Background: Hypertension is common, affecting over one billion people worldwide. Importantly, in Sub-Saharan Africa hypertensive disease not only affects the older population group, but is becoming increasingly prevalent in younger patients. In South Africa, over 30% of the adult population has hypertension, making it the single most common cardiovascular risk factor and the predominant contributor to cardiovascular disease and mortality. In non-cardiac surgical patients, elevated blood pressure is the most common perioperative comorbidity encountered with an overall prevalence of 20-25%, and it remains poorly controlled in low and middle-income countries. Furthermore, hypertension in the perioperative setting may adversely affect patient outcome. It thus not only flags possible perioperative challenges to anaesthesiologists, but also identifies patients at risk of long-term morbidity and mortality. Objectives: The primary objective of this study was to determine the prevalence and severity of hypertension in elective adult surgical patients in the Western Cape. Results: The study population included all non-cardiac, non-obstetric, elective surgical patients from seven hospitals in the Western Cape during a one-week period. Hypertension, defined as having had a previous diagnosis of hypertension or meeting the blood pressure criteria of more than 140/90 mmHg, was identified in 51.8% of patients during the preoperative assessment. Significantly, newly diagnosed hypertension was present in 9.6% of all patients presenting for elective surgery. Although 98.1% of the known hypertensive patients were on antihypertensive therapy, 36.9% were inadequately controlled. Numerous reasons exist for this but notably 32% of patients admitted to forgetting to take their medication, making patient factors the most common cause for treatment non-compliance. Conclusion: This study suggests that the perioperative period may be an important opportunity to identify undiagnosed hypertensive patient. The perioperative encounter may have a significant public health implication in facilitating appropriate referral and treatment of hypertension to decrease long-term cardiovascular complications in South Africa.

Background and aims: Hypertension is a public health problem and a major reason for hospitalisation and death. In Mozambique, low levels of detection, treatment and control have been described. However, data on target-organ damage and associated clinical conditions is lacking. We therefore aimed at characterising the clinical profile of patients with severe hypertension, describing the pattern of target organ damage and determining the outcomes at 6-month follow-up. Methods: We designed a prospective descriptive cohort study to assess adult patients with severe hypertension defined according to the Joint National Committee VII guidelines. The study was conducted from July 2015 to May 2017 at Mavalane General Hospital in Maputo-Mozambique. Patients were characterized through physical examination, laboratory profile, electrocardiography, and echocardiography, and followed for six months to assess occurrence of complications such as hypertensive heart failure, stroke, renal failure, hospital admission and death. Data were analysed using SPSS software version 20.0. The study was approved by the National Bioethics Committee for Health of Mozambique. Results: We studied 116 subjects (111 [95.7%] black; women 81 [70%]). Women were slightly younger than men (mean 57 years vs 59 years); 18 (15.5%) patients were younger than 44 years. The risk profile of the studied population included obesity (46; 42.5%); dyslipidaemia (59; 54.1%); diabetes (10; 8.6%) and smoking (8; 6.9%). At baseline, mean values for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2, respectively. The most frequent target-organ damage were left atrial enlargement in 91 (88.3%) with atrial fibrillation in 9 (7.9%); left ventricular hypertrophy in 57 (50.4%); hypertensive retinopathy in 30 (26. 3%) and renal damage in 29 (25.7%) subjects. Major events during 6-month follow-up were hospitalisations (12; 10.3%) and death (10; 8.6%). Renal damage (4; 4.2%), stroke (4; 3.4%) and heart failure (2; 1.7%) were the most common complications occurring over the follow up period. Conclusion: Severe and complicated hypertension affects young people with higher incidence of obesity, diabetes and smoking than that found in general population. High occurrence of target organ damage is found at baseline, particularly heart damage, renal lesion and stroke. On follow up, severe hypertension is associated with high number of hospitalisations and high case-fatality rate. Moreover, renal damage, stroke and hypertensive heart disease were common complications on follow up. Further research is needed to understand the determinants of these poor outcomes.

