Purpose: This study aims to analyse the direct and indirect relationship between the prevalence of depression and hypertension through central obesity in the Indonesian population.Material and methods: This quantitative analytical observational study is based on secondary data with a cross-sectional design. The data is taken from the Indonesian Baseline Health Research of the Health Research and Development Agency in 2018, which is aggregated data from survey results on household members in 34 Indonesian provinces. We used path analysis and the Sobel test using AMOS 23.0 program to assess the direct and indirect relationship of depression and obesity to hypertension. Multiple linear regression analysis was used to determine the effect of confounding factors on hypertension.Results: The average prevalence (± SD) of depression, central obesity and hypertension in 2018 was 6.21% (± 2.30), 31.26% (± 4.80), and 31.07% (± 4.76). There was an indirect positive relationship between depression and hypertension through central obesity (p = 0.041). The direct effect of depression was associated with a 17% chance of being centrally obese (p = 0.009), and the direct effect of depression and central obesity was associated with a 32.7% chance of becoming hypertensive (p = 0.001). There is no significant direct relationship between depression and hypertension. The effect of confounding factors on hypertension was 21.9% (p = 0.007), lower than the effect of depression and central obesity.Conclusion: Central obesity might be an intermediate variable linking depression and hypertension.
{"title":"The association of depression and central obesity on hypertension in Indonesian provinces: a path analysis of the Indonesian baseline health research 2018 data.","authors":"Achmad Shofwan Hadi, Achmad Lefi, Budi Susetyo Pikir, Budi Utomo, Terrence Timothy Evan Lusida","doi":"10.1080/08037051.2022.2104216","DOIUrl":"https://doi.org/10.1080/08037051.2022.2104216","url":null,"abstract":"<p><p><b>Purpose:</b> This study aims to analyse the direct and indirect relationship between the prevalence of depression and hypertension through central obesity in the Indonesian population.<b>Material and methods</b>: This quantitative analytical observational study is based on secondary data with a cross-sectional design. The data is taken from the Indonesian Baseline Health Research of the Health Research and Development Agency in 2018, which is aggregated data from survey results on household members in 34 Indonesian provinces. We used path analysis and the Sobel test using AMOS 23.0 program to assess the direct and indirect relationship of depression and obesity to hypertension. Multiple linear regression analysis was used to determine the effect of confounding factors on hypertension.<b>Results:</b> The average prevalence (± SD) of depression, central obesity and hypertension in 2018 was 6.21% (± 2.30), 31.26% (± 4.80), and 31.07% (± 4.76). There was an indirect positive relationship between depression and hypertension through central obesity (<i>p</i> = 0.041). The direct effect of depression was associated with a 17% chance of being centrally obese (<i>p</i> = 0.009), and the direct effect of depression and central obesity was associated with a 32.7% chance of becoming hypertensive (<i>p</i> = 0.001). There is no significant direct relationship between depression and hypertension. The effect of confounding factors on hypertension was 21.9% (<i>p</i> = 0.007), lower than the effect of depression and central obesity.<b>Conclusion:</b> Central obesity might be an intermediate variable linking depression and hypertension.</p>","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"187-193"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40639977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.1080/08037051.2022.2095254
Brent M Egan, Sverre E Kjeldsen, Krzysztof Narkiewicz, Reinhold Kreutz, Michel Burnier
Hypertension is the most prevalent cardiovascular risk factor and carries the greatest population attributable risk for cardiovascular disease [1]. Better hypertension control is among the most effective public health and population healthcare levers for reducing years of life lost and disability adjusted life years [2]. Unfortunately, the global burden of hypertension and related cardiovascular and renal diseases continues to grow. Hypertension control rates remain low globally [3]. One relatively simple and potentially scalable approach to improving hypertension control is greater use of singlepill combinations (SPC) containing two or more different classes of antihypertensive medications as initial and add-in therapy [4–12]. In this editorial, the literature is selectively reviewed and summarised on SPC, especially as initial therapy, compared with monotherapy and multiple pill regimens on adherence, hypertension control, clinical outcomes, population impact and adverse effects. An attempt is made to quantify the relative use of SPC versus monotherapy and free-dose combinations in hypertension management. Barriers and potential pathways to greater use of SPC in managing hypertension are explored.
