Antihypertensive Medicines Research Articles

Development and validation of a Medication Adherence Universal Questionnaire: the MAUQ

BackgroundDifferent questionnaires assess self-reported medication adherence and others quantify aspects of patients attitudes towards medication, but not together in a single instrument. Gathering these two aspects in a single instrument could reduce patients survey burden.AimThe aim of this study was to develop the Medication Adherence Universal Questionnaire (MAUQ) using the Maastricht Utrecht Adherence in Hypertension short version (MUAH-16) factorial structure as the hypothesized model.MethodA multistep process started with the modification of the MUAH-16 to obtain the MAUQ. Patients using at least one antihypertensive medicine were recruited. The two questionnaires, the MUAH-16 and MAUQ, were applied. A confirmatory factor analysis (CFA) was performed using the initial MUAH-16 s-order 4-factor model. An additional bifactor model with four uncorrelated factors and an overall score was tested. The comparative fit index (CFI), root mean square error of approximation (RMSEA) with confidence intervals (CIs), and standardized root mean squared residual (SRMR) were used to assess both models.ResultsA sample of 300 hypertensive patients completed the instruments. The CFA with the second-order 4-factor solution resulted in similar results for the MUAH-16 and MAUQ: CFIs of 0.934 and 0.930, RMSEAs of 0.043 [CI 0.030–0.056] and 0.045 [CI 0.031–0.057] and SRMRs of 0.060 and 0.061, respectively. The CFA with the bifactor model showed slightly better results for both the MUAH-16 and MAUQ: CFIs of 0.974 and 0.976, RMSEAs of 0.030 [CI 0.005–0.046] and 0.028 [CI 0.001–0.044], and SRMRs of 0.043 and 0.044, respectively.ConclusionCFA demonstrated that the MAUQ presented a better fit to both models than the MUAH-16, obtaining a robust universal free instrument to assess medicine-taking behaviour and four medicine beliefs components.

Comparison of Urinary Ace 2 Levels in Individuals with Hypertension and Type 2 Diabetes with Individuals who have Hypertension but not Diabetes

Background: In this investigation, the levels of urine Angiotensin Converting Enzyme(ACE2)in patients with Type 2 diabetes and high blood pressure were evaluated and their results compared in individuals having raised blood pressure but they had normal blood sugar control. Given the growing body of evidence linking ACE 2 insufficiency to the etiology of hypertension in diabetic patients, we hoped to find higher Angiotensin Converting Enzyme2 levels in the urine of hypertensive diabetic patients than in those without diabetes. Aim: As a result, new pathways for the development of antihypertensive medicines aimed at protecting Angiotensin Converting Enzyme2, particularly in diabetic patients, may open up. Methods: Two groups, each with 49 subjects, were created from a population of chosen subjects.Patients with diabetes and hypertension were chosen from the Services Institute of Medical Sciences diabetic clinic and medical wards in Lahore. In the clinics, anthropometric characteristics and blood sugar levels were recorded. In the Physiology Laboratory at University of Health Sciences, blood samples were obtained and maintained in order to evaluate biochemical characteristics. Results: We calculated the median value in each group because the data for urine Angiotensin Converting Enzyme 2 readings was not dispersedevenly. Non-diabetic hypertension participants had a median of 26.47mg/dl, while hypertensivediabetic subjects had a median of 22.86mg/dl. This difference in ACE 2 levels in the urine was statistically significant (p0.05). Non-diabetic, hypertension patients had greater urinary Angiotensin Converting Enzyme 2 levels than diabetic, hypertensive patients. Conclusion: Contrary to our expectations, we were unable to confirm that urine Angiotensin Converting Enzyme 2 readingsare higher in people with high arterial pressure and type 2 diabetes mellitus. This is despite the fact that the current study confirmed that both type 2 diabetes mellitus and hypertension are risk factors for chronic kidney disease. Key words: Renin Aldosterone-Angiotensin System, urinary Angiotensin Converting Enzyme 2 levels, Chronic Kidney Disease

Prevalence of Hypertensive Disorders, Antihypertensive Therapy and Pregnancy Outcomes among Pregnant Women: A Retrospective Review of Cases at Tamale Teaching Hospital, Ghana.

