Hypertension Research最新文献

Non-adherence to antihypertensive therapy remains a major barrier to blood pressure (BP) control globally. The behavioural distinction between intentional (INA) and unintentional non-adherence (UNA) is underexplored in low- and middle-income countries. We aimed to validate the Spanish MMAS-8, identify adherence-complexity phenotypes, and assess the mediating role of adherence between regimen complexity and BP control. In this multicenter, cross-sectional study (2022-2024), 1144 hypertensive patients from Argentina were evaluated. Adherence was assessed using the Spanish MMAS-8. Psychometric validation included Cronbach's alpha and principal component analysis. INA and UNA were classified by domain-based response patterns. K-means clustering was applied to MMAS-8 items and regimen complexity (number of drugs, daily doses). Mediation analysis tested the indirect effect of adherence. The MMAS-8 showed acceptable reliability (α = 0.78) and a unidimensional structure. Full adherence was observed in 41.1%. Among non-adherent patients, 38.5% were INA, 33.6% UNA, and 27.9% mixed. Four phenotypes were identified: (1) high adherence/low complexity; (2) very low adherence/simple regimens; (3) moderate adherence/intermediate complexity; (4) low adherence/high complexity. Adherence significantly mediated the effect of complexity on BP control (β = 0.004; p < 0.001), while the direct effect was non-significant. Compared with phenotype 1, phenotype 2 showed 58% lower odds of control (OR 0.42; 95% CI 0.29-0.61) and phenotype 4 showed 32% lower odds (OR 0.68; 95% CI 0.49-0.94). The Spanish MMAS-8 is valid for this population. Adherence-complexity phenotypes reflect structural and behavioural barriers. Tailored interventions should address INA and UNA using adherence profiling, fixed-dose combinations, and social support.

Exercise and physical activity are known to have a positive effect on antihypertensive and cardiovascular risk reduction. Combination of different types of exercise: aerobic exercise and resistance exercise is reported to have comprehensive cardiovascular benefits than either training alone. Appropriate types of exercise vary depending on the individual's age, gender, underlying disease, and activity level. Maintaining a robust physical state through exercise is critical for preventing cognitive decline or in-hospital death in cases of heart failure.

To evaluate the effect of morning or evening antihypertensive therapy on heart failure (HF), myocardial infarction, stroke and all-cause death in community resident patients in the TIME and BedMed trials, by study-level meta-analysis. These trials included 24,461 patients, experiencing 248 HFs, 371 myocardial infarctions, 331 strokes and 1,044 all-cause deaths. The pooled hazard ratio (HR) and 95% confidence interval (CI) between therapy groups were calculated for each event. For HF, myocardial infarction, stroke and all-cause death, the HRs (95%) CIs, P value, for evening versus morning therapy were 0.77 (0.60-0.99), P = 0.04, 1.02 (0.77-1.35), P = 0.91, 0.92 (0.74-1.14), P = 0.43, and 1.02 (0.90-1.14), P = 0.79, respectively. No heterogeneity was found for HF, stroke and all-cause death, and mild heterogeneity was observed for myocardial infarction. In the TIME and BedMed trials, compared to morning therapy, evening therapy was associated with a 23% lower risk of HF, whereas no difference was observed for other outcomes. This analysis of the TIME and BedMed trials evaluating community resident patients shows that, when compared to morning antihypertensive therapy, evening therapy was associated with a 23% lower risk of HF. CI confidence interval, HR hazard ratio.

Liver fibrosis is a proposed risk factor for intracerebral hemorrhage (ICH) and a predictor of ICH-related mortality. However, its impact on functional outcomes and hemorrhage location remains unclear. We aimed to investigate whether liver fibrosis is associated with clinical outcomes and hematoma characteristics according to ICH location. Consecutive patients with ICH between July 2012 and November 2023 were retrospectively included. Favorable outcomes were defined as a modified Rankin Scale score of 0 to 1 at 3 months following stroke onset. We elucidated whether liver fibrosis, assessed by the Fibrosis-4 index (FIB-4 index), was associated with prognosis and hematoma volume in the entire ICH cohort, and separately in lobar and non-lobar ICH cohorts. Following screening of 608 consecutive ICH patients, 356 patients with ICH (entire cohort) who met the inclusion criteria (198 [56%] males, median age 73 years), including 69 with lobar ICH and 287 patients with non-lobar ICH, were identified. Similar to the entire ICH cohort, especially in the lobar ICH cohort, the FIB-4 index correlated negatively with favorable outcomes (prevalence ratio (PR) 0.823, 95% confidence interval (CI) 0.692-0.979, p = 0.027) and positively with hematoma volume (unstandardized coefficient 3.914, 95% CI 1.914-5.915, p < 0.001). Conversely, the FIB-4 index was associated with neither prognosis nor hematoma volume in the non-lobar ICH cohort. Liver fibrosis, as assessed by the FIB-4 index, is associated with unfavorable outcomes and hematoma volume in ICH, particularly in lobar ICH.