Aim. The aim of present study was to determine the safety and efficacy of a new renal artery denervation system for treatment of hypertensive patients. Methods. Hypertensive patients with mean office systolic blood pressure &#x2265;150mmHg and &#x2264;180mmHg or an average of 24-hour ambulatory systolic blood pressure &#x2265;145mmHg and &#x2264;170mmHg after stopping hypertensive medications for 2 weeks or more were enrolled to undergo renal denervation (RDN) using a new RDN system. Changes in office blood pressure and mean 24-hour ambulatory blood pressure and safety were assessed after 6 months. Results. Fifteen patients underwent RDN and followed up for 6 months. At the 6-month follow-up, office systolic blood pressure decreased 11.5&#xb1;9.9mmHg (P&#x3c;0.01) and office diastolic blood pressure decreased 6.9&#xb1;4.8mmHg (P&#x3c;0.01); mean 24-hour ambulatory systolic blood pressure decreased 7.5&#xb1;7.7mmHg (P&#x3c;0.05) and mean 24-hour diastolic blood pressure decreased 3.3&#xb1;4.7mmHg (P&#x3e;0.05) compared to baseline values. There were no serious RDN-related adverse events during follow-up. Conclusion. Our results demonstrate that the new RDN system is safe and could significantly reduce blood pressure in hypertensive patients in the absence of antihypertensive medications. This trial is registered with <a target="_blank" href="http://www.chictr.org.cn/showprojen.aspx?proj=30066">ChiCTR1800017815</a>.

Yang Li

Abdul Qadir Nawabi

Yi Feng

Qiming Dai

Genshan Ma

Naifeng Liu

Safety and Efficacy of a New Renal Denervation Catheter in Hypertensive Patients in the Absent of Antihypertensive Medications: A Pilot Study