Hypertensive disorders associated with pregnancy are a major health concern and a leading cause of maternal indisposition and transience. The main objective of this study was to assess the prevalence of hypertension in pregnancy as well as antihypertensive therapy and pregnancy outcomes among pregnant women at Tamale Teaching Hospital (TTH) in Ghana. This was a retrospective study conducted using data from the folders of pregnant hypertensive patients. The study was conducted at the maternity ward of TTH from 1 June 2018 to 31 May 2019. Participants were all pregnant women with a diagnosis of hypertensive disorders. The prevalence of hypertensive disorders in pregnancy was 12.5%. The most common antihypertensive medication prescribed was sustained-release oral nifedipine, which was prescribed for 548 (81.4%) participants either alone or with methyldopa, followed by oral methyldopa: 506 (75.2%), intravenous hydralazine: 94 (14.0%), intravenous labetalol: 28 (4.2%) and diuretics: 10 (1.5%). Thirty-eight (5.7%) babies died before delivery, whereas 635 (94.3%) babies were born alive. Twenty-six out of the 38 dead babies (68.4%) were babies of pregnant women with elevated BP, whereas 12 (31.6%) were babies of those with normal BP. There was a statistically significant association between BP control and delivery outcomes. The study observed adherence to antihypertensive medicines recommended by the standard treatment guidelines of Ghana for the management of hypertensive disorders in pregnancy. The BPs of about two-thirds of the study participants were well controlled with the antihypertensive therapy. The majority of the study participants with well-controlled BP had positive delivery outcomes.

Moving toward improved access to medicines and health technologies for cardiovascular disease.

The objectives of this article are to describe the interventions carried out by the Strategic Fund of the Pan American Health Organization to facilitate access to and availability of antihypertensive medicines and devices for measuring blood pressure across the Region of the Americas as part of the HEARTS initiative, and to present the preliminary results of price analyses of antihypertensive medicines. The study methodology included a review of reports made by the Strategic Fund between 2019 and 2020, an evaluation of modalities of procurement, a review of the public procurement databases for five antihypertensive medicines, and a comparison with the price obtained by the Strategic Fund. Differences in price ranging from 20% to 99% were identified, indicating significant opportunities for savings. The study also presents interprogrammatic actions that can support the HEARTS initiative, such as the inclusion of antihypertensive medicines recommended by the World Health Organization, consolidation of regional demand and competitively-priced long-term agreements to manage the procurement of quality generic products, and the definition of technical specifications and regulatory requirements to support the procurement of devices to measure blood pressure. This mechanism will enable Member States to reduce their costs significantly, while extending treatment and diagnostic coverage to more people.

Association between use of antihypertensive drugs and the risk of cancer: a population-based cohort study in Shanghai

BackgroundPreviously studies shown a potential risk of antihypertensive medicines in relation to cancer susceptibility, which creating significant debate in the scientific community and public concern. We sought to investigate the relationship between antihypertensive medicines and cancer risk, by drug type and class.MethodsWe conducted a population-based cohort study and enrolled patients diagnosed with hypertension from community healthcare centers in Changning District, Shanghai, China. Antihypertensive drug administration were classified as five common antihypertensive drugs. The main outcomes were incidence of total cancer and by major cancer type.ResultsBetween January 2013 and December 2017, a total of 101,370 hypertensive patients were enrolled in this cohort. During a mean follow-up of 5.1 (SD 1.3) years, 4970 cancer cases were newly diagnosed in the cohort. CCBs were the most frequently used antihypertensives which were associated with a moderately increased risk of total cancer (hazard ratio, HR = 1.11, 95% CI: 1.05–1.18). The second commonly used drug ARBs were also associated with increased risk of total cancer (HR = 1.10, 95%CI: 1.03–1.17) as well as lung and thyroid cancers (HR = 1.21, 95%CI: 1.05–1.39; HR = 1.62 95%CI: 1.18–2.21, respectively). No significant association was found between cancer and other antihypertensives. Hypertensive patients who use more than one class of antihypertensives drugs had a higher risk of total cancer (HR: 1.22, 95%CI: 1.10–1.35 for two classes; HR: 1.22, 95%CI: 1.03–1.45 for three or more classes), and a possible dose–response relationship was suggested (P for trend < 0.001). The risk of thyroid cancer was higher in hypertensive patients prescribed with three or more antihypertensive classes.ConclusionsUse of ARBs or CCBs may be associated with an increased risk of total cancer. Taking more than one class of antihypertensives drugs appeared to have a higher risk for total cancer.

Antihypertensive effects of Pleurospermum lindleyanum aqueous extract in spontaneously hypertensive rats.

