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8 Scientific basis for information on the treatment of hypertension

Tuesday, June 8, 2021

Hypertension

Scientific basis for information on the treatment of hypertension

Hypertension and Weight Loss Diet

Hypertension is considered to be one of the most common conditions that can increase the possibility of serious health problems such as early death. In recent years, the standard values have been altered, making people wonder what hypertension is. However, it is said that there is a relationship between high blood pressure and morbidity. Therefore, many people are making efforts to lower their blood pressure in some way.

One such method is diet therapy, and there is a study investigating how it affects the results.

The study

This is a search for studies that compare the effects of a weight loss diet with and without a weight loss diet on people with hypertension.

The reviewer was interested in the effects of diet on blood pressure and weight.

They also wanted to know how many people experienced undesirable effects, how many developed cardiovascular disease, and how many died.  We were reviewing randomized controlled trials in which the treatment received by the participants was randomly determined. We also assessed the reliability of the evidence found and considered factors such as how the study was conducted, the number of people involved, and whether the findings were consistent across studies. 

Eight studies of 2,100 people with hypertension (mean age 45-66 years) were reviewed. The studies were conducted in the United States (four studies) and Europe (four studies) and lasted from 6 to 36 months.  None of the studies reported useful information on the undesirable effects of adhering to a weight loss diet. 

Diets that employed weight-loss diets allowed people to lose weight and resulted in lower blood pressure compared to those who did not follow the diet.   

Not enough evidence was found to determine whether the diet affected the number of people who died or developed cardiovascular disease after the diet.

Three of the studies reported that no one died during the study.

Only one study looked at the number of people who developed cardiovascular disease. 

Reviewer's Conclusion

This second update did not find any new studies, so the conclusions remain the same. In people with primary hypertension, weight loss diets reduced weight and blood pressure, but the magnitude of the effect is unknown because of the small number of participants and studies included in the analysis. It is not known whether weight loss reduces mortality and morbidity. No useful information on side effects was reported in the relevant trials.

Semlitsch T, Krenn C, Jeitler K, Berghold A, Horvath K, Siebenhofer A. Long-term effects of weight-reducing diets in people with hypertension. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD008274. DOI: 10.1002/14651858.CD008274.pub4.

Weight loss medications and hypertension

Weight loss medications include orlistat and naltrexone combined with bupropion, and there is a combination of phentermine and topiramate that is approved in the US and prescribed to reduce weight. Some of these drugs are actually prescribed in Japan, but under a different name than the one in the study I will introduce.

The study presented here was conducted to find out if weight loss medication has a long-term effect on blood pressure and if it can reduce the undesirable effects of high blood pressure on people's health.

The studies  

Six studies have been levied on 12,724 people with hypertension, with an average age of 46-62 years. The studies were conducted in the United States (3 studies) and Europe (3 studies) and lasted from 6 to 28 months. 

All of the studies compared the effects of taking a weight loss drug with the effects of taking a dummy drug (placebo).  

Orlistat may reduce weight and lower blood pressure. (4 studies; 2058 participants)

In addition, the combination of phentermine and topiramate may reduce weight and lower blood pressure. (1 study; 1305 patients)

Naltrexone and bupropion may reduce weight, but not blood pressure. (1 study; 8283 patients)

Another study looked at the risk of death and the major undesirable cardiovascular effects. After two years, there was no difference between naltrexone and bupropion treatment versus placebo.  However, those taking the weight loss drug reported less desirable effects than those taking the placebo. The negative effects reported included digestive problems, dry mouth and numbness.

Reviewer's conclusion 

In people with hypertension, orlistat, phentermine/topiramate, and naltrexone/bupropion reduced weight. The effect size was greatest with phentermine/topiramate. In the same study, orlistat and phentermine/topiramate lowered blood pressure, but naltrexone/bupropion did not. One RCT of naltrexone/bupropion versus placebo showed no difference in all-cause mortality or cardiovascular mortality or morbidity after two years. The European Medicines Agency refused marketing authorization for phentermine/topiramate due to safety concerns, while the application for European marketing authorization for lorcaserin was withdrawn due to the negative overall benefit/risk balance. lorcaserin was also withdrawn from the U.S. market in 2020. In 2020, lorcaserin was also withdrawn from the US market.

