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Hypertension: HELP
Articles from University of Sydney
Based on 447 articles published since 2010
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These are the 447 published articles about Hypertension that originated from University of Sydney during 2010-2020.
 
+ Citations + Abstracts
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176 Article Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji. 2018

Webster, Jacqui / Pillay, Arti / Suku, Arleen / Gohil, Paayal / Santos, Joseph Alvin / Schultz, Jimaima / Wate, Jillian / Trieu, Kathy / Hope, Silvia / Snowdon, Wendy / Moodie, Marj / Jan, Stephen / Bell, Colin. ·The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia. jillian.wate@fnu.ac.fj. · School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia. jillian.wate@fnu.ac.fj. · Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji. arti.pillay@fnu.ac.fj. · Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji. arleen.sukhu@fnu.ac.fj. · The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia. paayalgohil2@hotmail.com. · The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia. jsantos@georgeinstitute.org.au. · School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia. jsantos@georgeinstitute.org.au. · Independent Nutrition Consultant, Suva, Fiji. jimaima63@gmail.com. · Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji. jimaima63@gmail.com. · The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia. ktrieu@georgeinstitute.org.au. · School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia. ktrieu@georgeinstitute.org.au. · Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia. hope.silvia@gmail.com. · Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia. wendy.snowdon@deakin.edu.au. · Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia. marj.moodie@deakin.edu.au. · Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia. marj.moodie@deakin.edu.au. · The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia. sjan@georgeinstitute.org.au. · Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia. colin.bell@deakin.edu.au. ·Nutrients · Pubmed #29385758.

ABSTRACT: This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

177 Article Is there a learning effect when the 6-minute walk test is repeated in people with suspected pulmonary hypertension? 2018

Spencer, Lissa / Zafiropoulos, Bill / Denniss, Wendy / Fowler, Dot / Alison, Jennifer / Celermajer, David. ·1 Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia. · 2 Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia. · 3 Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Sydney, NSW, Australia. · 4 Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia. ·Chron Respir Dis · Pubmed #29361830.

ABSTRACT: The aim of the study was to determine if there was a difference in 6-minute walk distance (6MWD) when two 6-minute walk tests (6MWTs) were performed at the initial assessment prior to attendance at the pulmonary hypertension (PH) clinic and at the 6-month follow-up. Two 6MWTs were performed at both visits on a 32-m continuous track in the physiotherapy hospital outpatient setting using standard instructions and encouragement. Two hundred and fourteen participants completed two 6MWTs at the initial assessment and 71 participants at the 6-month follow-up (mean (standard deviation) age: 57 (16) years; body mass index: 27 (6) kg/m

178 Article Impact of the IADPSG criteria for gestational diabetes, and of obesity, on pregnancy outcomes. 2018

Cheung, N Wah / Jiang, Shan / Athayde, Neil. ·Department of Diabetes & Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia. · University of Sydney, Sydney, New South Wales, Australia. · Women's and Newborn Services, Westmead Hospital, Sydney, New South Wales, Australia. ·Aust N Z J Obstet Gynaecol · Pubmed #29359312.

ABSTRACT: BACKGROUND: The adoption of the International Association of Diabetes Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) in Australia has been controversial. Obesity in pregnancy is also a growing concern. AIMS: To assess the impact of IADPSG criteria on the incidence of GDM and pregnancy outcomes, and to compare this to the effect of obesity, particularly among women who would not have GDM by the Australasian Diabetes in Pregnancy Society 1998 criteria (ADIPS1998). MATERIAL AND METHODS: A retrospective observational cohort study linking results of 75 g glucose tolerance tests with demographic and pregnancy data was conducted. RESULTS: In our cohort of 6175 pregnancies, GDM was present in 926 (15%) women by the ADIPS1998 criteria; it increased to 1098 (17.8%) women by the IADPSG criteria. Among the 5248 pregnancies which did not meet the ADIPS1998 criteria and were not treated for GDM, women with IADPSG GDM had increased risk of gestational hypertension, pre-eclampsia, induction of labour (IOL), primary caesarean section (PCS) and large for gestational age (LGA) compared to women without GDM (all P < 0.05), whereas obese women had increased risk of gestational hypertension, pre-eclampsia, IOL, PCS, small for gestational age (SGA) and shoulder dystocia compared to women of normal weight (all P < 0.05). On multivariate analysis, IADPSG GDM was an independent risk factor only for IOL (P = 0.04) and LGA (<0.001). Obesity was an independent risk factor for gestational hypertension, pre-eclampsia, IOL, PCS, shoulder dystocia and SGA (all P < 0.001). CONCLUSIONS: Within our population, of women who are not currently treated for GDM, obesity is associated with greater pregnancy risk than GDM diagnosed by IADPSG criteria.

179 Article A simple prediction model to estimate obstructive coronary artery disease. 2018

Chen, Shiqun / Liu, Yong / Islam, Sheikh Mohammed Shariful / Yao, Hua / Zhou, Yingling / Chen, Ji-Yan / Li, Qiang. ·Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China. · Guangdong General Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai, 519000, China. · The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2050, Australia. · Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China. chenjiyandr@126.com. ·BMC Cardiovasc Disord · Pubmed #29338684.

ABSTRACT: BACKGROUND: A simple noninvasive model to predict obstructive coronary artery disease (OCAD) may promote risk stratification and reduce the burden of coronary artery disease (CAD). This study aimed to develop pre-procedural, noninvasive prediction models that better estimate the probability of OCAD among patients with suspected CAD undergoing elective coronary angiography (CAG). METHODS: We included 1262 patients, who had reliable Framingham risk variable data, in a cohort without known CAD from a prospective registry of patients referred for elective CAG. We investigated pre-procedural OCAD (≥50% stenosis in at least one major coronary vessel based on CAG) predictors. RESULTS: A total of 945 (74.9%) participants had OCAD. The final modified Framingham scoring (MFS) model consisted of anemia, high-sensitivity C-reactive protein, left ventricular ejection fraction, and five Framingham factors (age, sex, total and high-density lipoprotein cholesterol, and hypertension). Bootstrap method (1000 times) revealed that the model demonstrated a good discriminative power (c statistic, 0.729 ± 0.0225; 95% CI, 0.69-0.77). MFS provided adequate goodness of fit (P = 0.43) and showed better performance than Framingham score (c statistic, 0.703 vs. 0.521; P < 0.001) in predicting OCAD, thereby identifying patients with high risks for OCAD (risk score ≥ 27) with ≥70% predictive value in 68.8% of subjects (range, 37.2-87.3% for low [≤17] and very high [≥41] risk scores). CONCLUSION: Our data suggested that the simple MFS risk stratification tool, which is available in most primary-level clinics, showed good performance in estimating the probability of OCAD in relatively stable patients with suspected CAD; nevertheless, further validation is needed.

