco shows that improvements in the management of hypertension and diabetes are needed in order to prevent the occurrence of serious and costly complications, especially given the context of increasing incidence of these two conditions.

  19. Association between salinity and hospital admission for hypertension: an ecological case-control study in the Mekong Delta Region in Vietnam.

    Science.gov (United States)

    Talukder, Mohammad Radwanur Rahman; Rutherford, Shannon; Chu, Cordia; Hieu Nguyen, Trung; Phung, Dung

    2017-04-13

    Drinking water in the Mekong Delta Region (MDR) is highly vulnerable to salinity intrusion and this problem is expected to increase with the projected climate change and sea level rise. Despite this, research on health effects of saline contaminated water is scarce in this region. This study examines the risk of hospital admission for hypertension in salinity-affected areas of the MDR. Cases and controls were obtained from national/provincial hospital admission records for 2013. The cases were adult patients whom hypertension (ICD10-code: I10-I15) was primary diagnosis for admission. Of the 13 provinces in the MDR, we identified seven as 'salinity exposed' and the remaining as 'non-exposed' areas. A multi-level logistic regression model was used to examine the association between salinity exposure and hypertension outcome. Of the total 573 650 hospital admissions, 22 382 (~3.9%) were hypertensive cases. The multi-level logistic model combining both individual and ecological factors showed a 9% increase in risk (95% CI: 3-14%) of hypertension admission among individuals in exposed areas compared to those in non-exposed areas. In order to develop and promote appropriate adaptation strategies, further research is recommended to identify the salt exposure pathways and consumption behaviours in the salinity exposed areas.

  20. Fenretinide inhibits macrophage inflammatory mediators and controls hypertension in spontaneously hypertensive rats via the peroxisome proliferator-activated receptor gamma pathway

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    Lin CH

    2016-11-01

    Full Text Available Ching-Han Lin,1,* Shang-Yu Lee,2,* Chun-Cheng Zhang,3 Ye-Fong Du,1 Hao-Chang Hung,1 Hung-Tsung Wu,4 Horng-Yih Ou1 1Department of Internal Medicine, Division of Endocrinology and Metabolism, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 2Department of Internal Medicine, Division of Endocrinology and Metabolism, Chi-Mei Medical Center, 3Department of Internal Medicine, Division of Holistic Care, Chi-Mei Medical Center, 4Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan *These authors contributed equally to this work Abstract: Fenretinide is a novel anticancer agent reported to exhibit anti-invasive and antimetastatic activities. It has also been shown to improve obesity and diabetes, although the effects of fenretinide on hypertension are still unknown, and the detailed mechanisms remain unclear. In this study, we have shown that treatment with lipopolysaccharide (LPS decreased the expression of peroxisome proliferator-activated receptor γ (PPARγ in RAW264.7 macrophages, and pretreatment with fenretinide reversed the effect of LPS on PPARγ expression. In addition, LPS-induced pro-inflammatory cytokine production, including tumor necrosis factor-α, interleukin 6, and monocyte chemoattractant protein 1 were dose-dependently reversed by fenretinide, and the effects of fenretinide on LPS-induced pro-inflammatory cytokine production were blocked by treatment with PPARγ antagonist. Moreover, fenretinide decreased LPS-induced inducible nitric oxide synthase expression and nitrogen oxide production. These effects were blocked by the pretreatment with PPARγ antagonist in a dose-dependent manner, indicating fenretinide activated PPARγ to exert anti-inflammation activity. In view of the role of inflammation in hypertension and the anti-inflammatory action of fenretinide, we found that administration of fenretinide in spontaneously hypertensive rats

  1. The effects of an integrated health education and exercise program in community-dwelling older adults with hypertension: a randomized controlled trial.

    Science.gov (United States)

    Park, Yeon-Hwan; Song, Misoon; Cho, Be-Long; Lim, Jae-Young; Song, Wook; Kim, Seon-Ho

    2011-01-01

    the aim of this study was to examine the effectiveness of HAHA (Healthy Aging and Happy Aging) program, which is an integrated health education and exercise program for community-dwelling older adults with hypertension. older adults with hypertension from one senior center were randomly allocated to experimental (n=18) or control group (n=22). Experimental group received health education, individual counseling and tailored exercise program for 12 weeks. the mean ages were 71 years (experimental group) and 69 (control group). After the intervention, systolic blood pressure of experimental group was significantly decreased than that of control group. Scores of exercise self-efficacy, general health, vitality, social functioning, and mental health in SF-36 were statistically higher than those of control group. the HAHA program was effective in control of systolic blood pressure and improving self-efficacy for exercise and health-related quality of life. 2010 Elsevier Ireland Ltd. All rights reserved.

  2. Nursing considerations in the care of patients with pulmonary hypertension.

    Science.gov (United States)

    Nieves, Jo Ann; Kohr, Lisa

    2010-03-01

    Pulmonary hypertension is a potentially lethal condition that may be encountered during the entire life span of patients with many forms of congenital or acquired heart disease, pulmonary disorders, and other diseases. Each pulmonary hypertensive patient requires anticipatory interventions geared to prevent severe exacerbations of the pulmonary hypertensive condition, promote pulmonary vasodilation, and optimize ventricular function. Patients with pulmonary hypertension are at higher risk for developing pulmonary hypertensive episodes in the immediate postoperative period after cardiac surgery, as well as during nonsurgical admissions. Nurses are in a critical position to provide anticipatory care to prevent the development of pulmonary hypertensive events. Nurses can be instrumental in optimizing outcomes for patients with pulmonary hypertension by providing immediate care upon the development of a pulmonary hypertension event and by monitoring ongoing responses to adjustments in therapeutic interventions.

  3. Improved Hypertension Control with the Imidazoline Agonist Moxonidine in a Multinational Metabolic Syndrome Population: Principal Results of the MERSY Study.

    Science.gov (United States)

    Chazova, Irina; Schlaich, Markus P

    2013-01-01

    This study was designed to assess the effects of moxonidine on blood pressure and aspects of the metabolic syndrome in racially diverse population of patients encountered in routine medical practice. Physicians collected data on a minimum of three consecutive patients with uncontrolled essential hypertension and criteria for metabolic syndrome, eligible to receive moxonidine (0.2-0.4 mg once daily) for 6 months, either as monotherapy or as adjunct therapy to current antihypertensive treatment. Systolic and diastolic blood pressure (BP) declined by an average of 24.5 + 14.3 mmHg and 12.6 + 9.1 mmHg, respectively. BP responder rates defined as attaining BP < 140/90 mmHg were significantly (P < 0.001) and substantially higher among younger patients, nonpostmenopausal women, and patients receiving monotherapy. While potentially relevant improvements in the entire cohort were observed in regard to body weight (-2.1 ± 5.4 kg), fasting plasma glucose (from 6.8 to 6.2 mmol/L), and triglycerides (2.4 to 2.0 mmol/L), statistically significant changes in metabolic parameters could only be detected in subgroup analyses. Moxonidine therapy reduced blood pressure and improved rates of blood pressure control in this group of patients. While the observed trend towards improvement in various metabolic parameters merits further investigation, the overall effect of moxonidine treatment is consistent with a reduction of total cardiovascular risk in this hypertensive metabolic syndrome cohort.

