Menu scheduling for high blood pressure patient with optimization method through Integer Programming

High blood pressure is a common coexisting condition in patients with type 2 diabetes mellitus, affecting over a third of adults with diabetes. The presence of high blood pressure increases the risk of numerous macro- and micro-vascular complications of diabetes, including cardiovascular disease, nephropathy, retinopathy, and possibly, neuropathy, and the association of blood pressure with complications extends into the blood pressure range usually considered normal in persons without diabetes. The relative increase in risk attributable to high blood pressure is comparable in persons with and without diabetes, but the combination of high baseline risk of complications in patients with diabetes and this relative risk generate a much larger absolute excess risk of high-blood-pressure-related complications in persons with diabetes than in those without. Clinical trial data have proven the benefits of blood pressure lowering therapy in patients with diabetes; however, the most appropriate goal for the treated blood pressure level is unknown. The clinical trial evidence clearly supports systolic blood pressure levels less than 150 mm Hg and diastolic blood pressure levels less than 80 mm Hg. Lower systolic blood pressure goals are supported by observational data. The relative benefits of various blood pressure lowering medications has received much attention and generated much controversy. Because most patients with diabetes will require triple drug therapy with a diuretic, ACE inhibitor (or angiotensin receptor blocker), and calcium channel blocker to achieve blood pressure control, this debate is largely academic. In patients with high blood pressure but not diabetes, the risk of developing diabetes may be reduced by ACE inhibitors, angiotensin receptor blockers and calcium channel blockers relative to diuretics and beta-blockers. Prevention of diabetes and high blood pressure remain important long-term public health goals; however, given the frequency and complications of high blood pressure in patients with diabetes, and the proven benefits of blood pressure control, attention to improving the quality of care for high blood pressure in patients with diabetes is of major importance.

CKD Treatment: Time to Alter the Focus to Albuminuria?

No agents have been proven to improve survival in heart failure with preserved ejection fraction (HFpEF), but the phenotypic diversity of HFpEF suggests it may be possible to identify specific HFpEF phenotypes that will benefit from certain treatments. This study compared the risk factors for and prognostic impacts of treatments on in-hospital mortality between HFpEF patients with (+) and without (-) high blood pressure (HBP). Data on 2238 consecutive HFpEF patients were extracted from Tokyo CCU Network data registry and analysed. HFpEF was defined as an ejection fraction greater than or equal to 50%; HBP was defined as elevated systolic blood pressure (>140 mmHg) at admission. Potential risk factors for in-hospital mortality were selected by univariate analyses and those with P < 0.10 were used in multivariate Cox regression analysis with forward selection (likelihood ratio) to identify significant factors. In-hospital mortality was significantly lower for HFpEF + HBP than HFpEF - HBP patients (log-rank, P < 0.001). Independent risk factors for in-hospital mortality in HFpEF + HBP patients were older age (hazard ratio 1.069) and in-hospital treatment without beta-blockers (hazard ratio 7.946), whereas older age (hazard ratio 1.035), higher C-reactive protein (hazard ratio 1.047), higher B-type natriuretic peptide (hazard ratio 1.000) and in-hospital treatment without diuretics (hazard ratio 4.201) were identified as independent risk factors in HFpEF - HBP patients. There were significant differences in prognostic factors, including beta-blocker and diuretic treatments, for in-hospital mortality between HFpEF patients with and without HBP. These findings suggest possible individualized therapies for patients with HFpEF.