Siebenhofer A, Winterholer S, Jeitler K, Horvath K, Berghold A, Krenn C, Semlitsch T. Long-term effects of weight loss medication in people with hypertension. Cochrane Database of Systematic Reviews 2021, no. 1. Art. No.: CD007654. doi: 10.1002 /14651858.CD007654.pub5.

Potassium supplementation for blood pressure regulation.

Potassium supplementation is sometimes recommended to improve primary hypertension, but there seems to be no evidence for this. However, there seems to be no evidence for it. In response to this situation, a study was conducted to obtain solid evidence. What were the results of the study? Here are the results of the study.

The study

Six RCTs (n = 483) with 8-16 weeks of follow-up met the selection criteria.

A meta-analysis of five trials (n = 425) using appropriate data showed that

Potassium supplementation compared with control showed a substantial but not statistically significant reduction in SBP. Substantial heterogeneity between trials was not explained by potassium dose, trial quality, or baseline blood pressure.

Exclusion of one trial in an African population with very high baseline blood pressure resulted in a smaller overall reduction in blood pressure. A further sensitivity analysis limited to two high-quality trials (n = 138) did not show a significant reduction in blood pressure.

Results

Potassium supplementation does not have a statistically significant effect on blood pressure; the evidence for an effect of potassium supplementation on blood pressure is inconclusive because of the small number of participants in the two high-quality trials, the short follow-up period, and the unexplained heterogeneity between trials. Further high quality RCTs of longer duration are needed to clarify whether potassium supplementation can lower blood pressure and improve health outcomes.

Dickinson HO, Nicholson D, Campbell F, Bayer FR, Mason J. Potassium supplementation for the management of primary hypertension in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. No.: CD004641. doi: 10.1002 / 14651858.CD004641.pub2.

Hypertension and cocoa

What are the studies?

35 trials were reviewed. In the active intervention group trials, participants consumed 30-1218 mg of flavanols (mean = 670 mg) in 1.4-105 grams of cocoa products per day. The control group received either a flavanol-free product (n = 26 treatment comparisons) or low flavanol-containing cocoa powder

The control group received either a product containing no flavanols (n = 26 treatment comparisons) or a cocoa powder containing low flavanol content (flavanols range from 6.4 to 88 mg (mean = 55 mg, 13 treatment comparisons; 259 mg, 1 trial)). In a meta-analysis including 1804 primarily healthy participants.

A meta-analysis involving 1804 primarily healthy participants revealed a small but statistically significant blood pressure-lowering effect of a flavanol-rich cocoa product compared with controls in two 18-week duration trials. In hypertensive subjects, systolic blood pressure was reduced by 4 mmHg (n = 9 treatment comparisons, 401 participants). There was a trend toward lower systolic blood pressure in prehypertensive subjects. (n = 8 treatment comparisons, 340 participants)

However, the subgroup differences were of borderline significance (P = 0.08; I 2 = 60%), requiring further study to confirm the findings.

Blinded subgroup meta-analysis, although not statistically significant.

Although not statistically significant, a blinded subgroup meta-analysis suggested a trend toward greater blood pressure reduction in the open-label study compared to the double-blind study. Further studies are needed to see if participant expectations may influence blood pressure outcomes.

Subgroup analysis by type of control (no flavanol control vs. low flavanol control) did not reveal any significant differences. Whether or not the age of the participants played a role in the effect of cocoa on blood pressure.

Whether the age of the participants plays a role in the effect of cocoa on blood pressure, and whether younger participants respond with higher blood pressure reductions. Further research is needed to determine whether age plays a role in the effect of cocoa on blood pressure and whether younger participants respond with higher blood pressure reductions.

A sensitivity analysis (33 trials, 1482 participants) that excluded trials with authors recruited from industry-sponsored trials revealed a small reduction in effect size.