  4. Improved Hypertension Control with the Imidazoline Agonist Moxonidine in a Multinational Metabolic Syndrome Population: Principal Results of the MERSY Study

    Directory of Open Access Journals (Sweden)

    Irina Chazova

    2013-01-01

    Full Text Available This study was designed to assess the effects of moxonidine on blood pressure and aspects of the metabolic syndrome in racially diverse population of patients encountered in routine medical practice. Physicians collected data on a minimum of three consecutive patients with uncontrolled essential hypertension and criteria for metabolic syndrome, eligible to receive moxonidine (0.2–0.4 mg once daily for 6 months, either as monotherapy or as adjunct therapy to current antihypertensive treatment. Systolic and diastolic blood pressure (BP declined by an average of 24.5+14.3 mmHg and 12.6+9.1 mmHg, respectively. BP responder rates defined as attaining BP < 140/90 mmHg were significantly (P<0.001 and substantially higher among younger patients, nonpostmenopausal women, and patients receiving monotherapy. While potentially relevant improvements in the entire cohort were observed in regard to body weight (-2.1±5.4 kg, fasting plasma glucose (from 6.8 to 6.2 mmol/L, and triglycerides (2.4 to 2.0 mmol/L, statistically significant changes in metabolic parameters could only be detected in subgroup analyses. Moxonidine therapy reduced blood pressure and improved rates of blood pressure control in this group of patients. While the observed trend towards improvement in various metabolic parameters merits further investigation, the overall effect of moxonidine treatment is consistent with a reduction of total cardiovascular risk in this hypertensive metabolic syndrome cohort.

  5. Vitamin D therapy to reduce blood pressure and left ventricular hypertrophy in resistant hypertension: randomized, controlled trial.

    Science.gov (United States)

    Witham, Miles D; Ireland, Sheila; Houston, J Graeme; Gandy, Stephen J; Waugh, Shelley; Macdonald, Thomas M; Mackenzie, Isla S; Struthers, Allan D

    2014-04-01

    Low 25-hydroxyvitamin D levels are associated with higher prevalent blood pressure. We tested whether high-dose intermittent oral vitamin D therapy could reduce blood pressure and left ventricular mass in patients with hypertension resistant to conventional treatment. We conducted a parallel-group, double-blind, randomized placebo-controlled trial. Patients with supine office blood pressure >140/90 mm Hg on ≥3 antihypertensive agents received 100 000 U oral vitamin D3 or matching placebo every 2 months. Office and 24-hour ambulatory blood pressure, glucose, and cholesterol were measured at baseline, 2, 4, and 6 months; left ventricular mass index was measured by cardiac MRI on a subgroup at baseline and 6 months. The primary outcome was mean 24-hour ambulatory blood pressure at 6 months. A total of 68 participants were randomized, 34 in each group. Mean age was 63 (SD 11) years, mean baseline office blood pressure was 154/84 (13/10) mm Hg, and mean baseline 25-hydroxyvitamin D level was 42 (16) nmol/L. Treatment with vitamin D did not reduce 24-hour ambulatory blood pressure (adjusted treatment effects: systolic, +3 mm Hg; 95% confidence interval, -4 to +11; P=0.33; diastolic, -2 mm Hg; 95% confidence interval, -6 to +2; P=0.29); similar results were seen for office blood pressure. Left ventricular mass index was measured in a subgroup (n=25); no reduction was seen with vitamin D treatment (adjusted treatment effect, +4 g/m(2); 95% confidence interval, 0 to +7; P=0.04). There was no significant change in cholesterol or glucose levels. Thus, 6 months of intermittent, high-dose oral vitamin D3 did not reduce blood pressure or left ventricular mass in patients with resistant hypertension.

  6. Plasma norepinephrine in hypertensive rats reflects α2-adrenoceptor release control only when re-uptake is inhibited

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    Torill eBerg

    2012-11-01

    Full Text Available α2 adrenoceptors (AR lower central sympathetic output and peripheral catecholamine release, thereby protecting against sympathetic hyperactivity and hypertension. Norepinephrine re-uptake transporter effectively (NET removes norepinephrine from the synapse. Overflow to plasma will therefore not reflect release. Here we tested if inhibition of re-uptake allowed presynaptic α2AR release-control to be reflected as differences in norepinephrine overflow in anesthetized hypertensive (SHR and normotensive (WKY rats. We also tested if α2AR modulated the experiment-induced epinephrine secretion, and a phenylephrine-induced, α1-adrenergic vasoconstriction. Blood pressure was recorded through a femoral artery catheter, and cardiac output by ascending aorta flow. After pre-treatment with NET inhibitor (desipramine, and/or α2AR antagonist (yohimbine, L-659,066 or agonist (clonidine, ST-91, we injected phenylephrine. Arterial blood was sampled 15 min later. Plasma catecholamine concentrations were not influenced by phenylephrine, and therefore reflected effects of pre-treatment. Desipramine and α2AR antagonist separately had little effect on norepinephrine overflow. Combined, they increased norepinephrine overflow, particularly in SHR. Clonidine, but not ST-91, reduced, and pertussis toxin increased norepinephrine overflow in SHR and epinephrine secretion in both strains. L-659,066+clonidine (central α2AR-stimulation normalized the high blood pressure, heart rate and vascular tension in SHR. α2AR antagonists reduced phenylephrine induced vasoconstriction equally in WKY and SHR. Conclusions: α2AAR inhibition increased norepinephrine overflow only when re-uptake was blocked, and then with particular efficacy in SHR, possibly due to their high sympathetic tone. α2AAR inhibited epinephrine secretion, particularly in SHR. α2AAR supported α1AR-induced vasoconstriction equally in the two strains. α2AR malfunctions were therefore not detected in SHR

  7. Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care.

    Science.gov (United States)

    Alami, Mohamed; El Hattaoui, Mustapha; Seqat, Mehdi; Sadik, Jamaa; Aouad, Aicha; Benghanem Gharbi, Mohammed

    2017-02-01

    Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40-60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m(2)]. There were significantly more obese females than males ( p high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

  8. The association of duration of hypertension and changes in cognitive function in hypertension patients

    Institute of Scientific and Technical Information of China (English)

    李拓

    2014-01-01

    Objective To investigate the relationship between duration of hypertension and cognitive function in adult hypertension patients.Methods A total of 224 subjects with normal blood pressure were enrolled in group A,and 1 296 patients with poorly controlled hypertension were further divided by the duration of hypertension into

  9. Immediate Effect of Postural Insoles on Gait Performance of Children with Cerebral Palsy: Preliminary Randomized Controlled Double-blind Clinical Trial.

