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PubMed1996

Prevalence of hypertension and sociodemographic characteristics of adult hypertensives in Riyadh City, Saudi Arabia.

OBJECTIVES: To estimate the prevalence of hypertension in adults residing in Riyadh city and to study the sociodemographic characteristics of adult hypertensives. DESIGN: Cross-sectional survey. SETTING: Primary Health Care Centres (PHCCs) in Riyadh city selected by stratified random sampling, the subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs. SUBJECTS AND METHODS: A total of 1394 adults aged 15 years and over were interviewed and examined during March 1993 to March 1994. The average of three measurements of blood pressure (BP) was taken to represent their current pressures. A subject is considered hypertensive if the average BP reading is 160/95 mm Hg or more, or is currently under treatment. RESULTS: The total hypertensive subjects were 214 giving an overall prevalence of hypertension of 15.4%. Of these 157 (11.3%) subjects were known hypertensives and were under some form of treatment. On the other hand 57 (4.1%) other subjects were newly detected by the study. Hypertension (BP = 160/95 mm Hg or more) was significantly related to age, marriage, education, occupation and employment status and consanguinity. Male subjects had a higher prevalence of hypertension but the differences were not significant. Nationality and income were not related to high BP. CONCLUSION: Hypertension is a problem among adults in Riyadh city. It is significantly related to some sociodemographic and family factors. About 27% of all hypertensives are not aware of their disease and more than 31% of known hypertensives are apparently not well controlled. There is a need for a programme to prevent and control hypertension in Riyadh city. Similar studies need to be done in other areas of the country to estimate the prevalence of hypertension and associated factors as prerequisites for any programme to control the disease.

Adolescent↗

PubMed1996

[Renin plasma profile and sodium sensitivity of blood pressure in hypertensive patients with or without a family history of hypertension].

The relationship between sodium-sensitive hypertension, renin profile and genetic predisposition to hypertension have not been fully clarified. The present study aimed to establish the influence of family history of hypertension (at least one of the parents suffering from hypertension) on the renin profile, incidence of sodium-sensitivity of blood pressure and plasma concentration of selected biochemical parameters (creatinine, uric acid, glucose, sodium, potassium, calcium and cholesterol). 85 patients with essential hypertension (38 females, 47 males) were enrolled in the study. Secondary forms of hypertension were excluded in all patients by careful clinical and biochemical examination performed in the Department of Nephrology, Silesian University School of Medicine in Katowice. Plasma renin activity (PRA) was estimated twice: first after administration of a normal sodium diet (100-120 mmol of sodium per day) and 8 hours of supine position (PRA I) and a second time after 3 days of sodium restriction (10-20 mmol of sodium per day) and 3 hours of upright position (PRA II). All other biochemical parameters were measured once. Only patients with urinary sodium excretion lower than 60 mmol per day (after 3 days of low salt diet), were enrolled in the study. Sodium-sensitive hypertension was diagnosed in patients with a decrease of mean arterial blood pressure (MAP) of more or equal to 10 mm Hg after three days of sodium restriction. Reduction of MAP of less than 10 mm Hg was classified as sodium-nonsensitive hypertension. Among 85 patients with essential hypertension 49 (57.6%) had a positive (group I) while 36 (42.4%) a negative family history of hypertension (group II). Using the criteria presented in this study low, normal, high and rigid plasma renin activity were found, in 14.3%, 57.1%, 18.4% and 10.2% respectively of patients of group I. In patients of group II the incidence of the above mentioned renin profiles was similar: 13.9%, 58.3%, 19.4% and 8.4% respectively. In patients of group I 16 (32.7%) had sodium-sensitive and 33 (67.3%) sodium-nonsensitive hypertension, while in patients of group II 16 (44.4%) had sodium-sensitive and 20 (55.6%) sodium-nonsensitive hypertension (difference between group I and group II is statistically not significant). Patients of group I did not differ significantly from patients of group II with respect to : sex, age, blood pressure, sodium urinary excretion and plasma concentration of above mentioned parameters. From results obtained in this study we may conclude, that patients with and without history of essential hypertension do not differ with respect to renin plasma profile, incidence of sodium-sensitivity of blood pressure and other biochemical parameters.

Adult↗

PubMed1997

Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy.

