hypertension

Essential hypertension remains a significant global health challenge. Self-care is among the most effective strategies for managing this condition. Understanding patients' perspectives and experiences regarding self-care behaviors can significantly aid nurses in enhancing these behaviors.

This study aims to explore self-care behaviors in patients with essential hypertension.

This qualitative study employed conventional content analysis to examine 16 patients and three healthcare providers associated with urban healthcare centers affiliated with Shahroud University of Medical Sciences in Semnan province, Iran, during 2023 - 2024. Participants were selected through purposive sampling. Data were collected via individual, semi-structured, in-depth interviews, which were recorded and transcribed. The transcripts were analyzed using the method proposed by Elo and Kyngäs (2008).

The study identified "Yo-Yo-like" self-care behaviors as the main concept, with four primary categories and 12 subcategories extracted. The main categories included fluctuating patterns in medication adherence, dietary adherence, exercise, and smoking.

The self-care behaviors of patients with essential hypertension exhibit coordinated fluctuations, correlating with the disease's severity. As the disease subsides, adherence decreases, and vice versa. This fluctuating pattern has created a vicious cycle in disease control. Interventions, particularly by nurses, are essential to break this cycle and effectively manage hypertension.

Aging is considered a natural developmental process in which physical, psychological,and social changes occur; hypertension can be one of these problems. Structured teaching, like theHealth Action Process Approach (HAPA), may improve self-care and health in chronic conditions.This study aimed to examine the effect of teaching intervention based on HAPA on self-care behaviorin older people with hypertension. This quasi-experimental study was performed from October 2023 to March 2024 at Valiasrhealth services center affiliated with Jahrom University of Medical Sciences; 70 older people weredivided into an intervention group (35 subjects) and a control group (35 subjects). Teaching interventionwas carried out based on HAPA for the intervention group through seven teaching sessions over sevenweeks. Data were collected using demographic and Hypertension Self-care Profile at baseline and 2months post-intervention. Data were analyzed using SPSS 21 with the Chi-square test, Fisher test,Wilcoxon, and Mann-Whitney tests. Statistical significance was considered for P value<0.05. The median of self-care was not significantly different between the control (median: 51(IQR:54-45)) and intervention groups (median: 50(IQR: 58-47)) before the intervention (P=0.26). Two monthsafter the intervention, the median of self-care was significantly different between the intervention(median: 73(IQR: 74-71)) and control groups (median: 50(IQR: 54-45)) (P<0.001). The HAPA could improve self-care behavior in older people with hypertension. Itis suggested that healthcare authorities should pay attention to HAPA in teaching and preventiveprograms for self-care behavior in older people with hypertension.

To investigate the mechanisms of exercise therapeutics in preclinical animal models of chronic kidney disease (CKD), PAG (D, L-propargylglycine), an inhibitor of hydrogen sulfide production, was used to examine the protective effects of physical activity on oxidative stress and inflammation levels during CKD.

Male Wistar rats with CKD, induced by the 5/6 nephrectomy procedure and subjected to 8 weeks of exercise training, received injections of PAG, a cystathionine γ-lyase (CSE) inhibitor, at a dose of 19 mg/kg, i.p., twice a week during those 8 weeks. The systolic blood pressure (BP) and renal sympathetic nerve activity (RSNA) were assessed. Additionally, plasma creatinine, BUN, renal hydrogen sulfide (H2S) levels, oxidative stress, and inflammatory markers were evaluated.

In the PAG group, inhibition of H2S production significantly reversed the improvements in plasma creatinine, BUN, renal malondialdehyde (MDA) level, superoxide dismutase (SOD) activity, TNF-α, and IL-6 that were achieved by exercise. Additionally, high RSNA and high BP, which were also reversed in the PAG group, compared to the CKD group subjected to exercise training.

The results suggest that the improvement in BP, oxidative stress, and inflammation status by exercise in CKD may be at least partially due to CSE/H2S signaling.