180 Article Factors associated with low birthweight in term pregnancies: a matched case-control study from rural Pakistan. 2018

Habib, Muhammad A / Greenow, Camille R / Ariff, Shabina / Soofi, Sajid / Hussain, Abid / Junejo, Qamar / Hussain, Amjad / Shaheen, Fariha / Black, Kirsten I. ·Department of Obstetrics, Gynecology and Neonatology, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Women and Child Health Division, Aga Khan University, Karachi, Pakistan. · Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. · Women and Child Health Division, Aga Khan University, Karachi, Pakistan. · Department of Obstetrics, Gynecology and Neonatology, Central Clinical School, University of Sydney, Sydney, NSW, Australia. ·East Mediterr Health J · Pubmed #29319147.

ABSTRACT: Low birthweight (LBW) remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy (AOR: 2.68; 95% CI: 1.59 - 4.38), nulliparity (AOR: 1.82; 95% CI: 1.26-2.44), having a previous miscarriage/abortion (AOR: 1.22; 95% CI: 1.06-2.35), having < 2 antenatal care (ANC) visits during last pregnancy (AOR: 2.43; 95% CI: 1.34-2.88), seeking ANC in third trimester (AOR: 3.62; 95% CI : 2.14-5.03), non-use of iron folic acid during last pregnancy (AOR: 2.72; 95% CI: 1.75-3.17), having hypertension during last pregnancy (AOR: 1.42; 95% CI: 1.13-2.20), being anemic (AOR: 2.67; 95% CI: 1.65-5.24) and having postpartum weight of <45 kg (AOR: 3.30; 95% CI : 1.97-4.52) were significantly associated with an increased odds of having a LBW baby. Our study identifies modifiable risk factors requiring immediate commitment from the health authorities.

181 Article Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. 2018

Keenan, Brendan T / Kim, Jinyoung / Singh, Bhajan / Bittencourt, Lia / Chen, Ning-Hung / Cistulli, Peter A / Magalang, Ulysses J / McArdle, Nigel / Mindel, Jesse W / Benediktsdottir, Bryndis / Arnardottir, Erna Sif / Prochnow, Lisa Kristin / Penzel, Thomas / Sanner, Bernd / Schwab, Richard J / Shin, Chol / Sutherland, Kate / Tufik, Sergio / Maislin, Greg / Gislason, Thorarinn / Pack, Allan I. ·Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA. · School of Nursing, University of Pennsylvania, Philadelphia, PA. · Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia. · Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil. · Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan. · Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia. · Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. · Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland. · Faculty of Medicine, University of Iceland, Reykjavik, Iceland. · Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany. · Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany. · Pulmonary, Critical Care and Sleep Disorder Center, Korea University Medical Center Ansan Hospital, Seoul, South Korea. ·Sleep · Pubmed #29315434.

ABSTRACT: Study Objectives: A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods: Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results: The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average. Conclusions: Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.

182 Article Y-chromosome lineage determines cardiovascular organ T-cell infiltration in the stroke-prone spontaneously hypertensive rat. 2018

Khan, Shanzana I / Andrews, Karen L / Jackson, Kristy L / Memon, Basimah / Jefferis, Ann-Maree / Lee, Man K S / Diep, Henry / Wei, Zihui / Drummond, Grant R / Head, Geoffrey A / Jennings, Garry L / Murphy, Andrew J / Vinh, Antony / Sampson, Amanda K / Chin-Dusting, Jaye P F. ·Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia. · Department of Medicine, Monash University, Melbourne, Victoria, Australia. · Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. · Department of Physiology, Anatomy, and Microbiology, La Trobe University, Bundoora, Victoria, Australia. · Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia. ·FASEB J · Pubmed #29301944.

ABSTRACT: The essential role of the Y chromosome in male sex determination has largely overshadowed the possibility that it may exert other biologic roles. Here, we show that Y-chromosome lineage is a strong determinant of perivascular and renal T-cell infiltration in the stroke-prone spontaneously hypertensive rat, which, in turn, may influence vascular function and blood pressure (BP). We also show, for the first time to our knowledge, that augmented perivascular T-cell levels can directly instigate vascular dysfunction, and that the production of reactive oxygen species that stimulate cyclo-oxygenase underlies this. We thus provide strong evidence for the consideration of Y-chromosome lineage in the diagnosis and treatment of male hypertension, and point to the modulation of cardiovascular organ T-cell infiltration as a possible mechanism that underpins Y- chromosome regulation of BP.-Khan, S. I., Andrews, K. L., Jackson, K. L., Memon, B., Jefferis, A.-M., Lee, M. K. S., Diep, H., Wei, Z., Drummond, G. R., Head, G. A., Jennings, G. L., Murphy, A. J., Vinh, A., Sampson, A. K., Chin-Dusting, J. P. F. Y-chromosome lineage determines cardiovascular organ T-cell infiltration in the stroke-prone spontaneously hypertensive rat.

183 Article Visit-to-visit (long-term) and ambulatory (short-term) blood pressure variability to predict mortality in an elderly hypertensive population. 2018

Chowdhury, Enayet K / Wing, Lindon M H / Jennings, Garry L R / Beilin, Lawrence J / Reid, Christopher M / Anonymous540931. ·Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria. · Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia. · Sydney Medical School, University of Sydney, New South Wales. · Baker Heart and Diabetes Institute, Melbourne, Victoria. · School of Medicine, University of Western Australia, Royal Perth Hospital. · School of Public Health, Curtin University, Perth, Western Australia, Australia. ·J Hypertens · Pubmed #29266060.