Blood pressure (BP) has been well documented to be associated with hearing loss previously. However, the role of blood pressure variability (BPV, representing BP fluctuation over a time period) on hearing remains unknown. We aimed to evaluate the relationship between BPV and hearing in Chinese population. We included 8646 male subjects from a population-based study (the Kailuan study). BP was measured every two years at routine physical examinations from 2006 to 2015. Based on five annual BP measurements, BPV was estimated by standard deviation of BP (SD), coefficient of the variation of BP (CV), and variation independent of mean of BP (VIM). Hearing was estimated by pure-tone average threshold (PTA) at low, intermediate, and high frequencies in the year of 2014. Regression models were used to evaluate the relationship between BPV and hearing. The results showed that PTAs and percentages of hearing loss at low, intermediate, and high frequencies grew gradually with increasing systolic SD (SSD) (p&lt;0.05). After adjusting for multiple covariates, multivariate regression analyses demonstrated that variations of SBP (SSD, SCV, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.29562pt" id="M1" height="11.6836pt" version="1.1" viewBox="-0.0498162 -8.38798 40.8361 11.6836" width="40.8361pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g121-84" d="M687 650H462V622C543 612 549 605 530 547C498 447 422 252 372 126H370C302 298 229 492 204 563C188 607 191 615 262 622V650H17V622C77 616 93 608 122 534C180 389 262 172 329 -11H360C436 196 541 450 568 516C606 605 619 614 687 622V650Z"/></g><g transform="matrix(.013,0,0,-0.013,9.139,0)"><path id="g121-71" d="M303 0V28C221 34 213 39 213 125V525C213 610 221 616 303 622V650H38V622C120 616 128 610 128 525V125C128 40 120 34 38 28V0H303Z"/></g><g transform="matrix(.013,0,0,-0.013,13.572,0)"><path id="g121-75" d="M861 0V28C774 35 771 41 768 147L759 509C756 612 762 614 851 622V650H681L449 149L221 650H57V622C148 613 153 609 144 479L130 271C123 166 117 123 111 88C104 46 85 34 26 28V0H259V28C192 35 169 42 167 90C166 130 166 173 170 256L185 541H187L411 7H431L675 555H679L683 147C683 41 680 35 598 28V0H861Z"/></g><g transform="matrix(.0091,0,0,-0.0091,25.249,3.132)"><path id="g58-81" d="M416 501L399 642C356 655 314 665 271 665C140 665 63 582 63 486C63 372 163 325 229 290C304 250 359 217 359 142C359 70 316 25 240 25C138 25 94 125 78 186L44 178C52 123 64 45 72 21C81 16 96 8 121 0S179 -15 220 -15C353 -15 445 68 445 176C445 289 350 335 270 375C191 414 143 449 143 520C143 572 177 627 253 627C340 627 366 556 382 495L416 501Z"/></g><g transform="matrix(.0091,0,0,-0.0091,29.553,3.132)"><path id="g58-64" d="M384 354C435 370 515 408 515 502C515 549 494 593 459 616C426 639 384 650 308 650H45V618C127 613 130 606 130 524V127C130 45 125 38 37 33V0H262C342 0 409 12 461 40C521 73 558 124 558 192C558 295 481 336 384 352V354ZM217 365V556C217 587 221 597 229 604C238 611 261 615 288 615C382 615 421 558 421 490C421 406 374 365 266 365H217ZM217 327H264C384 327 457 284 457 183C457 80 383 38 301 38C235 38 217 55 217 127V327Z"/></g><g transform="matrix(.0091,0,0,-0.0091,34.968,3.132)"><path id="g58-78" d="M46 650V618C122 613 130 611 130 522V128C130 46 123 40 40 32V0H319V32C227 40 217 42 217 128V279L292 260C303 259 322 258 338 261C436 272 534 337 534 467C534 534 508 580 469 609C428 640 371 650 299 650H46ZM217 558C217 585 220 596 228 603C235 610 256 615 284 615C367 615 435 571 435 463C435 339 358 304 291 304C256 304 229 310 217 317V558Z"/></g></svg>) were all positively correlated with PTA at intermediate and high frequencies (p&lt;0.05). Each SD increase in SSD, SCV, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.29562pt" id="M2" height="11.6836pt" version="1.1" viewBox="-0.0498162 -8.38798 40.8361 11.6836" width="40.8361pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g121-84"/></g><g transform="matrix(.013,0,0,-0.013,9.139,0)"><use xlink:href="#g121-71"/></g><g transform="matrix(.013,0,0,-0.013,13.572,0)"><use xlink:href="#g121-75"/></g><g transform="matrix(.0091,0,0,-0.0091,25.249,3.132)"><use xlink:href="#g58-81"/></g><g transform="matrix(.0091,0,0,-0.0091,29.553,3.132)"><use xlink:href="#g58-64"/></g><g transform="matrix(.0091,0,0,-0.0091,34.968,3.132)"><use xlink:href="#g58-78"/></g></svg> was also positively associated with hearing loss at intermediate and high frequencies. No significant correlation was observed between variations of DBP and hearing. These findings suggest that increase in long-term BPV is associated with hearing and hearing loss. Trial registration number: Kailuan study (<a target="_blank" href="http://chictr.org.cn/showprojen.aspx?proj=8050">ChiCTRTNC-11001489</a>).

Minghui Bao

Yongjian Song

Jun Cai

Shouling Wu

Xinchun Yang

Blood Pressure Variability Is Associated with Hearing and Hearing Loss: A Population-Based Study in Males

