Diuretic Effects of Roselle (Hibiscus Sabdariffa) – Stevia (Stevia Rebaudiana) Tea Compared with Hydrochlorothiazide in Diabetic Patients with Hypertension

Objective: To compare diuretic effects of Roselle-Stevia (R-S) tea withhydrochlorothiazide (HCTZ) in diabetic patients with hypertension. Method:This study was a prospective randomized, open label, crossover study.Twenty two diabetic patients with hypertension were randomly assignedwith concealed allocation to receive either R-S tea (each sachet 2/0.2 g) 2sachets daily or HCTZ 25 mg once daily for 30 days. Then a two-waycrossover with a 7-day washout period was used. Serum and 24-hour urinespecimens were collected at the beginning and the end of each 30 daystreatment period. Diuretic effects were assessed from urinary sodiumexcretion and urinary volume. Results: After 30-day treatment periods, themean changes from baseline on urinary sodium excretion (-5.4±92.5 vs.-21.3±100.2 mmol/day, n=22) and urinary volume (-101.4±684.8 vs -40.5±806.4 mL, n=22) were not significantly difference between R-S teaand HCTZ respectively. HCTZ significantly increased serum glucose anddecreased serum potassium and chloride from baseline (p<0.05) but nosignificantly changed after R-S drinking. Nobody dropped out because ofadverse events. Conclusion: There was no statistically significantdifference in diuretic effects between R-S tea and HCTZ in hypertensivediabetic patients. Our result do not support diuretic effects from bothtreatments after 30 days.Keywords: Roselle, Stevia, diuretic, hydrochlorothiazide, hypertension,diabete

2022 Thai Hypertension Society guidelines on home blood pressure monitoring

Abstract In 2021, the Universal Health Coverage Payment Scheme of Thailand approved home blood pressure monitoring (HBPM) devices for reimbursement. National utilization of HBPM devices will begin in 2022. This article provides the recommendations for HBPM from the Thai Hypertension Society. In this report, the authors review the benefits of HBPM and recommend confirming the diagnosis of hypertension by HBPM. Devices for HBPM should be the automated and validated upper arm cuff devices. HBPM should be ideally done for seven consecutive days before each clinic visit and take at least two readings (1 min apart) in the morning and before going to bed. The average blood pressure (BP) of 125–134/75–84 mmHg is classified as high normal BP and hypertension is BP of 135/85 mmHg or more. Target BP levels depend on the age of the patients; that is, < 125/75 mmHg for patients aged 18–65 years old, and <135/85 mmHg for patients over 65 years of age

Home Blood Pressure Control and Drug Prescription Patterns among Thai Hypertensives: A 1-Year Analysis of Telehealth Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

Background. Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand. Objective. To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project. Methods. A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (<135/85 mmHg). Results. A total of 1,177 patients (mean age 58 ± 12.3 years, 59.4% women, 13.1% with diabetes) from 46 hospitals (81.5% primary care centers) were enrolled in the study. The mean clinic BP was 143.9 ± 18.1/84.3 ± 11.9 mmHg while the mean HBP was 134.4 ± 15.3/80.1 ± 9.4 mmHg with 609 (51.8%) patients having HBP reading <135/85 mmHg at enrollment. At one year of follow-up after implementing the HBP telemonitoring, 671 patients (57.0%) achieved HBP control. Patients with uncontrolled HBP had a higher prevalence of dyslipidemia and greater waist circumference than the controlled group. The majority of uncontrolled patients were still prescribed only one (36.0%) or two drugs (34.4%) at the end of the study. The antihypertensive drugs were not uptitrated in 136 (24%) patients with uncontrolled HBP at baseline. Calcium channel blocker was the most prescribed drug class (63.0%) followed by angiotensin-converting enzyme inhibitor (44.8%) while the thiazide-type diuretic was used in 18.9% of patients with controlled HBP and 16.4% in uncontrolled patients. Conclusion. With the implementation of HBP telemonitoring, the BP control rate based on HBP analysis was still low. This is possibly attributed to the therapeutic inertia of healthcare physicians. Calcium channel blocker was the most frequently used agent while the diuretic was underutilized. The long-term clinical benefit of overcoming therapeutic inertia alongside HBP telemonitoring needs to be validated in a future study