Tag : HYPERTENSION
In an interview with Dr. Ayesha Mohd Zain and Dr. Wan Nur Najwa Wan Zakaria further shared their clinical insights on the management of age-related macular degeneration (AMD) and diabetic macular edema (DME).
The hypertension paradox persists, with the rising prevalence of hypertension and many patients remaining inadequately controlled despite advancements in therapy.
Whether the timing of administering antihypertensive medication affects major adverse cardiovascular events (MACEs) is highly uncertain due to conflicting results from randomized trials. While the MAPEC trial in 2010 and Hygia trial in 2019 showed significant reductions in MACE (61% and 45% respectively) when blood pressure (BP) medications were taken at bedtime instead of conventional morning use, the TIME trial in 2022 showed no additional benefit in doing so. The BedMed and BedMed-Frail trials were thus conducted to investigate these contradictory findings in a hypertensive primary care population, as well as in older, hypertensive patients living in continuing care wards. The outcomes of the trials were presented at the ESC Congress 2024 by Professor Scott Garrison from the University of Alberta in Canada.
Obstructive sleep apnea (OSA) is a modifiable cause of hypertension but is often underdiagnosed. Patients with hypertension are at a higher risk for cardiac and cerebrovascular diseases and are thus recommended to undergo screening and treatment of OSA. While the continuous positive airway pressure (CPAP) machine is the first-line treatment for OSA that helps maintain airway patency during sleep, many patients either refuse to use it or struggle to adhere to the treatment. A mandibular advancement device (MAD) is an alternative treatment method that reduces airway collapsibility by advancing the mandible during sleep. MAD has been shown to improve sleepiness and quality of life, with better acceptance and tolerance.1 However, whether treating OSA using MAD is as effective as CPAP in reducing blood pressure (BP) is unclear due to limitations of early studies. During the ACC Annual Scientific Session 2024, Professor Lee, Chi-Hang Ronald from the National University Heart Centre, Singapore, presented the results from the CRESCENT trial which aimed to compare the effectiveness of MAD against CPAP in reducing BP in patients with moderate-to-severe OSA, hypertension and high cardiovascular (CV) risk.