ABSTRACT: OBJECTIVES: To explore the association of different types of blood pressure (BP) variability measures estimated from either short-term ambulatory reading-to-reading or long-term clinic visit-to-visit BP records with long-term survival in an elderly treated hypertensive population. METHODS: A subset of patients (n = 508) aged at least 65-years was studied from the Second Australian National Blood Pressure study. We estimated SBP and DBP BP variability as the SD of ambulatory (24-h, daytime, night-time) and clinic visit-to-visit BP directly from all corresponding on-treatment within-individual BP records. Ambulatory 'weighted day-night' variability was calculated as a weighted mean of daytime and night-time SD. Cox-proportional hazard models adjusted for baseline risk factors (Model 1) and corresponding on-treatment BP (Model 2) or average night-time SBP (best predictive BP measure for outcome) (Model 3) were used to determine the relationship between long-term outcome and BP variability. RESULTS: Over a median of 10.6 years, 101 patients died from any cause, of which 51 deaths were cardiovascular. We observed increase in 'daytime' and 'weighted day-night' SBP/DBP variability was significantly associated with increased all-cause mortality in all models. For cardiovascular mortality, only 'weighted day-night' SBP variability significantly predicted risk in all models (Model 3 hazard ratio: 1.09, 95% confidence interval: 1.00-1.19, P = 0.04). Long-term BP variability was not associated with any outcome. On direct comparison, both 'daytime' and 'weighted day-night' BP variability measures provided similar prognostic information. CONCLUSION: Short-term 'daytime' and 'weighted day-night' SBP variability from ambulatory BP recordings was a better predictor of mortality in elderly treated hypertensive patients than long-term BP variability from visit-to-visit BP recordings.

184 Article PACAP-(6-38) or kynurenate microinjections in the RVLM prevent the development of sympathetic long-term facilitation after acute intermittent hypoxia. 2018

Kakall, Zohra M / Pilowsky, Paul M / Farnham, Melissa M J. ·Department of Physiology, Sydney Medical School, The University of Sydney , Sydney, New South Wales , Australia. · Heart Research Institute , Sydney, New South Wales , Australia. ·Am J Physiol Heart Circ Physiol · Pubmed #29212793.

ABSTRACT: Intermittent hypoxia causes a persistent increase in sympathetic activity that progresses to hypertension in chronic conditions such as obstructive sleep apnea. Pituitary adenylate cyclase-activating polypeptide (PACAP) is an excitatory neurotransmitter that causes long-lasting sympathetic excitation. We aimed to determine if intermittent activation of the rostral ventrolateral medulla (RVLM) causes PACAP-mediated elevation of sympathetic nerve activity, termed sympathetic long-term facilitation (sLTF). The role of PACAP in mediating sLTF in response to intermittent activation of the RVLM was investigated in urethane-anaesthetized and artificially ventilated rats ( n = 65, Sprague-Dawley). Bilateral RVLM microinjections of the PACAP type 1 receptor/vasoactive intestinal polypeptide receptor type 2 receptor antagonist PACAP-(6-38) [ n = 6, change (Δ): -16.4 ± 6.5%) or an ionotropic glutamate antagonist, kynurenate ( n = 6, Δ:-7.2 ± 2.3%), blocked the development of acute intermittent hypoxia-induced sLTF ( n = 6, Δ: 49.2 ± 14.2%). Intermittent RVLM microinjections of glutamate caused sLTF ( n = 5, Δ: 56.9 ± 14.7%) that was abolished by PACAP-(6-38) pretreatment ( n = 5, Δ:-1.2 ± 4.7%). Conversely, intermittent microinjections of PACAP in the RVLM did not elicit sLTF. Intermittent bilateral disinhibition of the RVLM by microinjection of γ-aminobutyric acid in the caudal ventrolateral medulla did not elicit sLTF. Direct activation of RVLM neurons is crucial for the development of sLTF. PACAP and glutamate act synergistically in the RVLM, with both being necessary for the sLTF response. We found that activation of glutamate but not PACAP receptors is necessary and sufficient to generate sLTF, even in the absence of intermittent hypoxia. Our results demonstrate that PACAP within the RVLM may contribute to the development of obstructive sleep apnea -induced hypertension. NEW & NOTEWORTHY Pharmacological blockade of either pituitary adenylate cyclase-activating polypeptide (PACAP) or ionotropic glutamate receptors in the rostral ventrolateral medulla prevents development of sympathetic long-term facilitation. PACAP receptor inhibition prevents the occurrence of hypoxia-induced peripheral chemoreflex sensitization. Thus, PACAP receptors may be a potential therapeutic target serving to reduce heightened sympathetic tone and hypersensitized cardiovascular reflexes.

185 Article Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension. 2018

da Silva Gonçalves Bós, Denielli / Van Der Bruggen, Cathelijne E E / Kurakula, Kondababu / Sun, Xiao-Qing / Casali, Karina R / Casali, Adenauer G / Rol, Nina / Szulcek, Robert / Dos Remedios, Cris / Guignabert, Christophe / Tu, Ly / Dorfmüller, Peter / Humbert, Marc / Wijnker, Paul J M / Kuster, Diederik W D / van der Velden, Jolanda / Goumans, Marie-José / Bogaard, Harm-Jan / Vonk-Noordegraaf, Anton / de Man, Frances S / Handoko, M Louis. ·Department of Pulmonology (D.d.S.G.B., C.E.V.D.B., X.-Q.S., N.R., R.S., H.-J.B., A.V.-N. F.S.d.M.). · VU University Medical Center / Amsterdam Cardiovascular Sciences, The Netherlands.. Department of Molecular Cell Biology, Laboratory of Experimental Cardiology, Leiden University Medical Center, The Netherlands (K.K., M.-J.G.). · Institute of Science and Technology, Universidade Federal de São Paulo, Brazil (K.R.C., A.G.C.). · Heart & Lung Transplant Unit, St. Vincent's Hospital and Bosch Institute, University of Sydney, Australia (C.d.R.). · University of Paris-Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France (C.G., L.T., P.D., M.H.). · INSERM UMR_S 999, Le Plessis-Robinson, France (C.G., L.T., P.D., M.H.). · Department of Physiology (P.J.M.W., D.W.D.K., J.v.d.V.). · Department of Cardiology (M.L.H.) ml.handoko@vumc.nl fs.deman@vumc.nl. ·Circulation · Pubmed #29167228.

