Relationship between duration of antihypertensive regimen and incidence of dry eye syndrome in patients with primary open-angle glaucoma

Purpose. To study the incidence of dry eye syndrome (DES) in patients with primary open-angle glaucoma (POAG), depending on the duration of the use of local antihypertensive therapy. Material and methods. The material for the study was patients who were examined in the treatment and diagnostic department of the Khabarovsk branch the S. Fyodorov Eye Microsurgery Federal State Institution with a confirmed clinical diagnosis of POAG. The main group included 45 patients with a duration of antihypertensive therapy of 1 month or more. The comparison group consisted of 15 patients with newly diagnosed POAG. The period of use of antihypertensive therapy in them did not exceed one month. Depending on the experience of using antihypertensive therapy, the patients of the main group were divided into 3 subgroups. All were questioned using the DEQ-5 dry eye questionnaire, Schirmer I, II and Norn's tests, objective examination of the anterior segment of the eyes. The analysis of the detection and severity of DES among patients with POAG was carried out, taking into account the experience of using the antihypertensive regimen. Results. According to the questionnaire, 26 patients (58%) of the main group presented complaints typical of DES, while in the comparison group only 3 patients (20%) presented them (p<0.05). There was also a tendency towards a decrease in the total and main type of tear production in the main group according to the results of Schirmer's tests I and II – 10.9±1.04 mm and 7.7±0.48 mm versus 13.9±2.5 mm and 10, 2±2.1 mm in the comparison group (p>0.05). The stability of the tear film, according to Norn's test, also differed: 8.2±0.35 sec. and 9.5±1.8 sec. in the main and comparison group, respectively (p> 0.05). Conclusion. The initial symptoms of xerosis of the ocular surface are recorded in the period from 1 to 3 years from the beginning of the use of antihypertensive drugs and increase in proportion to the increase in the length of the disease. Key words: dry eye syndrome, glaucoma, antihypertensive therapy.

Efficacy and tolerability of vitamin C as an add on therapy to standard antihypertensive regimen

Background: In both developing and developed countries, elevated arterial blood pressure is perhaps the most significant public health issue. It is widespread, often asymptomatic, readily observable, typically easily treatable and, if left untreated, frequently leads to lethal complications. According to the Framingham report, the prevalence of hypertension in the white suburban population is almost one-fifth of those with blood pressure >160/95 mm Hg, while almost half of those with blood pressure >140/90 mm Hg. Aim and objectives were to estimate the efficacy of vitamin C as an add-on therapy to the antihypertensive regimen.Methods: The prospective comparative study was undertaken in mild to moderate hypertensive patients to find out the efficacy and tolerability of vitamin C as an add-on therapy to the standard anti-hypertensive regimen in the reduction of blood pressure and C-reactive protein levels. This study was done at the Saraswathi institute of medical sciences, Hapur, UP.Results: For Systolic BP as well as DBP, at baseline there was non-significant difference among all the four group with p value 0.28, whereas at all the visit at 1, 3 and 6 month there was significant difference among the four group with p value<0.01, <0.001 and<0.001.Conclusions: There was significant addon benefit of vit C when added with standard antihypertensive regimen.

Factors in Adherence to Antihypertensive Regimen in Imo State South Eastern Nigeria

Aim: To determine the level of adherence and identify factors that prevent adherence to antihypertensive treatment. Study Design: The study employed the survey method. Methods: Descriptive study was employed and a simple random sampling were used to collect data from 200 randomly consenting respondents. Results: Results showed that the majority of the respondents (65.0%) were females, a large proportion (48.5%) were in the age bracket of 51 – 60 years, the majority (93.5%) were educated and 45.5% were civil servants. A majority (57.5%) of the respondents agreed that lack of income family support was a factor that could lead to non-adherence and only 40% adhered strictly to the doctor’s prescription. Conclusion: Based on the findings, the level of adherence to antihypertensive regimen among the respondents is satisfactory. However, several factors hindered their adherence to medication among which were financial stress, access to drugs and availability of health facilities. It is therefore recommended that the cost of medication be subsidized and health facilities brought closer to people to enhance adherence to regimen.