Hypertension (HTN) is a major global health concern and a leading risk factor for conditions such as coronary artery disease (CAD), stroke, and chronic kidney disease. Recent advancements have led to the development of single-pill combinations (SPCs) of antihypertensive medications, which aim to improve patient adherence and outcomes.

This study investigates the consumption patterns of SPCs among hypertensive patients in eastern Iran.

This cross-sectional study involved 1,208 hypertensive patients treated by cardiologists, internists, or general practitioners (GPs) between December 2022 and September 2023 in Birjand, located in the east of Iran. Demographic data, medical history, and details regarding antihypertensive medication usage—specifically types and dosages—were collected by trained nursing staff. Data analysis was performed using SPSS software version 22.0. Chi-square tests and Fisher's exact tests were utilized (P ≤ 0.05).

The participants had a mean age of 62.6 ± 10.3 years, with 63% being women, 86.6% residing in urban areas, and 30% holding a university degree. The predominant treatment among patients was monotherapy, primarily using angiotensin receptor blockers (ARBs) such as losartan. Only 11% of patients were utilizing SPCs. Combination therapies were significantly more common among patients with concurrent CAD (39.1% monotherapy vs. 43.7% combination therapy, P < 0.001), heart failure (17.5% monotherapy vs. 77.5% combination therapy, P = 0.05), obesity, higher education levels, and urban residency. Additionally, GPs prescribed monotherapy more frequently than internists and cardiologists. The study identified only two types of combined SPCs in use: ARB + Calcium Channel Blocker (CCB) and ARB + diuretic.

The findings indicate that only one-tenth of hypertensive patients in this study were prescribed SPCs. General practitioners favored monotherapy more than specialists, and the variety of SPCs available in Iran appears limited. These results underscore the need for enhanced educational efforts to improve physicians' understanding of SPCs. Furthermore, pharmaceutical companies have an opportunity to develop more diverse SPCs by combining various antihypertensive drug categories.

Sexual dimorphism in blood pressure regulation has been extensively noted in humans, but the underlying mechanisms remain to be fully understood. Our research aims to investigate the possible correlation between gender-associated differences in blood pressure and renal sodium transport. 

We measured male and female mice’s blood pressure, urine, and plasma sodium concentration when fed a regular or high-Na+ diet. After that, their renal sodium transporters were assessed by western blot and immunofluorescence. For further investigation, male mice were castrated to observe the differences in blood pressure and renal sodium transporters compared to normal mice. 

Male mice exhibited higher blood pressure and lower renal sodium excretion than female littermates. Furthermore, the blood pressure of male mice exhibited a more significant and rapid increase relative to female mice when the diet was switched from control sodium to high sodium. Western blot and immunofluorescent staining revealed that in male mice, the sodium transporters epithelial sodium channel (ENaC) and the upstream kinases SPAK (Ste20-related proline/alanine-rich kinase), OSR1 (oxidative stress response kinase 1), and WNK4 (Lysine-Deficient Protein Kinase 4) were elevated. Beyond that, male mice exhibited lowered blood pressure and reduced abundance of ENaC (α, β, and γ) after castration.

ENaC plays a significant role in gender-associated differences in blood pressure and renal sodium reabsorption.

There is a belief that opium consumption has a protective effect on hypertension and diabetes, which are important risk factors for cardiovascular disease.

This study aimed to compare blood pressure and blood sugar measurements between opium users and non-users.

This cross-sectional study is based on the Fasa Adults Cohort Study (FACS). Participants from FACS who had no history of diabetes or hypertension with medication were included in this study. Systolic and diastolic blood pressure as well as fasting blood sugar (FBS) were compared between participants who use opium (regularly or ever) and those who do not, across different sociodemographic characteristics such as sex, marital status, employment, smoking, and other variables such as age, BMI, and physical activity. To control for the effect of confounders, a linear regression model was used in SPSS version 22.