ABSTRACT: BACKGROUND: The beneficial effects of parasympathetic stimulation have been reported in left heart failure, but whether it would be beneficial for pulmonary arterial hypertension (PAH) remains to be explored. Here, we investigated the relationship between parasympathetic activity and right ventricular (RV) function in patients with PAH, and the potential therapeutic effects of pyridostigmine (PYR), an oral drug stimulating the parasympathetic activity through acetylcholinesterase inhibition, in experimental pulmonary hypertension (PH). METHODS: Heart rate recovery after a maximal cardiopulmonary exercise test was used as a surrogate for parasympathetic activity. RV ejection fraction was assessed in 112 patients with PAH. Expression of nicotinic (α-7 nicotinic acetylcholine receptor) and muscarinic (muscarinic acetylcholine type 2 receptor) receptors, and acetylcholinesterase activity were evaluated in RV (n=11) and lungs (n=7) from patients with PAH undergoing heart/lung transplantation and compared with tissue obtained from controls. In addition, we investigated the effects of PYR (40 mg/kg per day) in experimental PH. PH was induced in male rats by SU5416 (25 mg/kg subcutaneously) injection followed by 4 weeks of hypoxia. In a subgroup, sympathetic/parasympathetic modulation was assessed by power spectral analysis. At week 6, PH status was confirmed by echocardiography, and rats were randomly assigned to vehicle or treatment (both n=12). At the end of the study, echocardiography was repeated, with additional RV pressure-volume measurements, along with lung, RV histological, and protein analyses. RESULTS: Patients with PAH with lower RV ejection fraction (<41%) had a significantly reduced heart rate recovery in comparison with patients with higher RV ejection fraction. In PAH RV samples, α-7 nicotinic acetylcholine receptor was increased and acetylcholinesterase activity was reduced versus controls. No difference in muscarinic acetylcholine type 2 receptor expression was observed. Chronic PYR treatment in PH rats normalized the cardiovascular autonomic function, demonstrated by an increase in parasympathetic activity and baroreflex sensitivity. PYR improved survival, increased RV contractility, and reduced RV stiffness, RV hypertrophy, RV fibrosis, RV inflammation, and RV α-7 nicotinic acetylcholine receptor and muscarinic acetylcholine type 2 receptor expression, as well. Furthermore, PYR reduced pulmonary vascular resistance, RV afterload, and pulmonary vascular remodeling, which was associated with reduced local and systemic inflammation. CONCLUSIONS: RV dysfunction is associated with reduced systemic parasympathetic activity in patients with PAH, with an inadequate adaptive response of the cholinergic system in the RV. Enhancing parasympathetic activity by PYR improved survival, RV function, and pulmonary vascular remodeling in experimental PH.

186 Article Vascular dysfunction in the stroke-prone spontaneously hypertensive rat is dependent on constrictor prostanoid activity and Y chromosome lineage. 2018

Khan, Shanzana I / Andrews, Karen L / Jefferis, Ann-Maree / Jennings, Garry L / Sampson, Amanda K / Chin-Dusting, Jaye P F. ·Cardiovascular Disease Program, Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia shanzana.khan@monash.edu. · Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia. · Department of Medicine, Monash University, Melbourne, Victoria, Australia. · Cardiovascular Disease Program, Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia. · Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia. ·Clin Sci (Lond) · Pubmed #29162746.

ABSTRACT: Vascular dysfunction is a hallmark of hypertension and the strongest risk factor to date for coronary artery disease. As Y chromosome lineage has emerged as one of the strongest genetic predictors of cardiovascular disease risk to date, we investigated if Y chromosome lineage modulated this important facet in the stroke-prone spontaneously hypertensive rat (SHRSP) using consomic strains. Here, we show that vascular dysfunction in the SHRSP is attributable to differential cyclooxygenase (COX) activity with nitric oxide (NO) levels playing a less significant role. Measurement of prostacyclin, the most abundant product of COX in the vasculature, confirmed the augmented COX activity in the SHRSP aorta. This was accompanied by functional impairment of the vasodilatory prostacyclin (IP) receptor, while inhibition of the thromboxane (TP) receptor significantly ameliorated vascular dysfunction in the SHRSP, suggesting this is the downstream target responsible for constrictor prostanoid activity. Importantly, Y chromosome lineage was shown to modulate vascular function in the SHRSP through influencing COX activity, prostacyclin levels and IP dysfunction. Vascular dysfunction in the renal and intrarenal arteries was also found to be prostanoid and Y chromosome dependent. Interestingly, despite no apparent differences in agonist-stimulated NO levels, basal NO levels were compromised in the SHRSP aorta, which was also Y chromosome dependent. Thus, in contrast with the widely held view that COX inhibition is deleterious for the vasculature due to inhibition of the vasodilator prostacyclin, we show that COX inhibition abolishes vascular dysfunction in three distinct vascular beds, with IP dysfunction likely being a key mechanism underlying this effect. We also delineate a novel role for Y chromosome lineage in regulating vascular function through modulation of COX and basal NO levels.

187 Article Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia. 2018

Rahmawati, Riana / Bajorek, Beata. ·1 Graduate School of Health: Discipline of Pharmacy, The University of Technology Sydney, Sydney, Australia. · 2 Pharmacology Department, Faculty of Medicine, Islamic University of Indonesia, Yogyakarta, Indonesia. · 3 Department of Pharmacy, Royal North Shore Hospital, Sydney, Australia. ·Chronic Illn · Pubmed #29119817.

ABSTRACT: Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5-4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0-3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3-15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.

188 Article Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis. 2018

Kahlaee, Hamid Reza / Latt, Mark D / Schneider, Carl R. ·The University of Sydney, Faculty of Pharmacy, Sydney, New South Wales, Australia. · Royal Prince Alfred Hospital, Geriatric Medicine, New South Wales, Australia. ·Am J Hypertens · Pubmed #29087440.

