Assess Blood Pressure Control Research Articles

Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)

Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)

The link between insurance and blood pressure control in U.S. stroke survivors

BackgroundAfter a stroke, poorly controlled blood pressure (BP) is associated with a higher risk of recurrent vascular events. Despite the importance of controlling BP to avert recurrent vascular events, fewer than half of stroke survivors in the United States achieve BP control. It is unclear to what extent insurance status affects BP levels after stroke. MethodsWe assessed BP control among adults with a history of stroke who participated in the National Health and Nutrition Examination Surveys from 1999 through 2016. The relationship between insurance type and BP level (low normal: <120/80 mmHg and normal: <140/90 mmHg) were evaluated using logistic regression before and after adjusting for sociodemographic characteristics and medical comorbidities for those <65 years and ≥ 65 years. ResultsAmong 1646 adult stroke survivors (weighted n = 5,586,417), 30% had BP in the low normal range while 64% had BP in the normal range. Among 613 stroke survivors <65 years (weighted n = 2,396,980), only those with other government insurance (CHAMPVA, CHAMPUS/TRICARE) had better BP control than the uninsured (adjusted HR 2.68, 95% CI 0.99–7.25). Among 1033 participants ≥65 years (weighted n = 3,189,437), those with private insurance plus Medicare trended toward better normal BP compared to Medicare alone (adjusted HR 1.34, 95% CI 0.94–1.90). ConclusionsOnly stroke survivors with CHAMPVA, CHAMPUS/TRICARE government insurance in the United States have lower odds of controlled BP compared to no insurance among those <65 years. Insurance alone does not improve BP control among stroke survivors.

LOW-RENIN VERSUS NON-LOW RENIN HYPERTENSION: A COMPARISON OF CONTROL IN A SPECIALIST CLINIC

Objective: A significant proportion of hypertensive individuals display a low-renin profile and are commonly referred as subjects with low-renin-hypertension (LRH) phenotype. LRH is associated with a significant increase in cardiovascular events but it is debated whether it is more difficult to treat than non-low-renin hypertension (NLRH). Here, we investigated the prevalence of LRH and blood pressure (BP) control at 3 and 12 months in specialist centre in the UK. Design and method: Consecutive hypertensive subjects not on treatment with beta-blockers and centrally acting drugs were recruited from the hypertension outpatient service at Guy's and St. Thomas’ Hospital, London. Anthropometric variables, biochemistry assessment and BP measurement were evaluated in a baseline visit following which subjects were classified as LRH if renin concentration was &lt; 5mU/L. Clinical data at 3 and 12 months were then used to assess BP control. Results: 205 patients ((mean±SD) age 44±13 years, 61% male) of whom 92% on pharmacological treatment were recruited. Prevalence of LRH was 28% and the two groups (LRH/NLRH) were similar in age, gender, body mass index, prevalence of diabetes and dyslipidaemia. Subjects with LRH (n=59) had higher systolic BP values compared to NLRH (156±23 mmHg vs 147±20 mmHg, P=0.013) whilst the difference was non-significant for diastolic BP (94±14 mmHg vs 91±14 mmHg, P=0.175). Decrease in systolic BP values were greater in LRH compared to NLRH at 3 months and 12 months (10.8±2.9 mmHg vs 5.1±1.6 mmHg and 13.1±3.4 mmHg and 6.3 ±1.7 mmHg respectively, both P&lt; 0.05). with BP values at 12 months similar between the two groups (144±20/88±11 mmHg vs 141±16/89±12 mmHg for LRH and NLRH respectively, P=0.375, Figure 1). Treatment at 12 months differed in the two groups, with LRH patients more likely to be prescribed diuretics (39% vs 25%) and less likely to be prescribed ACE-i/ARB (39.0% v 61.4%), both P&lt;0.05. Conclusions: LRH phenotype is common among patients evaluated in a specialist centre for hypertension. Despite higher BP values at the time of the encounter, LRH patients achieve similar levels of BP control compared to NLRH at 3 and 12 months during the follow up.