Due to remaining heterogeneity that could not be accounted for in terms of blinding, flavanol content of the control group, age of participants, or study duration, we lowered the quality of evidence from high to medium. The results of subgroup analyses should be interpreted with caution and should be confirmed or refuted by trials using direct randomized comparisons.

In general, cocoa products are very well tolerated and adverse effects including gastrointestinal upset and nausea were reported by 1% of participants in the active cocoa intervention group and 0.4% of participants in the control group.

The conclusions suggest that flavanol-rich chocolate and cocoa products may

moderate quality evidence that flavanol-rich chocolate and cocoa products can lower blood pressure by 1.8 mmHg in a short period of time. However, the question remains whether regular consumption of flavanol-rich cocoa products will have a beneficial effect in the long term?

Whether there are any side effects from long-term use?

Long-term studies are needed to find out.

Ried K, Fakler P, Stocks NP. Effects of cocoa on blood pressure Cochrane Database of Systematic Reviews 2017, No. 4. Number: CD008893. doi: 10.1002 / 14651858.CD008893.pub3.

Complying with Blood Pressure Numbers and Life Expectancy

For some people with a history of hypertension or heart disease, checking their blood pressure is an everyday occurrence. For some people, it can be a number to check their physical condition, or it can be a guide to take some action.

There is evidence that lower blood pressure is always better, and that if you have a standard blood pressure, you will be healthier.

I personally wondered if the risk of disease would change that much if the blood pressure value became lower. I had some doubts about this, so I would like to introduce the results of this study.

Contents of the study

This review includes six trials with 9484 participants who were followed from one to four or up to seven years. The data was analyzed to detect differences between lower and standard blood pressure targets in terms of the number of deaths and serious side effects (leading to hospitalization). As a result, there was little or no difference in the total number of deaths, or cardiac or vascular deaths, between the lower and standard blood pressure target approaches. Similar findings were found for the total number of cardiac or vascular problems and serious harm, with little or no difference, but the evidence is less certain.

Based on the very uncertain and limited information, we found that there were more dropouts due to drug-related harms in the low blood pressure target group and no overall health benefits among people in the low target group.

Reviewer's conclusions

Compared with standard blood pressure targets, we found probably little or no difference in total and cardiovascular mortality among people treated for hypertension and cardiovascular disease. There may also be little or no difference in serious adverse events or total cardiovascular events. This suggests that there is no net health benefit from lower systolic blood pressure targets. The evidence on withdrawal due to adverse effects is very limited, leading to a high degree of uncertainty. Currently, there is insufficient evidence to justify lower blood pressure targets (below 135/85 mmHg) in people with hypertension and established cardiovascular disease. Several trials are still underway and may provide important information on this topic in the near future.

Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, LeacheL. Blood pressure goals for the treatment of people with hypertension and cardiovascular disease. Cochrane Database of Systematic Reviews 2020, No. 9. Art. No.: CD010315. doi: 10.1002 /14651858.CD010315.pub4.

Interventions to improve white coat hypertension.

If you've been to the hospital, you may have heard of "white coat hypertension.
If you've ever been to the hospital, you may have heard of "white coat hypertension," a condition in which the sight of a white coat causes high blood pressure. As a result, the blood pressure values measured in hospitals and other environments where people in white coats are present and those without white coats fluctuate, and this may have adverse effects on diagnosis. So, how does this happen? As you can imagine, this is because

As you can imagine, this is because there is a problem with the relationship of trust between the patient and the doctor. I'll spare you the details, but what I'd like to introduce is a psychological study on how to improve the situation.

Results of the intervention

Fifteen studies on the effects of communication interventions on cardiovascular disease outcomes were reviewed. Only four studies reported significant effects of communication skills interventions on clinical cardiovascular-related outcomes, highlighting the need for methodological improvements in future studies evaluating the relationship between communication and health outcomes.

Because central components of white coat hypertension include anxiety and psychological distress, it is useful to consider studies of interventions to improve communication skills with a focus on emotional outcomes.