Introduction: High blood pressure is a global public health problem due to its high prevalence and multiple complications that often lead to major disability. It is a major cardiovascular risk factor for often late diagnosis. It is emerging in Africa, particularly in Mali. Objective: To determine the epidemiological, diagnostic and progressive aspects of high blood pressure in patients 15 years of age or older. Patients and methods: This is a descriptive cross-sectional study over a two-year period (June 1, 2008 to May 31, 2010) in the Cardiology Department of Sikasso Hospital in any patient aged 15 years and over admitted for high blood pressure. Results: Two hundred and fifty patients were selected, representing a hospital prevalence of 18.2%. High blood pressure was most common in patients 50 years of age and older (65.6%), followed by those 19 to 49 years of age (30%) and those 15 to 18 years of age. The average age of the population was 50 years (15-92 years) with a male predominance of 61.6% and a sex ratio of 1.6. The predominance of traditional housewives and farmers was 30% and 26.4%. The notion of a family history of high blood pressure was found in 56.4% of cases. High blood pressure grade 3 according to the classification of the World Health Organization was mostly found in our patients (64%). Biological abnormalities were dominated by hyperglycemia (14%), hypercreatininemia (8%). The main clinical manifestations were headache (40%), dyspnea (20%) and vertigo (16%). On physical examination, there were mainly signs of heart failure (50%), arrhythmia (12%), heart murmur (28%), hemiplegia (10%). The electrocardiogram showed left ventricular hypertrophy in 79.2% of cases, left atrial hypertrophy (16.4%), repolarization disorder (3.2%), atrial fibrillation (1.2%). Chest x-rays showed cardiomegaly in 67.2%. Echocardiographic abnormalities were left ventricular hypertrophy (64.8%), left atrial dilation (16.4%), left ventricular systolic dysfunction (14.4%). Therapeutically, diuretic combination with conversion enzyme inhibitors was the most prescribed treatment (58%), followed by combination of calcium channel blockers and conversion enzyme inhibitors (15.6%), calcium channel blockers (18%), conversion enzyme inhibitors (4.4%), beta-blockers (4%). The low-salt diet and physical activity were constantly recommended. Complications were hypertensive retinopathy (33.2%), heart failure (25.2%), stroke (24.8%), renal failure 4.8%. Conclusion: High blood pressure is a major public health problem. This work identified a high hospital prevalence of high blood pressure in patients aged 15 years and older with a clear male predominance. Late diagnosis is responsible for serious complications that often lead to major disabilities.

Aggressive blood pressure reduction and renin–angiotensin system blockade in chronic kidney disease: time for re-evaluation?

The prevalence of high blood pressure in adolescence is increasing with the number of adolescence at risk of overweight or overweight. Due to the known relationship between high blood pressure and increased risk of coronary artery disease (CAD) and stroke, this is an obvious health concern for adolescent children. PURPOSE: To characterize the incidence of high normal blood pressure and hypertension in a large population of ninth grade, physical education students. METHODS: 884 ninth grade, physical education students (14 ± 1 yrs) participated. Blood pressure was initially recorded with an automated device (Omron, HEM-907XL). If the initial automated reading was above 120/80 mmHg, then a manual ausculatory re-measurement was taken. Blood pressure was classified as high normal blood pressure if the reading fell between the 90th and 95th percentile based on the CDC growth charts (National high blood pressure education program working group on high blood pressure in children and adolescents, 2001), while hypertension was defined as a reading above the 95th percentile. Frequency of high normal blood pressure and hypertension was calculated for two groups based on BMI: at risk for being overweight or overweight students and normal weight students. RESULTS: Overall, 8.5% of students were classified as having high normal blood pressure and 4.8% were considered hypertensive. The incidence was greater for high normal blood pressure for the at risk for being overweight or overweight group (11.9%) compared to the normal weight students (7.4%). Hypertension was present in 7.3% of the at risk for being overweight or overweight population and 3.9% of the normal weight population. The at risk for being overweight or overweight group and normal weight group had a mean systolic blood pressure of 117.5 ± 9 mmHg and 112.8 ±10 mmHg, respectively, and a mean diastolic blood pressure of 64.7 ± 7 mmHg and 61.2 ± 8 mmHg, respectively. CONCLUSION: Our data indicates that a large percentage of the at risk for being overweight or overweight population (19.2%) has elevated blood pressure. At risk for being overweight or overweight students have a greater incidence of high normal blood pressure, and are twice as likely as normal weight students to have hypertension. The at risk for being overweight or overweight group also has a higher mean systolic and diastolic blood pressure values. This is alarming because elevated blood pressure is associated with an increased risk of CAD and stroke, and is in itself a progressive chronic disease.

