Hypertension
Cohort Study: Increased fracture risk linked with initiation of antihypertensive medication in older veterans
26 Apr, 2024 | 12:29h | UTCStudy Design and Population:
This retrospective cohort study evaluated the association between antihypertensive medication initiation and fracture risk among older long-term care nursing home residents within the Veterans Health Administration. Conducted from 2006 to 2019 with data analysis spanning 2021 to 2023, the study utilized target trial emulation techniques and included 29,648 residents. A 1:4 propensity score-matched method was employed to compare medication initiators with non-initiators.
Main Findings:
Out of the matched cohort of 64,710 residents, those who initiated antihypertensive medication showed a higher incidence of fractures (5.4 per 100 person-years) compared to controls (2.2 per 100 person-years). The adjusted hazard ratio for fractures was 2.42. Notably, higher risks were observed in subgroups with dementia or elevated blood pressure thresholds (systolic ≥140 mm Hg or diastolic ≥80 mm Hg). Risks for severe falls and syncope were also elevated in the medication-initiating group.
Implications for Practice:
The study indicates a significant association between the initiation of antihypertensive medications and increased fracture risks among older, frail nursing home residents. Given these findings, clinicians should exercise caution and consider enhanced monitoring and preventive strategies when prescribing these medications to this vulnerable population.
Reference (link to abstract – $ for full-text):
Dave, C. V. et al. (2024). Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents. JAMA Intern Med, Published online April 22, 2024. DOI:10.1001/jamainternmed.2024.0507.
Pragmatic Cluster-Randomised Trial: Efficacy of a Fixed-Dose Polypill in Reducing Cardiovascular Disease Risk in Rural Iran
21 Apr, 2024 | 21:05h | UTCStudy Design and Population: The PolyPars Study was structured as a two-arm pragmatic cluster-randomised trial within the larger PARS cohort study. It targeted residents aged over 50 in a district in southern Iran, dividing 91 villages into two groups: one receiving a once-daily polypill (containing two antihypertensives, a statin, and aspirin) alongside non-pharmacological interventions, and the other receiving only the non-pharmacological interventions. The trial included 4,415 participants aged 50-75 years, with the primary endpoint being the first occurrence of major cardiovascular events.
Main Findings: Over a median follow-up of 4.6 years, adherence to the polypill was high at 86%. The intervention arm showed a significant reduction in the incidence of the primary outcome, with only 4.0% (88 participants) experiencing major cardiovascular events compared to 8.0% (176 participants) in the control arm. This translates to a hazard ratio of 0.50, indicating a 50% reduction in risk, and an absolute risk reduction of 4.0%.
Implications for Practice: The study demonstrates the significant potential of fixed-dose combination therapy with the polypill to halve the risk of major cardiovascular diseases in a population-level intervention. This finding supports the polypill as a safe and effective strategy for both primary and secondary prevention of cardiovascular diseases, particularly in settings where access to individual medications and consistent medical supervision might be limited.
RCT: Quadruple quarter-dose hypertension medication versus monotherapy for ambulatory blood pressure control
20 Mar, 2024 | 18:00h | UTCStudy Design and Population: This randomized clinical trial investigated the efficacy of a combination of four ultra-low-dose blood pressure medications (quadpill) compared to standard monotherapy in adults with hypertension. A total of 591 participants, either untreated or currently on monotherapy for hypertension, were enrolled and randomly assigned to receive either the quadpill (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or a monotherapy control (irbesartan 150 mg).
Main Findings: At 12 weeks, the quadpill group demonstrated significantly lower mean 24-hour ambulatory systolic and diastolic blood pressure (SBP and DBP) by 7.7 mmHg and 5.3 mmHg, respectively, compared to the monotherapy group, with similar reductions observed during daytime and night-time. Additionally, the rate of blood pressure control (24-hour average BP < 130/80 mmHg) was significantly higher in the quadpill group (77% vs. 50%). The study highlighted the quadpill’s effectiveness in reducing blood pressure variability and enhancing control rates across a 24-hour period.
Implications for Practice: The findings from this study support the superior efficacy of an ultra-low-dose quadruple medication strategy over monotherapy in managing ambulatory blood pressure among hypertensive patients. These results suggest that a quadpill approach could offer a more effective means for clinicians to achieve and maintain blood pressure control in hypertensive patients, potentially improving cardiovascular outcomes.