Background. Percutaneous transluminal renal angioplasty (PTRA) improves blood pressure (BP) and renal function only in selected patients with atherosclerotic renovascular disease (ARVD). Hyperuricemia is associated with elevated risk for hypertension and chronic renal disease, but its role in renovascular hypertension is unclear. We hypothesized that hyperuricemia negatively impacts renal and BP outcomes among patients with ARVD undergoing PTRA. Methods. This retrospective, observational cohort study included 94 patients with ARVD and preserved systolic cardiac function, who underwent PTRA at Mayo Clinic, Rochester, Minnesota. Renal, BP, and mortality outcomes were compared among patients according to their serum uric acid (SUA) levels. Multivariate analysis was used to determine significant predictors of renal, BP, and mortality outcomes after PTRA. Results. Compared to patients with normal basal SUA levels (&#x2264;5.7&#x2009;mg/dl), patients with very high SUA (&#x2265;8.7&#x2009;mg/dl) had lower baseline estimated glomerular filtration rate (eGFR), more extensive use of antihypertensive and diuretic drugs, increased baseline systolic blood pressure (SBP), and elevated left ventricular mass index. After PTRA, multiple logistic regression analysis showed that, compared to normal SUA, very high SUA was associated with decreased odds ratio (OR) of change in eGFR (adjusted OR=0.90; 95&#x25; confidence interval [CI], 0.86-0.95), but not of change in SBP. In multivariate linear analysis SUA independently predicted delta urine protein/creatinine ratio (&#x3b2;: 26.0; 95&#x25; confidence interval, 13.9 to 38.1). Conclusion. Severe hyperuricemia in patients with AVRD may have a negative impact on outcomes of renal revascularization.

Xiao-jun Chen

Alfonso Eirin

Garvan C. Kane

Sanjay Misra

Stephen C. Textor

Amir Lerman

Lilach O. Lerman

Impact of Serum Uric Acid Levels on Outcomes following Renal Artery Revascularization in Patients with Renovascular Disease

In this paper, we present a new model based on modular neural networks (MNN) to classify a patient&#x2019;s blood pressure level (systolic and diastolic pressure and pulse). Tests are performed with the Levenberg-Marquardt (trainlm) and scaled conjugate gradient backpropagation (traincsg) training methods. The modular neural network architecture is formed by three modules. In the first module we consider the diastolic pressure data; in the second module we use details of the systolic pressure; in the third module, pulse data is used and the response integration is performed with the average method. The goal is to design the best MNN architecture for achieving an accurate classification. The results of the model show that MNN presents an excellent classification for blood pressure. The contribution of this work is related to helping the cardiologist in providing a good diagnosis and patient treatment and allows the analysis of the behavior of blood pressure in relation to the corresponding diagnosis, in order to prevent heart disease.

Martha Pulido

Patricia Melin

German Prado-Arechiga

Blood Pressure Classification Using the Method of the Modular Neural Networks

Objective. There is poor adherence to antihypertensive therapies among women in India. To determine its socioeconomic barriers we performed a qualitative study on Indian rural women with hypertension. Methods. In-depth interviews with women having hypertension and presenting to outpatient department at a teaching hospital were performed in 30 women aged 35-65 years, using a questionnaire focused on reasons for nonadherence and poor lifestyle modification. Low to medium adherence was observed in two-thirds of women. Results. Majority of women were from low socioeconomic status and were illiterate. Awareness of hypertension and its complications was poor. Knowledge and practices of cessation of smoking and tobacco use and salt restriction in hypertension were low. Efforts to increase physical activity and decrease dietary fat and sugar intake were largely absent. Local follow-up at rural community health centres was not practiced due to physician nonavailability and about half used alternative systems of medicine. None had health insurance or access to free medicines. All the women had to pay out-of-pocket for medicines and were concerned with cost of therapy as well as pill burden. Half of the women borrowed money from relatives or friends to reach the hospital and pay for medicines. Conclusions. Socioeconomic barriers for low adherence to antihypertensive medication in women in India are low awareness of hypertension and complications, poor access to care, out-of-pocket payments, borrowing money, lack of insurance, and cost of medicines.