{"title":"Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions.","authors":"Brent M Egan, Sverre E Kjeldsen, Krzysztof Narkiewicz, Reinhold Kreutz, Michel Burnier","doi":"10.1080/08037051.2022.2095254","DOIUrl":"https://doi.org/10.1080/08037051.2022.2095254","url":null,"abstract":"Hypertension is the most prevalent cardiovascular risk factor and carries the greatest population attributable risk for cardiovascular disease [1]. Better hypertension control is among the most effective public health and population healthcare levers for reducing years of life lost and disability adjusted life years [2]. Unfortunately, the global burden of hypertension and related cardiovascular and renal diseases continues to grow. Hypertension control rates remain low globally [3]. One relatively simple and potentially scalable approach to improving hypertension control is greater use of singlepill combinations (SPC) containing two or more different classes of antihypertensive medications as initial and add-in therapy [4–12]. In this editorial, the literature is selectively reviewed and summarised on SPC, especially as initial therapy, compared with monotherapy and multiple pill regimens on adherence, hypertension control, clinical outcomes, population impact and adverse effects. An attempt is made to quantify the relative use of SPC versus monotherapy and free-dose combinations in hypertension management. Barriers and potential pathways to greater use of SPC in managing hypertension are explored.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"164-168"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40623426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-14DOI: 10.1080/08037051.2022.2086531
Aikaterini Damianaki, Kenji Theiler, T. Beaney, Wei Wang, M. Burnier, G. Wuerzner
Abstract Purpose May Measurement Month (MMM) is an international screening campaign for arterial hypertension (HT) organised by the International Society of Hypertension and the World Hypertension League. It aims at raising the awareness of elevated blood pressure (BP) in the population. The goal of this analysis was to assess the results obtained in Swiss pharmacies during a 3-year campaign. Material and methods Swiss data from the MMM17 to MMM19 campaigns were extracted from the global MMM database. The analysis was conducted specifically on measures taken in pharmacies. BP and a questionnaire including demographical and clinical information were recorded for each participant. To assess BP control, ESH 2018 thresholds of <140/90 mmHg and ESH 2021 pharmacy-thresholds of <135/85 mmHg were used. Results From an initial sample of 3634 Swiss participants included during this 3-year campaign, 2567 participants (73.2%women and 26.8% men, p<.001) had their BP measured in triplicates in pharmacies. The first BP measurement was associated with 2.0 ± 4.9 mmHg effect on systolic blood pressure (SBP) (p<.001) and 0.7 ± 3.7 mmHg on diastolic blood pressure (DBP) (p<.001) compared to the mean of the second and third measurements. Based on the ESH 2018 and the ESH 2021 pharmacy thresholds, prevalence of HT (mean of second and third measurements) increased from 29.5% to 38.3%, respectively. In treated participants, 58.3% (279) had an average BP < 140/90 mmHg and 40.3% (193) had an average BP < 135/85 mmHg. Conclusions HT screening campaigns in pharmacies recruits mainly women. It helps the detection of untreated hypertensive participants and uncontrolled treated participants. Our data suggest that the average BP should be calculated on the second and third measurements due to a significant first measure effect in pharmacies measurement. Summary High blood pressure (BP) is a major global public health issue as the leading risk factor of global death. World-wide initiatives like May Measurement Month (MMM) aim to screen thousands of people each year to raise awareness of hypertension (HT). Switzerland participated in MMM 2017–2019 and screened more than 2500 participants in pharmacies. When adopting the recent proposed thresholds of HT diagnosis in pharmacies (ESH 2021 > 135/85 mmHg), HT prevalence in Switzerland is high (38.3%) with only 2/3 of treated hypertensive achieving the BP goals. Women are more likely to participate in such campaigns taking place in pharmacies. A first measurement effect (FME) was also present in pharmacies, highlighting that taking three BP measurements in pharmacies and discarding the first should be also considered in the pharmacy setting. Involving a routine pharmacy-based health care of patients would help to identify more hypertensive patients and uncontrolled treated patients, who may not have had access to BP measurement.
