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American Journal of Obstetrics &... Dec 2023Postpartum hypertension is a common medical complication of pregnancy and is associated with increased healthcare use, including unplanned interactions with the medical... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postpartum hypertension is a common medical complication of pregnancy and is associated with increased healthcare use, including unplanned interactions with the medical system and readmission, which can add significant stress to both a newly postpartum patient and the medical care delivery system. We currently do not know what the best antihypertensive treatment for postpartum hypertension is and tend to use antihypertensives commonly used during pregnancy. However, the mechanism of action of angiotensin-converting enzyme inhibitors may be well suited for the pathophysiology of hypertension in the postpartum period and may help to provide better control of hypertension and, in turn, decrease healthcare use.
OBJECTIVE
This study aimed to determine if enalapril is superior to nifedipine in preventing prolonged hospitalizations, unplanned medical visits, and/or readmission among women with postpartum hypertension.
STUDY DESIGN
We performed an open-label, randomized controlled trial (ClinicalTrials.gov registered: NCT04236258) in which patients ≥18 years with chronic hypertension, gestational hypertension, or preeclampsia were recruited to receive either 10 mg enalapril daily or 30 mg extended-release nifedipine daily as an initial antihypertensive agent in the period from delivery to 6 weeks postpartum. Recruitment occurred at a tertiary academic hospital from January 2020 to February 2021. Exclusion criteria included being on an antihypertensive when pregnancy started or requiring ≥2 daily antihypertensives during pregnancy. The antihypertensive regimen was managed by the participants' obstetrical provider after the initial randomization. The primary outcome was a composite of prolonged hospitalization, unplanned clinic visits, triage visits, and/or readmission. A total of 40 patients in each arm were needed to detect a decrease in the primary outcome rate from 70% to 40% (α=0.05; power 0.80). Analyses were performed based on the intention-to-treat principal, and each arm was oversampled because of the risk for participant dropout.
RESULTS
A total of 47 patients were randomized to each arm. Aside from the mode of delivery and twin gestation, the maternal demographics were similar between the 2 groups. The primary outcome occurred in 31 of 47 patients (66%) randomized to the nifedipine group and in 30 of 47 (64%) randomized to the enalapril group (P=.83). There was no significant difference in the primary outcome after controlling for mode of delivery and twin gestation. More patients in the enalapril arm had a second antihypertensive added during their primary hospitalization (16 vs 6) and more patients in the nifedipine arm were still on their antihypertensive at 2 weeks postpartum (42 vs 36). There were no adverse events in either group.
CONCLUSION
Enalapril was not superior to nifedipine when used as an initial antihypertensive in the immediate postpartum period in terms of decreasing healthcare use.
Topics: Pregnancy; Humans; Female; Nifedipine; Antihypertensive Agents; Enalapril; Treatment Outcome; Hypertension; Postpartum Period
PubMed: 37806651
DOI: 10.1016/j.ajogmf.2023.101178 -
Phytotherapy Research : PTR Jun 2024Hypertension, or high blood pressure (BP), is a complex disease influenced by various risk factors. It is characterized by persistent elevation of BP levels, typically... (Review)
Review
Hypertension, or high blood pressure (BP), is a complex disease influenced by various risk factors. It is characterized by persistent elevation of BP levels, typically exceeding 140/90 mmHg. Endothelial dysfunction and reduced nitric oxide (NO) bioavailability play crucial roles in hypertension development. L-NG-nitro arginine methyl ester (L-NAME), an analog of L-arginine, inhibits endothelial NO synthase (eNOS) enzymes, leading to decreased NO production and increased BP. Animal models exposed to L-NAME manifest hypertension, making it a useful design for studying the hypertension condition. Natural products have gained interest as alternative approaches for managing hypertension. Flavonoids, abundant in fruits, vegetables, and other plant sources, have potential cardiovascular benefits, including antihypertensive effects. Flavonoids have been extensively studied in cell cultures, animal models, and, to lesser extent, in human trials to evaluate their effectiveness against L-NAME-induced hypertension. This comprehensive review summarizes the antihypertensive activity of specific flavonoids, including quercetin, luteolin, rutin, troxerutin, apigenin, and chrysin, in L-NAME-induced hypertension models. Flavonoids possess antioxidant properties that mitigate oxidative stress, a major contributor to endothelial dysfunction and hypertension. They enhance endothelial function by promoting NO bioavailability, vasodilation, and the preservation of vascular homeostasis. Flavonoids also modulate vasoactive factors involved in BP regulation, such as angiotensin-converting enzyme (ACE) and endothelin-1. Moreover, they exhibit anti-inflammatory effects, attenuating inflammation-mediated hypertension. This review provides compelling evidence for the antihypertensive potential of flavonoids against L-NAME-induced hypertension. Their multifaceted mechanisms of action suggest their ability to target multiple pathways involved in hypertension development. Nonetheless, the reviewed studies contribute to the evidence supporting the useful of flavonoids for hypertension prevention and treatment. In conclusion, flavonoids represent a promising class of natural compounds for combating hypertension. This comprehensive review serves as a valuable resource summarizing the current knowledge on the antihypertensive effects of specific flavonoids, facilitating further investigation and guiding the development of novel therapeutic strategies for hypertension management.