A total of 7,428 adults participated in this study. The mean age of participants was 46.5 years. Of the participants, 27.05% were opium users. The mean diastolic blood pressure was 73.18 mmHg in non-opium users, while it was 70.95 mmHg in opium users (P = 0.000). The mean systolic blood pressure was 105.20 mmHg in opium users, compared to 107.78 mmHg in non-users (P = 0.000). The mean fasting blood sugar was 86.75 mg/dL in non-opium users and 85.88 mg/dL in opium users (P = 0.019). Lower blood pressure was observed in opium users despite higher fasting blood sugar levels.

After controlling for confounders such as age, sex, smoking, BMI, physical activity, and calorie intake, both systolic and diastolic blood pressure were lower in opium users, while fasting blood sugar was higher. Given the numerous side effects of opium, it should not be used arbitrarily. However, these findings could be useful when making clinical decisions for diabetic or hypertensive individuals who are opium users.

Stress is an important psychosocial factor responsible for the hypertension. Globally, university employees reported a high prevalence of hypertension, and perceived stress; however, in Indian context, as few studies documented this association, we conducted a study documenting the prevalence of hypertension and perceived stress among employees of Solapur University.

A cross-sectional study was conducted during June – September 2022 to screen 231 university employees for hypertension following International Society of Hypertension guidelines. Perceived psychological stress was assessed with Cohen’s Perceived Stress Scale. Chi-square test and both univariate and multivariate logistic regressions were used to evaluate the hypotheses. The significance level for the p-value was set at ≤0.05, and statistical analysis was conducted using Stata 12.1. 

The overall prevalence of hypertension was 39%. More than half of employees (54%) were under moderate to high levels of stress, and they were more likely to be hypertensive than those under low stress. Staff with more than 30 years and in non-teaching posts were about two times more at higher risk of hypertension, and male staff, and those having moderate to high-stress levels were 2.5 times more likely associated with the risk of hypertension as compared to others.

University employees are under high levels of stress which are prone to developing hypertension. There is a need to screen more and more Indian university employees for the presence of hypertension and stress to design appropriate hypertension prevention programmes.

Smoking is one of the major factors causing atherosclerosis. It results in elevated blood flow and blood pressure (BP) inside vessels. Tobacco smoking in any form, due to injecting toxins into the body, causes the development of cardiovascular disorders. Accordingly, this study investigates the effects of cessation of smoking on BP changes and hypertension incidence.

In the present cohort study, we assessed 8170 male workers in good health who worked for a steel manufacturing firm and underwent professional health checkups in 2019 at the company’s healthcare centers. They were reevaluated in 2021. The variables adjusted for baseline age, cigarette smoking, body mass index, exercise, alcohol consumption, systolic or diastolic BP, family history of hypertension, and changes in the body mass index along with alcohol consumption were investigated in the follow-up phase.

The adjusted relative risks of hypertension in subjects who had quit cigarette smoking for more than 1 and 1-3 years was 0.6 (95% confidence interval [CI], 0.2%, 1.9%) and 1.5 (95% CI, 0.8%, 2.8%) and 3.5 (95% CI, 1.7%, 7.4%) compared to the current smokers. The ascending trend of risk of hypertension for longer periods of cigarette smoking was observed in the subgroups of those who had maintained the weight as well as those who acquired high weight gain after smoking cessation.

Smoking cessation may cause elevated BP, hypertension, or both.

Multicystic dysplastic kidney (MCDK) is a congenital kidney abnormality with an overall incidence rate of 1/4300 live births that is more prevalent in males than females. Here, we describe a rare case of bilateral MCDK complicated by hypertension, severe vesicoureteral reflux (VUR), and urinary tract infection (UTI), who stabilized during hospitalization with prospective kidney transplantation due to poor prognosis. Since bilateral MCDK is a rare disease with numerous complications and a poor prognosis, patient symptom management and treatment may be more challenging.

Preeclampsia may cause maternal and child morbidity and mortality. Evidence suggests that oxidative stress may be involved in the development of preeclampsia; however, the role of dietary total antioxidant capacity (DTAC) on preeclampsia risk has not yet been elucidated. Thus, this study aims to assess the relationship between DTAC and odds of preeclampsia.