{"title":"High blood pressure screening in pharmacies during May Measurement Month campaigns in Switzerland","authors":"Aikaterini Damianaki, Kenji Theiler, T. Beaney, Wei Wang, M. Burnier, G. Wuerzner","doi":"10.1080/08037051.2022.2086531","DOIUrl":"https://doi.org/10.1080/08037051.2022.2086531","url":null,"abstract":"Abstract Purpose May Measurement Month (MMM) is an international screening campaign for arterial hypertension (HT) organised by the International Society of Hypertension and the World Hypertension League. It aims at raising the awareness of elevated blood pressure (BP) in the population. The goal of this analysis was to assess the results obtained in Swiss pharmacies during a 3-year campaign. Material and methods Swiss data from the MMM17 to MMM19 campaigns were extracted from the global MMM database. The analysis was conducted specifically on measures taken in pharmacies. BP and a questionnaire including demographical and clinical information were recorded for each participant. To assess BP control, ESH 2018 thresholds of <140/90 mmHg and ESH 2021 pharmacy-thresholds of <135/85 mmHg were used. Results From an initial sample of 3634 Swiss participants included during this 3-year campaign, 2567 participants (73.2%women and 26.8% men, p<.001) had their BP measured in triplicates in pharmacies. The first BP measurement was associated with 2.0 ± 4.9 mmHg effect on systolic blood pressure (SBP) (p<.001) and 0.7 ± 3.7 mmHg on diastolic blood pressure (DBP) (p<.001) compared to the mean of the second and third measurements. Based on the ESH 2018 and the ESH 2021 pharmacy thresholds, prevalence of HT (mean of second and third measurements) increased from 29.5% to 38.3%, respectively. In treated participants, 58.3% (279) had an average BP < 140/90 mmHg and 40.3% (193) had an average BP < 135/85 mmHg. Conclusions HT screening campaigns in pharmacies recruits mainly women. It helps the detection of untreated hypertensive participants and uncontrolled treated participants. Our data suggest that the average BP should be calculated on the second and third measurements due to a significant first measure effect in pharmacies measurement. Summary High blood pressure (BP) is a major global public health issue as the leading risk factor of global death. World-wide initiatives like May Measurement Month (MMM) aim to screen thousands of people each year to raise awareness of hypertension (HT). Switzerland participated in MMM 2017–2019 and screened more than 2500 participants in pharmacies. When adopting the recent proposed thresholds of HT diagnosis in pharmacies (ESH 2021 > 135/85 mmHg), HT prevalence in Switzerland is high (38.3%) with only 2/3 of treated hypertensive achieving the BP goals. Women are more likely to participate in such campaigns taking place in pharmacies. A first measurement effect (FME) was also present in pharmacies, highlighting that taking three BP measurements in pharmacies and discarding the first should be also considered in the pharmacy setting. Involving a routine pharmacy-based health care of patients would help to identify more hypertensive patients and uncontrolled treated patients, who may not have had access to BP measurement.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"129 - 138"},"PeriodicalIF":1.8,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49383892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-03DOI: 10.1080/08037051.2022.2077698
C. Thomopoulos, J. Brguljan, R. Cífková, A. Persu, R. Kreutz
ESH Editor: Guido Grassi, Milan ESH Co-Editors: Rosa Maria Bruno, Paris Georg Ehret, Geneva Costas Thomopoulos, Jana Brguljan, Renata C ıfkov a, Alexandre Persu and Reinhold Kreutz Department of Cardiology, Helena Venizelou General & Maternity Hospital, Athens, Greece; Hypertension Department, Medical University Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia; Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer University Hospital, Charles University in Prague, Prague, Czech Republic; Department of Medicine II, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Exp erimentale et Clinique, Universit e Catholique de Louvain, Brussels, Belgium; Institute of Clinical Pharmacology and Toxicology, Charit e – Universit€atsmedizin Berlin, Berlin, Germany
ESH编辑：Guido Grassi，Milan ESH联合编辑：Rosa Maria Bruno，Paris Georg Ehret，Geneva Costas Thomopoulos，Jana Brguljan，Renata Cıfkov a，Alexandre Persu和Reinhold Kreutz Helena Venizelou综合妇产医院心内科，希腊雅典；卢布尔雅那医科大学高血压系，卢布尔雅纳大学医学中心，卢布尔雅那，斯洛文尼亚；捷克共和国布拉格查尔斯大学第一医学院和托马耶大学医院心血管预防中心；捷克共和国布拉格查尔斯大学第一医学院第二医学系；圣卢克临床大学心内科和比利时布鲁塞尔天主教大学实验与临床研究所心血管研究中心；德国柏林大学临床药理学和毒理学研究所
