An Analysis of the Effects of Blood Pressure and Antihypertensive Drugs on Heart Disease

Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline (2017 ACA/AHA Guideline) in November 2017. However, other organizations such as the European Society of Cardiology and European Society of Hypertension maintained their diagnostic thresholds. It is necessary to evaluate the effects of blood pressure (BP) and antihypertensive drugs on the probability of having heart disease (HD). Data and Methods: The effects of BP, antihypertensive drugs and other factors on the probability of undergoing HD treatment were analyzed. We used a dataset containing 83,287 medical check-up and treatment records obtained from 35,504 individuals in 5 fiscal years. The probit models were used in the study. Considering the possibility of endogeneity problems, different types of models were used. Results: We could not find evidence that a higher systolic BP increased the probability of undergoing HD treatment. However, diastolic BP increased the probability in most of the models. Taking antihypertensive drugs also increased the probability of undergoing HD treatment. Diabetes was another important risk factor. Conclusion: The results of this study did not support the new 2017 ACC/AHA Guideline. It is necessary to choose proper drugs and methods to reduce the risks of side effects. Limitations: The dataset was observatory, the data were obtained from just one medical society, and sample selection bias might exist.

Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

High blood pressure (HBP) is a health problem world—wide. In Togo, that affection constitutes a more and more pre-occupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients’ blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01 ± 12.55 years;sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn’t observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients’ SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients’ DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p < 0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p < 0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine, α methyldopa for outpatients;furosemide, nicardipine, captopril, α methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

Reliability of Blood Pressure Measurements: An Analysis of the White Coat Effect and Its Fluctuations

In this paper, we evaluate the difference between the first and second measurements of blood pressure (BP) when BP is measured twice using the results of 17,775 medical checkups. The two measurements for both systolic BP (SBP) and the diastolic BP (DBP) fluctuated a large amount even though they were measured at a short interval. The first measurements were 6.7 and 2.4 mmHg higher than the second ones for SBP and DBP, suggesting a white coat effect. Then, the factors that might affect the differences between the two measurements were analyzed by the regression models. For both SBP and DBP, the difference increased as the first measurement increased. Age, gender, BMI and alcohol consumption were other important factors affecting the difference. In the case of a typical male individual, the typical criteria for hypertension of 140/90, 160/100 and 180/110 mmHg criteria in the first measurement would correspond to 135/86, 150/94 and 165/102 mmHg in the second measurement. The necessity of developing accurate and cost-efficient BP measurement methods is strongly suggested.

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy

Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.

Effects of erythromycin on pressure in pyloric antrum and plasma motilin and somatostatin content in dogs

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Understanding the effect of propofol and electrical cardioversion on the systolic blood pressure of emergency department patients with atrial fibrillation

Dear editor, We read with pleasure the well-designed study by Butler et al of electrical cardioversion of emergency department patients with atrial fibrillation. We appreciate their analysis of the distinctives of procedural sedation when employed for this indication. Understanding the dosing adjustments to propofol undertaken by their sedationists will help us more carefully evaluate our own approach to sedating patients undergoing electrical cardioversion of atrial fibrillation.

Effect of an Environmental Contaminant, Diisopropyl Methylphosphonate, on the Blood Pressure of the Mallard

During a toxicological test using diisopropyl methylphosphonate (DIMP) on mallards, an anaesthesia-like response was noted after oral dosing. In order to further elucidate these effects, arterial blood pressures were determined both pre-and post-dosing on adit male and female mallards by cannulation of the left carotid artery. A significant decrease in systolic, diastolic, and mean blood pressure was noted after the oral administration of DIMP. There was no significant difference in response between males and females. During the first 30 min after dosing, systolic pressure fell from an average of 158 mmHg, to 94 mmHg, diastolic decreased from 127 mmHg to 63 mmHg, and mean blood pressure dropped from 138 mmHg to 75 mmHg. However, there was no significant effect on pulse pressure, heart rate, or respiratory rate. These results are compared to physiological data cited in the literature for various CNS-acting drugs on mallards.