Topics: Antihypertensive Agents; Flavonoids; Humans; Hypertension; Animals; Antioxidants; Nitric Oxide; NG-Nitroarginine Methyl Ester; Oxidative Stress; Blood Pressure
PubMed: 38616386
DOI: 10.1002/ptr.8199 -
MMW Fortschritte Der Medizin May 2024
Topics: Humans; Hypertension; Antihypertensive Agents
PubMed: 38755385
DOI: 10.1007/s15006-024-3916-1 -
MMW Fortschritte Der Medizin May 2024
Topics: Humans; Antihypertensive Agents; Hypertension; Risk Factors; Osteoporotic Fractures; Aged
PubMed: 38755356
DOI: 10.1007/s15006-024-3940-1 -
American Journal of Respiratory and... Dec 2023
Topics: Humans; Pulmonary Arterial Hypertension; Antihypertensive Agents; Hypertension, Pulmonary; Familial Primary Pulmonary Hypertension
PubMed: 37734029
DOI: 10.1164/rccm.202305-0800LE -
Hypertension (Dallas, Tex. : 1979) Aug 2023The prognostic value of systolic blood pressure (SBP) time in target range (TTR) on cognitive outcomes among adults with hypertension remains unclear.
BACKGROUND
The prognostic value of systolic blood pressure (SBP) time in target range (TTR) on cognitive outcomes among adults with hypertension remains unclear.
METHODS
We performed secondary analysis of SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension), which compared intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP intervention in hypertensive individuals. TTR was calculated from baseline to month 3 using 110 to 130 mm Hg and 120 to 140 mm Hg as target range for the intensive and standard groups, respectively. Cognitive outcomes included probable dementia, mild cognitive impairment, and the composite of probable dementia or mild cognitive impairment. Cox regression models were used to evaluate the relationship between SBP-TTR and cognitive outcomes.
RESULTS
A total of 8298 patients were included. Participants with higher TTR were younger and less likely to be women or to have a history of cardiovascular disease. After adjustment of baseline demographics, medical history, and mean SBP, a 1-SD (31.5%) increase in TTR was independently associated with a 14% lower risk of probable dementia (hazard ratio, 0.86 [95% CI, 0.76-0.98]; =0.023). Sensitivity analysis showed consistent results when combining target range as 110 to 140 mm Hg. However, there was no significant association between SBP-TTR and mild cognitive impairment.
CONCLUSIONS
In this post hoc analysis of SPRINT MIND, SBP-TTR was an independent predictor of probable dementia beyond mean SBP. Maintaining SBP within 110 to 140 mm Hg over time may be beneficial for dementia prevention.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT01206062.