Reserpine Substantially Lowers Blood Pressure in Patients With Refractory Hypertension: A Proof-of-Concept Study

BACKGROUND Refractory hypertension (RfHTN), a phenotype of antihypertensive treatment failure, is defined as uncontrolled automated office blood pressure (AOBP) ≥130/80 mm Hg and awake ambulatory blood pressure (ABP) ≥130/80 mm Hg on ≥5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist. Previous studies suggest that RfHTN is attributable to heightened sympathetic tone. The current study tested whether reserpine, a potent sympatholytic agent, lowers blood pressure (BP) in patients with RfHTN. METHODS Twenty-one out of 45 consecutive patients with suspected RfHTN were determined to be fully adherent with their antihypertensive regimen. Seven patients agreed to participate in the current clinical trial with reserpine and 6 patients completed the study. Other sympatholytic medications, such as clonidine or guanfacine, were tapered and discontinued before starting reserpine. Reserpine 0.1 mg daily was administered in an open-label fashion for 4 weeks. All patients were evaluated by AOBP and 24-hour ABP at baseline and after 4 weeks of treatment. RESULTS Reserpine lowered mean systolic and diastolic AOBP by 29.3 ± 22.2 and 22.0 ± 15.8 mm Hg, respectively. Mean 24-hour systolic and diastolic ABPs were reduced by 21.8 ± 13.4 and 15.3 ± 9.6 mm Hg, mean awake systolic and diastolic ABPs by 23.8 ± 11.8 and 17.8 ± 9.2 mm Hg, and mean asleep systolic and diastolic ABPs by 21.5 ± 11.4 and 13.7 ± 6.4 mm Hg, respectively. CONCLUSIONS Reserpine, a potent sympatholytic agent, lowers BP in patients whose BP remained uncontrolled on maximal antihypertensive therapy, lending support to the hypothesis that excess sympathetic output contributes importantly to the development of RfHTN.

Long-term results of trabeculotomy ab interno in surgery of glaucoma and cataract

Purpose. To study long-term results of combined surgery for glaucoma and cataract by trabeculotomy ab interno. Material and Methods. 62 patients (64 eyes) with combination of glaucoma and cataract. The age of patients is from 53 to 84 years. The initial stage of glaucoma - 10 eyes, developed - 33 eyes, far-advanced - 21 eyes, level of intraocular pressure (IOP) before surgery in all eyes was intolerant for these stages of glaucoma and ranged from 21 to 36 mmHg. Indications for surgical treatment were absence of persistent IOP level compensation in hypotensive mode, the presence of lens opacification, which affects central visual acuity (VA). Best corrected VA is from 0.01 to 0.6. The technique of combined surgery included: 1st stage - phacoemulsification with implantation of flexible IOL; 2nd stage - trabeculotomy ab interno. The observation period is 18 months. Results. During the observation period of up to 18 months, IOP decreased on average to 20.8±3.1 mmHg. The target level of IOP without an additional antihypertensive regimen remained in 22 eyes (34.37%), with antihypertensive regimen - in 42 eyes (65.63%). In most patients VA increased to 0.2–1.0 and only in 2 cases decreased due to development of posterior capsular fibrosis. Conducting trabeculotomy ab interno has significantly reduced number of drugs used. However, 3-12 months after surgery, IOP increase up to 26-30 mmHg was observed in 4 eyes with antihypertensive drug regimen; microinvasive non-penetrating deep sclerectomy was performed to compensate for it. Conclusion. Trabeculotomy ab interno in combination with phacoemulsification with IOL implantation was effective and safe operation. Sufficient hypotensive effect and high visual functions observe at 18 months observation period.

1423Adherence to triple component antihypertensive regimen is higher in single-pill combination than two-pill regimen: data from a randomized controlled trial using medication event monitoring system