This case-control study was conducted on 240 pregnant women (preeclampsia, n=60; controls, n=180) in Qazvin, Iran. Controls were 3:1 ratio matched with cases in terms of participants’ age and gestational age. Dietary intakes were assessed using a validated food frequency questionnaire evaluating the preceding year. DTAC was measured by two methods ferric reducing antioxidant potential (FRAP) and oxygen radical absorbance capacity (ORAC). Multivariable logistic regression was employed to evaluate the association between preeclampsia and DTAC and also selected antioxidants.

After controlling for potential confounders, a significant inverse relationship was found between ORAC and preeclampsia; individuals in the highest tertile of ORAC were 67% less likely to have preeclampsia than those in the lowest tertile of ORAC (OR: 0.33; 95% CI: 0.11-0.97; P-trend<0.05). There was no significant relation between FRAP and preeclampsia. The risk of preeclampsia was 70% lower among subjects with the highest tertile of vitamin C intake compared to the lowest tertile of it.

Pregnant women with the highest tertile of ORAC and vitamin C intake were at lower risk of preeclampsia. Therefore, prospective studies are needed to confirm the protective effects of dietary anti-oxidants on preeclampsia incidence.

Hypertension is the most significant modifiable risk factor for cardiovascular disease (CVD) and is associated with substantial negative effects on both individual and societal levels. Renal denervation (RDN) has been established as a safe and effective medical intervention for treating resistant hypertension, with approval from the Food and Drug Administration and endorsement by guidelines such as those of the European Society of Cardiology (2023) and the American Heart Association. However, with the advent of various types of RDN methods, including radiofrequency-, ultrasound-, and alcohol-based techniques, debates have intensified regarding their comparative efficacy and safety. Additionally, researchers have expanded their focus to consider outcomes beyond hypertension management. Most studies have demonstrated that this non-pharmacologic treatment significantly improves systolic and diastolic 24-hour ambulatory and office blood pressure in both the short- and long-term. Despite these findings, the social and psychological impacts of RDN on a broader scale have been less frequently discussed. Given the high burden of hypertension and its complications, such as cardiovascular and cerebrovascular events, this intervention could substantially enhance the quality of life and mental health of affected populations. Non-adherence to antihypertensive medications remains a critical challenge, driven by factors such as side effects, pregnancy, financial constraints, psychiatric disorders, and polypharmacy with its associated consequences. Renal denervation, by improving blood pressure control, offers the potential to enhance quality of life and reduce the incidence of severe physical and mental health conditions. This study provides a comprehensive perspective on this advanced treatment, emphasizing its impact on individual and societal well-being, physical health, and mental health.

The relationship between antihypertensive medication and breast cancer outcomes remains a subject of growing interest in clinical research. This systematic review aims to evaluate the potential associations between antihypertensives and breast cancer outcomes, providing a detailed synthesis of current evidence and identifying areas for future research.

We conducted a systematic review of studies published between January 2014 and January 2024, in accordance with a registered protocol on the Open Science Framework. Multiple databases were searched for English-language studies of various designs, includingclinical trials, cohort studies, and observational studies. A total of 51 studies were selected from 1,591 records after a rigorous screening process. The review focused on summarizing the evidence without formal quality appraisal, adhering to the scope of this review.

Our review identified potential links between certain antihypertensive classes, such as ACE inhibitors and calcium channel blockers, and breast cancer outcomes. The findings indicate that specific antihypertensive medications may influence breast cancer-specific mortality, recurrence rates, and overall survival. The role of the Renin-Angiotensin System and genetic predispositions emerged as important factors in these associations. However, the review also highlights substantial evidence gaps, particularly regarding long-term outcomes and the interaction between antihypertensive treatment and breast cancer biology.