{"title":"Mild chronic hypertension in pregnancy: to treat or wait?","authors":"C. Thomopoulos, J. Brguljan, R. Cífková, A. Persu, R. Kreutz","doi":"10.1080/08037051.2022.2077698","DOIUrl":"https://doi.org/10.1080/08037051.2022.2077698","url":null,"abstract":"ESH Editor: Guido Grassi, Milan ESH Co-Editors: Rosa Maria Bruno, Paris Georg Ehret, Geneva Costas Thomopoulos, Jana Brguljan, Renata C ıfkov a, Alexandre Persu and Reinhold Kreutz Department of Cardiology, Helena Venizelou General & Maternity Hospital, Athens, Greece; Hypertension Department, Medical University Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia; Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer University Hospital, Charles University in Prague, Prague, Czech Republic; Department of Medicine II, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Exp erimentale et Clinique, Universit e Catholique de Louvain, Brussels, Belgium; Institute of Clinical Pharmacology and Toxicology, Charit e – Universit€atsmedizin Berlin, Berlin, Germany","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"121 - 124"},"PeriodicalIF":1.8,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45347577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-23DOI: 10.1080/08037051.2022.2075826
A. Benetos, A. Persu, R. Kreutz
ESH Editor: Guido Grassi, Milan ESH Co-Editors: Rosa Maria Bruno, Paris Georg Ehret, Geneva Athanase Benetos, Alexandre Persu and Reinhold Kreutz Geriatric Department, University Hospital of Nancy, Universit e de Lorraine, Nancy, France; Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Exp erimentale et Clinique, Universit e catholique de Louvain, Brussels, Belgium; Charit e – Universit€atsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
编辑:Guido Grassi，米兰编辑:Rosa Maria Bruno, Paris Georg Ehret, Geneva Athanase Benetos, Alexandre Persu和Reinhold Kreutz老年病科，法国南希洛林大学南希大学医院;心脏病,倩碧大学医疗Saint-Luc、心血管研究钢管研究所de矫揉造作的Exp erimentale倩碧,e catholique de鲁汶大学的布鲁塞尔,比利时;柏林医学大学临床药理学和毒理学研究所，柏林，德国
{"title":"Hypertension in older patients: a STEP forward?","authors":"A. Benetos, A. Persu, R. Kreutz","doi":"10.1080/08037051.2022.2075826","DOIUrl":"https://doi.org/10.1080/08037051.2022.2075826","url":null,"abstract":"ESH Editor: Guido Grassi, Milan ESH Co-Editors: Rosa Maria Bruno, Paris Georg Ehret, Geneva Athanase Benetos, Alexandre Persu and Reinhold Kreutz Geriatric Department, University Hospital of Nancy, Universit e de Lorraine, Nancy, France; Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Exp erimentale et Clinique, Universit e catholique de Louvain, Brussels, Belgium; Charit e – Universit€atsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"118 - 120"},"PeriodicalIF":1.8,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46953774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-16DOI: 10.1080/08037051.2022.2074367
A. Persu, F. Maes, S. Toennes, S. Ritscher, C. Georges, P. Wallemacq, Nicole Haratani, H. Parise, T. Fischell, L. Lauder, F. Mahfoud
Abstract Purpose While poor drug adherence is frequent in patients with resistant hypertension, detailed analyses of the impact of drug adherence on the success of renal denervation are scarce. We report drug adherence at baseline, changes in drug adherence, and the influence of these parameters on blood pressure changes at 6 and 12 months in patients treated with alcohol-mediated renal denervation as part of the Peregrine study. Materials and methods Urinary detection of antihypertensive drugs was performed using high-performance liquid chromatography-tandem mass spectrometry. Full adherence, partial adherence, and complete non-adherence were defined as 0, 1, or ≥2 drugs not detected, respectively. Results Renal denervation was performed in 45 patients with uncontrolled hypertension on ≥3 antihypertensive medications (62% men, age 55 ± 10 years). At baseline, the proportion of fully, partially, and non-adherent patients was 62% (n = 28), 16% (n = 7), and 22% (n = 10), respectively. At 6 months, adherence improved by 21% (n = 9), remained unchanged at 49% (n = 21), and worsened by 30% (n = 13). Mean 24-h systolic blood pressure decreased by 10 ± 13, 10 ± 4, and 14 ± 19 mmHg in fully, partially, and non-adherent patients (p = 0.77), and by 14 ± 14, 8 ± 11, and 14 ± 18 mmHg in patients who improved, maintained, or decreased adherence, respectively (p = 0.35). The results at 12 months were similar. Conclusion About 40% of patients with apparently treatment-resistant hypertension were not fully adherent at baseline, and adherence decreased further in 30%. Nevertheless, mean blood pressure changes after renal denervation were similar irrespective of drug adherence. Our results suggest that such patients may benefit from alcohol-mediated renal denervation, irrespective of drug adherence. These findings are hypothesis-generating and need to be confirmed in ongoing sham-controlled trials.