Background Simplicity of regimen is known to be an important determinant of medication adherence and using single-pill combination (SPC) in hypertension treatment resulted in better adherence and persistence than free-equivalent combination. However, this finding has been studied only in dual-component antihypertensive treatments and in observational studies using medication possession ratio as an index of adherence. Medication event monitoring system (MEMS) is considered to be the gold standard in estimating medication adherence. Purpose To investigate the superiority in adherence of triple-component SPC compared to equivalent two-pill regimen using MEMS Methods This is a multi-center open-label randomized controlled trial. Inclusion criteria were hypertensive patients whose clinic blood pressure is not adequately controlled (systolic >140 mmHg or diastolic >90 mmHg) with combination antihypertensive regimen comprising two of three classes (angiotensin receptor blocker, calcium channel blocker and thiazide diuretics) for at least 4 weeks. Eligible patients were randomized either to single-pill (triple-component SPC, olmesartan/amlodipine/ hydrochlorothiazide 20/5/12.5 mg) or two-pill (dual-component SPC + one free pill, olmesartan/hydrochlorothiazide 20/12.5 mg + amlodipine 5 mg) groups and maintained for 12 weeks. Medications were dispensed in MEMS. Primary outcomes were the difference of percentage of dose taken (PDT) and percentage of days with prescribed dose taken correctly (PDTc) between single- and two-pill therapy, calculated from MEMS data. Results From 8 hospitals, 146 hypertensive patients were randomized into single- and two-pill groups. Final analysis was done in 65 and 66 patients in each group from which adherence index could be obtained. Baseline clinical characteristics of the two groups were not different. The single-pill group had significantly higher PDT and PDTc compared to the two-pill group. (median (25–75 percentile) (%), PDT 95.1 (87.9 - 100.0) vs 91.2 (79.8 - 96.5); PDTc 93.1 (79.8 - 96.5) vs 91.3 (70.7 - 96.4), p = both 0.04, by Wilcoxon rank sum test) Percent dose taken Conclusion Single-pill combination of triple-component antihypertensive regimen showed superior adherence compared to equivalent two-pill therapy. Reducing pill burden by using SPC is a relevant strategy to enhance the adherence to multi-drug antihypertensive therapy. Acknowledgement/Funding Daiichi-Sankyo

Association of depression with mortality in an elderly treated hypertensive population

ABSTRACTBackground:Both elevated blood pressure and/or depression increase the risk of cardiovascular disease and mortality. This study in treated elderly hypertensive patients explored the incidence of depression, its association (pre-existing and incident) with mortality and predictors of incident depression.Methods:Data from 6,083 hypertensive patients aged ≥65 years enrolled in the Second Australian National Blood Pressure study were used. Participants were followed for a median of 10.8 years (including 4.1 years in-trial) and classified into: “no depression,” “pre-existing” and “incident” depression groups based on either being “diagnosed with depressive disorders” and/or “treated with an anti-depressant drug” at baseline or during in-trial period. Further, we redefined “depression” restricted to presence of both conditions for sensitivity analyses. For the current study, end-points were all-cause and any cardiovascular mortality.Results:313 (5%) participants had pre-existing depression and a further 916 (15%) participants developed depression during the trial period (incidence 4% per annum). Increased (hazard-ratio, 95% confidence-interval) all-cause mortality was observed among those with either pre-existing (1.23, 1.01–1.50; p = 0.03) or incident (1.26, 1.12–1.41; p < 0.001) depression compared to those without. For cardiovascular mortality, a 24% increased risk (1.24, 1.05–1.47; p = 0.01) was observed among those with incident depression. The sensitivity analyses, using the restricted depression definition showed similar associations. Incident depression was associated with being female, aged ≥75 years, being an active smoker at study entry, and developing new diabetes during the study period.Conclusions:This elderly cohort had a high incidence of depression irrespective of their randomised antihypertensive regimen. Both pre-existing and incident depression were associated with increased mortality.

Sleep-disordered Breathing in Uncontrolled Blood Pressure: Our Experience

Introduction: Sleep-disordered breathing is one of the greatest health problems. It comprises of obstructive sleep apnea, central sleep apnea, periodic breathing, and upper airway resistance syndrome. There are several studies reporting association of uncontrolled blood pressurewith individuals having sleep disordered breathing. Data regarding this were sparse in developing countries. Therefore this study was performed to find out the sleep-disordered breathing among uncontrolled hypertensive patients.Materials and Methods: Study was performed from January, 2014 to January, 2017 in sleep center in Kathmandu, Nepal. Patient with uncontrolled BP were included. Uncontrolled BP was defined as blood pressure>130/80mmHg not on intensive antihypertensive regimen and resistant elevated BP was defined as blood pressure >130/80 mmHg despite intensive antihypertensive regimen. These patients were subjected for polysomnography.Results: Three hundred patients were selected out of which 250 patients with uncontrolled blood pressure were included. They were subjected for overnight polysomnography. Among them, 70patients (28%)were found to have mild obstructive sleep apnea, 20 patients had moderate obstructive sleep apnea (8%)&15 had severe obstructive sleep apnea (6%).Conclusions: This study concludes that those individuals having uncontrolled blood pressure has obstructive sleep apnea and these individuals have to undergo polysomnography.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 36-38