Reference: Janis M Nolde et al. (2024). Ambulatory blood pressure after 12 weeks of quadruple combination of quarter doses of blood pressure medication vs. standard medication. J Hypertens, 2024 Feb 29. DOI: 10.1097/HJH.0000000000003683. Access the study here: [Link]
Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes
11 Aug, 2023 | 15:41h | UTCEffects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)
Commentaries:
When it comes to blood pressure cuffs, size matters – MedicalResearch.com
One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN
Related:
Commentary on Twitter
Using a regular blood pressure (BP) cuff regardless of individual’s arm size resulted in 3.6 mmHg lower systolic BP when a regular cuff was one size too-large, and 4.8 and 19.5 mmHg higher when a regular cuff was one and two sizes too small. https://t.co/ZKnGfWc9fy
— JAMA Internal Medicine (@JAMAInternalMed) August 7, 2023
M-A | Pharmacist-led home BP telemonitoring enhances control over usual care
11 Aug, 2023 | 15:29h | UTC
Review | Primary aldosteronism: a pragmatic approach to diagnosis and management
4 Aug, 2023 | 12:06h | UTCPrimary Aldosteronism: A Pragmatic Approach to Diagnosis and Management – Mayo Clinic Proceedings
Meta-analysis | Even low levels of alcohol consumption may increase blood pressure
2 Aug, 2023 | 14:07h | UTCNews Release: Routinely drinking alcohol may raise blood pressure even in adults without hypertension – AHA Newsroom
Review | Revisiting resistant hypertension
1 Aug, 2023 | 14:16h | UTCRevisiting resistant hypertension: a comprehensive review – Internal Medicine Journal
Related: Resistant hypertension: A stepwise approach – Cleveland Clinic Journal of Medicine
Podcast: #390 Resistant Hypertension – The Curbsiders
M-A | Various exercise training modes reduce resting blood pressure, isometric exercise most effective
31 Jul, 2023 | 14:35h | UTCNews Release: Static isometric exercise, such as wall sits, best for lowering blood pressure – BMJ Newsroom
Commentary: Wall squats and planks best at lowering blood pressure – BBC
Systematic Review | Insufficient evidence for ACEi/ARB’s impact on early non-diabetic CKD
24 Jul, 2023 | 12:56h | UTC
Phase 1 Trial | Zilebesiran demonstrates potential as prolonged-action hypertension therapeutic
21 Jul, 2023 | 13:32h | UTCZilebesiran, an RNA Interference Therapeutic Agent for Hypertension – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Experimental Shot Given Every Six Months Controlled High Blood Pressure in Early Trial – HealthDay
Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide
19 Jul, 2023 | 14:33h | UTC
Nationwide Cohort Study | Adolescent hypertension linked with increased stroke risk in young adulthood
18 Jul, 2023 | 13:49h | UTCCommentary: The Relationship Between Adolescent Hypertension and Stroke Risk After Age 40 Years – Neurology Advisor
M-A | First-line thiazide diuretics show reduced cardiovascular events, comparable mortality vs. other antihypertensive drugs
14 Jul, 2023 | 12:55h | UTC
M-A | The effect of blood pressure lowering medications on the prevention of episodic migraine
12 Jul, 2023 | 13:50h | UTCNews Release: New study shows common blood pressure meds underused for migraine – George Institute for Global Health
Cohort Study | Hypertensive disorders of pregnancy linked to a 66% higher stroke risk in U.S. black women
10 Jul, 2023 | 13:31h | UTCHypertensive Disorders of Pregnancy and Risk of Stroke in U.S. Black Women – NEJM Medicine
2023 ESH Guidelines for the management of arterial hypertension
3 Jul, 2023 | 14:34h | UTC
Review | Hypertension management in patients with cardiovascular comorbidities
27 Jun, 2023 | 13:39h | UTCHypertension management in patients with cardiovascular comorbidities – European Heart Journal
Commentary on Twitter
Hypertension management in patients with cardiovascular comorbidities. A State-of-the-Art review just published in #EHJ.@escardio @ESC_Journals #CardioTwitter #hypertensionhttps://t.co/esgOEkxlta pic.twitter.com/xDRHSWn6sZ
— EHJ Editor-in-Chief (@ehj_ed) June 21, 2023
Brief Review | Why is cuff size so important and other factors that affect accurate blood pressure measurement
16 Jun, 2023 | 14:12h | UTC
SR | Management of postpartum hypertensive disorders of pregnancy
14 Jun, 2023 | 14:37h | UTC
Brief Review | What BP target is appropriate for pregnant patients with mild chronic hypertension?
6 Jun, 2023 | 14:20h | UTC
RCT | Adapted mindfulness training shows efficacy in reducing elevated office blood pressure
1 Jun, 2023 | 12:03h | UTC
Study finds potential glaucoma risk in patients using calcium channel blockers
1 Jun, 2023 | 11:51h | UTCCommentary: Calcium Channel Blocker Use Associated with Higher Prevalence of Glaucoma – HCP Live
M-A | Effect of more vs. less intensive BP control on cardiovascular, renal and mortality outcomes in people with type 2 diabetes
29 May, 2023 | 10:37h | UTC
Cohort Study | Ambulatory blood pressure more predictive of mortality than clinic blood pressure
24 May, 2023 | 13:19h | UTCSummary: This cohort study analyzed the relationship between clinic and ambulatory blood pressure with mortality. The study utilized data from March 2004 to December 2014, sourced from the Spanish Ambulatory Blood Pressure Registry, which included 59,124 patients from 223 primary care centers across all regions of Spain. Patients were monitored until their date of death or until December 31, 2019.
During a median follow-up of 9.7 years, 7174 (12.1%) patients died, including 2361 (4.0%) due to cardiovascular causes. Findings revealed J-shaped associations for several blood pressure measures. Notably, 24-hour systolic blood pressure had a stronger association with all-cause death (HR 1.41 per 1 SD increment [95% CI 1.36–1.47]) than clinic systolic blood pressure. When adjusted for clinic blood pressure, the association between 24-hour blood pressure and all-cause death remained strong (HR 1.43 [95% CI 1.37–1.49]). Night-time systolic blood pressure was found to be the most predictive of all-cause and cardiovascular death.
The findings imply that ambulatory blood pressure, particularly night-time blood pressure, is more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure. Masked hypertension and sustained hypertension were associated with increased mortality risks, but not white-coat hypertension. These results emphasize the importance of ambulatory blood pressure monitoring in hypertension management and risk prediction. Future research should focus on potential causes and strategies to control night-time blood pressure effectively, considering its substantial association with death risk.
Commentary: Tight Link Between Ambulatory BP and Mortality Affirmed in Revamped Analysis – TCTMD