Pleurospermum lindleyanum (Lipsky) B. Fedtsch is a perennial herb classified in the Apiaceae family, genus Pleurospermum, chiefly native to the Taxkorgan County, Xinjiang, China. In the Xinjiang Province, it is a well-known ethnic traditional herb, often addressed by its tribal name, Kurumuti. It grows in harsh conditions over 4000m above sea level, such as the Pamirs plateau. It is rich in flavonoids, coumarins, terpenoids, essential oil, substances that have been widely applied in the prevention and treatment of hypertension, diabetes, coronary heart disease, and cerebral thrombosis by local Tajik residents. The present study aimed to evaluate the antihypertensive effects of the Pleurospermum Lindleyanum aqueous extract (PLAE) in spontaneously hypertensive rats (SHRs). The Pleurospermum lindleyanum was collected from the Taxkorgan Tajik Autonomous County, Xinjiang, China. The main chemical composition of PLAE was identified using the ultra-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS). SHRs were treated by gavage with PLAE (equivalent to Pleurospermum lindleyanum 5 or 10g/kg/day) for 6 weeks, using Captopril (10mg/kg/day) as positive control. The systolic blood pressure (SBP), renal and cardiac morphology, plasma levels of angiotensin-converting enzyme (ACE), aldosterone (ALD), angiotensinⅡ (AngⅡ), superoxide dismutase (SOD), endothelin-1 (ET-1) and nitric oxide (NO) were measured. A total of 30 compounds were identified in PLAE. PLAE significantly attenuated the SBP of SHRs. The effects began after 3 weeks of administration and then became steady and long-lasting. Its potential mechanisms may be associated with the protective effects on renal and cardiac injury caused by hypertension, the decrease of plasma vasoconstrictors, such as ACE, ALD, AngⅡ, and ET-1 levels, the maintenance of NO/ET balance, the increase in plasma NO levels and SOD activity, thereby reducing oxidative stress. Pleurospermum lindleyanum can be suggested as a novel antihypertensive ethnic traditional herb, which lays the foundation for researching safe and effective antihypertensive herbal medicines.

Assessment of Volume Status Using Body Composition Monitor for Blood Pressure Control in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Trial

Introduction: Optimal fluid balance and blood pressure control have been shown to improve outcomes in hemodialysis population. We investigated the effectiveness of body composition monitor (BCM) to target dry weight in maintenance hemodialysis (MHD) patients for blood pressure (BP) control and intradialytic adverse events. Methods: A total of 61 consenting adults under MHD were randomly allocated into either BCM group or Clinical Method group. Target dry weight was set every 4-weekly based on BCM report or clinical assessment; dry weight was adjusted with 200-500 ml/session reduction or increment of ultrafiltration in addition to interdialytic weight gain. Outcomes were analyzed in terms of BP control, anti-hypertensive medicine score, and intradialytic adverse events. Results: During 12 weeks of study period, systolic blood pressure (p&lt;0.001), diastolic blood pressure (p=0.01) and mean arterial pressure (p&lt;0.001) significantly decreased from baseline in BCM group but there were no significant changes in Clinical Method group. Lower blood pressure was achieved in BCM group as compared to Clinical Method group. There was a significant decrease from baseline in anti-hypertensive medicine score in the BCM group (p&lt;0.001) but not in the clinical method group (p=0.34). There were significantly fewer events of cramps in the BCM group as compared to the Clinical Method group (p=0.04). Conclusion: BCM guided volume management in MHD patients was more effective than volume management based on clinical judgment only in controlling blood pressure and decreasing anti-hypertensive medicine burden and intradialytic cramps.

Impact of covid-19 pandemic on the hypertension control: perspectives from health system

Background: The COVID-19 pandemic impacts daily lives and healthcare access, including hypertension healthcare access and utilization. The aim of this study is to evaluate how Covid-19 pandemic affects to local public and private healthcare systems in response to hypertension control. Methods: A mixed-method approach of both quantitative and qualitative studies was applied. The participants being representatives of the healthcare facilities at the district, commune, private clinic, and pharmacy level in two districts (one urban and one rural district) of Hanoi, Vietnam were invited to the study. A descriptive analysis for quantitative and a content analysis approach for qualitative were employed. Results: All healthcare facilities were mostly fully or partly interrupted by COVID-19 as the number of outpatients visited with hypertension decreased during COVID-19, especially at the commune level. Insufficient clinical staff was the reason that was frequently stated. In parallel, insufficient antihypertensive medicines leading to increased prices, psychological effects on health staff and disruption of training-related activities for healthcare workers were notably impact of Covid-19 pandemic on the healthcare system regarding hypertension control. Conclusion: Our study confirmed the disruption of COVID-19 on hypertension-related activities (including screening, diagnosis, treatment and management of hypertension).

The impact of a reimbursement rate reduction on the utilization of antiulcer, antidepressants and antidiabetics in Portugal: A time series analysis

ABSTRACT Background According to international research, an increase in the patient share of pharmaceutical expenditure results in a decrease in medicines utilization. In 2010, the Portuguese government reduced the reimbursement rate for certain therapeutic classes. The aim of this study was to evaluate the impact of raising cost to the patient on the utilization of medicines. Methods Between January 1996 and December 2015, medicines utilization and cost to the patient per DDD of antihypertensive, antidyslipidemic, antidiabetic, antiulcer and antidepressant medicines were compared. A segmented linear regression of two time series – before and after the change in reimbursement percentage – was used. Results During the two time series, there was an increase in the utilization of antidepressants and antiulcer medicines. The consumption growth decelerated following the reduction in reimbursement rate. Cost to the patient decreased for both classes across the two time series, although the trend accelerated during the second. Conclusion These findings suggest that a decrease in the reimbursement rate had little impact on the utilization of medicines. It is reasonable to assume that the reduction in percentage covered by the Portuguese National Health System was gradually compensated by the decrease in the absolute amount that patients paid for medicines.