OBJECTIVES: To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS: To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES: 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE: Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and classification, as well as documents on diagnosis and classification from authorities in the United States, Europe and Australia and from special interest groups. VALUES: High priority was given to the principle of preventing adverse maternal and neonatal outcomes through the provision of diagnostic criteria for severity and prognosis and through dissemination of reliable and pertinent information and research results using a common language. BENEFITS, HARMS AND COST: Higher degree of vigilance in diagnosing hypertensive disorders in pregnancy, allowing for earlier assessment and intervention, and more efficient dissemination of comparative information through common language. No harm or added cost is perceived at this time. RECOMMENDATIONS: (1) A diastolic blood pressure of 90 mm Hg or more should be the criterion for a diagnosis of hypertension in pregnancy and should trigger investigation and management. Except for very high diastolic readings (110 mm Hg or more), all diastolic readings of 90 mm Hg or more should be confirmed after 4 hours. (2) A regularly calibrated mercury sphygmomanometer, with an appropriate-sized cuff, is the instrument of choice. A rest period of 10 minutes should be allowed before taking the blood pressure. The woman should be sitting upright and the cuff positioned at the level of the heart. (3) Both Korotkoff phase IV and V sounds should be recorded, but the phase IV sound should be used for initiating clinical investigation and management. (4) A urine protein level of more than 0.3 g/d should be the criterion for a diagnosis of proteinuria; 24-hour urine collection should be the standard method for determining proteinuria. (5) Edema and weight gain should not be used as diagnostic criteria. (6) Hypertensive disorders diagnosed during pregnancy should be classified as pre-existing hypertension; gestational hypertension with or without proteinuria; pre-existing hypertension with superimposed gestational hypertension with proteinuria; and unclassifiable antenatally but final classification 42 days after delivery. VALIDATION: Except for expert opinions and reviews solicited for this project, these recommendations need to be field tested and validated in Canada. Guidelines endorsed by the Canadian Hypertension Society and the Society of Obstetricians and Gynaecologists of Canada.

Blood Pressure Determination↗

PubMed2000

Oral beta-blockers for mild to moderate hypertension during pregnancy.

BACKGROUND: Hypertension is a common complication of pregnancy. Antihypertensive drugs are widely used in the belief these will improve outcome for both the woman (such as decreasing the risk of stroke or eclampsia) and her baby (such as decreasing the risk of preterm birth and its complications). Beta-blockers are a popular choice of antihypertensive agent during pregnancy; other choices include methyldopa and calcium channel blockers. OBJECTIVES: The aim of this review is to assess whether oral beta-blockers are overall better than placebo, or no beta-blocker, for women with mild-moderate hypertension during pregnancy, and to assess whether oral beta-blockers have any advantages over other antihypertensive agents for women with mild-moderate hypertension during pregnancy. Both maternal outcomes (e.g., the incidence of severe hypertension) and perinatal outcomes (e.g., mortality) were of interest. SEARCH STRATEGY: Register of trials maintained by the Cochrane Pregnancy and Childbirth Group, MEDLINE 1966-97, bibliographies of retrieved papers, personal files. Date of last search: June 2000. SELECTION CRITERIA: Trials comparing beta-blockers with (i) placebo or no therapy, or (ii) other antihypertensive agents, for women with mild-moderate pregnancy hypertension (i.e., blood pressure under 170 mm Hg systolic, or 110 mm Hg diastolic). DATA COLLECTION AND ANALYSIS: All data were extracted independently by two investigators, who were not blinded to outcome or other trial characteristics. Whenever possible, missing data were obtained by personal communication with authors. Discrepancies were resolved by discussion. The overview was divided into two comparisons: (i) beta-blockers versus placebo or no therapy, and (ii) beta-blockers versus other antihypertensives. MAIN RESULTS: Twenty-seven trials, involving just under 2400 women, are included in this review. Fourteen trials (1516 women) compared beta-blockers with placebo/no beta blocker. Oral beta-blockers decrease the risk of severe hypertension (relative risk (RR) 0.37, 95% confidence interval (CI) 0.26-0.53) and the need for additional antihypertensive drugs (RR 0.44, 95% CI 0.31-0.62). There are insufficient data for any conclusions about the effect on perinatal mortality or preterm delivery. Beta-blockers seem to be associated with an increase in small for gestational age infants (RR 1.34, 95% CI 1.01-1.79). Maternal hospital admission may be decreased, neonatal bradycardia increased and respiratory distress syndrome decreased, but these outcomes are only reported in a very small proportion of trials. Eleven trials (787 women) compared beta-blockers with methyldopa. Beta-blockers appear to be no more effective and probably equally as safe (from maternal and perinatal perspectives) as methyldopa. Single small trials have compared beta-blockers with hydralazine and with nicardipine. It is unusual for women to change drugs due to side effects. REVIEWER'S CONCLUSIONS: The improvement in control of maternal blood pressure with use of beta-blockers would be worthwhile only if it were reflected in other more substantive benefits for the mother and/or baby, and none have yet been clearly demonstrated. The effect of beta-blockers on perinatal outcome is uncertain, given that the worrying trend to an increase in small for gestational age infants is partly dependent on one small outlying trial. Large, randomised controlled trials are needed to determine whether antihypertensive therapy in general (rather than beta-blocker therapy specifically) results in benefits that outweigh the risks for treatment of mild-moderate pregnancy hypertension. If so, then it would be appropriate to look at which antihypertensive is best. Beta-blockers would remain a candidate class of agents.