Blood Pressure Goals: How Low Is Safe in CKD?

Marc Fisher MD Kennedy Lees MD Section Editors: Hypertension is the most important modifiable risk factor for stroke.1,2 It is estimated that 25% or more of strokes may be attributable to hypertension. Because many patients with stroke have mild hypertension or prehypertension, we have shifted our focus and now think of stroke on a continuum of risk based on blood pressure (BP) level rather than on a threshold effect.3 Because high BP may not exist in isolation, a wider definition of hypertension has been proposed that also takes into account the absolute risk of cardiovascular events and associated metabolic factors or early disease markers.3 Lowering BP reduces the risk of stroke. Epidemiological studies have shown that for each 10 mm Hg lower systolic blood pressure (SBP), there is a decrease in risk of stroke of approximately one third in persons aged 60 to 79 years. This association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, stroke subtypes, and for fatal and nonfatal events.4 Lowering diastolic blood pressure (DBP) was once the main target to achieve stroke and other cardiovascular event reduction, but SBP has now become the target.3 As recently shown, even the elderly with sustained SBP elevation may gain from BP reduction in relation to less fatal or nonfatal stroke, death, and heart failure.5 Although the role of longer-term BP control to improve outcomes in patients with stroke is undisputed, BP management immediately after a stroke remains controversial. In an effort to resolve this controversy, several pilot clinical trials have been initiated. In this review, we discuss the results of some of these trials and available evidence-based guidelines for BP control in the settings of acute ischemic and hemorrhagic stroke (excluding subarachnoid hemorrhage) and …

Little Effect of Ordinary Antihypertensive Therapy on Nocturnal High Blood Pressure in Patients with Sleep Disordered Breathing

Adult telomere length (TL) is a biological marker of aging associated with vascular health. TL at birth is associated with later life TL and may contain early biological information of later life cardiovascular health and disease. To evaluate whether newborn TL is associated with early life blood pressure differences in childhood. This cohort study was part of the ENVIRONAGE (Environmental Influence on Aging in Early Life) study, a birth cohort of Belgian mother-child pairs with recruitment at birth and a median follow-up of 4.5 years conducted between October 2014 and July 2021. Participants included for analysis provided full data for evaluation at follow-up visit. Data analysis was conducted between August and September 2021. Cord blood and placental average relative TL were measured at birth using quantitative polymerase chain reaction (qPCR). Systolic, diastolic, and mean arterial pressure (MAP) were evaluated at follow-up. High childhood blood pressure (standardized for child age, sex, and height) was defined following the 2017 American Academy of Pediatrics guidelines. Multivariable adjusted linear and logistic regression models were used to associate newborn TL and blood pressure indicators in childhood. This study included 485 newborn children (52.8% girls) with a mean (SD) age of 4.6 (0.4) years at the follow-up visit. Newborn TL was associated with lower blood pressure in childhood. A 1-IQR increase in cord blood TL was associated with a -1.54 mm Hg (95% CI, -2.36 to -0.72 mm Hg) lower diastolic blood pressure and -1.18 mm Hg (95% CI, -1.89 to -0.46 mm Hg) lower MAP. No association was observed with systolic blood pressure. Furthermore, a 1-IQR increase in cord blood TL was associated with lower odds of having high blood pressure at the age of 4 to 6 years (adjusted OR, 0.72; 95% CI, 0.53 to 0.98). In placenta, a 1-IQR increase in TL was associated with a -0.96 mm Hg (95% CI, -1.72 to -0.21 mm Hg) lower diastolic, -0.88 mm Hg (95% CI, -1.54 to -0.22 mm Hg) lower MAP, and a lower adjusted OR of 0.69 (95% CI, 0.52 to 0.92) for having a high blood pressure in childhood. In this prospective birth cohort study, variation in early life blood pressure at school-age was associated with TL at birth. Cardiovascular health may to some extent be programmed at birth, and these results suggest that TL entails a biological mechanism in this programming.