Study on Perioperative Management of Blood Pressure and Effects of Anaesthesia in Hypertensive Patients Undergoing General &amp; Orthopaedic Surgery

Background and Aim: During anesthesia, hypertension is the most common additional risk factor that contributes to higher mortality rate. Antihypertension medicine’s withdrawal might leads to symptoms such as anxiety, rebound hypertension, myocardial infarction, tachyarrhythmia, angina exaggeration, and sudden death. The present study aimed to assess the perioperative management of blood pressure and effects of anesthesia in hypertensive patients undergoing general and orthopedic surgery. Patients and Methods: This cross-sectional study was carried out on 162 hypertensive patients in the General Surgery and Orthopedics Units of Khyber Teaching Hospital, Peshawar for the duration from April 2022 to September 2022. Study protocol was approved by institute ethical committee. Patients aged 16 to 70 years of either gender underwent general surgery and orthopaedic surgery were enrolled. The data was acquired during the anesthetist’s initial visit to the operated hypertensive patients' 24 hour postoperative period. Antihypertensive medications, hemodynamics, anesthesia drugs, fluid use, and blood loss were main variables noted. Heart rate, systolic blood pressure, and diastolic blood pressure were Intraoperative hemodynamics. SPSS version 27 was used for data analysis. Results: Of the total 162 hypertensive patients, there were 68 (42%) male and 94 (58%) females. The overall mean age was 58.62±8.4 years. Before surgery, about 119 (73.5%) patients took antihypertensive medication whereas 124 (76.5%) had antihypertensive medication within 24 hours. The most prevalent antihypertensive medication used and most common class during postoperative management was Calcium channel Blockers and Amlodipine. The most prevalent used anesthetic drug use was Bupivacaine. The incidence of Systolic Blood Pressure (SBP) fall and rise was found in 28 and 6 patients respectively. The incidence of Diastolic Blood Pressure (DBP) fall and rise during intraoperative management was 11 and 8 patient respectively. Conclusion: The present study found that a decreased heart rate in patients who were taking beta blockers consistently. Those who took diuretics had greater DBP and HR at the completion of the procedure. There was no significant change in hemodynamic parameters with any other antihypertensive treatment. Keywords: Hypertension, General Surgery, Orthopaedic, Hemodynamics

Exploring the repurposing potential of telmisartan drug in breast cancer: an in-silico and in-vitro approach.

Anticancer drug resistance is one of the biggest hurdles in the treatment of breast cancer. Drug repurposing is a viable option fordeveloping novel medical treatment strategies since this method is more cost-efficient and rapid. Antihypertensive medicines have recently been found to have pharmacological features that could be used to treat cancer, making them effective candidates for therapeutic repurposing. The goal of our research is to find a potent antihypertensive drug that can be repurposed as adjuvant therapy for breast cancer. In this study, virtual screening was performed using a set of Food and Drug Administration (FDA)-approved antihypertensive drugs as ligands with selected receptor proteins (EGFR, KRAS, P53, AGTR1, AGTR2, and ACE) assuming these proteins are regarded to have a significant role in hypertension as well as breast cancer. Further, our in-silico results were further confirmed by an in-vitro experiment (cytotoxicity assay). All the compounds (enalapril, atenolol, acebutolol, propranolol, amlodipine, verapamil, doxazosin, prazosin, hydralazine, irbesartan, telmisartan, candesartan, and aliskiren) showed remarkable affinity towards the target receptor proteins. However, maximum affinity was displayed by telmisartan. Cell-based cytotoxicity study of telmisartan in MCF7 (breast cancer cell line) confirmed the anticancer effect of telmisartan. IC50 of the drug was calculated to be 7.75 µM and at this concentration, remarkable morphological alterations were observed in the MCF7 cells confirming its cytotoxicity in breast cancer cells. Based on both in-silico and in-vitro studies, we can conclude that telmisartan appears to be a promising drug repurposing candidate for the therapeutic treatment of breast cancer.