This systematic review contributes to a better understanding of the complex relationship between antihypertensive medications and breast cancer outcomes. Key findings suggest that healthcare providers should consider the potential implications of specific antihypertensive drugs in patients with breast cancer. Further large-scale randomized controlled trials with extended follow-up are recommended to clarify these associations and inform clinical guidelines. Our findings underscore the importance of personalized treatment approaches and adherence to cardiovascular regimens in this patient population

We examined the association of breakfast habits with hypertension and obesity risk among Korean adults and older adults, focusing on sex-based and age-based differences.

We collected data from 2,779 adults (1,380 men and 1,399 women, aged 19–64 years) and 623 older adults (289 men and 334 women, aged ≥65 years) from the 2015 Korea National Physical Fitness Project, an extensive survey organized biennially by the Korea Ministry of Culture, Sports and Tourism and the Korea Institute of Sport Science.

For women aged 19 to 64 yr, skipping breakfast was linked to an increased likelihood of developing both high blood pressure and obesity. For men aged 19–64 years, having breakfast irregularly or replacing it with snacks were linked to a reduced likelihood of hypertension, whereas skipping breakfast slightly elevated the risk. For older women aged above 65 years, irregular breakfast consumption or replacing it with snacks was linked to a heightened likelihood of developing hypertension. Nonetheless, there was no notable correlation identified between breakfast habits and obesity in men and older adults. In older men and women, consistent physical exercise proved to be an essential factor in mitigating the chance of hypertension.

These findings emphasize the importance of sex- and age-specific public health strategies, with implications for public health interventions and guidelines that promote regular breakfast consumption and physical activity.

Older adults are the most hypertensive population compared to other age groups. The purpose of this study was to determine an education model involving the family and the outcomes of the program.

Studies conducted in 2023. The search terms "Aged or Older Adult or Elderly and Family-centered or Family Nursing and Hypertension or High Blood Pressure" were used to conduct a scoping review in the journals PROQUEST, SCOPUS, MEDLINE, COCHRANE, and PubMed until 2022. The flowchart for the PRISMA Scoping review shows the search and selection procedure. Tools from the Joanna Briggs Institute (JBI) for Randomized Controlled Trials and Quasi-Experimental Studies are used to critically evaluate a few chosen papers.

There were 11 articles found out of 2,355 articles in the search results. To increase perceived threat, self-efficacy, and self-confidence, the family-involved education intervention is implemented in phases. Knowledge, family involvement, blood pressure, cholesterol, uric acid, quality of life, and behavioral changes were among the outcomes that were evaluated.

Education involving families of the elderly with hypertension can affect a decrease in blood pressure, an increase in self-efficacy and good behavioral change, an increase in self-esteem, improved life quality, and family empowerment.Older adults

 Hypertension is a prevalent medical condition associated with cardiovascular and kidney diseases, leading to premature death and disability. Despite medication use, hypertension continues to rise due to unhealthy lifestyles. Self-care strategies play crucial roles in effectively treating hypertension. We aimed to evaluate the effectiveness of interventions based on the transtheoretical model (TTM) in improving self-care, self-efficacy, and health-related quality of life (HRQOL) in hypertensive adults.

 A comprehensive search was performed in multiple databases using appropriate search strategies. Two independent reviewers screened articles, and assessed their adherence to the inclusion and exclusion criteria. The risk of bias in randomized controlled trials was assessed by the Cochrane Collaboration tool and quasi-experimental studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies.

 The review included 24 studies with a total of 6553 participants. Most interventions aimed to encourage a healthier lifestyle and improve diet and physical activity. The message was delivered through various methods such as slide/tape messages, individual education/counseling sessions, telephone-delivered interventions, and multimedia training software based on the TTM. Control groups received physician visits or attended lifestyle lectures but did not receive specific behavior change programs like the intervention groups.

 Our results indicated that the TTM and stage of change model can be an appropriate framework for delivering educational messages to patients.

