Modern treatment of patients with arterial hypertension and chronic coronary syndrome

Approximately 1,2 billion people worldwide suffer from arterial hypertension. Among these patients, less than half receive effective treatment. Poor blood pressure control contributes to the development of complications such as stroke or coronary artery disease. A patient with such complications automatically becomes a patient at very high cardiovascular risk, and thus requires personalized and effective treatment, not only of hypertension, but also of its complications. Despite the advancement of the disease, lifestyle modification and correct choice of pharmacotherapy can protect the patient from developing heart failure and prevent acute cardiovascular events.

Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association

The widespread treatment of hypertension and resultant improvement in blood pressure have been major contributors to the dramatic age-specific decline in heart disease and stroke. Despite this progress, a persistent gap remains between stated public health targets and achieved blood pressure control rates. Many factors may be important contributors to the gap between population hypertension control goals and currently observed control levels. Among them is the extent to which patients adhere to prescribed treatment. The goal of this scientific statement is to summarize the current state of knowledge of the contribution of medication nonadherence to the national prevalence of poor blood pressure control, methods for measuring medication adherence and their associated challenges, risk factors for antihypertensive medication nonadherence, and strategies for improving adherence to antihypertensive medications at both the individual and health system levels.

Factors Conditioning the Adherence to Pharmacological Prescription in Patients with Hypertension Attending Primary Healthcare Units in Quito – Ecuador

Low adherence to pharmacological treatment in patients diagnosed with hypertension is related to poor blood pressure control and an increased incidence of cardiovascular complications and deaths. A cross-sectional study was performed to determine conditioning factors towards adherence. Questionnaires and clinical evaluations were applied to 187 patients attending three first-level health units; in 130 of them laboratory tests were carried out. Diagnostic criteria were based on the European Clinical Practice Guidelines; adherence was based on the Morinsky test. 57.1% of patients had blood pressure values above the controlled threshold, and 71.1% reported non-adherence to pharmacological prescription. Factors associated whit low adherence were coexisting moderate to severe depression (OR = 2,054; CI 1,064 - 3,964), low educational level (3.75 ± 3.05 years), poor understanding of medical prescriptions (OR = 2.3 CI 1.188 - 4.477), irregular supply and limited economic access to prescribed drugs ((OR = 1.97 CI 1.08 - 3.817), and low satisfaction with the care offered at health services (OR = 2.45; CI 1.202-5.00).

A Review on Prevalence of Medication Adherence among Hypertensive Patients in India

Prevalence of hypertension is increasing exponentially in India. Hence hypertension has become a crucial public health problem in India. High blood pressure (BP) could be a major risk factor for cardio vascular disease and better control can result in prevention of 300,000 of the 1.5 million annual deaths from cardiovascular diseases in India. Various studies among Indian patients evident that not adherence to their antihypertensive regimen and this might end in poor blood pressure control. Adherence to medication among the hypertensive people from the current studies is poor. A comprehensive strategy to enhance adherence to antihypertensive medications is the need of the hour. In this article an attempt has been made to compile all the research evidence on prevalence of Medication Adherence among hypertensive patients in India. Keywords: Medication, Adherence, Prevalence, Hypertension, India.