Roter et al. randomly assigned physicians to an 8-hour training program that focused on articulating patients' emotional concerns and addressing those feelings.

Results showed that trained physicians made a stronger effort to treat patients' emotional problems, and patients subsequently showed less emotional distress by six months later. Another study with cancer patients focused on the effects of physicians' communication skills training on patients' anxiety after a consultation.
These authors found that supportive communication and asking questions designed to elicit other concerns that had not been addressed correlated with a reduction in anxiety. What is the communication that needs to be done?
Of all the non-verbal and verbal communication that was studied and implemented in face-to-face situations, the one that reduced patients' anxiety the most was.
The most effective way to reduce patient anxiety was to "ask questions to see if they have any other concerns.

Cobos B, Haskard-Zolnierek K, Howard K, White coat hypertension: improving the patient-provider relationship. Psychol Res Behav Manag. 2015; 8: 133-141. published May 2, 2015 doi: 10.2147 / PRBM.S61192

Acupuncture and Blood Pressure

The purpose of the paper presented here is to evaluate the efficacy and safety of acupuncture in lowering blood pressure in adults with primary hypertension.

The study included

The study included 1744 patients from 22 RCTs.

The RCTs were of varying methodological quality, so there was a risk of bias.

There was no evidence of a sustained hypotensive effect of acupuncture.

There was no evidence of a sustained hypotensive effect of acupuncture. Only one trial investigated a sustained effect and found no hypotensive effect at 3 and 6 months after acupuncture. In the four simulated acupuncture trials, acupuncture reduced SBP (change) -3.4 mmHg (-6.0 to -0.9) and DBP -1.9 mmHg (-6.0 to -0.9).
In four simulated acupuncture trials, there was very low quality evidence that acupuncture had a short-term (1-24 hours) effect on SBP (change) -3.4 mmHg (-6.0 to -0.9) and DBP -1.9 mmHg (95% CI -3.6). Eight trials comparing acupuncture with angiotensin-converting enzyme inhibitors were also conducted.
A pooled analysis of seven trials comparing acupuncture with calcium channel blockers was conducted.

A pooled analysis of seven trials comparing acupuncture with calcium channel blockers was conducted. These results suggested that acupuncture lowered blood pressure in the short term more than antihypertensive drugs.

Reviewer's comment.

At present, there is no evidence for a sustained blood pressure lowering effect of acupuncture for the management of chronically elevated blood pressure. The short-term effects of acupuncture are uncertain due to the very low quality of evidence. The larger effects shown in the non-sham acupuncture controlled trials probably reflect bias and are not real effects. Future RCTs should use sham acupuncture and assess whether there is a blood pressure lowering effect of acupuncture that lasts for at least 7 days.

Yang J, Chen J, Yang M, Yu S, Ying L, Liu GJ, Ren YL, Wright JM, Liang FR. acupuncture for hypertension A Cochrane Database of Systematic Reviews 2018, No. 11. Number: CD008821. doi: 10.1002 / 14651858.CD008821.pub2.

The link between barbering and hypertension

There is data that the presence of a trustworthy person in the community contributes to behavioral changes against diseases. I will introduce the content of such a study.

It was a study like this.

One in three adults in the United States is said to have high blood pressure.
If untreated, hypertension can lead to heart disease and other illnesses. We know that African-Americans are more susceptible to disease, but guess what! The reason for this is a lack of preventive awareness. It is said that the reason for this is low preventive awareness. If we can improve such low preventive awareness, we can reduce the number of hypertension patients.

With this in mind, the researchers turned their attention to the barbershop as the center of communication.

Methods and Results

1,300 black men from 17 barbershops were evaluated.

9 barbershops encouraged men to have their blood pressure checked at a medical facility during the haircut. The remaining barbershops received a pamphlet.

The remaining barbershops distributed pamphlets.

Results showed improvement in blood pressure in both groups. Blood pressure control was more successful in the group that was advised to go to the doctor.
There was an improvement in blood pressure for 20% of the subjects.

The pamphlet group, instead, saw an 11% improvement in blood pressure. These results were achieved over a 10-month period.

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