{"title":"Impact of drug adherence on blood pressure response to alcohol-mediated renal denervation","authors":"A. Persu, F. Maes, S. Toennes, S. Ritscher, C. Georges, P. Wallemacq, Nicole Haratani, H. Parise, T. Fischell, L. Lauder, F. Mahfoud","doi":"10.1080/08037051.2022.2074367","DOIUrl":"https://doi.org/10.1080/08037051.2022.2074367","url":null,"abstract":"Abstract Purpose While poor drug adherence is frequent in patients with resistant hypertension, detailed analyses of the impact of drug adherence on the success of renal denervation are scarce. We report drug adherence at baseline, changes in drug adherence, and the influence of these parameters on blood pressure changes at 6 and 12 months in patients treated with alcohol-mediated renal denervation as part of the Peregrine study. Materials and methods Urinary detection of antihypertensive drugs was performed using high-performance liquid chromatography-tandem mass spectrometry. Full adherence, partial adherence, and complete non-adherence were defined as 0, 1, or ≥2 drugs not detected, respectively. Results Renal denervation was performed in 45 patients with uncontrolled hypertension on ≥3 antihypertensive medications (62% men, age 55 ± 10 years). At baseline, the proportion of fully, partially, and non-adherent patients was 62% (n = 28), 16% (n = 7), and 22% (n = 10), respectively. At 6 months, adherence improved by 21% (n = 9), remained unchanged at 49% (n = 21), and worsened by 30% (n = 13). Mean 24-h systolic blood pressure decreased by 10 ± 13, 10 ± 4, and 14 ± 19 mmHg in fully, partially, and non-adherent patients (p = 0.77), and by 14 ± 14, 8 ± 11, and 14 ± 18 mmHg in patients who improved, maintained, or decreased adherence, respectively (p = 0.35). The results at 12 months were similar. Conclusion About 40% of patients with apparently treatment-resistant hypertension were not fully adherent at baseline, and adherence decreased further in 30%. Nevertheless, mean blood pressure changes after renal denervation were similar irrespective of drug adherence. Our results suggest that such patients may benefit from alcohol-mediated renal denervation, irrespective of drug adherence. These findings are hypothesis-generating and need to be confirmed in ongoing sham-controlled trials.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"109 - 117"},"PeriodicalIF":1.8,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42559192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-14DOI: 10.1080/08037051.2022.2071674
Eline H Groenland, M. Bots, F. Visseren, R. McManus, W. Spiering
Abstract Purpose Out-of-office blood pressure (BP) measurements are essential for the diagnosis and monitoring of hypertension. Current guidelines vary in their recommendations on the protocol for home blood pressure monitoring (HBPM). We aimed to assess the number of blood pressure (BP) measurement days needed for a reliable estimation of true home BP (the expected BP level over time) and hypertension status, using the European guideline-based 7-day HBPM protocol as a reference. Materials and Methods Data from 567 adults who performed a 7-day HBPM were analysed. Blood pressure was measured twice daily (morning and evening readings) using the Microlife Average Mode (MAM), which takes a weighted average of 3 consecutive BP readings. The variability of average BP for an increasing number of measurements was assessed using a linear mixed model including a random intercept per individual and correlated residuals. The reliability of home hypertension status was assessed by the κ statistic. Results Mean home BP of the population was 143 ± 16/84 ± 10 mm Hg. On average, the first BP measurements gave the highest values which then decreased over time. Systolic BP in the morning was systematically lower than systolic BP in the evening (142 ± 17mm Hg versus 144 ± 17 mm Hg, p <0.05). The average of 7 twice-daily MAM BP measurements was at most 5.2/3.3 mm Hg higher and 9.5/4.8 mm Hg lower than the true home BP for 95% of the individuals. Reducing this protocol to 3 days increased this variability by 1.5/1.0 mm Hg and 4.8/2.3 mm Hg, respectively. For diagnosing home hypertension, there was good agreement with a minimum of 4.5 days of HBPM (ĸ-statistic 0.88; 95% Confidence Interval: 0.82–0.94). Conclusion Twice-daily MAM BP measurements for 3 consecutive days provide a reliable estimate of home BP. At least 4.5 consecutive days of HBPM are required for a reliable diagnosis of home hypertension.
【摘要】目的门诊外血压(BP)测量对高血压的诊断和监测至关重要。目前的指南对家庭血压监测(HBPM)方案的建议各不相同。我们的目的是评估可靠估计真实家庭血压(随时间推移的预期血压水平)和高血压状态所需的血压(BP)测量天数，使用基于欧洲指南的7天HBPM方案作为参考。材料和方法对567例进行7天HBPM的成人数据进行分析。使用微生命平均模式(MAM)每天测量两次血压(早晨和晚上的读数)，该模式取连续3次血压读数的加权平均值。使用线性混合模型(包括每个个体的随机截距和相关残差)评估越来越多测量的平均BP的可变性。采用κ统计量评估家庭高血压状况的可靠性。结果人群的平均血压为143±16/84±10 mm Hg，平均首次血压测量值最高，随后随时间下降。早晨收缩压明显低于晚上收缩压(142±17mm Hg vs 144±17mm Hg, p <0.05)。每日7次MAM血压测量的平均值最多比真实家庭血压高5.2/3.3 mm Hg，比真实家庭血压低9.5/4.8 mm Hg，占95%。将试验时间缩短至3天，这一变异性分别增加1.5/1.0 mm Hg和4.8/2.3 mm Hg。对于家庭高血压的诊断，至少4.5天的HBPM (ĸ-statistic 0.88;95%置信区间:0.82-0.94)。结论每日两次连续3天的MAM血压测量可提供可靠的家庭血压估计。至少连续4.5天的HBPM需要可靠的家庭高血压诊断。