Management of Hypertension in Women. Pakistan Hypertension Clinical Practice Guidelines

Hypertension has been recognized as a global health concern. In developing countries, it is not addressed and described to the extent that the actual prevalence of the disease makes it necessary. In these countries, control of blood pressure (BP) remains suboptimal. Worldwide BP reduction is a serious issue, and the situation is more alarming situation in our country. Pakistan is one of them, more than 46% of the Pakistani population are hypertensive. In 2010, hypertension was the leading cause of death and disability worldwide, and a greater contributor to events in women. South Asia contributes 24% of world population and is undergoing a rapid epidemiological transition with significant rates of hypertension in different countries. The prevalence of hypertension in low socioeconomic population in Pakistan is 39% in women vs. 37% in men. There is no proper data regarding hypertension in women in Pakistan, except for a few populations based surveys conducted which showed the prevalence of hypertension. The pooled prevalence in Pakistani women is 24.76% vs. 24.9% for men for an age bracket of above 40 years. The occurrence is higher in urban compared to rural areas. General practitioners (GP) in Pakistan underdiagnose and undertreat high BP, especially in the elderly women. Only in 37% of patients, the treatment was initiated by a GP. 23% of this group received only sedatives alone or combination of sedatives and hypertension control medication. We lack published guidelines regarding hypertension. Hypertension still remains the major preventable cause of cardiovascular disease. Hypertension is a leading cause of mortality globally, and especially in our continent. The purpose of these guidelines is to highlight the neglected population (i.e., Women) of Pakistan, who are physically and hormonally different from men. They have more complications as a result of hypertension. Early diagnosis and proper treatment and adherence to the treatment is therefore important. The task of developing guideline on hypertension is by Go Red Chairperson and Scientific Council Pakistan in collaboration with Pakistan cardiac society. This is first clinical practice guidelines for management of hypertension which is a need of our time with the objective to control the epidemic of hypertension in women. This scientific document on hypertension in women with local recommendation which are made local studies and randomized trials and south Asian studies. These educational tool help the health care providers GP and doctors because all see the women in theirs practice and using this guideline facilitate them for treatment because specially in elderly women usually received only sedative alone or in combination with antihypertensive medicines by GPS. Our efforts will encourage GPs and medical practitioners to practice these guidelines in their clinical judgment about risk and complications, as well as in the determination and implementation of preventive, diagnostic or therapeutic medical strategies for control of hypertension. What is new in this guideline is that we focused on treatment of hypertension according to our circumstance as women have limited access to health care and are undertreated. That is the reasons why more women develop complications of hypertension as delay in diagnosis, initiation of recommended treatment and the control is only in 50% in women. These guidelines focused on risk factors and complication throughout the life cycle of women. Lifestyle management should be started in adolescent and more focus should be given to adherence to treatment. This is crucial for control of hypertension. New topics like management of hypertension in chronic kidney diseases is added. Recommendation-based treatment should be started in such cases. The initiation of widespread and intensive continuing medical education for all physicians involved in the management of women patients with hypertension will be the main benefit from this guideline.

Cirsium japonicum var. maackii fermented with Pediococcus pentosaceus induces immunostimulatory activity in RAW 264.7 cells, splenocytes and CTX-immunosuppressed mice

Cirsium japonicum var. maackii (CJ), a perennial herb from the Compositae family, is a traditional antihypertensive, uretic antihepatitis, and antihemorrhagic medicine in Korea. However, CJ reported has minimal immune-enhancing effects. We investigated whether fermentation with Pediococcus pentosaceus (P. p) increases the immune efficacy of CJ through in vitro, ex vivo and in vivo. Results showed that CJ and P. p fermentation (PCJ) produced nitric oxide, induced immune-related cytokine secretion, and up-regulated the MAPK and NF-κB signaling pathways in RAW 264.7 cells. Furthermore, PCJ markedly stimulated proliferation and Th1 and Th2 response by inducing the production of cytokines in splenocytes. Oral administration of PCJ significantly alleviated cyclophosphamide (CTX)-induced immunosuppression in mice, as evidenced by increased immune-related cytokine production and improved gut microbiota. These results suggest that PCJ could have a positive impact on the development of functional food with the ability on immunomodulation and intestinal microenvironment improvement.

Analyzing ACEI-Furosemide and ARB-Furosemide Drugs Combination on Hypertension and Chronic Kidney Disease Patients

The purpose of this study was to compare the efficacy of ACE-inhibitor + Furosemide and ARB + Furosemide in lowering creatinine, urea, and blood pressure in individuals with hypertension and chronic renal disease. This is a retrospective study in which data were extracted from the medical records of patients with hypertension and chronic kidney disease in the Internal Medicine Ward of the General Hospital dr. M. Jamil Padang in West Sumatera. A 2-by-3 ANOVA hypothesis test design was utilized. The hypothesis was evaluated using an alpha value of 0.05. The results demonstrated that the ARB + Furosemide combination was superior to the ACE-Inhibitor + Furosemide combination by 86.2%. In addition, this study demonstrated that the medication combinations ACE inhibitor plus furosemide and ARB plus furosemide were equally efficient in lowering creatinine, urea, and blood pressure in individuals with hypertension and chronic renal disease. The researchers found that antihypertensive medicines, including the ACE-Inhibitor + Furosemide combination and the ARB + Furosemide combination, can be administered at levels determined by the patient's clinical situation. Also, while selecting a pharmacological combination between an ACE inhibitor and furosemide or an ARB and furosemide, it is important to consider the adverse effects of the drugs. For instance, it is preferable to combine ARB with Furosemide.

