Differential Approaches are Much Needed for "Real World" Management of Hypertension in the Era of "Hypertension Paradox"

The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series

BACKGROUND

To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA.

METHODS

Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan-Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant.

RESULTS

At a median follow-up of 42 months (IQR 27-54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan-Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11-0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1-1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32-6.1; p = 0.007) was the only independent predictor of absent clinical success.

CONCLUSIONS

TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.

National Hypertension Guidelines: A Review of the India Hypertension Control Initiative (IHCI) and Future Prospects

Hypertension is a silent killer; however, the treatment of hypertension is simple, effective, readily available, and needs to be continued lifelong. It is a significant health problem that is included under the umbrella of non-communicable disease conditions and has a strong alliance with cardiovascular morbidity and mortality. The India Hypertension Control Initiative (IHCI) is an extensive program in India that involves the Indian Council of Medical Research, the Ministry of Health and Family Welfare (Government of India), the state governments of India, and World Health Organization Country Office for India (WHO-India). The IHCI is a multi-partner initiative carried forward systemically across various states. The states are categorized into Grade I and Grade II. There is the involvement of specialized teams of cardiovascular experts and health officials to insure precise execution and seamless healthcare service. 

The implementation of the free and easy-to-use mobile application and software, Simple (Resolve to Save Lives, New York City, United States), in the analysis and storage of data, is a novel step taken to insure safe record keeping and follow-ups. Emphasis is on the adoption of demography-specific interventional methods and drugs, and proper acquisition and storage of these drugs is the key step. Treatment modalities involve the adoption of medicines and lifestyle modifications as a combined recipe. Advancements have been made in the area of drug development like gene therapies but they seem to show low success rates at the given moment. Adoption of lifestyle modifications along with medications is the gold standard treatment option. This review article aims to shed light on the current status of IHCI, its milestones, and the future of the initiative in India.

Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Arterial Hypertension in Current Medical Practice in Algeria

OBJECTIVE

There are limited data on the management of hypertension (HT) in Algeria. The aim of this study was to assess, in current medical practice, the use and benefits of ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of HT.

METHODS

A prospective, observational, multicenter study was performed in 2017. Patients aged ≥ 18 years with suspected or treated HT were included. A 24-hour ABPM was performed at baseline in all patients. Therapeutic decision was taken by the physician according to ABPM results and patients were then followed up to 6 weeks.

RESULTS

The analysis included 1027 patients (mean age, 51.0 years; women, 61.6%) with treated HT (37.3%) or suspected HT (62.7%). Major cardiovascular risk factors were diabetes (15.7%) and lipid disorders (7.2%). ABPM was pathological in 55.1% of patients on antihypertensive treatment and in 60.8% of patients with suspected HT. A therapeutic adjustment or a treatment switch was performed after pathological ABPM in 37.4% of patients already on antihypertensive treatment and an antihypertensive therapy was initiated in 54.9% of patients with initially suspected HT.

CONCLUSION

This study is the first evaluation of the usefulness of ABPM for the management of HT in Algeria. Our results emphasize that ABPM is a highly valuable method for avoiding the whitecoat effect and for detecting patients who are insufficiently treated with antihypertensive drugs.