{"title":"Number of measurement days needed for obtaining a reliable estimate of home blood pressure and hypertension status","authors":"Eline H Groenland, M. Bots, F. Visseren, R. McManus, W. Spiering","doi":"10.1080/08037051.2022.2071674","DOIUrl":"https://doi.org/10.1080/08037051.2022.2071674","url":null,"abstract":"Abstract Purpose Out-of-office blood pressure (BP) measurements are essential for the diagnosis and monitoring of hypertension. Current guidelines vary in their recommendations on the protocol for home blood pressure monitoring (HBPM). We aimed to assess the number of blood pressure (BP) measurement days needed for a reliable estimation of true home BP (the expected BP level over time) and hypertension status, using the European guideline-based 7-day HBPM protocol as a reference. Materials and Methods Data from 567 adults who performed a 7-day HBPM were analysed. Blood pressure was measured twice daily (morning and evening readings) using the Microlife Average Mode (MAM), which takes a weighted average of 3 consecutive BP readings. The variability of average BP for an increasing number of measurements was assessed using a linear mixed model including a random intercept per individual and correlated residuals. The reliability of home hypertension status was assessed by the κ statistic. Results Mean home BP of the population was 143 ± 16/84 ± 10 mm Hg. On average, the first BP measurements gave the highest values which then decreased over time. Systolic BP in the morning was systematically lower than systolic BP in the evening (142 ± 17mm Hg versus 144 ± 17 mm Hg, p <0.05). The average of 7 twice-daily MAM BP measurements was at most 5.2/3.3 mm Hg higher and 9.5/4.8 mm Hg lower than the true home BP for 95% of the individuals. Reducing this protocol to 3 days increased this variability by 1.5/1.0 mm Hg and 4.8/2.3 mm Hg, respectively. For diagnosing home hypertension, there was good agreement with a minimum of 4.5 days of HBPM (ĸ-statistic 0.88; 95% Confidence Interval: 0.82–0.94). Conclusion Twice-daily MAM BP measurements for 3 consecutive days provide a reliable estimate of home BP. At least 4.5 consecutive days of HBPM are required for a reliable diagnosis of home hypertension.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"100 - 108"},"PeriodicalIF":1.8,"publicationDate":"2022-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42987633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-12DOI: 10.1080/08037051.2022.2064266
Kristina Lundwall, A. Jekell, L. Desta, S. Jacobson, T. Kahan, J. Spaak
Abstract Purpose The dismal combination of hypertension and chronic kidney disease potentiates both cardiovascular disease and loss of renal function. Research points to the importance of arterial and left ventricular stiffening in this process but few studies have compared aspects of central and peripheral hemodynamics in relation to renal function in hypertension. Materials and methods We investigated 107 hypertensive individuals with renal function ranging from normal to severe dysfunction with pulse wave analysis to obtain central blood pressures (BP), augmentation index, carotid-femoral and carotid-radial pulse wave velocity (cfPWV, crPWV), aortic-to-brachial stiffness mismatch (cfPWV/crPWV), endothelial function by forearm flow-mediated vasodilation and myocardial microvascular function by subendocardial viability ratio, and indices of left ventricular structure (left ventricular mass index and relative wall thickness, RWT) and diastolic function (left atrial volume index, E/A, and E/é). Results Mean age was 58 years, BP 149/87 mm Hg, 9% had cardiovascular disease, and 31% were on antihypertensive treatment. Mean estimated glomerular filtration rate (eGFR) was 74 (range 130–21) ml/min × 1.73 m2. Whereas cfPWV and cfPWV/crPWV were independently related to eGFR (r = −0.20, p = 0.002, r = −0.16, p = 0.01), central diastolic BP (r = 0.21, p = 0.04), RWT (r = −0.34, p = 0.001), E/é (r = −0.39, p < 0.001) and E/A (r = 0.27, p = 0.01) were related to eGFR in bivariate correlations, but these findings were not retained in multivariate analyses. Remaining markers of hypertensive heart disease and measures of microvascular function were not related to eGFR. Conclusion Increased aortic stiffness and aortic-to-brachial stiffness mismatch are independently related to reduced eGFR in hypertensive patients, suggesting an important role for aortic stiffness in the evolution of hypertension-mediated renal dysfunction. Aortic stiffness and aortic-brachial stiffness mismatch may be useful early markers to find hypertensive patients at risk for decline in renal function.