Topics: Humans; Female; Male; Blood Pressure; Antihypertensive Agents; Hypertension; Cognition; Dementia; Risk Factors
PubMed: 37165869
DOI: 10.1161/HYPERTENSIONAHA.122.20711 -
International Journal of Biological... Dec 2023Marine organisms such as fish and shellfish are composed of compounds with properties and characteristics that have been proven useful in a variety of sectors such as... (Review)
Review
Marine organisms such as fish and shellfish are composed of compounds with properties and characteristics that have been proven useful in a variety of sectors such as cosmetics, healthcare (wound healing), food industries, and tissue engineering. Collagen extraction from fish waste as a "blue resource" has attracted research attention over the past decade. Around 75 % of fish waste contains a high concentration of collagen. This has driven research in the conversion of these low-cost by-products into valuable products. Collagen extracted by acidic or/and enzymatic methods is gaining a lot of attention today due to its low cost and high yield. Fermentation and enzymatic hydrolysis stand out as one of the most environmentally sustainable and ecologically friendly methods for collagen extraction. Because of its great biocompatibility, excellent bioactivity, and low antigenicity, marine collagen is receiving more attention. Furthermore, collagen-derived peptides may exhibit interesting antioxidant activity, potent antihypertensive activity, and antimicrobial activity against different strains of bacteria. This review focuses on the advancements in extraction and detection methods of marine collagen, both from a technological and legislative standpoint, in addition to exploring its diverse range of application domains.
Topics: Animals; Collagen; Wound Healing; Antihypertensive Agents; Antioxidants; Peptides
PubMed: 37806417
DOI: 10.1016/j.ijbiomac.2023.127253 -
BMJ (Clinical Research Ed.) Aug 2023
Topics: Humans; Cardiovascular Agents; Antihypertensive Agents; Cardiovascular Diseases; Drug Combinations; Hydroxymethylglutaryl-CoA Reductase Inhibitors
PubMed: 37562792
DOI: 10.1136/bmj.p1847 -
Journal of Internal Medicine Sep 2023The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences,... (Review)
Review
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
Topics: Humans; Blood Pressure; Antihypertensive Agents; Financial Stress; Hypertension; Drug Therapy, Combination
PubMed: 37401044
DOI: 10.1111/joim.13678 -
Hypertension (Dallas, Tex. : 1979) Aug 2023Previous meta-analyses using traditional pairwise comparisons did not support intensive systolic blood pressure (SBP) control in patients with diabetes and included... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous meta-analyses using traditional pairwise comparisons did not support intensive systolic blood pressure (SBP) control in patients with diabetes and included trials published before 2015. We aimed to identify the optimal SBP control targets in patients with type 2 diabetes using a systematic review and network meta-analysis of accumulating evidence.
METHODS
We systematically searched PubMed, Embase, and Cochrane Library from inception to August 29, 2022 for randomized controlled trials comparing different blood pressure targets, antihypertensive agents against placebo, or dual antihypertensive agents against single agent in patients with type 2 diabetes. Network meta-analysis was used to obtain pooled results of direct and indirect comparisons of each 5 mm Hg SBP category in association with clinical outcomes adjusted for baseline risk and intervention duration (PROSPERO [International Prospective Register of Systematic Reviews], CRD42022316697).
RESULTS
We identified 30 trials including 59 934 patients with type 2 diabetes. The mean achieved SBP levels ranged from 117 mm Hg to 144 mm Hg among treatment groups. A total of 7799 major cardiovascular diseases events and 4130 deaths were reported. The lowest risk of major cardiovascular diseases was found in patients with achieved SBP level of 120 to 124 mm Hg. The hazard ratio and 95% CI were 0.73 (0.52-1.02) compared with 130 to 134 mm Hg, 0.60 (0.41-0.85) compared with 140 to 144 mm Hg, and 0.41 (0.26-0.63) compared with ≥150 mm Hg. Similar results were found for cardiovascular diseases components including stroke, myocardial infarction, heart failure, and cardiovascular death. All-cause death was reduced at an achieved SBP <140 mm Hg but further reduction did not show additional benefits.
CONCLUSIONS
Our findings support an intensive blood pressure-lowering strategy to prevent major cardiovascular diseases in patients with type 2 diabetes.
Topics: Humans; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Hypertension; Myocardial Infarction; Network Meta-Analysis
PubMed: 37254768
DOI: 10.1161/HYPERTENSIONAHA.123.20954