ABSTRACT: BACKGROUND: Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults. METHODS: Data sources: Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE, and MEDLINE databases from January 1 2007 to June 1 2017. Study selection: Research studies of cohort, case-control, case-crossover, cross-sectional, or randomized controlled trial (RCT) design examining association between antihypertensives and falls in people older than 60 years were evaluated. Data synthesis: Twenty-nine studies (N = 1,234,667 participants) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). PRISMA and MOOSE guidelines were used for abstracting data and random-effects inverse-variance meta-analysis was conducted on 26 articles examining chronic antihypertensive use, with odds ratios (ORs) and hazards ratios (HRs) analyzed separately. Time-risk analysis was performed on 5 articles examining acute use of antihypertensives. Outcomes: Pooled ORs and HRs were calculated to determine the association between chronic antihypertensive use and falls. For time-risk analysis, OR was plotted with respect to number of days since antihypertensive commencement, change, or dose increase. RESULTS: There was no significant association between risk of falling and chronic antihypertensive medication use (OR = 0.97, 95% confidence interval [CI] 0.93-1.01, I2 = 64.1%, P = 0.000; and HR = 0.96, 95% CI 0.92-1.00, I2 = 0.0%, P = 0.706). The time-risk analysis demonstrated a significantly elevated risk of falling 0-24 hours after antihypertensive initiation, change, or dose increase. When diuretics were used, the risk remained significantly elevated till day 21. CONCLUSIONS: There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.

189 Article Environmental stress and vestibular inputs modulate cardiovascular responses to orthostasis in hypertensive rats. 2018

Raffai, Gábor / Csekő, Csongor / Nádasy, György / Kocsis, László / Dézsi, László / Hunyor, Stephen N / Monos, Emil. ·Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary. · Department of General Pharmacology, Gedeon Richter Plc., Budapest, Hungary. · Department of Physiology, Semmelweis University Budapest, Budapest, Hungary. · Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary. · Kolling Institute of Medical Research, University of Sydney At Royal North Shore Hospital, Sydney, Australia. ·Hypertens Res · Pubmed #29070830.

ABSTRACT: The frequent accompaniment of hypertension by orthostatic circulatory disorders prompted us to investigate the effect of repeated and sustained head-up and head-down tilt positions on cardiovascular responses in spontaneously hypertensive rats vs. Wistar rats using radiotelemetric implants. Repeated orthostasis caused a transient elevation in blood pressure (7.3±1.7 mmHg) and heart rate (39.7±10.5 BPM), while repeated antiorthostasis led only to reversible tachycardia (85.6±11.7-54.3±16.8 BPM) in spontaneously hypertensive rats. In contrast to the Wistar rats, sustained tilt failed to affect the blood pressure or heart rate in spontaneously hypertensive rats because the environmental stress of being placed in horizontal tilt cages prior to the sustained tilt test induced marked changes in cardiovascular parameters. Non-specific stress responses were eliminated both by the anxiolytic diazepam and a sub-anesthetic dose of chloralose. Unlike diazepam, chloralose amplified the orthostatic pressor responses in the Wistar rats. In contrast to diazepam preventing the pressor response and associated tachycardia in spontaneously hypertensive rats, chloralose elicited this effect during both sustained orthostasis (36.0±7.3 mmHg, 63.7±21.8 BPM) and antiorthostasis (42.9±10.9 mmHg, 82.8±25.4 BPM), with a reduced baroreflex sensitivity. However, during sustained orthostasis, removal of the vestibular input led to a depressor response with bradycardia (12.5±3.2 mmHg, 59.3±17.3 BPM), whereas antiorthostasis only reduced blood pressure (20.5±7.1 mmHg) in the spontaneously hypertensive rats. We conclude that repeated tilts induce a transient pressor response and/or tachycardia in spontaneously hypertensive rats. Cardiovascular parameters are suppressed by diazepam, whereas chloralose evokes both blood pressure and heart rate responses during sustained tilts, which are primarily elicited by baroreflex suppression in hypertension. Vestibular inputs support cardiovascular tolerance to sustained postural changes in a rat model of human 'essential' hypertension.

190 Article A spectrum of retinal vasculature measures and coronary artery disease. 2018

Wang, Sarah B / Mitchell, Paul / Liew, Gerald / Wong, Tien Yin / Phan, Kevin / Thiagalingam, Aravinda / Joachim, Nichole / Burlutsky, George / Gopinath, Bamini. ·Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. · Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia. · Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia. Electronic address: bamini.gopinath@sydney.edu.au. ·Atherosclerosis · Pubmed #29050745.

ABSTRACT: BACKGROUND AND AIMS: We aimed to comprehensively describe a spectrum of retinal vessel measures including fractal dimension (D METHODS: The Australian Heart Eye Study (AHES) is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. A range of newer retinal vessel geometric measures (D RESULTS: A total of 1187 participants had complete data on retinal vessel measurements and coronary vessel evaluation. Retinal vascular D CONCLUSIONS: A range of retinal vessel measures were associated with CAD extent and severity. A sparser retinal microvascular network (smaller D

191 Article Survival of Idiopathic Pulmonary Arterial Hypertension Patients in the Modern Era in Australia and New Zealand. 2018

Strange, Geoff / Lau, Edmund M / Giannoulatou, Eleni / Corrigan, Carolyn / Kotlyar, Eugene / Kermeen, Fiona / Williams, Trevor / Celermajer, David S / Dwyer, Nathan / Whitford, Helen / Wrobel, Jeremy P / Feenstra, John / Lavender, Melanie / Whyte, Kenneth / Collins, Nicholas / Steele, Peter / Proudman, Susanna / Thakkar, Vivek / Keating, Dominic / Keogh, Anne / Anonymous3860923. ·School of Medicine, University of Notre Dame, Perth, WA, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Pulmonary Hypertension Society of Australia and New Zealand, Sydney, NSW, Australia. · Sydney Medical School, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: edmund.lau@sydney.edu.au. · Computational Genomics Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia. · Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia. · Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Qld, Australia. · Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic, Australia. · Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia. · Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia. · School of Medicine, University of Notre Dame, Perth, WA, Australia; Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia. · Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia. · Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand. · Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia. · Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia. · Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia. · Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia. ·Heart Lung Circ · Pubmed #29029950.