Clinico-epidemiological profile and risk factors of hypertensive crisis among patients attended at a tertiary care hospital in Somalia

Hypertensive crisis (HC) is a life-threatening clinical condition in which an abrupt rise in arterial blood pressure can lead to acute damage to vital organs. The main objective of our study is to determine the epidemiological profile, clinical characteristics, and risk factors of hypertensive crisis patients in Somalia. This study was a prospective cross-sectional study conducted on HC patients attended at Mogadishu Somali Turkish Training and Research Hospital in Mogadishu, Somalia, from November 2020 to April 2021. A total of 6239 patients were screened during the study period. The prevalence of HC was 2.1% (128/6239). Of them, 76 (59.4%) were males. The mean (SD) age of the participants was 56.5 (± 16.9) years (range: 24–98 years). 54.7% (70/128) met the criteria for a hypertensive emergency, while 45.3% (58/128) met the criteria of hypertensive urgency. Most patients (55.5%) took a single antihypertensive medicine, with calcium channel blockers being the most frequently used (57.8%). Headache and palpitation were the most often reported symptoms upon admission (39.1% and 25%). The most often prescribed antihypertensive drugs for the initial therapy included Intravenous furosemide (35.2%), Sublingual captopril (25.8%), intravenous nitroglycerin (23.4%), and intravenous labetalol (20%). Among the forms or patterns of end-organ damage of HE, we most frequently observed acute heart failure (45.7%), acute pulmonary edema (29.9%), and acute renal injury (25.7%). Infrequent medical checkups, poor compliance with medications, poor compliance with exercise, positive family history of hypertension, and being male gender were significant predictors of HC, AOR = 20.312; p < 0.000, AOR = 7.021; p < 0.008, AOR = 6.158; p < 0.017, AOR = 3.545; p < 0.032, and AOR = 2.144; p = 0.001, respectively. In Somalia, the hypertensive crisis is common in this clinic population. Infrequent medical checkups, poor compliance with medications and exercise, positive family history of hypertension, and being male gender were significant predictors of HC.

AW-NI-4: MAY MEASUREMENT MONTH 2021: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM NEPAL

Objective: This study presents the result of May measurement Month 2021 in Nepal, a global initiative of the International Society of Hypertension (ISH) aiming to screen high blood pressure and raise awareness at the population level. Design and Methods: An opportunistic cross-sectional survey of&gt; = 18 years of age was conducted in 15 out of 77 districts from September-December 2021. The trained enumerators administered the structured questionnaire of the ISH adopted into Nepali and took three blood pressure (BP) readings while in a sitting position at 1-minute intervals, using electronic BP machines. Participants were identified with hypertension using the following criteria: 1) mean of the 2nd and 3rd BP readings&gt; = 140/90 mmHg or 2) being on at least one antihypertensive medicine taken for raised BP. Ethical approval was obtained from the Nepal Health Research Council. Results: A total of 5,172 participants were included. The median age was 37.0 (IQR 25–51) years and 49.9 % were female. Self-reported tobacco use, alcohol drinking, diabetes, and history of myocardial infarction (MI) or stroke were reported in 21.7%, 21.9%, 4.1%, and 0.5% of participants, respectively. The mean of 2nd and 3rd BP readings or history of anti-hypertensive medication use were available for 5,167 participants. The mean was 123.9 mmHg ± 10.3 for systolic blood pressure, and 81.2 mmHg ± 9.3 for diastolic blood pressure. 1,066 (20.6%) met the criteria for hypertension, of which 399 (39.5%) were aware and 298 (29.5%) were treated with at least one anti-hypertensive medicine. Of those who were treated, 167 (56.0%) had their BP under control. With the BP threshold of the AHA/ACC guideline (i.e., SBP&gt; = 130 mmHg or DBP&gt; = 80 mmHg), 3,015 (58.9%) were identified with hypertension. Multivariate logistic regression using age, sex, smoking, alcohol use, diabetes, and history of MI or stroke as covariates showed a significant association between hypertension and age (&lt;40: OR = 1.13, 95 CI:1.11–1.15, &gt; = 40: OR = 1.05 95% CI:1.04–1.06), male (OR = 1.57, 95% CI:1.33–1.89), alcohol use (OR = 1.59, 95% CI:1.30–1.93), and diabetes (OR = 2.63, 95% CI:1.93–3.58). Conclusions: MMM 2021 in Nepal found more than half of the adults in communities were undiagnosed and untreated. Community-based campaigns such as MMM are meaningful for countries to collect hypertension cascade data in hard-to-reach areas and identify those at high-risk.