{"title":"Aortic stiffness and aortic-brachial stiffness mismatch as markers of renal dysfunction in hypertension","authors":"Kristina Lundwall, A. Jekell, L. Desta, S. Jacobson, T. Kahan, J. Spaak","doi":"10.1080/08037051.2022.2064266","DOIUrl":"https://doi.org/10.1080/08037051.2022.2064266","url":null,"abstract":"Abstract Purpose The dismal combination of hypertension and chronic kidney disease potentiates both cardiovascular disease and loss of renal function. Research points to the importance of arterial and left ventricular stiffening in this process but few studies have compared aspects of central and peripheral hemodynamics in relation to renal function in hypertension. Materials and methods We investigated 107 hypertensive individuals with renal function ranging from normal to severe dysfunction with pulse wave analysis to obtain central blood pressures (BP), augmentation index, carotid-femoral and carotid-radial pulse wave velocity (cfPWV, crPWV), aortic-to-brachial stiffness mismatch (cfPWV/crPWV), endothelial function by forearm flow-mediated vasodilation and myocardial microvascular function by subendocardial viability ratio, and indices of left ventricular structure (left ventricular mass index and relative wall thickness, RWT) and diastolic function (left atrial volume index, E/A, and E/é). Results Mean age was 58 years, BP 149/87 mm Hg, 9% had cardiovascular disease, and 31% were on antihypertensive treatment. Mean estimated glomerular filtration rate (eGFR) was 74 (range 130–21) ml/min × 1.73 m2. Whereas cfPWV and cfPWV/crPWV were independently related to eGFR (r = −0.20, p = 0.002, r = −0.16, p = 0.01), central diastolic BP (r = 0.21, p = 0.04), RWT (r = −0.34, p = 0.001), E/é (r = −0.39, p < 0.001) and E/A (r = 0.27, p = 0.01) were related to eGFR in bivariate correlations, but these findings were not retained in multivariate analyses. Remaining markers of hypertensive heart disease and measures of microvascular function were not related to eGFR. Conclusion Increased aortic stiffness and aortic-to-brachial stiffness mismatch are independently related to reduced eGFR in hypertensive patients, suggesting an important role for aortic stiffness in the evolution of hypertension-mediated renal dysfunction. Aortic stiffness and aortic-brachial stiffness mismatch may be useful early markers to find hypertensive patients at risk for decline in renal function.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"91 - 99"},"PeriodicalIF":1.8,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42496955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-12DOI: 10.1080/08037051.2022.2055530
H. Yalcin, Mohamed A. Elrayess, H. Al-Jighefee, M. K. A. Al-Ruweidi, Shamma Almuraikhy, H. Yassine
Abstract Purpose This study examines the effect of antihypertensive drugs on ACE2 and Angiotensin II levels in hypertensive COVID-19 patients. Introduction Hypertension is a common comorbidity among severe COVID-19 patients. ACE2 expression can be modulated by antihypertensive drugs such as ACEis and ARBs, which may affect COVID-19's prognosis. BB and CCB reduce mortality, according to some evidence. Their effect on circulating levels of ACE2 and angiotensin II, as well as the severity of COVID-19, is less well studied. Materials and methods The clinical data were collected from 200 patients in four different antihypertensive medication classes (ACEi, ARB, BB, and CCB). Angiotensin II and ACE2 levels were determined using standard ELISA kits. ACE2, angiotensin II, and other clinical indices were evaluated by linear regression models. Results Patients on ACEi (n = 57), ARB (n = 68), BB (n = 15), or CCB (n = 30) in this study had mild (n = 76), moderate (n = 76), or severe (n = 52) COVID-19. ACE2 levels were higher in COVID-19 patients with severe disease (p = 0.04) than mild (p = 0.07) and moderate (p = 0.007). The length of hospital stay is correlated with ACE2 levels (r = 0.3, p = 0.003). Angiotensin II levels decreased with severity (p = 0.04). Higher ACE2 levels are associated with higher CRP and D-dimer levels. Elevated Angiotensin II was associated with low levels of CRP, D-dimer, and troponin. ACE2 levels increase with disease severity in patients taking an ARB (p = 0.01), patients taking ACEi, the degree of disease severity was associated with a decrease in angiotensin II. BB patients had the lowest disease severity. Conclusion We found different levels of soluble ACE2, and angiotensin II are observed among COVID-19 patients taking different antihypertensive medications and exhibiting varying levels of disease severity. COVID-19 severity increases with elevated ACE2 levels and lower angiotensin II levels indicating that BB treatment reduces severity regardless of levels of ACE2 and angiotensin II.