    Science.gov (United States)

    Neto, Hugo Pasini; Grecco, Luanda André Collange; Duarte, Natália Almeida Carvalho; Christovão, Thaluanna Calil Lourenço; Franco de Oliveira, Luis Vicente; Dumont, Arislander Jonathan Lopes; Galli, Manuela; Oliveira, Claudia Santos

    2014-07-01

    [Purpose] Improved gait efficiency is one of the goals of therapy for children with cerebral palsy (CP). Postural insoles can allow more efficient gait by improving biomechanical alignment. The aim of the present study was to assess the effect of postural insoles on gait performance of children with CP classified as levels I or II of the Gross Motor Function Classification System (GMFCS). [Subjects and Methods] the study was a randomized controlled double-blind clinical trial. After meeting the legal aspects and the eligibility criteria, 10 children between four and 12 years old were randomly divided into a two groups: a control group (n=5), and an experimental group (n=5). Children in the control group used a placebo insoles, and children in the experimental group used postural insoles. Evaluation consisted of three-dimensional gait analysis under three conditions: barefoot, shoes without insoles and shoes with postural insoles or shoes with placebo insoles. [Results] Regarding the immediate effects of insole use, significant improvements in gait velocity and cadence were observed in the experimental group in comparison to the control group. [Conclusion] The use of postural insoles led to improvements in gait velocity and cadence of the children with cerebral palsy classified as levels I or II of the GMFCS.

  10. Cocoa, hazelnuts, sterols and soluble fiber cream reduces lipids and inflammation biomarkers in hypertensive patients: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Rosa Solà

    Full Text Available BACKGROUND: Cocoa, mixed with other food ingredients, intake can have beneficial effects on cardiovascular disease (CVD biomarkers. We compared the effects of 4 cocoa cream products on some of these biomarkers. METHODS AND FINDINGS: In this multi-centered, randomized, controlled, double-blind, parallel trial, volunteers (n = 113; age range: 43-65 years who were pre-hypertensive, stage-1 hypertensive and hypercholesterolemic received one of 4 cocoa cream products (13 g/unit; 1 g cocoa/unit, 6 units/d; 465 Kcal/d added to a low saturated fat diet for 4 weeks. The groups were: A (n = 28, cocoa cream considered as control; B (n = 28, cocoa+hazelnut cream (30 g/d hazelnuts; C (n = 30, cocoa+hazelnuts+phytosterols (2 g/d; and D (n = 27, cocoa+hazelnuts+phytosterols+soluble fiber (20 g/d the patented "LMN product". Primary outcome measures were BP, LDL-c, apolipoprotein B-100 (Apo B, ApoB/ApoA ratio, oxidized LDL (oxLDL and high-sensitive C-reactive protein (hsCRP determined at baseline and post-cocoa cream product intake. Statistical analysis used was ANCOVA or mixed models (in case of repeated measurements, with baseline observation included as a covariate. After 4 weeks, compared to product A, product C reduced LDL-c by 11.2%, Apo B by 8.1% and ApoB/ApoA ratio by 7.8% (P = 0.01. LMN decreased LDL-c by 9.2%, Apo B-100 by 8.5%, ApoB/ApoA ratio by 10.5%, hsCRP by 33.4% and oxLDL by 5.9% (P = 0.01. Surprisingly, even "control" product A reduced systolic BP (-7.89 mmHg; 95%CI: -11.45 to -4.3 and diastolic BP (-5.54 mmHg; 95%CI: -7.79 to -3.29. The BP reductions were similar with the other 3 products. Limitations of the study are that the trial period was relatively short and that a better "BP control" product would have been preferable. CONCLUSION: The creams (particularly the LMN have anti-inflammatory and antioxidant effects in addition to lowering LDL-c, Apo B and ApoB/ApoA ratio. Thus, the soluble fiber effects amplified with sterols (as contained in

  11. Metabolic reprogramming and inflammation act in concert to control vascular remodeling in hypoxic pulmonary hypertension.

    Science.gov (United States)

    Stenmark, Kurt R; Tuder, Rubin M; El Kasmi, Karim C

    2015-11-15

    Pulmonary hypertension (PH) is a complex, multifactorial syndrome that remains poorly understood despite decades of research. PH is characterized by profound pulmonary artery (PA) remodeling that includes significant fibro-proliferative and inflammatory changes of the PA adventitia. In line with the emerging concept that PH shares key features with cancer, recent work centers on the idea that PH results from a multistep process driven by reprogramming of gene-expression patterns that govern changes in cell metabolism, inflammation, and proliferation. Data demonstrate that in addition to PA endothelial cells and smooth muscle cells, adventitial fibroblasts from animals with experimental hypoxic PH and from humans with PH (hereafter, termed PH-Fibs) exhibit proinflammatory activation, increased proliferation, and apoptosis resistance, all in the context of metabolic reprogramming to aerobic glycolysis. PH-Fibs can also recruit, retain, and activate naïve macrophages (Mϕ) toward a proinflammatory/proremodeling phenotype through secretion of chemokines, cytokines, and glycolytic metabolites, among which IL-6 and lactate play key roles. Furthermore, these fibroblast-activated Mϕ (hereafter, termed FAMϕ) exhibit aerobic glycolysis together with high expression of arginase 1, Vegfa, and I1lb, all of which require hypoxia-inducible factor 1α and STAT3 signaling. Strikingly, in situ, the adventitial Mϕ phenotype in the remodeled PA closely resembles the Mϕ phenotype induced by fibroblasts in vitro (FAMϕ), suggesting that FAMϕ crosstalk involving metabolic and inflammatory signals is a critical, pathogenetic component of vascular remodeling. This review discusses metabolic and inflammatory changes in fibroblasts and Mϕ in PH with the goal of raising ideas about new interventions to abrogate remodeling in hypoxic forms of PH.

  12. Intensive blood pressure control during the hyperacute phase of intracerebral hemorrhage in patients at risk for resistant hypertension: a retrospective cohort study.

    Science.gov (United States)

    Mohrien, Kerry M; Elijovich, Lucas; Venable, Garrett T; Taylor, Douglas R; Jones, G Morgan

    2015-04-01

    There are limited data evaluating intensive systolic blood pressure (SBP) control during the hyperacute phase of intracerebral hemorrhage (ICH) in patients with multiple risk factors for resistant hypertension. We evaluated the feasibility and safety of this intervention in a primary population that includes patients with multiple risk factors for resistant hypertension. We conducted a retrospective analysis of ICH patients for which intensive SBP control (risk factors that have been associated with resistant hypertension. Our primary objective was to determine the percentage of patients who achieved goal SBP within 1 hour of ICH diagnosis. Secondary objectives included identifying predictors of achieving goal SBP within 6 hours. Goal SBP within 1 hour was achieved in 8.1% of patients. The total number of risk factors a patient possessed was found to negatively predict ability to achieve goal SBP. For each risk factor possessed, the odds of achieving goal SBP within 6 hours are reduced by 31% (odds ratio, 0.69 [95% confidence interval, 0.54-0.89]). Intensive SBP control after ICH was difficult to achieve within 1 hour in those with risk factors for resistant hypertension. Patients' total risk factors were found to reduce the odds of achieving goal SBP within 6 hours. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Safety and Efficacy of Intravenous Clevidipine for the Perioperative Control of Acute Hypertension in Neurosurgical Patients: A Dose Update

    Directory of Open Access Journals (Sweden)

    Kristin I Brower

    2017-06-01

    Full Text Available Clevidipine is a third-generation dihydropyridine calcium channel blocker approved in 2008 by the Food and Drug Administration for parenteral therapy of arterial hypertension. The high degree of lipophilicity of clevidipine provides a rapid onset of action and ease of titration to reach the desired clinical effect. Since its introduction into clinical practice, clevidipine has been shown to be safe and effective for perioperative use in patients undergoing procedures in which rapid and effective blood pressure control is essential. In 2011, clevidipine received institutional approval for intraoperative use during neurosurgical procedures and for postoperative blood pressure control in the Post-Anesthesia Care Unit and Surgical Intensive Care Unit during the first 24 hours after surgery. This review describes the efficacy and safety of intravenous clevidipine in intraoperative blood pressure management during neurosurgical procedures in 11 patients over a period of 3 months. The evaluation revealed that lower rates of clevidipine infusion than previously documented in the literature achieved blood pressure control within the desired limits during surgery while avoiding dose-related adverse reactions.