PS-P03-3: PREVALENCE OF HYPERTENSION IN NEPAL: RESULTS OF MAY MEASUREMENT MONTH 2020

Objective: To increase public awareness on importance of blood pressure (BP) screening for hypertension prevention and management through a national campaign in Nepal. Design: Opportunistic BP screening campaign was carried out among people 18 years or more in the year 2020, following the COVID-19 safety measures. The study used a cross-sectional survey design. Method: Systolic and diastolic BP data of the participants were obtained from three consecutive measurements of which second and third measurements were used to estimate the mean. Hypertension was defined as the systolic BP more than or equal to 140 and/or diastolic BP more than or equal to 90 mmHg or currently taking antihypertensive medicine. The screening campaign was conducted in 25 sites of the country. Measurement was done using OMRON automatic monitors. Altogether, 115 volunteer research assistants with public health background used mobilized for data collection. Logistic regression analysis was used to identify the factors associated with hypertension. Results: In total, 11,481 people participated in the BP screening campaign of which more than half were females (57%, 6568/11,481). Mean age of the participants was 45 ± 17 years. Mean systolic and diastolic BP were 125.8 ± 18 and 81.6 ± 10.5 respectively. Nearly a third (31.1%, 3592/11,481) of participants were hypertensive of which only 40% (1444/3592) were aware about their hypertension status. However, only about 80% (1146/14444) hypertensive participants were talking medicines. High age-group, high body mass index and smoking were found associated with hypertension adjusting age, sex and body mass index and smoking status of the participants. Conclusions: Blood pressure screening campaign provided an important opportunity to identify undiagnosed hypertension and raise awareness on hypertension among the general population. Awareness raising programs at the population and targeted interventions are warranted for prevention and control of hypertension in Nepal among older, overweight, and obese people and smokers.

PS-P03-8: INFLUENCE OF AVERAGE AIR TEMPERATURE, PRESSURE AND AIR RELATIVE HUMIDITY ON BLOOD PRESSURE

Objective: To investigate the influence of average air temperature, pressure and air relative humidity on blood pressure (BP) and blood pressure variability in population. Methods: A total of 97,784 participants were included from the May Month Measurement 2020 in China. BP was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications. Average air temperature, pressure, and air relative humidity of the day were recorded. The mean BP was taken as the mean of the second and third BP, and the systolic blood pressure variability (SBPV) was the standard deviation/mean of three systolic blood pressures (SBP). Statistical analysis was performed using SAS 9.4. Results: Linear regression analysis found that the average air temperature was negatively correlated with the mean SBP and SBPV in all participants and hypertensive subjects (P &lt; 0.0001, P = 0.01). The average pressure was positively correlated with the mean SBP and SBPV in all participants and hypertensive subjects (P &lt; 0.0001, P &lt; 0.0001). The average air relative humidity was negatively correlated with SBPV in hypertensive subjects (P = 0.03). The relationship between average air relative humidity and SBP in all participants and hypertensive subjects, between average air relative humidity and SBPV in all participants was not found. After adjustment for age, sex, body mass index, taking antihypertensive medicine, smoking, alcohol consumption, diabetes, history of heart disease and previous stroke, the average air temperature and pressure remained associated with mean SBP in all participants and in hypertensive subjects. Logistic regression analysis showed that for every 1°C increase in air temperature, the risk of hypertension decreased by 1.8%, and for every 10hpa increase in pressure and 1% increase in air relative humidity, the risk of hypertension increased by 0.3% and 0.4%, respectively. When air temperature increased 1°C, the happen of hypertension control increased by 2.3%, and decreased by 0.2% for every 1% increase in air relative humidity. The relationship was not found between mean pressure and control of hypertension. Conclusion: The lower average air temperature and higher average pressure are possibly related with higher SBP, more likely to suffer hypertension, while the lower average air temperature and the higher average air relative humidity may resulted in more difficult hypertensive control.