ABSTRACT: BACKGROUND: Epidemiology and treatment strategies continue to evolve in pulmonary arterial hypertension (PAH). We sought to define the characteristics and survival of patients with idiopathic, heritable and drug-induced PAH in the current management era. METHODS: Consecutive cases of idiopathic, heritable and drug-induced PAH were prospectively enrolled into an Australian and New Zealand Registry. RESULTS: Between January 2012 and December 2016, a total of 220 incident cases were enrolled (mean age 57.2±18.7years, female 69.5%) and followed for a median duration of 26 months (IQR17-39). Co-morbidities were common such as obesity (34.1%), systemic hypertension (30.5%), coronary artery disease (16.4%) and diabetes mellitus (19.5%). Initial combination therapy was used in 54 patients (dual, n=50; triple, n=4). Estimated survival rates at 1-year, 2-years and 3-years were 95.6% (CI 92.8-98.5%), 87.3% (CI 82.5-92.4%) and 77.0% (CI 70.3-84.3%), respectively. Multivariate analysis showed that male sex and lower 6-minute distance at diagnosis independently predicted worse survival, whereas obesity was associated with improved survival. Co-morbidities other than obesity did not impact survival. Initial dual oral combination therapy was associated with a trend towards better survival compared with initial oral monotherapy (adjusted HR=0.27, CI 0.06-1.18, p=0.082) CONCLUSIONS: The epidemiology and survival of patients with idiopathic PAH in Australia and New Zealand are similar to contemporary registries reported in Europe and North America. Male sex and poorer exercise capacity are predictive of mortality whereas obesity appears to exert a protective effect. Despite current therapies, PAH remains a life-threatening disease associated with significant early mortality.

192 Article The prevalence and predictors of hypertension in a National Survey of Australian Children. 2018

Larkins, Nicholas G / Teixeira-Pinto, Armando / Craig, Jonathan C. ·a Department of Nephrology , Princess Margaret Hospital , Subiaco , Australia. · b Sydney School of Public Health , University of Sydney , Sydney , Australia. · c Centre for Kidney Research , The Children's Hospital at Westmead , Westmead , Australia. ·Blood Press · Pubmed #28937287.

ABSTRACT: PURPOSE: To determine the prevalence of hypertension and predictors of blood pressure (BP) in a population based survey of Australian children. SUBJECTS AND METHODS: We analysed cross-sectional data for 2071 children, aged 5-17 years, from the Australian Health Survey 2011-13. Hypertension and high-normal BP were defined by a systolic or diastolic BP greater than the 95th and 90th centiles respectively, using the National High Blood Pressure Education Program fourth report reference data. We also examined the association of several predictor variables (age, sex, remoteness, socioeconomic status, body mass index) with BP as a continuous variable. RESULTS: A total of 5.8% (95%CI 4.4-7.2) of children had hypertension, and a further 6.8% (95%CI 5.4-8.3) had high-normal BP. The strongest predictor of BP was body mass index. After adjustment, children in the overweight and obese categories had a BP that was on average 4 (95%CI 2-6) and 8 mmHg (95%CI 6-11) higher than those of normal weight. Socio-economic status was a statistically significant predictor of BP, but the effect size was more modest (2 mmHg [95%CI 0-4] between the highest and lowest tertile). CONCLUSIONS: Hypertension or high-normal BP is present in 12.6% of Australian children. Body mass index is the most important predictor of BP, followed by low socioeconomic status. These at-risk children may be suitable for screening and intervention studies.

193 Article Understanding untreated hypertension from patients' point of view: A qualitative study in rural Yogyakarta province, Indonesia. 2018

Rahmawati, Riana / Bajorek, Beata. ·1 Graduate School of Health, Discipline of Pharmacy, The University of Technology Sydney, New South Wales, Australia. · 2 Pharmacology Department, Faculty of Medicine, Islamic University of Indonesia, Yogyakarta, Indonesia. · 3 Department of Pharmacy, Royal North Shore Hospital, Sydney, New South Wales, Australia. ·Chronic Illn · Pubmed #28669227.

ABSTRACT: Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients' expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients' expectations. Reluctance to take anti-hypertensive medications was influenced by patients' beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients' beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.

194 Article Prevalence, management and control of hypertension in older adults on admission to hospital. 2017

Alhawassi, T M / Krass, I / Pont, L G. ·College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. · Department of Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia. · Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia. · Faculty of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia. · Centre for Health Systems and Safety Research, Macquarie University, North Ryde, Australia. · Sydney Nursing School, University of Sydney, Sydney, NSW, Australia. ·Saudi Pharm J · Pubmed #30166910.

ABSTRACT: Introduction: The aim of this study was to explore the prevalence and management of hypertension among older adults on admission to hospital and to assess the choice of antihypertensive pharmacotherapy in light of relevant comorbid conditions using the national treatment guideline. Materials and methods: A retrospective cross sectional study of 503 patients aged 65 years or older admitted to a large metropolitan teaching hospital in Sydney Australia was conducted. The main outcome measures were prevalence of hypertension, blood pressure (BP) control, antihypertensive medication use and the appropriateness of antihypertensive medications. Results: Sixty-nine percent (n = 347) of the study population had a documented diagnosis of hypertension and of these, approximately one third were at target BP levels on admission to hospital. Some concerns regarding choice of antihypertensive noted with 51% of those with comorbid diabetes and 30% of those with comorbid heart failure receiving a potentially inappropriate antihypertensive agent. Conclusions: Despite the use of antihypertensive pharmacotherapy, many older adults do not have optimal BP control and are not reaching target BP levels. New strategies to improve blood pressure control in older populations especially targeting women, those with a past history of myocardial infarction and those on multiple antihypertensive medications are needed.

195 Article Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data. 2017

Attaei, Marjan W / Khatib, Rasha / McKee, Martin / Lear, Scott / Dagenais, Gilles / Igumbor, Ehimario U / AlHabib, Khalid F / Kaur, Manmeet / Kruger, Lanthe / Teo, Koon / Lanas, Fernando / Yusoff, Khalid / Oguz, Aytekin / Gupta, Rajeev / Yusufali, Afzalhussein M / Bahonar, Ahmad / Kutty, Raman / Rosengren, Annika / Mohan, Viswanathan / Avezum, Alvaro / Yusuf, Rita / Szuba, Andrzej / Rangarajan, Sumathy / Chow, Clara / Yusuf, Salim / Anonymous4700930. ·Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. · Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, USA. · Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK. · Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada. · Heart and Lung Institute, Laval University, Quebec City, QC, Canada. · School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa. · Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia. · School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India. · Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, North-West Province, South Africa. · Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada. · Universidad de La Frontera, Temuco, Chile. · Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia; UCSI University, Cheras, Selangor, Malaysia. · Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet Univeristy, Istanbul, Turkey. · Eternal Heart Care Centre and Research Institute, Jawahar Circle, Jaipur India. · Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates. · Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. · Health Action by People, Medical College, Trivandrum, India. · Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Madras Diabetes Research Foundation, Chennai, India. · Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. · School of Life Sciences, Independent University, Bangladesh, Dhaka, Bangladesh. · Wroclaw Medical University, Department of Internal Medicine, Borowska, Wroclaw, Poland. · Western Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. · Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada. Electronic address: salim.yusuf@phri.ca. ·Lancet Public Health · Pubmed #29253412.