Ma’aljobon is used in Persian medicine (PM) as a natural antihypertensive product. This study aimed to evaluate the hypotensive effect of Ma’aljobon in patients with uncontrolled grade 1 primary hypertension (HTN). This double-blind, placebo-controlled clinical trial included 114 patients (20-80 years) with uncontrolled grade 1 primary HTN. After obtaining informed consent, the participants were randomly divided into two groups and administered with 25g of Ma’aljobon or maltodextrin twice daily for six weeks. Systolic and diastolic blood pressures (SBP and DBP, respectively) were analyzed. A total of 97 patients (52.3±10.7 years, %53.6 female) completed the study. In the Ma’aljobon group, SBP decreased from 150.3±12.3 to 130.6±12.1 mm Hg, and DBP decreased from 93.3±8.2 to 80.1±6.6 mm Hg (p<0.001). In the control group, SBP decreased from 147.6±11.2 to 138.7±14.4 mm Hg, and DBP decreased from 86.6±7.7 to 82.2±8.2 mm Hg (p<0.001). There was a significant difference in the changes of SBP and DBP between the two groups over time (p<0.001). No adverse events were observed. Ma’aljobon has a stronger hypotensive effect than placebo in patients with HTN and can be recommended as an add-on therapy for uncontrolled HTN.

The relationship between body mass index (BMI) and blood pressure in the Vietnamese population has not been clearly defined. This study aims to examine the clinical characteristics and BMI of hypertensive patients and investigate the relationship between BMI and blood pressure.

This study employs a cross-sectional descriptive design and random sampling. Participants’ blood pressure was measured 3 times using an automatic sphygmomanometer.

A total of 5910 individuals participated in the study, with 2138 being diagnosed with hypertension. Among the participants, 20.8% were overweight, 20.8% were obese, and 9.9% were underweight. Linear regression analysis demonstrated a positive correlation between BMI and systolic blood pressure in both sexes (men: r = 0.339, P < 0.05; women: r = 0.324, P < 0.05; overall: r = 0.345, P < 0.05). After adjustments for age and gender, a 1-unit increase in BMI corresponded to a 1.414 mm Hg increase in systolic blood pressure. Obesity and overweight were associated with an increased risk of hypertension compared with normal weight (OR, 1.91; 95% CI, 1.67 to 2.18; P < 0.05 and OR, 1.81; 95% CI, 1.58 to 2.07; P < 0.05, respectively). Conversely, being underweight was associated with a reduced risk of hypertension (OR, 0.34; 95% CI, 0.27 to 0.43; P < 0.05).

The study found a positive correlation between BMI and blood pressure. It is advisable to manage weight even in individuals without hypertension and utilize BMI as a tool for detecting hypertension within the community. 

 Hypertension (HTN) has become a serious health problem in developing countries. The family has an important role in maintaining blood pressure (BP) at home, and sodium diet compliance in people with HTN needs to be developed. Therefore, this research aimed to evaluate the effectiveness of a family self-management program (FSMP) in HTN management and compliance with sodium consumption in rural areas of Indonesia.

Study Design:

 A parallel-group, single-blind randomized controlled trial.

 One hundred twenty-six eligible participants were randomly allocated to an intervention (n=63) and a control group (n=63). Participants in the intervention group received a 24-week (6-month) FSMP intervention. The primary outcome measures included the systolic and diastolic BP, the Score Sodium Questionnaire (SSQ), and the Morisky Medication Adherence Scale 8 (MMAS-8). The Knowledge of Health Care for HTN questionnaire and the Efficacy and Behavior Toward Health Care for Patients with HTN questionnaire were used to assess the secondary outcome.

 The final results were analyzed from 121 participants (n=61 intervention and n=60 control group). The repeated analysis of variance (ANOVA) test results demonstrated significant effects on the management of HTN and adherence to sodium consumption as indicated by systolic (P=0.004) and diastolic BP (P=0.006), SSQ (P<0.001), MMAS 8 (P<0.001), caregivers’ knowledge (P<0.001), caregivers’ self-efficacy (P<0.001), and caregivers’ behaviors (P=0.005).

 The FMSP emerges as a promising strategy for managing BP and adherence to sodium consumption in people with HTN through the support of family caregivers and selfmanagement activities.