Prevalence of primary aldosteronism in patients with concomitant hypertension and obstructive sleep apnea, baseline data of a cohort

Obstructive sleep apnea (OSA) and primary aldosteronism (PA) often coexist in hypertension, whereas whether hypertensive patients with OSA should be screened for PA is controversial and whether gender, age, obesity and OSA severity should be considered is unexplored. We explored cross-sectionally prevalence and associated factors of PA in co-existent hypertension and OSA by considering gender, age, obesity and OSA severity. OSA was defined as AHI ≥5 events/h. PA diagnosis was defined, based on the 2016 Endocrine Society Guideline. We included 3306 patients with hypertension (2564 with OSA). PA prevalence was significantly higher in hypertensives with OSA than in those without OSA (13.2 vs 10.0%, P = 0.018). In gender-specific analysis, PA prevalence was significantly higher in hypertensive men with OSA, compared to non-OSA ones (13.8 vs 7.7%, P = 0.001). In further analysis, PA prevalence was significantly higher in hypertensive men with OSA aged <45 years (12.7 vs 7.0%), 45-59 years (16.6 vs 8.5%), and with overweight and obesity (14.1 vs 7.1%) than did their counterparts (P < 0.05). For OSA severity, men participants showed increased PA prevalence from non to moderate OSA and a decrease in the severe OSA group (7.7 vs 12.9 vs 15.1 vs 13.7%, P = 0.008). Young and middle age, moderate-severe OSA, weight, and blood pressure showed a positive independent association with PA presence in logistic regression. In conclusion, PA is prevalent in co-existent hypertension and OSA, indicating the need for PA screening. Studies are needed for women, older and lean population due to the smaller samples in this study.

SKINFOLD MEASUREMENTS AS DETERMINANTS OF BLOOD PRESSURE LEVELS AMONG ADULT HYPERTENSIVES ATTENDING A SECONDARY HEALTHCARE CENTRE IN NIGERIA

Background

Background: The prevalence of obesity is increasing globally, making it a growing pandemic affecting adults and children. Obesity is associated with multiple morbidities and mortalities increasing the burden on the health care system.

Objective

There is inadequacy of data in Nigeria on the prevalence of obesity among adult patients with hypertension and adequate data on these conditions would help in their comprehensive management.

Methods

This was a cross-sectional study of 354 patients with hypertension, and the systematic sampling technique was used to recruit patients. The data were analysed using SPSS software version 23. Logistic regressions and linear regressions were done to determine the predictors of obesity and blood pressure levels.

Results

The mean age of the respondents was 52.60(SD±8.26) years and the prevalence of obesity was 53.1%. After adjusting for other variables, the predictors of obesity were female sex. Females were about six times more likely to be obese than males (OR=6.23; 95%CI= 3.16 - 12.32). For every 1 unit increase in triceps skinfold, there was a statistically significant increase in diastolic blood pressure by about 2.77units (95% C.I equals 2.63 to 2.91, p-value= 0.0001). Also, for every 1 unit increase in biceps skinfold, there was a statistically significant increase in systolic blood pressure by about 5.78 units (95% C.I equals 5.46- 6.10, p-value= 0.0001).

Conclusion

The prevalence of obesity was high, and the predictors of obesity were female sex. Triceps skinfold measurements were predictors of diastolic blood pressure while biceps skinfold measurements were predictors of systolic blood pressure.

Adherence to a Healthy Sleep Pattern and Incidence of Cardiometabolic Multimorbidity Among Hypertensive Patients: A Prospective Study of UK Biobank

Study Objectives

To investigate whether a healthy sleep pattern would reduce the risk of cardiometabolic multimorbidity (CMM) among hypertensives.

Methods

This is a prospective cohort analysis from the UK Biobank. A total of 69 524 hypertensives without a history of diabetes mellitus, coronary heart disease, or stroke at baseline were enrolled. Five dimensions of healthy sleep at baseline including early chronotype, sleep 7–8 h/d, free of insomnia, no snoring, and no frequent excessive daytime sleepiness were used to generate a healthy sleep score ranging from 0 to 5 (one point was given for each dimension of healthy sleep). A higher score indicated a healthier sleep pattern. We set five groups corresponding to the healthy sleep score of 5, 4, 3, 2, and 0–1, respectively. The primary outcome was the incidence of overall CMM among enrolled hypertensives. We assessed the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by Fine-Gray subdistribution hazard models.

Results

We found the full-adjusted HR (95% CI) for overall CMM was 0.93 (0.91–0.95) for a 1-point increase in the healthy sleep score. Compared to hypertensives with a healthy sleep score of 0–1, those with a score of 5 had a 27% lower risk of overall CMM, and 37%, 23%, and 20% lower risks of diabetes mellitus, coronary heart disease, and stroke, respectively, after adjusting for sociodemographic characteristic, lifestyle, and clinical factors.

Conclusions

Our results indicated that a healthy sleep pattern was associated with lower risks of CMM outcomes among hypertensives.