An educational module on hypertension was created in response to the recurring pattern of patient visits with hypertension and an observed knowledge gap among nursing staff in an outpatient clinic located in the southern United States. The educational module was patterned after Joint National Committee-8 and American College of Cardiology guidelines involving patient lifestyle modification and provided clinic staff with information on hypertension diagnosis and self-management for use in patient education. The module was reviewed by a panel of 3 experts who approved it for appropriateness and clarity of content and made one minor recommendation for revision. The education materials were modified to meet the panel's recommendations and subsequently presented to 5 nursing staff members. Pre- and postmodule questionnaires were provided to the staff to determine the extent of their learning from the education program. Pretest results indicated that staff lacked information on the guidelines for treatment of hypertension. Posttest results indicated that all 5 participants found the module information useful for staff to use in educating patients on self-management of hypertension. Providing nursing staff with current evidence-based practice guidelines can increase staff nurse knowledge on hypertension management. Educating nursing staff has the potential to effect positive social change by empowering staff and patients to improve health care outcomes by enabling staff to coach patients on hypertension management using up-to-date evidence-based practice guidelines.

The repeated-measures experimental design utilized in the present study permitted a controlled comparison of the clinical efficacy of meditation treatment (MT), biofeedback treatment (BT), and pharmacological control (PC) conditions in the reduction of seven dependent variables: (1) within clinic (W-C) systolic blood pressure (SBP), (2) W-C diastolic blood pressure (DBP), (3) outside-clinic (0-C) SEP, (4) 0-C DBP, (5) within-session (W-S) SEP, (6) W-S DBP, and (7) antihypertensive medication requirements. Twenty-four medicated subjects with medically .verified essential hypertension were matched by rank-order on sex, age, and mean baseline levels of SBP and DBP, and randomly assigned to MT, BT, or PC conditions, each composed of five females and three males.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Pulmonary Hypertension (PH) is a devastating disease characterized by pulmonary arterial remodeling, right ventricular dysfunction and ultimately right heart failure. Increased emphasis has been given to skeletal muscle dysfunction in PH, and to its implication in the severe exercise intolerance that is a hallmark of the condition. In this dissertation, skeletal muscle blood flow was measured via the microsphere technique at rest and during exercise (Aim 1), with an acute dose of dietary nitrate via beetroot juice (BRJ) gavage used to determine if supplementation could improve muscle blood flow and alter energetics (Aim 2). VO2max, voluntary running and grip strength tests were used to determine the effect of disease on performance, and to test for an ergogenic effect of BRJ vs. placebo (PL) in healthy and PH rats (Aim 3). Methods: A prospective, randomized, counterbalanced, placebo-controlled trial was used to examine the aforementioned aims across four groups; PH rats (induced with monocrotaline, MCT, 60mg/kg, s.q., 4 weeks) supplemented with BRJ (MCT BRJ, n=9); PH rats supplemented with placebo (MCT PL, n=9); healthy control rats (vehicle, s.q.) supplemented with BRJ (CON BRJ, n=8); healthy control rats supplemented with placebo (CON PL, n=9). Results: Monocrotaline induced a severe PH phenotype evidenced by increased RV wall thickness, RV hypertrophy, RVSP and reduced cardiac output and stroke volume compared to controls (p=<0.001). MCT rats demonstrated lower muscle blood flow at rest, and more prominently during exercise compared to controls (p=0.007-0.047), regardless of supplementation. MCT rats displayed a greater reliance on anaerobic metabolism, demonstrated by increased blood lactate accumulation (p=<0.001), and this was significantly related to reduced blood flow during exercise (r=-0.5879, p=0.001). BRJ supplementation resulted in increased plasma nitrate and nitrite compared to PL (p=<0.001), but at the skeletal muscle level, only nitrate was increased after BRJ. BRJ did not have a significant effect on blood flow, with no improvement during exercise shown vs. PL. Similarly, BRJ did not significantly improve exercise function in MCT or CON rats. Conclusion: MCT rats demonstrated a reduction in muscle blood flow, with BRJ supplementation not resulting in improved flow or exercise performance.

No description available.

No description available.

No description available.

No description available.

No description available.