Evaluation of Blood Pressure Control Medicines Using Health and Medical Checkup Data in Japan: Alternative Methods for Randomized Controlled Trials

Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious problems. Data and Methods: We evaluated the effects of BP medicines in Japan using a dataset containing 113,979 cases. We employed four statistical methods in the analysis. First, we simply compared the systolic blood pressure (SBP) of individuals with and without BP medicines. We then used a regression model with a dummy variable, representing taking medicines or not. We replaced the dummy variable by its expected value, and estimated the regression model again. Finally, we selected individuals who had both taken and not taken medicines at different times. The effect of sample selection was also considered in the estimation. Results: For the simple comparison, SBP with BP medicines was 11 mmHg higher than without medicines. In the next regression analysis, SBP with BP medicines was still 5 mmHg higher. When the dummy variable was replaced by its expected value, SBP with medicines decreased by 7 mmHg. For individuals taking medicines at some times and not at others, SBP decreased by 9 and 8 mmHg in models with and without a sample bias correction, respectively. Conclusion: The methods eliminated some problems of RCT and might be attractive. However, we obtained contradictory conclusions depending on the statistical methods employed, despite using the identical dataset. Statistical methods must be selected carefully to obtain a reliable evaluation. Limitations: The dataset was observatory, and the sample period was only 3 years.

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.

Seasonal changes in blood pressure:Cardiac and cerebrovascular morbidity and mortality

Cold is a seasonal and circadian risk factor for cardioand cerebrovascular morbidity and mortality. Colder temperatures have been associated with higher blood pressure(BP), based on studies which show that BP levels measured during the summer months are generally lower than those measured during the winter months. Residents in geographic areas which have greater seasonal temperature differences show greater fluctuation in BP. Surprisingly, atmospheric pressure, rainfall, and humidity were not related to BP levels. The increased sympathetic nervous activity due to cold, as evidenced by elevated BP and by plasma and urinary catecholamines, has been proposed as being the underlying etiology. Patients with heart failure may experience, in cold conditions, endothelial dysfunction and produce fewer endogenous vasodilators(e.g., nitric oxide, prostaglandins) and more endogenous vasoconstrictors(e.g., endothelin), thus increasing afterload. Arterial stiffness is also related to seasonal BP changes. Increased BP, arterial stiffness and endothelial dysfunction could predispose to increased coronary and cerebrovascular events. Improved protection against lower temperatures or increased doses of existing medications or the addition of newer medications could lead to a reduction in increased cardiovascular mortality in winter. Here, we briefly review findings from existing literature and provide an update on seasonal long-term variation in BP along with the related complications.

An Analysis of Blood Pressure Situations in Japan Using the Large-Scale Medical Checkup Dataset

Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.

Non-alcoholic fatty liver disease,diabetes medications and blood pressure

New glucose-lowering agents reduce liver enzyme levels and blood pressure(BP).Whether this finding can be extended to non-alcoholic fatty liver disease(NAFLD)patients,in whom a bidirectional association of NAFLD measures and BP has been also demonstrated,remains by and large unknown.

Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index

Background: In new outpatients, blood pressure should be measured in both arms. A previous study reported that an inter-arm systolic blood pressure difference (ΔSBP) of ≥10 mm Hg is associated with an increased risk of mortality. Aim: The aim was to identify the associations with absolute values of ΔSBP (|ΔSBP|) ≥10 mm Hg. Subjects and Methods: This study included 2481 patients. Patients with a body mass index ≥25 kg/m2 were defined as obese. The group of A was defined as following: ankle-brachial index (ABI) was <0.9 or ≥1.3. ΔSBP was expressed as right arm BP minus left arm BP. |ΔSBP| ≥10 mm Hg were analyzed using multivariate logistic analysis. Results: |ΔSBP| ≥10 mm Hg was found in 6.0% of patients and |ΔSBP| < 5 mm Hg in 80.4%. In multivariate analysis, the odds ratios (ORs) of the associations with |ΔSBP| ≥10 mm Hg were significantly associated with abnormal ABI and obesity regardless of sex and age. Moreover, the OR of the combined effects of abnormal ABI and obesity was higher than that of abnormal ABI and obesity alone. Conclusion: |ΔSBP| ≥10 mm Hg was associated with abnormal ABI and obesity. In a primary care setting, blood pressure should be actively measured in both arms. This study suggests that the associations with |ΔSBP| ≥10 mm Hg may be a useful part of screening for abnormal ABI.