Blood Pressure Control and Associated Factors among Hypertension Comorbid Type 2 Diabetic Patients in Southeast Ethiopia.

Hypertension is the main contributor to the morbidity and mortality of patients with cardiovascular disease. Even though hypertension is very common in comorbid type 2 diabetic patients, it is frequently overlooked. This study aimed to assess blood pressure control and its associated factors among hypertension comorbid type 2 diabetic patients in Bale Zone public hospitals in Southeast Ethiopia. A hospital-based cross-sectional study design was conducted among hypertension comorbid type 2 diabetic patients. The data were collected using an interviewer-administered structured questionnaire and a review of the medical charts of patients. A simple random sampling technique was used to select the study participants. The bivariate and multivariate logistic regression analyses were performed to assess the association between blood pressure control and its associated factors. Independent variables that showed a P < 0.25 in the bivariate analysis was included in the multivariate analysis. Finally, variables with a P < 0.05 were declared statistically significant factors. The total number of participants in the study was 378. The overall magnitude of uncontrolled hypertension among hypertension comorbid diabetic patients was found to be 82.5% (95% CI: 78.7%, 86.4%). Nonadherence to antihypertensive medication (AOR = 2.45, 95% CI: 1.11, 5.39, P = 0.027), duration of hypertension >10 years (AOR = 5.2, 95% CI: 1.27, 21.38, P = 0.022), participants who attended secondary education (AOR = 3.2, 95% CI: 1.18, 8.87, P = 0.023), and being obese (AOR = 4.1, 95% CI: 1.24, 13.49, P = 0.021) were significantly associated with uncontrolled hypertension. Uncontrolled hypertension was found to be high among hypertension comorbid type 2 diabetic patients. Patients' adherence to antihypertensive medication, physical activity, and alcohol abstinence should be maximized. Loss of weight is also crucial, as is the early detection and management of comorbidities.

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 2. How to manage high blood pressure in children and adolescents.

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. Arterial hypertension is not only the most important risk factor for cardiovascular morbidity and mortality, but also the most important modifiable risk factor. Early hypertension-mediated organ damage may already occur in childhood. The duration of existing hypertension plays an important role in risk assessment, and structural and functional organ changes may still be reversible or postponed with timely treatment. Therefore, appropriate therapy should be initiated in children as soon as the diagnosis of arterial hypertension has been confirmed and the risk factors for hypertension-mediated organ damage have been thoroughly evaluated. Lifestyle measures should be recommended in all hypertensive children and adolescents, including a healthy diet, regular exercise, and weight loss, if appropriate. If lifestyle changes in patients with primary hypertension do not result in normalization of blood pressure within six to twelve months or if secondary or symptomatic hypertension or hypertension-mediated organ damage is already present, pharmacologic therapy is required. Regular follow-up to assess blood pressure control and hypertension-mediated organ damage and to evaluate adherence and side effects of pharmacologic treatment is required. Timely multidisciplinary evaluation is recommended after the first suspicion of hypertension. A grading system of the clinical evidence is included.

PS-P10-1: ARTERIAL HYPERTENSION AS A COMMON DISEASE IN ACUTE KIDNEY INJURY AND ITS SIGNIFICANT DEPENDENCE ON THE DAMAGE MECHANISM