Comparative Analysis of Left Ventricular Geometry in Adult Nigerians with and without Chronic Kidney Disease: Results from Ibadan CRECKID STUDY

BACKGROUND

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular morbidity and mortality. Left ventricular hypertrophy (LVH) is considered the strongest independent predictor of cardiovascular disease and events among CKD patients. We reported the echocardiographic left ventricular geometry in CKD patients compared to non-CKD hypertensive and apparently healthy controls in Ibadan.

MATERIALS AND METHODS

A total of 683 participants in the CRECKID STUDY comprising 220(32.2%) CKD patients, 281(41.1%) non-CKD hypertensive patients and 182(26.6%) healthy controls were included in this analysis. Basic demographic and clinical information with echocardiographic parameters were obtained.

RESULTS

Study participants in the non-CKD hypertensive group were on average older than the CKD and the healthy controls (56.2±13.1 vs 47.2±14.6, and 46.8±13.3 years, respectively; p<0.01). Compared with other groups, greater proportions of participants with CKD were men (40.5% vs.38.1% and 21.3%; p<0.0001). The left atrial and left ventricular dimensions were significantly higher in CKD compared with others. LVH was significantly more prevalent among CKD patients (68.2%) compared to hypertensive (43.9%) and normotensive (19.5%) group (p<0.01). The participants with CKD had a greater proportion of abnormal LV geometry with concentric LVH predominating (p<0.0001). Having LVH was associated with lower mean estimated glomerular filtration rate (eGFR) (40.6±37.71 vs 67±37.38, p<0.0001).

CONCLUSION

In our study, patients with CKD had the highest prevalence of abnormal LV geometry and functions. A unit decrease in eGFR was associated with increased left ventricular mass. Early detection and prompt management of abnormal LV geometry may help in reducing adverse cardiovascular outcome in patients with CKD.

Potential Mechanisms Behind the Blood Pressure-Lowering Effect of Dynamic Resistance Training

PURPOSE OF REVIEW

To elucidate the hemodynamic, autonomic, vascular, hormonal, and local mechanisms involved in the blood pressure (BP)-lowering effect of dynamic resistance training (DRT) in prehypertensive and hypertensive populations.

RECENT FINDINGS

The systematic search identified 16 studies involving 17 experimental groups that assessed the DRT effects on BP mechanisms in prehypertensive and/or hypertensive populations. These studies mainly enrolled women and middle-aged/older individuals. Vascular effects of DRT were consistently reported, with vascular conductance, flow-mediated dilation, and vasodilatory capacity increases found in all studies. On the other hand, evidence regarding the effects of DRT on systemic hemodynamics, autonomic regulation, hormones, and vasoactive substances are still scarce and controversial, not allowing for any conclusion. The current literature synthesis shows that DRT may promote vascular adaptations, improving vascular conductance and endothelial function, which may have a role in the BP-lowering effect of this type of training in prehypertensive and hypertensive individuals. More studies are needed to explore the role of other mechanisms in the BP-lowering effect of DRT.

BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE SUBJECTS IN DUTSE, NORTHWESTERN NIGERIA

AIM

Background: High blood pressure is an independent risk factor for cerebrovascular, renal and cardiovascular disease. According to World Health Organization treatment to target Blood Pressure (BP) of <140/90 mmHg has been associated with decrease in morbidity and mortality. Despite this BP control has been very poor even in developed economies.

OBJECTIVE

We set to assess level of BP control among hypertensive patients on treatment in Dutse, Jigawa state, and to identify treatable causes of failure to achieve target for better management.

METHODS

It is a cross sectional study of all hypertensives for more than one year attending medical out patients clinic who have consented. An interviewer administered questionnaire was used to obtain information from the patients.

RESULTS

A total of 123 patients of which 45% were females with mean age, duration of hypertension of 51.9 and 5.9 years respectively and BMI of 40.9Kg/ m². Eighty-three per cent, 91% and 94% were aware of salt restriction, cessation of smoking and alcohol moderation as lifestyle modifications respectively. The mean Systolic and Diastolic BP were 142mmHg and 86mmHg respectively. Fifty-two per cent were on two drugs combination including a diuretic while 4.87% were on three drugs or more. Less than a third (27.6%) had their BP controlled at <140/90mmHg. There was no significant difference in the demographic and clinical data between patients with controlled and uncontrolled BP.

CONCLUSION

This study found that control of BP is still poor in our setting. This could be due to physician inertia in the treatment, use of inappropriate combination of anti hypertensives or failure to reinforce lifestyle modifications.

A blend of sesame oil and rice bran oil lowers blood pressure and improves the lipid profile in mild-to-moderate hypertensive patients

BACKGROUND

Sesame oil and rice bran oil are known for their unsaturated fatty acids and antioxidants contents and have been reported to reduce the cardiovascular risk.

OBJECTIVE

To determine the effect of a blend of 20% unrefined cold-pressed lignans-rich sesame oil and 80% physically refined γ-oryzanol-rich rice bran oil (Vivo) as cooking oil in mild-to-moderate hypertensive patients.