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

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 b^ood 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 （HbAlc）, 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 Huaju intervention. TRIAL REGISTRATION IDENTIFIER： ChiCTR-TRC-11001633.

Approach by Health Professionals to the Side Effects of Antihypertensive Therapy： Strategies for Improvement of Adherence

The aim was to determine whether complaints about side effects made by stage Ill hypertensive patients undergoing antihypertensive therapy lead to adequate blood pressure control. Forty-eight patients were monitored by a nurse every 15 days over the course of 180 days. At baseline, both groups presented similar SBP （systolic blood pressure） （GA, 196 （5）） mm Hg and GB, 189 （6） mm Hg） and DBP （diastolic blood pressure） （GA, 122 （3） mm Hg and GB, 121 （4） mm Hg）. On day 165, after a progressive decline in blood pressure levels, the two groups differed significantly from each other regarding SBP （GA, -16.9 （24） mm Hg and GB, -40.8 （31） mm Hg）. At the final follow-up, the patients were allocated to two groups： without complaints （GA） and with （GB） complaints about side effects. Complaining about side effects was a decisive factor for immediate nursing intervention and improved control over BP.

不同降压药物治疗原发性高血压患者血压变异的研究进展

血压变异性是心、脑血管疾病及肾脏损伤的独立危险因素,并在其发生、发展及严重程度方面较平均动脉压具有更高的预测价值,同时也是评价降压药物疗效的重要指标之一。所以早期判断高血压患者的血压变异情况并对其进行积极干预,防止心脑血管事件的进一步发展已成为高血压管理过程中的重要环节。本文将从血压变异性的定义及分类、控制血压变异性的意义以及常见降压药物的疗效观察这几个方面展开综述。

云南元江诺丽果汁对正常大鼠血压与糖尿病模型小鼠血糖的影响

为了探究云南元江诺丽果汁与其他种类诺丽果汁对正常大鼠血压与糖尿病模型小鼠血糖的影响,以正常大鼠和糖尿病模型小鼠为研究对象,观察试验前后正常大鼠血压和糖尿病模型小鼠血糖的变化。正常大鼠麻醉后经十二指肠灌注药或果汁,采用直接测压法测定血压,读取试验前后的血压值并进行数据分析;采用腹腔注射四氧嘧啶建立糖尿病小鼠模型,并分别给予造模成功的小鼠相对应的药物或果汁,每日给药或果汁1次,连续给药或果汁9 d,并在第10天采集小鼠血液测定其空腹血糖数值进行研究对比分析。分析大鼠血压发现,云南元江高剂量组在注射云南元江诺丽果汁前后血压值无显著差异;中剂量组在注射90 min前后血压值差异极显著;低剂量组在注射240 min前后血压值差异显著;中剂量组降血压效果最佳。分析糖尿病模型小鼠血糖发现,注射云南元江诺丽果汁的低、中、高3个剂量组均可不同程度地降低血糖,且低剂量组的降血糖效果最佳;大溪地诺丽果汁降糖率为0.00%。云南元江诺丽果汁具有降血糖和降血压的双重功效,且低剂量组降血糖的效果最显著;诺丽由美国夏威夷引种至云南西双版纳和元江,对其降血糖的功效并无显著影响。