Factors associated with poor tensional control in the elderly

Funding Acknowledgements Type of funding sources: None. Background Hypertension is a major cardiovascular risk factor, responsible for significant morbidity and mortality. Despite therapeutic progress, blood pressure control remains insufficient. Purpose The aim of our study was to identify the factors associated with poor blood pressure control in the elderly. Methods This was a descriptive study with a prospective data collection including 101 hypertensive treated subjects, aged 65 years and over, followed on outpatient basis between November and December 2019 at the cardiology consultation either at the Habib Thameur hospital or at the Materi hospital. Results Median age was 73 and sex ratio 0.57. The major cardiovascular risk factor was diabetes in 60.4% of cases, followed by dyslipidaemia 48.5% and smoking 40.6%. A history of coronary syndrome was present in 36.6% of cases, followed by atrial fibrillation in 19.8% and 12.9% had a history of ischemic stroke. Thirty-three percent realized regular physical activity and 31% had a high-sodium diet. Four percent of our patients were completely dependent. Among our patients aged 80 and over, 68.2% were frail. The prevalence of poor blood pressure control was 59%. Adherence to treatment was satisfactory in 75.2% of cases. Twelve percent of patients had information about their condition and 89% knew the dosage and schedule for their medication. In multivariate analysis, the factors associated with poor blood pressure control were: non-compliance with treatment (adjusted OR = 0.19; p = 0.013), frailty (adjusted OR = 7.194; p = 0.004), the number of antihypertensive tablets (Adjusted OR = 0.382; p = 0.008), non-use of thiazide diuretics (adjusted OR = 25.903; p = 0.001) and the patient"s lack of knowledge of antihypertensive treatment (adjusted OR = 0.56; p = 0.008). Conclusion Detection of the risk of non-compliance, the use of thiazide diuretics, reducing the number of antihypertensive tablets, screening for frailty and informing the patient about his treatment are necessary to improve blood pressure control in the elderly.

The association between medication adherence and blood pressure control among hypertensive patients attending a tertiary hospital in south-south Nigeria

Background: Hypertension is a common disease among adults. It is a global health condition that requires drugs and lifestyle changes for its management and control. Despite this, the rate of hypertension related deaths has been increasing in prevalence across the world. The purpose of this paper is to determine the association between medication adherence and blood pressure control among hypertensive patients in Family Medicine Clinic, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.Methods: A hospital based cross-sectional study was conducted in Family Medicine Clinic, University of Port Harcourt Teaching Hospital. Systematic sampling method was used to select 400 participants. A structured questionnaire namely Morisky Medication Adherence Scale-4 was adapted and used for data collection in this study. Bivariate analysis was done using Chi square test and odd ratio.Results: A total of 400 (118 males and 282 females) adult hypertensive patients participated in this study. Majority of the participants had poor adherence to medication treatment 71.2% (n=285), whereas the remaining ones 28.8% (n=115) had good adherence. Similarly, most of the participants, 77.2% (n=309) had poor blood pressure control while the remainder 22.8% (n=91) experienced the opposite. The bivariate analysis showed that good medication adherence was significantly associated with good blood pressure control.Conclusions: Medication adherence was low especially among those with poor blood pressure control. This link was statistically significant therefore doctor-patient interaction with emphasis on medication adherence is advocated.

Association between insulin resistant surrogate index and arterial stiffness in hypertensive population: a five year follow-up cohort study

Background Causal association between triglyceride-glucose (TyG) index and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio with arterial stiffness remains unclear. This study aims to assess the effect of TyG index and TG/HDL-C ratio on the incidence of arterial stiffness in hypertensive population, and identify the susceptible subgroups. Methods This study enrolled 1201 hypertensive participants without arterial stiffness aged 18 or above in 2013 and 2014 as baseline. Physical examination and biochemical test including fasting blood glucose (FBG), TG, HDL-C were measured. The TyG index was denoted as ln[TG*FBG/2]. Incident arterial stiffness cases were confirmed during the following annual examination by brachial-ankle pulse wave velocity (baPWV, > 1800 cm/s), until December 31 of 2019. The Cox model was used to explore the association of TyG index and TG/HDL-C ratio with the arterial stiffness. Results During a mean follow-up of 5.09 years, 430 cases of arterial stiffness were confirmed. In the multivariate Cox model, the higher TyG index and TG/HDL-C ratio were positively associated with a higher risk of arterial stiffness (adjusted HR for per-unit increase: 1.39 and 1.08, P < 0.05). The adjusted HR (95% CI) comparing participants in the highest quartile versus lowest quartile of TyG and TG/HDL-C ratio were 1.51 (1.10–2.07) and 1.08 (1.01–1.15), respectively. This positive linear association of evaluated TyG index and TG/HDL-C ratio with arterial stiffness was confirmed using restricted cubic spline function. The observed association was stronger in subgroups with overweight, co-diabetes and poor blood pressure control (systolic pressure ≥ 140 mmHg or without anti-hypertension medication). Conclusion The elevated TyG index and TG/HDL-C ratio independently increased the future risk of arterial stiffness in hypertensive population. Monitoring TyG index and TG/HDL-C ratio deserves more attention in clinical practice, especially in the population with overweight, co-diabetes and poor blood pressure control.

