Controversies in Hypertension V: Resistant and Refractory Hypertension

Cross-cultural adaptation of the simple Chinese version of the medication adherence reasons scale in patients undergoing adjuvant endocrine therapy for breast cancer

Adjuvant endocrine therapy (AET) is essential for improving survival and reducing mortality and recurrence rates in breast cancer (BrCa) patients. However, the adherence to AET among BrCa patients is poor, and there is no scale to measure adherence to AET or the reasons for non-adherence among BrCa patients in mainland China. The aim of this study was to assess the psychometric properties of the simple Chinese version of the Medication Adherence Reasons (MAR) scale in BrCa patients undergoing AET. This study utilized a cross-sectional research design with two phases: (1) translation and cross-cultural adaptation of the original English version of the MAR scale into simple Chinese and (2) validation of the simple Chinese version of the MAR scale (s-ChMAR scale) in BrCa patients. Instrument assessments included content validity, face validity, item analysis, construct validity, criterion-related validity and reliability testing. This study recruited participants using convenience sampling to investigate adherence to AET among BrCa patients. Inclusion criteria were: (a) female, (b) aged 18 years or older, (c) diagnosed with Stage I to III BrCa, (d) completed primary treatment for hormone receptor-positive BrCa and had been on AET for more than six months but less than five years, (e) proficient in Mandarin, and (f) provided informed consent. Exclusion criteria included psychiatric illness, cognitive impairment, or a diagnosis of another cancer type. The sample size for exploratory factor analysis (EFA) was determined based on a ratio of five to ten participants per scale item to ensure sufficient statistical power. Data were collected from a sample of 325 participants who received AET for over six months. All the items had a content validity index (CVI) of more than 0.80. Regarding construct validity, the s-ChMAR scale fit a four-dimensional model, the same as the original MAR scale tested in asthma patients. The s-ChMAR scale had good internal reliability (Cronbach's α = 0.896) and good stability (ICC = 0.837). In terms of quantifying non-adherence, the s-ChMAR scale identified a non-adherent participant rate of over 50%. The study findings support the reliability and validity of the s-ChMAR scale in measuring the non-adherence of Chinese BrCa patients to AET.

Reduced systemic microvascular function in patients with resistant hypertension and microalbuminuria: an observational study

Resistant hypertension (RH) may be associated with microalbuminuria (MAU), a marker of cardiovascular risk and target organ damage, and both may be related to microvascular damage. Laser speckle contrast imaging (LSCI) is an innovative approach for noninvasively evaluating systemic microvascular endothelial function useful in the context of RH with or without MAU. Microalbuminuria was defined as a urine albumin-to-creatinine ratio between 30 and 300 mg/g. Microvascular reactivity was evaluated using LSCI to perform noninvasive measurements of cutaneous microvascular perfusion changes. Pharmacological (acetylcholine [ACh], or sodium nitroprusside [SNP]) and physiological (postocclusive reactive hyperemia [PORH]) stimuli were used to evaluate vasodilatory responses. Thirty-two patients with RH and a normal urine albumin-to-creatinine ratio (RH group) and 32 patients with RH and microalbuminuria (RH + MAU) were evaluated. Compared with patients without MAU, patients with RH + MAU showed reduced endothelial-dependent systemic microvascular reactivity, as demonstrated by an attenuation of microvascular vasodilation induced by PORH. On the other hand, ACh-induced vasodilation did not differ between groups. The results also revealed reduced endothelial-independent (SNP-induced) microvascular reactivity in hypertensive patients with MAU compared with patients without MAU. In this study, there was evidence of endothelial dysfunction associated with impaired microvascular smooth muscle function in patients with RH + MAU. This may suggest that patients with RH need more intensive therapeutic strategies for the control of blood pressure to avoid further vascular damage and the resulting consequences.The study was registered at ClinicalTrials.gov ( https://register.clinicaltrials.gov ) under protocol # NCT05464849, initial release 12/07/2022.

Opportunities and Limitations of Renal Denervation: Where Do We Stand?

Hypertension is a primary contributor to cardiovascular disease, and the leading risk factor for loss of quality adjusted life years. Up to 50% of the cases of hypertension in the United States remain uncontrolled. Additionally, 8%-18% of the hypertensive population have resistant hypertension; uncontrolled pressure despite 3 different antihypertensive agents. Recently, catheter-based percutaneous renal denervation emerged as a method for ablating renal sympathetic nerves for difficult-to-control hypertension. Initial randomized (non-sham) trials and registry analyses showed impressive benefit, but the first sham-controlled randomized controlled trial using monopolar radiofrequency ablation showed limited benefit. With refinement of techniques to include multipolar radiofrequency, ultrasound denervation, and direct ethanol injection, randomized controlled trials demonstrated significant blood pressure improvement, leading to US Food and Drug Administration approval of radiofrequency- and ultrasound-based denervation technologies. In this review article, we summarize the major randomized sham-controlled trials and societal guidelines regarding the efficacy and safety of renal artery denervation for the treatment of uncontrolled hypertension.