围手术期高血压的管理与控制

围手术期未得到控制的高血压可能影响患者手术中血流动力学稳定性,进而影响患者预后,增加其他并发症出现和死亡的风险。对于接受手术的高血压患者,都需要权衡利弊选择合适的降压药物来降低围手术期不良事件的发生率。目前我国对围手术期血压的管理尚无统一定论,该文从非心脏手术、心脏手术、妊娠、嗜铬细胞瘤4个手术类型系统梳理围手术期血压的控制目标与药物使用方案,为高血压患者的围手术期管理提供参考。

腺苷负荷与ATP负荷评估冠状动脉微血管疾病中的不良反应分析

背景 冠状动脉微血管疾病(CMVD)的诊疗一直是非冠状动脉阻塞性缺血性心脏病的重点。腺苷注射液和ATP注射液是目前测定冠状动脉血流储备(CFR)评估CMVD的临床常用负荷药物,两者有所关联,但具有显著区别。ATP是腺苷的前体,其价格低廉且血管扩张机制与腺苷类似,临床上常代替腺苷,但忽视了其潜在的不良反应。目的 比较腺苷负荷与ATP负荷在评估CMVD过程中的不良反应发生率。方法 选取2019年6月—2020年7月因典型心绞痛就诊于陕西省人民医院心内科行冠状动脉造影术/冠状动脉CT血管造影术(CTA)明确各支冠状动脉残余狭窄直径<50%的患者170例,依据随机数字表法分为腺苷组和ATP组,腺苷组88例,ATP组82例。腺苷组给予腺苷注射液负荷测定CFR,ATP组采用ATP负荷测定CFR,检测过程中记录患者的血压、心率、扫描时间及不良反应发生情况。结果 与腺苷组相比,ATP组患者胸闷[61.0%(50/82)和20.4%(18/88)]、头晕[72.0%(59/82)和31.8%(28/88)]、头痛[68.3%(56/82)和11.4%(10/88)]、胃肠道不适[13.4%(11/82)和4.5%(4/88)]、心悸[69.5%(57/82)和5.7%(5/88)]、气促[40.2%(33/82)和2.3%(2/88)]、大汗[28.0%(23/82)和3.4%(3/88)]、潮热[19.5%(16/82)和2.3%(2/88)]、颜面潮红[13.4%(11/82)和4.5%(4/88)]的发生率均较高(P<0.05);两组患者神经过敏、耳鸣、咽干、颈部不适的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 与ATP负荷相比,腺苷负荷测定CFR的不良反应发生率更低。

经皮去肾神经术治疗高血压临床试验的展望

高血压作为最常见的心血管疾病,存在患病率高、知晓率低、控制率低的问题。由于药物治疗的局限性,近十年来,经皮去肾神经术(RDN)作为一种新兴的治疗高血压介入手段脱颖而出。经过长达十余年的循证医学研究证明了该技术在降压方面的有效性与安全性。目前,RDN临床试验的挑战在于患者为了控制血压而无法避免对降压药物进行调整,从而对RDN降压效果产生干扰。无论是Simplicity HTN-36个月试验和REQUIRE试验等失败案例,还是SPYRAL与RADIANCE系列试验,其结果都表明RDN临床试验的结果评估需要纳入降压药物的变化。因为降压药物与介入手术治疗是影响血压水平的两个决定因素,所以评估RDN的降压疗效时不得不考虑患者降压药物的调整,还要回答一个重大临床问题即RDN术后患者是否可以少服以至不服用药物。我国的SMART研究不再以单纯的血压可以降低的mmHg数,而是以高血压防治指南中的治疗目标即诊室血压达标率为主要终点之一;引入了预设的“药物负荷指数”并将诊室收缩压(OSBP)达标率和降压用药变化作为临床试验的复合终点。其结果证明了RDN作为降压的辅助疗法,可以显著降低患者的药物负荷水平,将患者的OSBP控制达标。在未来的RDN临床试验中,应当充分考虑药物负荷的影响,明确血压指标和受试人群。RDN治疗高血压的临床试验方式会更加多元化,包括更能回答临床重大问题和符合治疗指南的有效性终点、更多种消融能量平台的尝试、术中手术终点的判定和试验对照组的设定等。