Administration, Oral↗

PubMed2002

Prostacyclin for pulmonary hypertension.

BACKGROUND: Primary pulmonary hypertension (PPH) is progressive, resulting in right ventricular failure. Survival seldom exceeds five years. Pulmonary hypertension can be idiopathic or associated with other conditions. It is common in patients with diffuse scleroderma and the CREST syndrome where it is clinically, haemodynamically and prognostically indistinguishable from idiopathic primary pulmonary hypertension. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation. Iloprost is a chemically stable derivative of prostacyclin with similar biologic properties and can be given orally, by infusion or nebulised. OBJECTIVES: To determine the efficacy of prostacyclin or one of its analogues in idiopathic primary pulmonary hypertension. SEARCH STRATEGY: A search was carried out using the Cochrane controlled clinical trial register. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving patients with primary pulmonary hypertension were selected by two reviewers. DATA COLLECTION AND ANALYSIS: Study quality was assessed and data extracted independently by two reviewers. Outcomes were analysed as continuous and dichotomous outcomes, using standard statistical techniques. MAIN RESULTS: Four RCTs were included, all of short duration (8-12 weeks). Three compared intravenous epoprostenol with conventional therapy, two were in PPH (n = 81 and n = 21) and one with pulmonary hypertension in scleroderma (n = 111). One compared intravenous Iloprost with placebo in 14 patients with scleroderma. Exercise capacity improved in patients treated with intravenous epoprostenol (Standardised Mean Difference) 0.69, 95% Confidence Intervals (CI) 0.40, 0.97. Several haemodynamic variables improved in the group treated with epoprostenol; e.g. mean pulmonary artery pressure fell: Weighted Mean Difference -6.3 mmHg (95% CI -3.9, -8.7). Mortality was improved Peto Odds Ratio 0.32 (95% CI 0.13, 0.77), although this effect was not significant when analysed using a more conservative random effects model: Odds Ratio 0.32 (95% CI 0.06, 1.58). Side effects and adverse events related to the indwelling catheter (sepsis and thrombosis) were common. REVIEWER'S CONCLUSIONS: Intravenous prostacyclin over 12 weeks improves exercise capacity, NYHA functional class and several cardiopulmonary haemodynamic variables. It may improve mortality.

Antihypertensive Agents↗

PubMed2004

The 2004 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I--Blood pressure measurement, diagnosis and assessment of risk.

OBJECTIVE: To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk and identifiable causes for adults with high blood pressure. OPTIONS: For persons in whom a high blood pressure value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, defining overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients. OUTCOMES: The identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension. EVIDENCE: Medline searches were conducted from November 2001, one year before the period of the last revision of the Canadian recommendations for the management of hypertension, to October 2003. Reference lists were scanned, experts were polled, and the personal files of subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content experts and methodological experts. VALUES: A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and persons with identifiable and potentially modifiable causes of hypertension. BENEFITS, HARMS AND COSTS: The identification of persons at higher risk of cardiovascular disease will permit counselling for lifestyle maneuvers and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. For certain subgroups of patients and specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality. RECOMMENDATIONS: The document contains recommendations for blood pressure measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension. VALIDATION: All recommendations were graded according to strength of evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Only the recommendations that achieved high levels of consensus are reported. These guidelines will be updated annually.

Adult↗

PubMed1954