  14. Impacts of hypertension community control technique on community hypertensives in Zhejiang province%社区控制技术对浙江省社区高血压人群干预效果的评价分析

    Institute of Scientific and Technical Information of China (English)

    徐小玲; 唐新华; 严静; 俞蔚; 章一丰; 罗建勇; 刘庆敏

    2014-01-01

    目的:评价以“规模化、规范化、信息化”为核心的高血压社区控制技术对高血压人群的管理效果。方法2010年以《中国高血压防治指南》为依据,建立以“规模化、规范化、信息化”为核心的高血压社区控制技术,选择浙江省有代表性的城市、城镇、农村社区高血压人群为研究对象进行大规模社区干预试验。按照高血压社区控制技术制订实施方案,规范化培训干预组医生,按照方案要求对干预组高血压患者进行分级管理。结果截至2013年12月共管理了高血压患者20807例。其中干预组从基线的8996例增加到12295例,规范管理率达到86.8%;干预组高血压患者平均收缩压和平均舒张压分别下降了11.21 mmHg和8.55 mmHg (均为P﹤0.05),治疗率和控制率由基线时的55.4%和38.6%提高到86.7%和77.8%(均为P﹤0.05),心血管危险因素有显著改善(均为P﹤0.05),急性心血管事件发生呈下降趋势。结论高血压社区控制技术能有效提高社区高血压规范管理率,有效改善社区高血压人群防治效果。%Objective To evaluate the effects of hypertension community control technique, which centered on ‘scalization, standardization, informatization ' , on community hypertension management in Zhejiang Province. Methods We established the hypertension community control technique based on 2005 Chinese guidelines for the management of hypertension, and conducted a large-scale community-based intervention trial. The selected communities were representative communities from city, town and countryside in Zhejiang province. An implement scheme was developed according to the hypertension community control technique. Grass-roots doctors in intervention group were trained standardly and required to manage hypertentives based on the implement scheme. Hypertension community standardized management rate, hypertensives' blood pressure, cardiovascular risk

  15. Poor blood pressure control and its associated factors among older people with hypertension: A cross-sectional study in six public primary care clinics in Malaysia.

    Science.gov (United States)

    Cheong, A T; Sazlina, S G; Tong, S F; Azah, A S; Salmiah, S

    2015-01-01

    Hypertension is highly prevalent in the older people. Chronic disease care is a major burden in the public primary care clinics in Malaysia. Good blood pressure (BP) control is needed to reduce the morbidity and mortality of cardiovascular disease (CVD). This study aimed to determine the status of BP control and its associated factors among older people with hypertension in public primary care clinics. A cross-sectional study on hypertensive patients aged 18 years and above was conducted in six public primary care clinics in Federal Territory, Malaysia. A total of 1107 patients were selected via systematic random sampling. Data from 441 (39.8%) patients aged 60 years and more were used in this analysis. BP control was determined from the average of two BP readings measured twice at an interval of 5 min. For patients without diabetes, poor BP control was defined as BP of ≥140/90 mm Hg and ≥150/90 for the patients aged 80 years and more. For patients with diabetes, poor control was defined as BP of ≥140/80 mm Hg. A total of 51.7% (n = 228) of older patients had poor BP control. The factors associated with BP control were education level (p = 0.003), presence of comorbidities (p = 0.015), number of antihypertensive agents (p = 0.001) and number of total medications used (p = 0.002). Patients with lower education (less than secondary education) (OR = 1.7, p = 0.008) and the use of three or more antihypertensive agents (OR = 2.0, p = 0.020) were associated with poor BP control. Among older people with hypertension, those having lower education level, or using three or more antihypertensive agents would require more attention on their BP control.

  16. NIVELES DE TRATAMIENTO Y CONTROL DE LA HIPERTENSIÓN ARTERIAL EN EL POLICLÍNICO TURCIOS LIMA / Treatment levels and hypertension control at the Turcios Lima polyclinic

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    Ángel Y. Rodríguez Navarro

    2012-10-01

    Full Text Available ResumenIntroducción y objetivo: El control farmacológico de la hipertensión arterial es un componente esencial en la estrategia para el control de las enfermedades cardiovasculares. El propósito de esta investigación fue determinar la tasa actual de control de la hipertensión arterial en la población que recibe atención médica en el consultorio médico N° 18 perteneciente al Policlínico Turcios Lima, del municipio de Pinar del Río. Método: Estudio descriptivo y transversal; el universo estuvo constituido por 1.589 pacientes mayores de 15 años de edad, y la muestra, por 504 pacientes seleccionados por muestreo probabilístico estratificado. Resultados: Se obtuvo una prevalencia del 21,2 % de hipertensión arterial, mayor en el sexo masculino; se calculó una tasa de control de 45 por cada 100 pacientes bajo tratamiento terapéutico y un porcentaje de control del 65,3 % entre los tratados. El 42,3 % de la población presenta un riesgo cardiovascular moderado de sufrir un accidente cardiovascular en los próximos 10 años. Conclusiones: Se obtuvo un nivel de control de la hipertensión arterial más elevado que lo notificado previamente por estudios poblacionales realizados en otros países, esta enfermedad es mejor controlada en las pacientes femeninas. En cuanto al riesgo cardiovascular global, predominó la categoría de moderado seguida por la de bajo riesgo, sin desestimar la población clasificada como de alto riesgo. / Introduction and Objectives: Pharmacological control of hypertension is an essential component in the strategy for the control of cardiovascular diseases. The purpose of this research was to determine the current control rate of hypertension in the population receiving care at the medical office N° 18 belonging to Turcios Lima Polyclinic, in Pinar del Rio municipality. Method: A descriptive and cross−sectional study was performed, the population consisted of 1589 patients over 15 years old, and the sample of

  17. Trends in population blood pressure and prevalence, awareness, treatment, and control of hypertension among middle-aged and older adults in a rural area of Northwest China from 1982 to 2010.