ABSTRACT: BACKGROUND: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. METHODS: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. FINDINGS: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59-3·12); p<0·0001), combination therapy (1·53, 1·13-2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69-2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25-1·62; p<0·0001), combination therapy (1·26, 1·08-1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00-1·28; p=0·0562) than were those unable to afford the medicines. INTERPRETATION: A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. FUNDING: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries.

196 Article Assessment of a Salt Reduction Intervention on Adult Population Salt Intake in Fiji. 2017

Pillay, Arti / Trieu, Kathy / Santos, Joseph Alvin / Sukhu, Arleen / Schultz, Jimaima / Wate, Jillian / Bell, Colin / Moodie, Marj / Snowdon, Wendy / Ma, Gary / Rogers, Kris / Webster, Jacqui. ·Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Suva, Fiji. arti.pillay@fnu.ac.fj. · The George Institute for Global Health, University of New South Wales, Sydney NSW 2052, Australia. ktrieu@georgeinstitute.org.au. · School of Public Health, University of Sydney, Sydney 2006, Australia. ktrieu@georgeinstitute.org.au. · The George Institute for Global Health, University of New South Wales, Sydney NSW 2052, Australia. jsantos@georgeinstitute.org.au. · School of Public Health, University of Sydney, Sydney 2006, Australia. jsantos@georgeinstitute.org.au. · Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Suva, Fiji. arleen.sukhu@fnu.ac.fj. · Independent Nutrition Consultant, Suva, Fiji. jimaima63@gmail.com. · Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Suva, Fiji. jillian.wate@fnu.ac.fj. · Global Obesity Centre, Deakin University, Geelong VIC 3220, Australia. colin.bell@deakin.edu.au. · Global Obesity Centre, Deakin University, Geelong VIC 3220, Australia. marj.moodie@deakin.edu.au. · Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood VIC 3125, Australia. marj.moodie@deakin.edu.au. · Global Obesity Centre, Deakin University, Geelong VIC 3220, Australia. wendy.snowdon@deakin.edu.au. · School of Medicine, University of Western Sydney, Campbell town, Sydney 2560, Australia. G.Ma@westernsydney.edu.au. · The George Institute for Global Health, University of New South Wales, Sydney NSW 2052, Australia. krogers@georgeinstitute.org. · The George Institute for Global Health, University of New South Wales, Sydney NSW 2052, Australia. jwebster@georgeinstitute.org.au. · School of Public Health, University of Sydney, Sydney 2006, Australia. jwebster@georgeinstitute.org.au. ·Nutrients · Pubmed #29231897.

ABSTRACT: Reducing population salt intake is a global public health priority due to the potential to save lives and reduce the burden on the healthcare system through decreased blood pressure. This implementation science research project set out to measure salt consumption patterns and to assess the impact of a complex, multi-faceted intervention to reduce population salt intake in Fiji between 2012 and 2016. The intervention combined initiatives to engage food businesses to reduce salt in foods and meals with targeted consumer behavior change programs. There were 169 participants at baseline (response rate 28.2%) and 272 at 20 months (response rate 22.4%). The mean salt intake from 24-h urine samples was estimated to be 11.7 grams per day (g/d) at baseline and 10.3 g/d after 20 months (difference: -1.4 g/day, 95% CI -3.1 to 0.3,

197 Article Home blood pressure measurement in women with pregnancy-related hypertensive disorders. 2017

Lan, Patrick G / Hyett, Jon / Gillin, Adrian G. ·Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. Electronic address: plan1744@uni.sydney.edu.au. · Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW 2006, Australia. · Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. ·Pregnancy Hypertens · Pubmed #29153682.

ABSTRACT: OBJECTIVES: To determine if home blood pressure measurement (HBPM) provides comparable results to clinic blood pressure (BP) measurement. STUDY DESIGN: A prospective, single-centre study of 37 pregnant and early post-partum women with a hypertensive pregnancy or at high-risk of developing a hypertensive pregnancy were asked to perform HBPM for a minimum period of one week. This was subsequently compared to clinic BP measurement both before and after the period of home measurement. MAIN OUTCOME MEASURES: The accuracy of HBPM compared to clinic measurement, and the acceptability by patients for HBPM. RESULTS: The HBPM was comparable to clinic measurements [for the systolic blood pressure (SBP), the mean home reading was 123.4mmHg (122.0-124.9mmHg) versus 123.9mmHg (121.3-126.5mmHg) for the clinic reading (p=0.69); for the diastolic blood pressure (DBP) the mean home reading was 81.6mmHg (80.4-82.8mmHg) versus 84.4mmHg (82.6-86.2mmHg) for the clinic (p<0.01)]. There were no reported issues associated with the use of HBPM, but it did lead to 5 women contacting health care professionals for management of their BP between clinic visits. CONCLUSIONS: HBPM provides comparable results to the clinic BP measurement. It is also an acceptable technique for pregnant and early post-partum women. However, it should be used as an adjunct to clinic measurement, and cannot at this present stage replace clinic visits or clinic BP measurement.

198 Article Who benefits from fixed-dose combinations? Two-year statin adherence trajectories in initiators of combined amlodipine/atorvastatin therapy. 2017

Schaffer, Andrea L / Buckley, Nicholas A / Pearson, Sallie-Anne. ·Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. · Sydney Medical School, University of Sydney, Camperdown, Australia. · Menzies Centre for Health Policy, University of Sydney, Camperdown, Australia. ·Pharmacoepidemiol Drug Saf · Pubmed #29067759.