METHODS

In this prospective, open-label dietary approach, 300 hypertensive patients and 100 normotensives were divided into groups as: (1) normotensives treated with sesame oil blend, (2) hypertensives treated with sesame oil blend, (3) hypertensives treated with nifedipine, a calcium channel blocker (20 mg/d), and (4) hypertensives receiving the combination of sesame oil blend and nifedipine (20 mg/d). Sesame oil blend was supplied to respective groups, and they were instructed to use it as the only cooking oil for 60 days. Resting blood pressure was measured at days 0, 15, 30, 45, and 60, whereas the fasting lipid profile was measured at days 0 and 60.

RESULTS

Significant reduction in blood pressure (systolic, diastolic, and mean arterial) from days 0 to 15, 30, 45, and 60 were observed in hypertensives treated with sesame oil blend alone (P < .001), nifedipine alone (P < .001), and combination of sesame oil blend and nifedipine (P < .001). Sesame oil blend with nifedipine-treated group showed greatest reduction in blood pressure. Total cholesterol, low-density lipoprotein cholesterol, triglycerides, and non-high-density lipoprotein cholesterol levels reduced, whereas high-density lipoprotein cholesterol levels increased significantly only in hypertensives treated with sesame oil blend alone and the combination of sesame oil blend and nifedipine (P < .001).

CONCLUSION

We demonstrate for the first time that using a blend of sesame oil and rice bran oil as cooking oil showed a significant antihypertensive and lipid-lowering action and had noteworthy additive effect with antihypertensive medication.

Assessment of voltage criteria for left ventricular hypertrophy in adult hypertensives in south-western Nigeria

BACKGROUND

Left ventricular hypertrophy (LVH) is a common pathophysiological consequence of hypertension. Various voltage (ECG) criteria exist for evaluation of LVH. This study assessed the performance of 4 commonly used ECG criteria in south-western Nigeria.

MATERIALS AND METHODS

A cross-sectional descriptive study of adult hypertensive subjects. Participants were assessed for LVH using 4 ECG criteria: Sokolow-Lyon, Araoye code system, Cornell voltage, and Gubner-Ungerleider criteria. Echocardiography was used to determine the left ventricular mass index for the participants, and a value greater than 125 g/m(2) was used as the cut-off point for LVH. The sensitivity, specificity, accuracy, positive and negative predictive values were determined for each of the ECG criteria.

RESULTS

90 subjects (45 males, 45 females) participated in the study. The prevalence of LVH by echocardiography was 32.2%. The prevalence of LVH by voltage criteria were: 45.6%, 42.2%, 34.4%, 13.3% by Sokolow-Lyon, Araoye code system, Cornell, and Gubner-Ungerleider criteria, respectively. The sensitivity and specificity respectively of the ECG criteria were 58.62% and 60.66% (Sokolow-Lyon), 48.28% and 60.65% (Araoye code system), 51.72% and 73.77% (Cornell), and 13.79% and 86.89% (Gubner-Ungerleider).

CONCLUSION

Out of the 4 ECG criteria, Araoye code system, Cornell and Sokolow-Lyon criteria compared favorably well with echocardiography and may be used in the initial assessment of LVH in adult hypertensive subjects. However, a combination of any of the 3 criteria with Gubner-Ungerleider criterion will be more clinically useful.

Amlodipine/valsartan 5/160 mg versus valsartan 160 mg in Chinese hypertensives

BACKGROUND

A majority of hypertensives require treatment with ≥2 antihypertensive therapies to achieve blood pressure (BP) goals. Single-pill combinations (SPC) may improve convenience and adherence to therapy and reduce health care resource use and costs. The antihypertensive effects of amlodipine and valsartan are well established. This study evaluated the efficacy and safety of amlodipine/valsartan 5/160 mg SPC for the treatment of hypertension in predominantly Chinese patients not adequately controlled on valsartan 160 mg alone.

METHODS

In this multicentre study (24 centres), adults with stage 1 or 2 hypertension not adequately controlled with valsartan monotherapy were randomised to receive double-blind amlodipine/valsartan 5/160 mg SPC or valsartan 160 mg once daily for 8 weeks.

RESULTS

The least-square mean change (standard error) from baseline to endpoint in mean sitting diastolic blood pressure (MSDBP) at trough, the primary efficacy variable, was -10.3 (0.39) mm Hg with amlodipine/valsartan and -6.6 (0.40) mm Hg with valsartan (difference: -3.7 [0.54] mm Hg, p<0.0001). The corresponding results for mean sitting systolic blood pressure (MSSBP) were -14.9 (0.61) mm Hg and -7.0 (0.61) mm Hg, respectively (difference: -7.9 [0.84] mm Hg, p<0.0001). A significantly greater proportion of patients achieved overall BP control (MSSBP/MSDBP<140/90 mm Hg) with combination therapy (61.3%) versus monotherapy (39.3%; p<0.0001). Both treatments were well tolerated.

CONCLUSION

Amlodipine/valsartan 5/160 mg SPC is a safe and effective therapy for lowering BP in predominantly Chinese adults with stage 1 or 2 hypertension not adequately controlled with valsartan 160 mg monotherapy.