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    Yaling Zhao

    Full Text Available OBJECTIVES: To assess trends in average blood pressure levels and prevalence, awareness, treatment, and control of hypertension among adults in a rural area of Northwest China, and to determine associated risk factors. METHODS: Four cross-sectional population-based surveys were conducted between 1982 and 2010 among randomly selected adults in rural areas of Hanzhong, in Northwest China. Data on blood pressure, body mass index, family history of hypertension, and socio-demographic and lifestyle characteristics were collected in similar way by trained investigators in four surveys. Data of 8575 participants aged 35-64 years was analyzed. Averages and proportions were adjusted for age and sex. RESULTS: Average blood pressure in the population has increased since 1982 from 76.9 mm Hg to 79.6 mm Hg in 2010 (diastolic and from 120.9 to 129.7 mm Hg (systolic. Prevalence of hypertension increased from 18.4% in 1982 to 30.5% in 2010, and awareness of hypertension increased from 16.8% to 38.4% in 2010. Treatment of hypertension increased from 1.0% in 1982 to 17.4% in 2010, and control of hypertension increased from 0.1% in 1982 to 3.5% in 2010. All these gradients were statistically significant (P<0.01 for trend. Population blood pressure and prevalence, awareness and treatment of hypertension were positively associated with increasing age, body mass index and having family history of hypertension. CONCLUSIONS: Average blood pressure levels and the prevalence, awareness, treatment and control of hypertension among adults in rural areas of Hanzhong have increased since 1982. However, awareness, treatment and control rates remain low. Public health programs and practical strategies are required to improve prevention and control of hypertension in rural Northwest China. In particular, attention should be given to the elderly and obese, and to those with a family history of hypertension, while raising awareness and treatment among younger adults.

  18. Drug treatment of hypertensive crisis in children.

    Science.gov (United States)

    Thomas, Christopher A

    2011-10-01

    Hypertensive crisis is a relatively rare event and is associated with significant morbidity and mortality in adults and pediatric patients alike. Rapid, safe, and effective treatment is imperative to alleviate immediate presenting clinical symptoms, prevent devastating morbidity, preserve long-term quality of life, and prevent mortality. Many medications in the hypertensive crisis arsenal have been used for nearly half a century. Nearly all treatment options have been utilized in children for decades, yet reliable data and sound clinical literature remain elusive. Every agent considered to be a first-line, second-line, or adjunctive option has yet to be evaluated in a randomized controlled trial in pediatric patients. With a paucity of clinical data to form evidence-based decisions, the clinician must rely entirely on the extrapolation from adult data and small retrospective studies, case series, and case reports of medication use in pediatric patients. Although more research in the treatment of pediatric hypertensive crisis is desperately needed, current practice demands a sharp knowledge of the pediatric clinical literature and pharmacology in this area as an essential tool to consistently improve patient outcomes with respect to morbidity and mortality.

  19. A randomized controlled trial of laparoscopic versus open cholecystectomy in patients with cirrhotic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Ling-Tang Li; Zhi-Ming Wang; Zhu-Fu Quan; Xun-Ru Chen; Jie-Shou Li

    2005-01-01

    AIM: To evaluate the characters, risks and benefits of laparoscopic cholecystectomy (LC) in cirrhotic portal hypertension (CPH) patients.METHODS: Altogether 80 patients with symptomatic gallbladder disease and CPH, including 41 Child class A,32 Child class B and 7 Child class C, were randomly divided into open cholecystectomy (OC) group (38 patients) and LC group (42 patients). The cohorts were well-matched for number, age, sex, Child classification and types of disease.Data of the two groups were collected and analyzed.RESULTS: In LC group, LC was successfully performed in 36 cases, and 2 patients were converted to OC for difficulty in managing bleeding under laparoscope and dense adhesion of Calot's triangle. The rate of conversion was 5.3%. The surgical duration was 62.6±15.2 min. The operative blood loss was 75.5±15.5 mL. The time to resume diet was 18.3±6.5 h. Seven postoperative complications occurred in five patients (13.2%). All patients were dismissed after an average of 4.6±2.4 d. In OC group, the operation time was 60.5±17.5 min. The operative blood loss was 112.5±23.5 mL. The time to resume diet was 44.2±10.5 h.Fifteen postoperative complications occurred in 12patients (30.0%). All patients were dismissed after an average of 7.5±3.5 d. There was no significant difference in operation time between OC and LC group. But LC offered several advantages over OC, including fewer blood loss and lower postoperative complication rate, shorter time to resume diet and shorter length of hospitalization in patients with CPH.CONCLUSION: Though LC for patients with CPH is difficult, it is feasible, relatively safe, and superior to OC.It is important to know the technical characters of the operation, and pay more attention to the meticulous perioperative managements.

  20. The effect of balneotherapy on antioxidant, inflammatory, and metabolic indices in patients with cardiovascular risk factors (hypertension and obesity)--a randomised, controlled, follow-up study.

    Science.gov (United States)

    Oláh, Mihály; Koncz, Ágnes; Fehér, Judit; Kálmánczhey, Judit; Oláh, Csaba; Nagy, György; Bender, Tamás

    2011-11-01

    The primary objective of our study was to explore the changes of antioxidant, inflammatory, and metabolic parameters in obese and hypertension people patients during balneotherapy and to evaluate the safety of balneotherapy in these participants. Following randomisation, 22 obese and 20 hypertensive patients underwent balneotherapy with thermal water of 38°C temperature, in 15 sessions of 30 minutes. An additional 22 obese and 20 hypertensive patients served as controls. Antioxidant, inflammatory, and metabolic parameters were determined at baseline, as well as post-treatment and at the end of follow-up (at 15 weeks). As regards changes observed in hypertensive patients subjected to balneotherapy, differences could be detected between baseline and post-treatment albumin and haemoglobin A(1c) levels only; however, these were no longer significant after 3 months. Although the difference between transferrin levels determined at the end of balneotherapy and 3 months later was significant, it remained within the physiological range, as well as it was accompanied by normal serum iron level and therefore, it was considered irrelevant. C-reactive protein levels of balneotherapy patients decreased significantly after treatment. In obese patients, haemoglobin A(1c) level decreased after balneotherapy, but this difference was not observed either after 3 months. Similarly, both transferrin and C-reactive protein levels changed from baseline, but not between groups. This study contributes important information regarding the safety of balneotherapy in hypertensive and obese diabetics by showing no alterations of antioxidant, inflammatory, or metabolic indices. The findings of this study confirm that balneotherapy is not contraindicated for hypertensive or obese patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. PREVALENCE OF HYPERTENSION AMONG FIREFIGHTERS IN RIVERS STATE, SOUTH-SOUTH, NIGERIA.

    Science.gov (United States)

    Douglas, Kingsley Enyinnah; Oraekesi, Chidi Kelvin

    2015-01-01

    High blood pressure is a major cause of morbidity and mortality in Sub-Saharan Africa and firemen (firefighters) may be especially predisposed to it or even exacerbate pre-existing hypertension as a result of the nature of their job. This study was to determine the prevalence of hypertension among firemen in Rivers state, South-South Nigeria. Following ethical clearance, 125 consenting firemen of the Rivers State Fire Service were recruited in this descriptive cross sectional study. They responded to a pre-tested, structured, closed-ended self-administered questionnaire which probed their socio-demographics, knowledge, attitude and practice towards hypertension. Also, their blood pressures heights and weights were measured from where Body Mass Index (BMI) was calculated. A WalkThrough Survey for immediate work place situation and safety was carried out. Data collected were later analyzed using descriptive and analytical statistical tools. There was a 9.6% prevalence of hypertension among this group of workers in Rivers State. The workforce was essentially young with a modal age group of between 31-36 years. The attendant associated risk factors included altered sleep patterns, over weight and smoking which were all statistically significant P hypertension was high (96%), the behaviour of respondents towards prevention and control of hypertension was poor. There is hypertension among firemen of the Rivers State Fire Service occasioned by modifiable risk factors despite adequate knowledge. It is recommended that intensive health education, early detection and treatment be instituted among this group of workers.