{"title":"Soluble ACE2 and angiotensin II levels are modulated in hypertensive COVID-19 patients treated with different antihypertension drugs","authors":"H. Yalcin, Mohamed A. Elrayess, H. Al-Jighefee, M. K. A. Al-Ruweidi, Shamma Almuraikhy, H. Yassine","doi":"10.1080/08037051.2022.2055530","DOIUrl":"https://doi.org/10.1080/08037051.2022.2055530","url":null,"abstract":"Abstract Purpose This study examines the effect of antihypertensive drugs on ACE2 and Angiotensin II levels in hypertensive COVID-19 patients. Introduction Hypertension is a common comorbidity among severe COVID-19 patients. ACE2 expression can be modulated by antihypertensive drugs such as ACEis and ARBs, which may affect COVID-19's prognosis. BB and CCB reduce mortality, according to some evidence. Their effect on circulating levels of ACE2 and angiotensin II, as well as the severity of COVID-19, is less well studied. Materials and methods The clinical data were collected from 200 patients in four different antihypertensive medication classes (ACEi, ARB, BB, and CCB). Angiotensin II and ACE2 levels were determined using standard ELISA kits. ACE2, angiotensin II, and other clinical indices were evaluated by linear regression models. Results Patients on ACEi (n = 57), ARB (n = 68), BB (n = 15), or CCB (n = 30) in this study had mild (n = 76), moderate (n = 76), or severe (n = 52) COVID-19. ACE2 levels were higher in COVID-19 patients with severe disease (p = 0.04) than mild (p = 0.07) and moderate (p = 0.007). The length of hospital stay is correlated with ACE2 levels (r = 0.3, p = 0.003). Angiotensin II levels decreased with severity (p = 0.04). Higher ACE2 levels are associated with higher CRP and D-dimer levels. Elevated Angiotensin II was associated with low levels of CRP, D-dimer, and troponin. ACE2 levels increase with disease severity in patients taking an ARB (p = 0.01), patients taking ACEi, the degree of disease severity was associated with a decrease in angiotensin II. BB patients had the lowest disease severity. Conclusion We found different levels of soluble ACE2, and angiotensin II are observed among COVID-19 patients taking different antihypertensive medications and exhibiting varying levels of disease severity. COVID-19 severity increases with elevated ACE2 levels and lower angiotensin II levels indicating that BB treatment reduces severity regardless of levels of ACE2 and angiotensin II.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"80 - 90"},"PeriodicalIF":1.8,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41388613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-23DOI: 10.1080/08037051.2022.2060182
T. Weber, J. Amar, T. D. de Backer, T. Burkard, M. van der Giet, P. Gosse, A. Januszewicz, T. Kahan, G. Mancia, C. Mayer, M. Muiesan, G. Stergiou, K. Tsioufis, B. Vaisse, R. Kreutz
Abstract Background The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on tertiary hypertension care. Methods We conducted an electronic survey regarding 6 key procedures in hypertension care within the Excellence Center network of the European Society of Hypertension. Results Overall, 54 Excellence Centers from 18 European and 3 non-European countries participated. From 2019 to 2020, there were significant decreases in the median number per centre of ambulatory blood pressure monitorings (ABPM: 544/289 for 2019/2020), duplex ultrasound of renal arteries (Duplex RA: 88.5/55), computed tomographic/magnetic resonance imaging angiography of renal arteries (CT/MRI RA: 66/19.5), percutaneous angioplasties of renal arteries (PTA RA: 5/1), laboratory tests for catecholamines (116/67.5) and for renin/aldosterone (146/83.5) (p < 0.001 for all comparisons, respectively). While reductions in all assessed diagnostic and therapeutic procedures were observed in all annual 3-months periods in the comparisons between 2019 and 2020, the most pronounced reduction occurred between April and June 2020, which was the period of the first wave and the first lockdown in most affected countries. In this period, the median reductions in 2020, as compared to 2019, were 50.7% (ABPM), 47.1% (Duplex RA), 50% (CT/MRI RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41.0% (renin/aldosterone), respectively. Overall differences in reduction between 3-month time intervals were statistically highly significant. Conclusion Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.
{"title":"Covid-19 associated reduction in hypertension-related diagnostic and therapeutic procedures in Excellence Centers of the European Society of Hypertension","authors":"T. Weber, J. Amar, T. D. de Backer, T. Burkard, M. van der Giet, P. Gosse, A. Januszewicz, T. Kahan, G. Mancia, C. Mayer, M. Muiesan, G. Stergiou, K. Tsioufis, B. Vaisse, R. Kreutz","doi":"10.1080/08037051.2022.2060182","DOIUrl":"https://doi.org/10.1080/08037051.2022.2060182","url":null,"abstract":"Abstract Background The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on tertiary hypertension care. Methods We conducted an electronic survey regarding 6 key procedures in hypertension care within the Excellence Center network of the European Society of Hypertension. Results Overall, 54 Excellence Centers from 18 European and 3 non-European countries participated. From 2019 to 2020, there were significant decreases in the median number per centre of ambulatory blood pressure monitorings (ABPM: 544/289 for 2019/2020), duplex ultrasound of renal arteries (Duplex RA: 88.5/55), computed tomographic/magnetic resonance imaging angiography of renal arteries (CT/MRI RA: 66/19.5), percutaneous angioplasties of renal arteries (PTA RA: 5/1), laboratory tests for catecholamines (116/67.5) and for renin/aldosterone (146/83.5) (p < 0.001 for all comparisons, respectively). While reductions in all assessed diagnostic and therapeutic procedures were observed in all annual 3-months periods in the comparisons between 2019 and 2020, the most pronounced reduction occurred between April and June 2020, which was the period of the first wave and the first lockdown in most affected countries. In this period, the median reductions in 2020, as compared to 2019, were 50.7% (ABPM), 47.1% (Duplex RA), 50% (CT/MRI RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41.0% (renin/aldosterone), respectively. Overall differences in reduction between 3-month time intervals were statistically highly significant. Conclusion Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"31 1","pages":"71 - 79"},"PeriodicalIF":1.8,"publicationDate":"2022-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42660395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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