S-02-3: A REVIEW AND NEW INSIGHTS FROM THE SPRINT MIND TRIAL DATA

Background: Proven treatments for reducing the risk of mild cognitive impairment (MCI) and dementia have been lacking. The impact of intensive treatment of hypertension on the incidence of Mild Cognitive Impairment (MCI) and dementia was tested in the Systolic Blood Pressure Intervention Trial (SPRINT-MIND) by prospectively assessing the effect of intensive blood pressure control to a target systolic blood pressure of &lt;120 mmHg versus a standard target (&lt;140 mmHg). This presentation reviews the SPRINT results demonstrating a reduction in risk of developing dementia and MCI and presents additional data on the reliability of the MCI and dementia diagnosis. We will also provide preliminary evidence for differential cognitive benefit from specific antihypertensive medicines and evidence for lack of benefit after onset of cognitive impairment Results: At one year, mean systolic blood pressure was 121.4 mmHg in the intensive-treatment group and 136.2 mmHg in the standard-treatment group. Treatment was stopped on 8/20/2015 due to CVD benefit after a median follow up of 3.26 years, but cognitive assessment continued. Participant mean age was 67.9 years (35.6% women) and 8,626 (92.1%) completed at least one follow-up cognitive assessment. There was a significantly lower rate of adjudicated incident MCI (HR 0.81, CI 0.67–0.97) and a non-significant reduction in probable dementia (HR 0.83, CI 0.69–1.04). The combined outcome of MCI plus probable all cause dementia was significantly lower (HR 0.85, CI 0.74–0.97) in the intensive versus standard treatment group. Most cases occurred in persons over age 70. At 2 years, MCI classification was 10X more likely to transition to dementia than normal cognition and 30% of classified as MCI reverted to normal, consistent with other large epidemiologic studies of MCI trajectory Conclusions: Among ambulatory adults at increased risk for CVD but without diabetes, treating to a SBP target &lt; 120 mmHg compared to a target of &lt; 140 mmHg reduces the risk of incident MCI and combined MCI/probable dementia. Reduction of dementia risk by cardiovascular interventions is feasible in the elderly population.

PS-BPP05-8: THE ACCESSIBILITY OF SUBSIDIZED ANTIHYPERTENSION DRUGS AMONG THE HYPERTENSIVE POPULATION IN MONGOLIA, 2019–2021.

Objective: Cardiovascular diseases (CVD) are the leading cause of mortality in Mongolia, and hypertension is the major risk factor for CVD in the country. In this study, we aim to assess the accessibility of subsidized antihypertensive drugs among the hypertensive population in Mongolia to draw a picture of hypertension control and monitoring at Primary Healthcare Centers (PHC). Design and method: For this study, we processed the full national data on subsidized medicine to obtain the number of unique people who had a subsidized antihypertensive medicine prescription at least once every 3 months. This number was compared to the number of hypertensive people in Mongolia, which was estimated using the hypertension prevalence from the 2019 National STEPS survey and the census data. Results: In 2019, the number of people who consulted their primary physician and had the antihypertensive drugs prescribed at least every 3 months was 60468 which comprised 11.3% of all hypertensive people 15 years of age or older in Mongolia. This percentage increased to 12.7% (68339) in 2020 and 16% (87621). Across the 3 years, the rate of access to the subsidized antihypertensive medicine remains significantly higher among the female hypertensive compared to their male counterparts (2019: 15.5% vs 7.5%, OR = 1.55, P &lt; 0.001; 2020: 17.3% vs 8.3%, OR = 1.55, P &lt; 0.001; 2021: 21.9% vs 10.5%, OR = 1.62, P &lt; 0.001). In addition, across the 3 years, older age groups, especially the oldest group of 55 and older, were significantly more active when accessing the subsidized care, although the gap between the youngest (15–24 years) and older age groups narrowed in 2021 (OR of older age groups decreased in 2021, compared to previous years) (Table 1). Around 30 international non-proprietary names (INN) of antihypertensive drugs were subsidized in the years 2019–2020. Amlodipine, losartan, lisinopril, amlodipine + lisinopril, and bisoprolol were the five most prescribed subsidized drugs. Across the three years, the ratio between fixed-dose combination drugs and single active ingredient drugs subsidized by the Health Insurance Fund was 3:7. The most prescribed classes of subsidized single active ingredient drugs were angiotensin receptor blockers (ARB), followed by calcium channel blockers and ACE inhibitors. Fixed-dose combination drugs, beta-adrenergic blocking agents, and ARBs were significantly more prescribed in Ulaanbaatar (OR = 1.15, P &lt; 0.001; OR = 1.93, P &lt; 0.001; OR = 1.53, P &lt; 0.001), while diuretics, calcium channel blockers, and ACE inhibitors were significantly more prescribed in rural areas (OR = 1.15, P = 0.008; OR = 1.75, P &lt; 0.001; OR = 1.22, P &lt; 0.001). Conclusion: The percentage of the hypertensive population accessing subsidized medicine is insufficient. Subsidization not only increases the affordability of the medicine but also can serve as a tool for monitoring as the subsidy can only be accessed through PHC visits, so it can be inferred that the rate of accessing the subsidized medicine is also the rate of hypertension control at PCCs. We can observe a slight surge in the access rate in 2021, especially among the younger population. In 2021, the National Health Insurance Fund modified their policy, allowing citizens to obtain the subsidized medicine prescription any day of the month, as opposed to the 1st of every month like in previous years. Additional measures need to be taken specifically toward decreasing the gap between sexes, as males are accessing the subsidized care at lower rates, while CVD mortality remains higher among them.