  2. Prevalence of taking actions to control blood pressure among adults with self-reported hypertension in 18 states and the District of Columbia, 2009.

    Science.gov (United States)

    Ayala, Carma; Fang, Jing; Yuan, Keming

    2015-03-01

    The authors used 2009 Behavioral Risk Factor Surveillance System data to assess the prevalence of taking actions to control hypertension among adults with self-reported hypertension. Differences by descriptive characteristics (sex, age, race/ethnicity, access to health care, medication adherence), presence of other health risk factors (overweight/obesity, smoking, heavy drinking, inadequate fruit/vegetable intake, and physical inactivity), and comorbidities (diabetes, high cholesterol, coronary heart disease, and stroke) were compared. The prevalence of hypertension was 29.6%, and 75.0% of these patients reported taking antihypertensive medications, 73.1% changed eating habits, 72.8% decreased the use of salt, 78.8% reduced alcohol consumption, and 69.9% increased their physical activity. Overall, 87.2% reported taking two or more actions to reduce blood pressure. Patients taking antihypertensive medications were more likely to take two or more actions than their counterparts (90.6% vs 79.4%, Ptake two or more actions as their counterparts (95% confidence interval, 1.18-2.92 times). More than 80% of hypertensive adults reported taking two or more actions to control blood pressure. The prevalence of taking actions differed significantly by descriptive characteristics, the presence health risk factors, and comorbidities.

  3. Influence of de qi on the immediate analgesic effect of SP6 acupuncture in patients with primary dysmenorrhoea and cold and dampness stagnation: a multicentre randomised controlled trial.

    Science.gov (United States)

    Zhao, Min-Yi; Zhang, Peng; Li, Jing; Wang, Lin-Peng; Zhou, Wei; Wang, Yan-Xia; She, Yan-Fen; Ma, Liang-Xiao; Wang, Pei; Hu, Ni-Juan; Lin, Chi; Hu, Shang-Qin; Wu, Gui-Wen; Wang, Ya-Feng; Sun, Jun-Jun; Jiang, Si-Zhu; Zhu, Jiang

    2017-07-11

    The aim of this multicentre randomised controlled trial was to investigate the contribution of de qi to the immediate analgesic effect of acupuncture in patients with primary dysmenorrhoea and the specific traditional Chinese medicine diagnosis cold and dampness stagnation. Eighty-eight patients with primary dysmenorrhoea and cold and dampness stagnation were randomly assigned to de qi (n=43) or no de qi (n=45) groups and underwent 30 min of SP6 acupuncture. The de qi group received deep needling at SP6 with manipulation using thick needles; the no de qi group received shallow needling with no manipulation using thin needles. In both groups the pain scores and actual de qi sensation were evaluated using a visual analogue scale for pain (VAS-P) and the acupuncture de qi clinical assessment scale (ADCAS), respectively. Both groups showed reductions in VAS-P, with no signficant differences between groups. ADCAS scores showed 43/43 and 25/45 patients in de qi and no de qi groups, respectively, actually experienced de qi sensation. Independent of original group allocation, VAS-P reductions associated with actual de qi (n=68) were greater than those without (28.4±18.19 mm vs 14.6±12.28 mm, p=0.008). This study showed no significant difference in VAS-P scores in patients with primary dysmenorrhoea and cold and dampness stagnation immediately after SP6 acupuncture designed to induce or avoid de qi sensation. Both treatments significantly reduced VAS-P relative to baseline. Irrespective of group allocation, patients experiencing actual de qi sensation demonstrated larger reductions in pain score relative to those without, suggesting greater analgesic effects. Chinese Clinical Trial Registry (ChiCTR-TRC-13003086); Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Immediate therapeutic effect of interferential current therapy on spasticity, balance, and gait function in chronic stroke patients: a randomized control trial.

    Science.gov (United States)

    Suh, Hye Rim; Han, Hee Chul; Cho, Hwi-Young

    2014-09-01

    To determine whether a single trial of interferential current therapy (ICT) can immediately alleviate spasticity and improve balance and gait performance in patients with chronic stroke. Randomized, placebo-controlled clinical trial. Inpatient rehabilitation in a local center. A total of 42 adult patients with chronic stroke with plantar flexor spasticity of the lower limb. The ICT group received a single 60-minute ICT stimulation of the gastrocnemius in conjunction with air-pump massage. In the placebo-ICT group, electrodes were placed and air-pump massage performed without electrical stimulation. After a single ICT application, spasticity was measured immediately using the Modified Ashworth Scale (MAS), and balance and functional gait performance were assessed using the following clinical tools: Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and 10-m Walk Test (10MWT). Gastrocnemius spasticity significantly decreased in the ICT group than in the placebo-ICT group (MAS: ICT vs placebo-ICT: 1.55±0.76 vs 0.40±0.50). The ICT group showed significantly greater improvement in balance and gait abilities than the placebo-ICT group (FRT: 2.62±1.21 vs 0.61±1.34, BBS: 1.75±1.52 vs 0.40±0.88, TUG: 6.07±6.11 vs 1.68±2.39, 10MWT: 7.02±7.02 vs 1.96±3.13). Spasticity correlated significantly with balance and gait abilities (P stroke patients, but not for long-term effects. Further study on the effects of repeated ICT is needed. © The Author(s) 2014.

  5. Changes in the Prevalence, Treatment and Control of Hypertension in Germany? A Clinical-Epidemiological Study of 50.000 Primary Care Patients

    Science.gov (United States)

    Labeit, Alexander Michael; Klotsche, Jens; Pieper, Lars; Pittrow, David; Einsle, Franziska; Stalla, Günter Karl; Lehnert, Hendrik; Silber, Sigmund; Zeiher, Andreas Michael; März, Winfried; Wehling, Martin; Wittchen, Hans-Ulrich

    2012-01-01

    Introduction Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001. Methods Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician’s diagnosis of hypertension (HTNdoc) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician’s diagnosis or the patient’s self-reported diagnosis of hypertension (HTNdoc,pat), physician’s or patient’s self-reported diagnosis or a BP measurement with a systolic BP≥140 mmHg and/or a diastolic BP≥90 (HTNdoc,pat,bp) and diagnosis according to the National Health and Nutrition Examination Survey (HTNNHANES). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined. Results The overall prevalence rate for hypertension was 35.5% according to HTNdoc and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity. Conclusions Rates

  6. Changes in the prevalence, treatment and control of hypertension in Germany? A clinical-epidemiological study of 50.000 primary care patients.