Objective: Hypertension (HT) is an overwhelming finding in chronic kidney disease and but again data on hypertension prevalence in acute kidney injury-AKI are very scarce. The etiology of HT in AKI could be multifactorial and depend on the type of AKI. The aim of the study was to assess blood pressure control in patients with AKI admitted to the nephrology department. Design and Method: The retrospective analysis of 215 (mean age 58y) patients with AKI (N17) was made based on the medical documentation. Demographic data as well as type of hypotensive drugs, the presence of volume overload, and BP control, need for dialysis were analyzed. Among patients with AKI 35% requires acute hemodialysis-HD due to either clinical or biochemical indications. Prevalence of hypertension was 70%, with the highest in postrenal AKI- 85% followed by renal 75 and prerenal -30% Results: AKI patients requiring HD were significantly older than patients treated conservatively group (Me = 67 vs. Me = 54y, p &lt; 0,01), had much higher both systolic and diastolic blood pressure values (p &lt; 0.01 for both). The renal function was less present in AKI group requiring HD. The peripheral edema as well as pulmonary congestion was observed significantly more often in HD group with uncontrolled BP, and postrenal origin of AKI. The average number of hypotensive drugs was 5 in HD and 3 in non-HD patients. The most used hypotensive drug was calcium channel blocker, diuretic and beta-blocker. Conclusions: Hypertension is very common in AKI, however it depends upon the origin of AKI. Uncontrolled hypertension together with oedema and pulmonary congestion are the indications for HD initiation. However, caution should be exercised during HD to avoid hypotensive episodes.

Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers

BackgroundUncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient’s BP is assumed uncontrolled.MethodsTo examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP).ResultsThe percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021).ConclusionsThe transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.

Hypertension Control among Adult Iraqis

Background: Hypertension is a chronic illness that affects one billion people both in high and low-income countries and is the most common risk factor for death throughout the world. It is also responsible for stroke, ischemic heart disease, heart, and kidney failure in addition to its huge effect on the economy. Like many developing countries, Iraq is undergoing a transitional epidemiological period with increasing burden of hypertension and its contributing risk factors e.g. unhealthy diet, physical inactivity, obesity, hyperglycemias, hypercholesterolemia, and smoking. In spite of the availability of a screening program for the early detection of hypertension in primary health care centres (PHCCs) little data on hypertension control is available. Objectives: Assessing blood pressure control rate among Iraqi adults 18 years and older, and identifying the related determinants. Patients and Methods: The study is derived from the second round of Non-Communicable Diseases Risk Factors STEPS survey Iraq 2016. A cross-sectional survey was performed on households from all Iraqi governorates excluding three governorates suffering instability. A Multi-stage cluster sampling technique for a sample of 4120 Iraqi adults was used. Interviews were held from the first week of November for 20 days using Arabic and Kurdish translated versions of STEPS questionnaire. A total of 4071 residents participated. Results: the prevalence of hypertension/ high blood pressure was 35.6%. Only 7.9% were under medication and controlled with an evident sex-based difference in favour of women (9.3% vs. 6.6% respectively). Uncontrolled blood pressure increased with age (t=7.4 p=&lt;0.001), and declined with years of education (t= -3.3 p=0.01). It was significant among subjects with hyper-triglycerides (X²= 4.07 p= 0.044), consumption of salty processed food (X²= 7.35 p= 0.007). Blood pressure was not controlled among those reported being currently on medication (X²= 22.4 p= &lt; 0.001). Conclusions: Blood pressure control rate is low among Iraqi adults on medical and lifestyle management. Further assessment and strengthening of clinical practice on hypertension management is recommended.

May Measurement Month 2017-2019: results from Switzerland.

May Measurement Month (MMM) is an international screening campaign for arterial hypertension initiated by the International Society of Hypertension and endorsed by the World Hypertension League. Its aim is to raise the awareness of elevated blood pressure (BP) in the population worldwide. The goal of the present analyses is to assess the results obtained during three years of this campaign in Switzerland. Swiss data from MMM17 to MMM19 campaigns were used. BP and a questionnaire for basic demographic and clinical information were recorded for each participant. BP measurements and definition of arterial hypertension followed the standard MMM protocol. To assess BP control, European Society of Hypertension 2018 thresholds of <140/90 mmHg were used. Overall, 3635 participants had their BP measured, including 2423 women (66.7%) and 1212 (33.3%) men. More than half of the data came from pharmacies during MMM18 and MMM 19 campaigns. The difference in BP between pharmacies and other screenings sites was small. Overall, prevalence and awareness rates were 32.7% and 72.3%, respectively. Of those on medication, 60.9% were controlled, and of all hypertensive patients, 39.4% had controlled BP. In Switzerland, the prevalence of hypertension based on a 3-year awareness campaign was similar to previous epidemiological data within the country. One third of the population screened had hypertension, two thirds were aware of it, and less than half had controlled BP.

