A Stronger Effect of Body Mass Index and Waist Circumference on the Prevalence of Uncontrolled Hypertension among Caucasian Men than Women

<b><i>Background:</i></b> Gender-related differences in fat distribution may affect blood pressure (BP) control in hypertensive subjects. The aim of the study was to assess how body mass (BM), BMI, and waist circumference (WC) influence the effectiveness of antihypertension therapy in hypertensive men and women in daily clinical practice. <b><i>Patients and Methods:</i></b> The observational study involved 12,289 adult hypertensive Caucasians (6,163 women) declaring regular use of antihypertensive drugs. BP control was scored based on the mean values of 2 attended office BP measurements. WC thresholds for visceral obesity were adopted from definitions of the International Diabetes Federation (≥94/80 cm for men/women) and National Cholesterol Education Program Adult Treatment Panel III (≥102/88 cm for men/women). Stepwise backward multivariable logistic regression was used to analyse correlates of the effectiveness of hypertension therapy. <b><i>Results:</i></b> The predictive value of BMI ≥30 (for uncontrolled hypertension) was stronger than that of visceral obesity, regardless of the criteria used. In men, BP control rapidly deteriorated with BMI (odds ratio [OR] up to 8.58 [95% CI: 5.74–12.83]) and WC (OR up to 5.09 [3.84–6.74]), while in women, the association was more flattened (OR up to 3.63 [2.78–4.74] and 1.93 [1.59–2.35], respectively). However, the highest risk of uncontrolled BP occurred in women with BM ≥110 kg (OR = 10.47 [5.05–21.71]) and men with BM ≥125 kg (OR = 9.66 [5.86–15.94]). <b><i>Conclusions:</i></b> (1) Obesity and visceral obesity limit the effectiveness of antihypertension therapy more in men than in women. (2) This phenomenon should be taken into account in the prescription of adequate doses of antihypertensive drugs.

Antihypertension drugs in prevention of cognition disorder and dementia: focus on calcium channel blockers and diuretics

Arterial hypertension is associated with elevated risk of cognition decline and vascular dementia development, as the Alzheimer disease development. Therefore, antihypertension therapy might be of preventive value. The review is focused on literary data that witness on, despite controversial, evidence of cerebroprotective action of the range of antihypertension medications. Especially, dihydropyridine calcium antagonists, diuretics and some blockers of renin-angiotensin-aldosterone system. These act not only via blood pressure decrease, but due to additional specific neuroprotective mechanisms. This makes it to consider calcium antagonists and diuretics as a major component of systemic hypertension management, incl. elderly and senile patients, aiming to prevent cognition decline and dementia of various types development.Nitrendipine, among the calcium channels antagonists, and indapamide among diuretics have acquired the broadest evidence that points on their cerebroprotective properties.

PENGARUH PEMBERIAN OBAT ANTIHIPERTENSI TERHADAP KUALITAS HIDUP PASIEN HIPERTENSI DENGAN GANGGUAN GINJAL KRONIK DI INSTALASI HEMODIALISA RSUP DR. HASAN SADIKIN BANDUNG

ABSTRAK Hipertensi merupakan penyebab gangguan ginjal kronik melalui suatu proses yang mengakibatkan hilangnya sejumlah besar nefron fungsional yang progresif dan irreversible. The Kidney Disease Outcome Quality Initiative (K/DOQI) of the national kidney foundation (NKF) merekomendasikan target tekanan darah pada pasien gangguan ginjal kronik < 140/90 mmHg sehingga dapat mengurangi risiko terjadinya penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian obat antihipertensi terhadap kualitas hidup pasien GGK yang menjalani hemodialisis di RSUP DR.Hasan Sadikin Bandung. Penelitian menggunakan desain cross sectional observational konkuren dengan mengkaji data rekam medis dan status harian pasien selama periode Desember 2015-Febuari 2016 dan hasil pengisian kuisioner Kidney Disease and Quality of Life (KDQOLTM-36). Subyek penelitian merupakan pasien GGK yang menjalani hemodialisis dan mendapatkan terapi obat antihipertensi (OAH), laki-laki dan perempuan, usia lebih dari 18 tahun. Terdapat perbedaan bermakna penurunan tekanan darah sistolik(p=0,011) dan diastolik (p=0,023) untuk setiap terapi OAH, kombinasi 2 OAH memberikan efek penurunan tekanan darah sistolik dan diastolik yang paling baik dan berbeda bermakna (p=0,001). Pengobatan tunggal dan kombinasi dua obat antihipertensi memberikan efek penurunan tekanan darah yang paling baik.Setiap jenis terapi obat antihipertensi tidak memberikan perbedaan bermakna terhadap kualitas hidup kecuali domain aspek efek penyakit (p=0,041). Kata kunci : Hipertensi, gagal ginjal kronik, hemodialisis, antihipertensi, KDQOL, kualitas hidup. 40 ABSTRACT Background: Hypertension is the leading cause of chronic kidney disease (CKD) through a process that resulted in loss of a large number of functional nephron on progressive and irreversible. The Kidney Disease Outcome Quality Initiative (K/DOQI) of The National Kidney Foundation (NKF) recommends a target blood pressure values of < 130/80 mmHg in CKD patients, it can reduce the risk of cardiovascular disease. Objective : The purpose of this study is to understand the antihypertension medication effects to the quality of life of hemodialysis patients in RSUP DR.Hasan Sadikin Bandung. Methods : The design of study is cross sectional observational with concurrent medical record with patients daily status analyses during December 2015 - February 2016 with questionnaire by the Kidney Disease and Quality of Life (KDQOL-36. Results : The analysis result shows significant differences in the reduction of systolic (p=0, 011) and diastolic (p=0, 023) blood pressure in each group of antihypertension therapy. Furthermore, 2 combination of antihypertension therapy gives the most significant different in reduction of systolic and diastolic blood pressure (p=0, 001). Conclusions : Second combination of antihypertension therapy can be reduce of blood pressure better than other therapy. Second combinations of antihypertension therapy is best for decrease of blood pressure and creatinin serum. In all domain of quality of lifes, symptom/problems have a highest score, and burden of kidney disease have a lowest score of quality of life. Keywords : chronic kidney disease, hemodialysis, antihypertension, KDQOL, quality of life.