    Directory of Open Access Journals (Sweden)

    Alexander Michael Labeit

    Full Text Available INTRODUCTION: Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN. Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001. METHODS: Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT study (2003 were analyzed. Physician's diagnosis of hypertension (HTN(doc was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician's diagnosis or the patient's self-reported diagnosis of hypertension (HTN(doc,pat, physician's or patient's self-reported diagnosis or a BP measurement with a systolic BP ≥ 140 mmHg and/or a diastolic BP ≥ 90 (HTN(doc,pat,bp and diagnosis according to the National Health and Nutrition Examination Survey (HTN(NHANES. The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg since 2001. Factors associated with pharmacotherapy and control were determined. RESULTS: The overall prevalence rate for hypertension was 35.5% according to HTN(doc and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD, hyperlipidemia and diabetes mellitus (DM. Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity

  7. Addition of Propranolol in Resistant Arterial hypertension Treatment (APROPRIATE study): study protocol for a randomized double-blind placebo-controlled trial.

    Science.gov (United States)

    Constantine, G R; Ranasinghe, P; Weeratunga, P; Weeraratne, C; Galappatthy, P; Rajapakse, S; Senarath, U; Katulanda, P

    2017-03-14

    Resistant hypertension is defined as an uncontrolled blood pressure despite treatment at best-tolerated doses with at least three antihypertensive agents including a diuretic. It is an emerging public health problem. At present clinical trial data on management of resistant hypertension is limited. Management is largely based on observational studies and expert opinions. Propranolol is a nonselective beta blocker. Several studies have confirmed that propranolol has a significant hypotensive action, both when used alone and as an adjuvant therapy. At present there are no prospective, randomized, clinical studies evaluating the effectiveness of propranolol in patients with resistant hypertension. Therefore, we have designed a prospective randomized trial to evaluate the safety and efficacy of propranolol in patients with resistant hypertension. The study will be conducted as a randomized, double-blind, placebo-controlled clinical trial for a period of 3 months. The study has been approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo. A total of 200 adults with resistant hypertension will be recruited for the study. They will be randomly assigned to the test and placebo groups on a 1:1 ratio. The test group will receive propranolol 40 mg three times a day and the control group will receive an identical placebo capsule. The study drugs will be double blinded to both investigators and subjects. The visits and the evaluations will be done as follows: screening (visit 0), 1 month (visit 1), 2 months (visit 2) and 3 months (visit 3). The primary outcomes of the study is to find a statistically significant difference between the fall in mean systolic and mean diastolic blood pressure measured by ABPM (ambulatory blood pressure monitoring) from baseline between the two groups. Data will be analyzed using SPSS v16. To our knowledge this is one of the first randomized controlled trials evaluating the effects of propranolol in resistant

  8. [Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)].

    Science.gov (United States)

    García Iglesias, A; Lozano Alonso, J E; Álamo Sanz, R; Vega Alonso, T

    2015-01-01

    Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mm Hg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mm Hg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

  9. Efficacy and safety of renal denervation for Chinese patients with resistant hypertension using a microirrigated catheter: study design and protocol for a prospective multicentre randomised controlled trial.

    Science.gov (United States)

    Liu, Zongjun; Shen, Li; Huang, Weijian; Zhao, Xianxian; Fang, Weiyi; Wang, Changqian; Yin, Zhaofang; Wang, Jianan; Fu, Guosheng; Liu, Xuebo; Jiang, Jianjun; Zhang, Zhihui; Li, Jingbo; Lu, Yingmin; Ge, Junbo

    2017-09-01

    Available data show that approximately 8%-18% of patients with primary hypertension will develop resistant hypertension. In recent years, catheter-based renal denervation (RDN) has emerged as a potential treatment option for resistant hypertension. A number of observational studies and randomised controlled trials among non-Chinese patients have demonstrated its potential safety and efficacy. This is a multicentre, randomised, open-label, parallel-group, active controlled trial that will investigate the efficacy and safety of a 5F saline-irrigated radiofrequency ablation (RFA) used for RDN in the treatment of Chinese patients with resistant hypertension. A total of 254 patients who have failed pharmacological therapy will be enrolled. Eligible subjects will be randomised in a 1:1 ratio to undergo RDN using the RFA plus antihypertensive medication or to receive treatment with antihypertensive medication alone. The primary outcome measure is the change in 24 hours average ambulatory systolic blood pressure from baseline to 3 months, comparing the RDN-plus-medication group with the medication-alone group. Important secondary endpoints include the change in office blood pressure from baseline to 6 months after randomisation. Safety endpoints such as changes in renal function will also be evaluated. The full analysis set, according to the intent-to-treat principle, will be established as the primary analysis population. All participants will provide informed consent; the study protocol has been approved by the Independent Ethics Committee for each site. This study is designed to investigate the efficacy and safety of RDN using a 5F saline microirrigated RFA. Findings will be shared with participating hospitals, policymakers and the academic community to promote the clinical management of resistant hypertension in China. ClinicalTrials.gov ID: NCT02900729; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017

  10. Taste and hypertension in humans

    DEFF Research Database (Denmark)

    Roura, Eugeni; Foster, Simon; Winklebach, Anja;

    2016-01-01

    The association between salty taste and NaCl intake with hypertension is well-established, although it is far from completely understood. Other taste types such as sweet, umami or bitter have also been related to alterations in blood pressure. Here, we review the mutual relationship between taste...... and hypertension to identify potential avenues to better control blood pressure. This review focuses on published data involving humans, with the exception of a section on molecular mechanisms. There is compelling evidence to suggest that changes in salty taste sensitivity can be used to predict the onset...... of hypertension. This goes hand in hand with the medical concept of sodium sensitivity, which also increases with age, particularly in hypertensive patients. The association of hypertension with the loss of taste acuity less definitive with some data/conclusions masked by the use of anti-hypertensive drugs...

  11. [Perspectives of application of evidence-based measures of blood pressure control in patients with arterial hypertension].

    Science.gov (United States)

    Posnenkova, O M; Kiselev, A P; Popova, Iu V; Gridnev, V I; Dovgalevskiĭ, P Ia; Oshchepkova, E V; Evstigneeva, S E

    2014-01-01

    of the study was to assess advantages and disadvantages of existing measures of adequacy blood pressure (BP) control and their appropriateness in Russian population of patients with arterial hypertension (AH). Two indicators were studied with the help of American College of Cardiology/American Heart Association methodology (ACC/AHA, 2005): Russian AH registry indicator "Achieving and maintenance of the goal BP" and indicator "Optimal AH treatment" adopted from UK and US measures for the data of Russian AH registry. Each indicator was calculated in the same group comprising 37 827 patients with diagnosis AH. The data from the year 2011 were used. Indicator "Achieving and maintenance of the goal BP" was evaluated in 27% of eligible patients. Extrapolation to the total study group showed that portion patients with goal BP was 17.5%. Indicator "Optimal AH treatment" was evaluated in 47.5% of its target group. Extrapolation to the total study group showed that portion of optimally treated patients was 42.4%. Analysis with the help of ACC/AHA methodology demonstrated feasibility of using both indicators for assessment of degree of BP control among Russian AH patients. According to its characteristics indicator "Optimal AH treatment" was found appropriate for monitoring the effectiveness of AH treatment on popular level. Use of indicator "Achieving and maintenance of the goal BP" in the system of interrelated quality measures was considered to be appropriate for audit of completeness of implementation of recommended treatments in medical care delivered to AH patients. Measures of adequacy of BP control being realized in Russia and abroad allow to characterize reliably the effectiveness of treatment among Russian AH patients and may be implemented on different organizational levels of healthcare system for monitoring of clinical situation in population as well as for audit of work of healthcare units.