Abstract P208: Utility Of Standing Office Blood Pressure In Assessing Blood Pressure Control In Patients With Autonomic Failure

Current guidelines recommend blood pressure (BP) target based on office BP taken in a seated position for hypertensive patients. However, the accuracy of standing BP measurements for determining blood pressure control in patients with autonomic (ATF) is unknown.We measured BP in seated and standing positions in 47 hypertensive and normotensive adults with ATF. Office BP was measured in the seated position 3 times and after standing for 3 minutes. Adequate BP control was defined by 24-hour ambulatory SBP/DBP of &lt; 125/75 mmHg. Area under receiver operator characteristic curve (AUROC) was calculated to determine accuracy of seated and standing BP in assessing BP control. Bayes factor (BF) was used to assess the significance of the difference between AUROC of seated and standing BP. Sensitivity and specificity of standing BP in determining blood pressure control was derived using cut-off points derived from Youden’s Index.Prevalence of HTN was 72% (34/47) and the mean age was 71 ± 11 years. Sensitivity and specificity of seated SBP was 65% and 73%, respectively. Optimal cutoffs selected by Youden’s index for standing SBP/DBP was 104/83 mmHg. Sensitivity and specificity of standing SBP was 96% and 64%, respectively. The AUROC of standing SBP was significantly higher when compared to seated SBP alone, when controlled SBP was defined as 24-Hr SBP &lt; 125 mmHg (BF &gt; 3). Similarly, when controlled SBP was defined as daytime SBP &lt; 130 mmHg, the AUROC of 3 rd standing was significantly higher when compared to seated SBP alone or in combination (BF &gt; 3).In conclusion, standing SBP is more useful than seated SBP in assessing BP control in patients with ATF.

High blood pressure screening in pharmacies during May Measurement Month campaigns in Switzerland

Purpose May Measurement Month (MMM) is an international screening campaign for arterial hypertension (HT) organised by the International Society of Hypertension and the World Hypertension League. It aims at raising the awareness of elevated blood pressure (BP) in the population. The goal of this analysis was to assess the results obtained in Swiss pharmacies during a 3-year campaign. Material and methods Swiss data from the MMM17 to MMM19 campaigns were extracted from the global MMM database. The analysis was conducted specifically on measures taken in pharmacies. BP and a questionnaire including demographical and clinical information were recorded for each participant. To assess BP control, ESH 2018 thresholds of <140/90 mmHg and ESH 2021 pharmacy-thresholds of <135/85 mmHg were used. Results From an initial sample of 3634 Swiss participants included during this 3-year campaign, 2567 participants (73.2%women and 26.8% men, p<.001) had their BP measured in triplicates in pharmacies. The first BP measurement was associated with 2.0 ± 4.9 mmHg effect on systolic blood pressure (SBP) (p<.001) and 0.7 ± 3.7 mmHg on diastolic blood pressure (DBP) (p<.001) compared to the mean of the second and third measurements. Based on the ESH 2018 and the ESH 2021 pharmacy thresholds, prevalence of HT (mean of second and third measurements) increased from 29.5% to 38.3%, respectively. In treated participants, 58.3% (279) had an average BP < 140/90 mmHg and 40.3% (193) had an average BP < 135/85 mmHg. Conclusions HT screening campaigns in pharmacies recruits mainly women. It helps the detection of untreated hypertensive participants and uncontrolled treated participants. Our data suggest that the average BP should be calculated on the second and third measurements due to a significant first measure effect in pharmacies measurement. Summary High blood pressure (BP) is a major global public health issue as the leading risk factor of global death. World-wide initiatives like May Measurement Month (MMM) aim to screen thousands of people each year to raise awareness of hypertension (HT). Switzerland participated in MMM 2017–2019 and screened more than 2500 participants in pharmacies. When adopting the recent proposed thresholds of HT diagnosis in pharmacies (ESH 2021 > 135/85 mmHg), HT prevalence in Switzerland is high (38.3%) with only 2/3 of treated hypertensive achieving the BP goals. Women are more likely to participate in such campaigns taking place in pharmacies. A first measurement effect (FME) was also present in pharmacies, highlighting that taking three BP measurements in pharmacies and discarding the first should be also considered in the pharmacy setting. Involving a routine pharmacy-based health care of patients would help to identify more hypertensive patients and uncontrolled treated patients, who may not have had access to BP measurement.

Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Background: Uncontrolled blood pressure has been associated with poor adherence to drug treatment. Objectives: To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil. Methods: Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers – one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to [...]

Blood Pressure Control and Associated Factors Among Hypertensive Patients Attending Shashemene Referral Hospital, Oromia, Ethiopia.

Hypertension is public health challenge worldwide. It is defined as persistently elevated arterial blood pressure (BP), systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or use of antihypertensive medication in adults older than 18 years. The aim of this study was to assess blood pressure control and associated factors among hypertensive patients attending the outpatient department of Shashemene Referral Hospital. Hospital based cross sectional study was conducted to determine level of blood pressure control and associated factors among hypertensive patients on medical follow-up. A medical chart review and interview was conducted from July 1 to October 31 2018. A total of 325 participants were included in this study with response rate of 320 (98.5%). More than half of study participants were males 171 (53.4%). The mean age of the respondents was 55.10 (SD ± 12.7) years and majority of the respondents 191 (59.7%) were within age of less than 60 years old. The mean Systolic blood pressure (SBP) was 131.80 mmHg (SD ± 20.92) while the mean diastolic blood pressure (DBP) was 82.30 mmHg (SD ± 10.52). About 51.30% of study participants had a controlled SBP and 54.7% had a controlled DBP. The overall control of BP was achieved in 40.3% of the study participants. Multivariable logistic regression analysis showed that age, experience of side effects, frequency of BP measuring, number of antihypertensive drugs used, duration on antihypertensive, source of medication and physical exercise showed significant association with blood pressure control. Blood pressure control level among chronic hypertensive patients at outpatient department was low. Age of patients, educational level, experience of side effects, and number of antihypertensive drugs used were important determinant factors associated with blood pressure control among study participants.

Variations in blood pressure control by medical comorbidities prior to sudden death.

Patients with hypertension have increased risk of sudden death, but the impact of blood pressure control in sudden death is not clear. To better understand potential opportunities to prevent sudden, we assessed blood pressure control, comorbidities, and the number of recent medical encounters among all‐cause sudden death victims. Less than 40% of sudden death victims with hypertension had controlled blood pressure prior to death. Furthermore, increased frequency of medical visits and number of comorbidities were associated with better blood pressure control Strategies to address clinical inertia in hypertension treatment particularly for patients with fewer comorbidities may attenuate the risk of sudden death.

Prognosis of Patients with Pregnancy Hypertensive Disorders Followed in University Hospital to Parzakou in 2020