Shreya Gupta

Jas Pal Dhamija

Indu Mohan

Rajeev Gupta

Qualitative Study of Barriers to Adherence to Antihypertensive Medication among Rural Women in India

Background. Hypertension is considered to be the most common condition in the general population. It is the most important risk factor for premature deaths in the world. Treatment compliance at every stage is a condition for successful antihypertensive therapy, and improving the effectiveness of treatment is a major goal in preventing cardiovascular incidents. Treatment noncompliance and lack of cooperation stem from numerous problems of older age, including frailty syndrome. Objective. To evaluate the effect of frailty syndrome on treatment compliance in older patients with hypertension. Methods. The study sample consisted of 160 patients (91 women, 69 men) with hypertension aged 65 to 78 (mean = 72.09, SD = 7.98 years), hospitalized at the University Clinical Hospital due to exacerbation of disease symptoms. Standardised research tools were used: the Tilburg Frailty Indicator questionnaire and the questionnaire for the assessment of treatment compliance in patients with hypertension, the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Results. Frailty syndrome was diagnosed in 65.62&#x25; of patients: 35.62&#x25; with mild, 29.38&#x25; with moderate, and 0.62&#x25; with severe frailty. The treatment compliance was 36.14&#x25;. The prevalence of the FS and its three components (physical, psychological, social) significantly affected (p &#x3c;0.05) the global score of the Hill-Bone Compliance to High Blood Pressure Therapy Scale and all subscales: &#x201c;reduced sodium intake&#x201d;, &#x201c;appointment keeping&#x201d;, and &#x201c;antihypertensive medication taking&#x201d;. Conclusions. The coexistence of frailty syndrome has a negative impact on the compliance of older patients with hypertension. Diagnosis of frailty and of the associated difficulties in adhering to treatment may allow for targeting the older patients with a poorer prognosis and at risk of complications from untreated or undertreated hypertension and for planning interventions to improve hypertension control.

Bartosz Uchmanowicz

Anna Chudiak

Izabella Uchmanowicz

Grzegorz Mazur

How May Coexisting Frailty Influence Adherence to Treatment in Elderly Hypertensive Patients?

Background. Hypertension is a major health problem that remains a significant threat to the health and general wellbeing of many people all over the world. In some patients, the etiology and prognosis of hypertension have been linked to psychological factors including personality traits. One primary goal of management is to improve the health-related quality of life (HRQoL) of patients with hypertension. This study aimed to examine the association between personality traits, clinical characteristics, and HRQoL in hypertension. Methods. A hospital-based cross-sectional quantitative study was conducted in a sample of 331 individuals with hypertension. Data on sociodemographic characteristics, clinical information, personality traits, and HRQoL were obtained from participants using an interviewer administered questionnaire. Results. The number of participants with a 1&#x2013;10 years&#x2019; duration of diagnosis for hypertension was highest (56.8&#x25;), with 52.9&#x25; having comorbidities such as diabetes (40.2&#x25;) and dyslipidaemia (20.9&#x25;). The average number of medications taken per patient was 2.14 (SD&#xb1;0.79) and about 47.1&#x25; of the participants reported adequate medication adherence. Significant associations for age, education, monthly income, number of years with hypertension, and HRQoL were observed. While conscientiousness was significantly associated with all HRQoL domains, extraversion and agreeableness were significantly related to only the environmental domain. Conclusion. This study has demonstrated that clinical characteristics and patients&#x2019; perception of their personality are relevant to their health-related quality of life outcomes. The findings suggest that when intervention efforts to improve the quality of life of patients with hypertension are being considered, a biopsychosocial approach should be employed. The implication is that treatment of hypertension in Ghana should be broadened to include the expertise of mental health professionals.

Irene A. Kretchy

Franklin Acheampong

Jane Laryea

Joseph Osafo

Emmanuel Asampong

Erica Dickson

Personality Traits, Clinical Characteristics, and Health-Related Quality of Life of Patients with Hypertension in a Primary Hospital in Ghana

About this journal

International Journal of Hypertension publishes original research articles, and review articles&nbsp;related to hypertension, with a special focus on vascular biology, epidemiology, pediatric hypertension, and hypertensive nephropathy.

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Chief Editor, Professor Franco Veglio, is a Full Professor of Internal Medicine at the University of Turin, Italy.

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International Journal of Hypertension - Table of contents 2019

International Journal of Hypertension | Hindawi

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International Journal of Hypertension publishes original research articles, and review articles related to hypertension, with a special focus on vascular biology, epidemiology, pediatric hypertension, and hypertensive nephropathy.

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