  12. Association of AGTR1 Promoter Methylation Levels with Essential Hypertension Risk: A Matched Case-Control Study.

    Science.gov (United States)

    Fan, Rui; Mao, Shuqi; Zhong, Fade; Gong, Minli; Yin, Fengying; Hao, Lingmei; Zhang, Lina

    2015-01-01

    The purpose of the present study was to investigate whether methylation of the angiotensin II type 1 receptor (AGTR1) promoter contributed to the risk of essential hypertension (EH). A total of 96 EH cases and 96 gender- and age-matched healthy controls were recruited. Methylation of 8 CpG dinucleotides (CpG1-8) in the AGTR1 promoter was examined using the bisulphite pyrosequencing technology. Three CpG dinucleotides (CpG6-8) could not be well sequenced, therefore only the remaining 5 CpG sites were analysed. A significantly lower CpG1 methylation level was identified in EH cases than in controls (cases vs. 6.74 ± 4.32% vs. 9.66 ± 5.45%, p = 0.007), and no significant association was observed in the remaining analyses. In addition, significantly lower CpG1 (p = 0.028) and higher CpG2 (p = 0.032) methylation levels were observed in males than in females. In the breakdown association test by gender, a higher CpG1 methylation level was also identified in EH in both males (p = 0.034) and females (p = 0.020). Receiver operating characteristic curves showed that CpG1 methylation was a significant predictor of EH. Furthermore, CpG1 methylation was inversely correlated with uric acid levels in controls. The present study suggests that CpG1 hypomethylation in the AGTR1 promoter is likely associated with the risk of EH in the population assessed. © 2015 S. Karger AG, Basel.

  13. HIPPO-Integrin-linked Kinase Cross-Talk Controls Self-Sustaining Proliferation and Survival in Pulmonary Hypertension

    NARCIS (Netherlands)

    Kudryashova, Tatiana V.; Goncharov, Dmitry A.; Pena, Andressa; Kelly, Neil; Vanderpool, Rebecca; Baust, Jeff; Kobir, Ahasanul; Shufesky, William; Mora, Ana L.; Morelli, Adrian E.; Zhao, Jing; Ihida-Stansbury, Kaori; Chang, Baojun; DeLisser, Horace; Tuder, Rubin M.; Kawut, Steven M.; Sillje, Herman H. W.; Shapiro, Steven; Zhao, Yutong; Goncharova, Elena A.

    2016-01-01

    Rationale: Enhanced proliferation and impaired apoptosis of pulmonary arterial vascular smooth muscle cells (PAVSMCs) are key pathophysiologic components of pulmonary vascular remodeling in pulmonary arterial hypertension (PAH). Objectives: To determine the role and therapeutic relevance of HIPPO si

  14. Electronic monitoring of adherence, treatment of hypertension, and blood pressure control

    NARCIS (Netherlands)

    Onzenoort, H.A. van; Verberk, W.J.; Kroon, A.A.; Kessels, A.G.; Neef, C.; Kuy, P.H. van der; Leeuw, P.W. de

    2012-01-01

    BACKGROUND: Although it is generally acknowledged that electronic monitoring of adherence to treatment improves blood pressure (BP) control by increasing patients' awareness to their treatment, little information is available on the long-term effect of this intervention. METHODS: In this observation

  15. Thiazide diuretics in the management of hypertension.

    Science.gov (United States)

    Khan, Nadia A; Campbell, Norman R C

    2004-01-01

    Hypertension is highly prevalent in Canada, affecting more than 20% of all adults. Thiazide diuretics have been shown in numerous studies to be effective agents for controlling blood pressure and reducing cardiovascular disease and death in hypertensive patients. Thiazide diuretics are recommended as initial first line therapy for uncomplicated hypertension in the 2003 Canadian Hypertension recommendations. However, these agents are underutilized and in Canada, the proportion of persons with hypertension treated with diuretics is declining. To improve understanding of thiazide diuretic use, this document outlines the clinical pharmacology of thiazide diuretics, evidence for effectiveness in treating hypertension, as well as the side effects and controversies surrounding their use.

  16. Immediate hypersensitivity to chlorhexidine.

    Science.gov (United States)

    Vu, Mi; Rajgopal Bala, Harini; Cahill, Jennifer; Toholka, Ryan; Nixon, Rosemary

    2017-06-07

    Chlorhexidine is a widely used and effective antiseptic agent. Although skin contact is usually well tolerated, it may cause both immediate and delayed hypersensitivity reactions. We report a case of immediate hypersensitivity to chlorhexidine causing both skin and respiratory symptoms following occupational exposure to chlorhexidine in a health-care worker. © 2017 The Australasian College of Dermatologists.

  17. Hypertension screening

    Science.gov (United States)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  18. Hypertension screening

    Science.gov (United States)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  19. Family history of hypertension increases risk of preeclampsia in pregnant women: a case-control study

    OpenAIRE

    2016-01-01

    Background Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortalities worldwide. Despite extensive research, the underlying cause of preeclampsia remains poorly understood. This study aimed to offer compelling evidence on the important risk factors of preeclampsia in Amhara region, Ethiopia. Methods A case control study was conducted in public health facilities of Bahir Dar city from September 2014 to January 2015. A total of 453 (151 cases and 302 co...

  20. FORMULATION AND EVALUATION OF ORAL CONTROLLED RELEASE DOSAGE FORM OF ANTI-HYPERTENSIVE AGENT

    Directory of Open Access Journals (Sweden)

    Lakshmi Parvathi A

    2012-12-01

    Full Text Available The aim of present investigation is preparation, characterization and evaluation of oral controlled release matrix tablets of Propranolol HCl in order to improve efficacy and to reduce the side effects. Tablets were prepared by direct compression method using different polymers like Guar gum, HPMC K4M, PVP and MCC used as the directly compressible vehicle. The granules were evaluated for pre-formulation characteristics and the tablets were subjected to post compression parameters, drug content and in-vitro dissolution release studies. In-vitro dissolution studies were carried out for 12 hrs and the results showed that among the nine formulations F8 and F9 showed good dissolution profile to control the drug release respectively. The drug release follows first order kinetics and the mechanism was found to be diffusion controlled for all the formulations (except F-9. The mechanism of drug release from F-9 was diffusion coupled with erosion. The Stability studies were carried out according to ICH guideline which indicates that the selected formulations (F8 and F9 were stable. In conclusion the results suggest that the developed matrix tablets of Propranolol HCl could perform therapeutically better than conventional dosage form, leading to improved efficacy and better patient compliance.