ABSTRACT: PURPOSE: We compared statin adherence in individuals initiating combined amlodipine/atorvastatin therapy as a fixed-dose (FDC) or free combination and identified subgroups benefiting most from FDCs. METHODS: We used a 10% sample of Australian Pharmaceutical Benefits Scheme dispensing data (2005-2015) to identify individuals initiating amlodipine and atorvastatin as an FDC (n = 3996) or free combination (n = 5434), with or without prior statin dispensing. We measured the proportion of days covered in each 30-day period over 24 months and classified patterns of statin adherence using group-based trajectory models. We identified predictors of adherence trajectories using logistic regression. RESULTS: The median age was 71 years, and 53% were female. We identified 4 patterns of statin adherence: near-perfect adherence (n = 5383), good adherence (n = 1893), declining adherence (n = 1247), and early nonadherence (n = 907). Compared with the free combination, FDC initiators were more likely to have near-perfect adherence if they were previously statin adherent irrespective of amlodipine dose (amlodipine 5 mg: OR = 1.61, 95% CI 1.38-1.87; amlodipine 10 mg: OR = 2.39, 95% CI 1.63-3.51) or they were previously statin nonadherent and initiated on the 5 mg amlodipine dose (OR = 1.87, 95% CI 1.50-2.32). Statin-naïve individuals initiating on the FDC with 10 mg amlodipine were less likely to have near-perfect adherence (OR = 0.60, 95% CI 0.41-0.88) and more likely to have early nonadherence (OR = 1.73, 95% CI 1.17-2.55). CONCLUSIONS: The amlodipine/atorvastatin FDC was associated with greater statin adherence among prevalent statin users, and individuals who initiated on lower amlodipine doses. The FDCs did not improve adherence in statin-naïve individuals and in some cases resulted in poorer adherence.

199 Article Elevated blood pressure and risk of mitral regurgitation: A longitudinal cohort study of 5.5 million United Kingdom adults. 2017

Rahimi, Kazem / Mohseni, Hamid / Otto, Catherine M / Conrad, Nathalie / Tran, Jenny / Nazarzadeh, Milad / Woodward, Mark / Dwyer, Terence / MacMahon, Stephen. ·The George Institute for Global Health, University of Oxford, Oxford, United Kingdom. · Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. · University of Washington, Seattle, Washington, United States of America. · The Collaboration Center of Meta-analysis Research, Sabzevar University of Medical Sciences, Sabzevar, Iran. · Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. · The George Institute for Global Health, University of Sydney, Sydney, Australia. · Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America. ·PLoS Med · Pubmed #29040269.

ABSTRACT: BACKGROUND: Mitral regurgitation in people without prior cardiac disease is considered a degenerative disease with no established risk factors for its prevention. We aimed to test the hypothesis that elevated systolic blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation. METHODS AND FINDINGS: We used linked electronic health records from the United Kingdom Clinical Practice Research Datalink (CPRD) from 1 January 1990 to 31 December 2015. CPRD covers approximately 7% of the current UK population and is broadly representative of the population by age, sex, and ethnicity. About 5.5 million UK patients with no known cardiovascular or valve disease at baseline were included in this cohort study. We investigated the relationship between blood pressure (BP) and risk of mitral regurgitation using Cox regression models. Our primary exposure variable was SBP and our primary outcome was incident reports of mitral regurgitation, which were identified from hospital discharge reports or primary care records. Of the 5,553,984 patients in the CPRD that met our inclusion criteria, during the 10-year follow-up period, 28,655 (0.52%) were diagnosed with mitral regurgitation and a further 1,262 (0.02%) were diagnosed with mitral stenosis. SBP was continuously related to the risk of mitral regurgitation with no evidence of a nadir down to 115 mmHg (p < 0.001). Each 20 mmHg increment in SBP was associated with a 26% higher risk of mitral regurgitation (hazard ratio [HR] 1.26; CI 1.23, 1.29). The observed association was partially mediated by diseases affecting the left ventricle during follow-up (myocardial infarction [MI], ischaemic heart disease [IHD], cardiomyopathy, and heart failure). However, the percentage of excess risk mediated (PERM) by these proximate causes of secondary mitral regurgitation was only 13% (CI 6.1%, 20%), and accounting for them had little effect on the long-term association between SBP and mitral regurgitation (mediator-adjusted HR 1.22; CI 1.20, 1.25; p < 0.001). Associations were similar for each 10 mmHg increment in diastolic blood pressure (DBP) (p < 0.001) or each 15 mmHg increment in pulse pressure (PP) (p < 0.001). By contrast, there was no association between SBP and risk of mitral stenosis (HR per 20 mmHg higher SBP 1.03; CI 0.93, 1.14; p = 0.58). These analyses are based on routinely collected data from health records which may be sensitive to measurement errors, and the observed associations may not be generalizable to less severe and subclinical cases of mitral regurgitation. CONCLUSIONS: Long-term exposure to elevated BP across its whole spectrum is associated with an increased risk of primary and secondary mitral regurgitation. These findings suggest that BP control may be of importance in the prevention of mitral regurgitation.

200 Article The Treatment Effect of an ACE-Inhibitor Based Regimen with Perindopril in Relation to Beta-Blocker use in 29,463 Patients with Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA and PROGRESS Trials. 2017

Brugts, J J / Bertrand, M / Remme, W / Ferrari, R / Fox, K / MacMahon, S / Chalmers, J / Simoons, M L / Boersma, E. ·Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. j.brugts@erasmusmc.nl. · Institut CŒUR Poumon, Lille, France. · STICARES Cardiovascular Research Institute, Rhoon, The Netherlands. · Centro Cardiologico Universitario University of Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Ravenna, Italy. · NHLI, Imperial College and ICMS, Royal Brompton Hospital, London, UK. · The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia. · Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. ·Cardiovasc Drugs Ther · Pubmed #28856537.

ABSTRACT: INTRODUCTION: In everyday practice, angiotensin converting enzyme inhibitors and beta-blockers are cornerstone treatments in patients with (cardio-)vascular disease. Clear data that evaluate the effects of the combination of these agents on morbidity and mortality are lacking. METHODS: In this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS), clinical outcomes were evaluated in 29,463 patients with vascular disease. Multivariate Cox regression analyses were performed in patients randomized to a perindopril-based regimen or placebo (treatment effect), and data were stratified according to background beta-blocker treatment. The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke. RESULTS: The cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) (p < 0.01). Adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71-0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65-0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68-0.88) as compared to placebo. Significant treatment benefit was not observed for stroke (HR 0.93; 95% CI 0.75-1.15). Significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension. However, the mortality benefit was only observed in patients with hypertension with background beta-blocker use. CONCLUSIONS: These data suggest that the beneficial cardioprotective effects of perindopril treatment are additive to the background beta-blockers use.

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