Poor blood pressure control and its associated factors among peoples living with Diabetes Mellitus in sub-Saharan Africa: A Systematic Review and Meta-analysis

Background Poor blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is paucity of evidence on the prevalence and associated factors of poor blood pressure control in SSA. Therefore, this review aimed to estimate the prevalence and its associated factors among people living with DM in SSA. Methods We systematically searched PubMed, African Journals online, Hinari, Google scholar and direct Google to access observational studies conducted in SSA. Microsoft excel spreadsheet was used to extract the data and then exported into STATA/MP version 16.0 for further analysis. Heterogeneity across studies was checked using Cochrane Q test statistic and I2 test and small study effect were checked using Funnel plot symmetry and Egger’s statistical test at 5% significant level. A random-effects model was used to estimates the pooled prevalence of poor blood pressure control with a 95% confidence interval (CI). Results Of the 1,043 articles retrieved, 21 articles with an overall sample size of 6308 were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of poor blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03–2.80, I2 = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57–3.68, I2 = 0.00%, p = 0.47) were significantly associated with poor blood pressure control. Conclusions Only one third of diabetic patients in SSA had achieved target blood pressure. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors. Systematic Review registrations: The review protocol has been registered in PROSPERO with protocol number of CRD42020187901.

Dyslipidemia in blood pressure control among adult hypertensive patients in Kiambu County Hospital Kenya

Introduction: Hypertension is one of the most common non-communicable diseases with about 40% global prevalence in adults and 46% in Africa. Dyslipidemia, among other factors may lead to poor blood pressure control in hypertensive patients. Dyslipidemia occurs when someone has abnormal levels of lipids in their blood However, the role of dyslipidemia in predicting hypertension has not received adequate attention. Objectives: This study aims to determine the relationship between dyslipidemia and blood pressure control among hypertensive patients in Kiambu County Hospital Kenya. Methods: This was a cross-sectional analytical study assessing independent association between blood pressure control and dyslipidemia in a cohort of 251 hypertensive patients in a hospital set up. Multiple logistic regression model was applied to determine factors associated with poor blood pressure control. Results: In total, 251 hypertensive patients, mean age 55.7 years, females-majority (80.9%) were considered in the study. The mean systolic blood pressure was 145.1±22.4mmHg and 87.4±13.0mmHg for diastolic blood pressure. Blood pressure was poorly controlled in 56.6% of the patients. High LDL levels was diagnosed in 82.1% of the patients, 23.1% low HDL levels, 31.9% high triglycerides and 59.8% high total cholesterol levels. Patients with poorly controlled hypertension (68.7%) recorded significantly higher mean total cholesterol (221.4 mg/dl) compared to193.4 mg/dl in the wellcontrolled group (mean 193.4 mg/dl), p0.05). Conclusion: Dyslipidemia was recorded in 68% of adult hypertensive patients and was significantly associated with development of of inadequate blood pressure control. Low density lipids ( LDL) was significantly higher in the poorly controlled group where 68.7% of the patients with high level of total cholesterol had poorly controlled blood pressure. Lifestyle modification, routine lipid profile testing among hypertensive patients, early treatment on high lipid level patients, change of lifestyle and use of statin were recommended for dyslipidemia treatment. Keyword: Hypertension, cardiovascular, blood pressure, diastolic, systolic,non-communicable,disease