Objectives148 cases combined dynamic blood pressure index analysis, this paper discusses the ambulatory blood pressure monitoring in essential hypertension with coronary heart disease in prediction function.MethodsAccording to the criteria, consecutive...

BackgroundHigh blood pressure in patients with stroke increases the risk of recurrence but management in the community is often inadequate. Home blood pressure monitoring may increase patients' involvement in their care, increase compliance, and reduce the need for patients to attend their General Practitioner if blood pressure is adequately controlled. However the value of home monitoring to improve blood pressure control is unclear. In particular its use has not been evaluated in stroke patients in whom neurological and cognitive ability may present unique challenges.DesignCommunity based randomised trial with follow up after 12 months.Participants: 360 patients admitted to three South London Stroke units with stroke or transient ischaemic attack within the past 9 months will be recruited from the wards or outpatients and randomly allocated into two groups. All patients will be visited by the specialist nurse at home at baseline when she will measure their blood pressure and administer a questionnaire. These procedures will be repeated at 12 months follow up by another researcher blind as to whether the patient is in intervention or control group.Intervention: Intervention patients will be given a validated home blood pressure monitor and support from the specialist nurse. Control patients will continue with usual care (blood pressure monitoring by their practice).Main outcome measures in both groups after 12 months:1. Change in systolic blood pressure.2. Cost effectiveness: Incremental cost of the intervention to the National Health Service and incremental cost per quality adjusted life year gained.Trial registrationClinical Trials.gov registration NCT00514800

The mechanisms causing high blood pressure in patients with Cushing's syndrome were investigated by measurements of humoral factors and pharmacological maneuvers. Twelve patients with adrenal adenomas were studied. The mean systolic and diastolic pressures of the patients were 171 +/- 28 and 109 +/- 15 mm Hg (+/- SEM), respectively, which were significantly higher than those of normal subjects. PRA, plasma renin concentration, plasma renin substrate, plasma cortisol, plasma aldosterone, urinary kallikrein, and urinary prostaglandin E2 were measured as the humoral factors. PC values were markedly elevated in patients with Cushing's syndrome. Among the components of the renin-angiotensin system, only plasma renin substrate was increased. Urinary kallikrein and prostaglandin E2 were decreased in patients with Cushing's syndrome. Oral administration of captopril lowered blood pressure, but infusion of an angiotensin II analog did not. Furthermore, the pressor responses to infusion of both norepinephrine and angiotensin II were increased. We conclude that blood pressure is elevated in patients with Cushing's syndrome because they have enhanced pressor responses to vasoactive substances, suppression of depressor systems, and some abnormalities of the renin-angiotensin system.

Aimed to investigate the associations between different growth patterns with high blood pressure, and further examine the mediation effect of BMI between growth patterns and high blood pressure among children and adolescents. A total of 31581 children and adolescents aged 7–18 years were selected based on the stratified cluster sampling method. Logistics regression models were used to calculate the odds rations (ORs) and 95% confidence interval (95%CI) of the association between different growth patterns and high blood pressure. Mediation effect analyses were applied to estimate the effect of BMI on the increase of blood pressure levels in different growth patterns. In different sex and ages, compared to reference group of normal growth, blood pressure levels and prevalence of high blood pressure of the catch‐up growth were higher, but that of the catch‐down growth were lower. The prevalence of high blood pressure was 11.69%, 16.06%, and 9.68% in normal growth, catch‐up growth, and catch‐down growth, respectively. In total, compared with the normal growth pattern, the ORs (95%CI) of high blood pressure, high systolic blood pressure and high diastolic blood pressure in the catch‐up growth were 1.171(1.073,1.280), 1.110(1.001,1.230) and 1.141(1.025,1.270) (p < .05), respectively. Additionally, the mediation effect of current BMI existed in the association between blood pressure levels and different growth patterns, particularly in boys. Our findings suggested that different growth patterns after birth could modify blood pressure, and the potential risks of high blood pressure could be increased by catch‐up growth at childhood and adolescence.

The lower the better: Does simplicity lead to absurdity?