Introduction: Hypertensive disorders of pregnancy (HDP) are often accompanied by cardiovascular sequelae. The objective of this study was to describe the prognosis in the postpartum period of patients with HDP in Departmental University Hospital of Borgou CHUD-B from Parakou in 2020. Methods: The study was prospective with a descriptive and analytical design and was conducted from January 2020 to September 2020. Patients with HDP were recruited from the gynecology-obstetrics department and each followed for 3 months in the cardiology department. HDP was classified according to the International Society for the Study of Hypertension in Pregnancy, and blood pressure (BP) was taken according to WHO recommendations. Self-measurement of BP at home was performed to assess blood pressure control outside the hospital. Epidata 3.1 and SPSS 21 software were used for data processing and analysis. P values Results: During the study period, the hospital frequency of HDP was 15.6%. The frequency of maternal complications in the postpartum period was 28% (severe hypertension: 23.2%; eclampsia: 3.6%; puerperal psychosis: 1.2%). At the end of the three-month follow-up, blood pressure returned to normal in 73.2% of cases; it persisted in 26.8% of women. Factors associated with persistence of hypertension after multivariate analysis were, overweight/obesity RRa 8.664 [1.566 - 47.941], (p = 0.013); family history of hypertension RRa 6.499 [1.493 - 28.289], (p = 0.013); history of hypertension in previous pregnancies RRa 7.764 [1.561 - 38.601], (p Conclusion: The frequency of HDP is not negligible at CHUD-B/A. The evolution of these HDP was marked in more than a quarter of cases by complications in the postpartum period followed by a persistence of hypertension 3 months after childbirth predicted by cardiovascular risk factors.

May Measurement Month 2019: adherence to treatment and hypertension control in Russia

The International Society of Hypertension and the World Hypertension League initiated a blood pressure screening study called May Measurement Month 2019 (MMM19) to improve the detection of elevated blood pressure (BP) and to assess BP control in patients with hypertension (HTN).Aim. To assess adherence to treatment of the hypertensive population according to MMM19 campaign in Russia.Material and methods. During May 2019, 5394 people from 21 regions of Russia took part in the screening. Participation was voluntary and did not imply gender restrictions; all subjects were over 18 years of age. During the screening, BP was measured three times using electronic and mechanical sphygmomanometers, as well as a questionnaire on the diabetes, history of cardiovascular events, smoking, and alcohol consumption was filled. Information was also collected on the date of last BP check and the administration of statins, acetylsalicylic acid and antihypertensive drugs. Data on height and body weight was obtained from respondents.Results. The analysis included data from 5274 participants aged 18 to 96 years (men — 1834 (34,8%)). Median age was 25 years, quartiles — 20 and 49 years. According to MMM19 data, the proportion of HTN patients in the Russian population was 31,9%, and with the exception of participants under 25 years old — 51,5%. Patients with HTN over 25 years old take antihypertensive therapy in 73,6%; 38,6% are characterized by irregular drug intake. Only 11,8% of men and 17,2% of women reach the target blood pressure &lt;130/80 mm Hg. Only 20-30% of patients who used 4-5 antihypertensives reached the target BP level.Conclusion. According to MMM19 in Russia, only a third of high-risk patients measured BP over the past 12 months. There is also low adherence to antihypertensive therapy and inadequate control of HTN. Patients with HTN and a history of cardiovascular events are more likely to take antihypertensives regularly.

Low blood pressure levels & incident stroke risk among elderly Ghanaians with hypertension

BackgroundClinical trial data indicate that more intensive blood pressure (BP) lowering below standard cut-off targets is associated with lower risks of strokes in the elderly. There is a relative paucity of real-world practice data on this issue, especially among Africans.Objective: To assess BP control rates, its determinants, and whether a lower BP < 120/80 mmHg is associated with a lower incident stroke risk among elderly Ghanaians with hypertension. MethodsWe retrospectively evaluated data, which were prospectively collected as part of a cohort study involving adults with hypertension and/or diabetes in 5 Ghanaian hospitals. BP control was defined using the JNC-8 guideline of <150/90 mmHg for elderly with hypertension aged >60 years or 140/90 mmHg for those with diabetes mellitus. Risk factors for poor BP control were assessed using multivariable logistic regression models. We calculated incident stroke risk over an 18-month follow-up at 3 BP cut-off's of <120/80, 120–159/80–99, and > 160/100 mmHg. ResultsOf the 1365 elderly participants with hypertension, 38.2% had diabetes mellitus and 45.8% had uncontrolled BP overall. Factors associated with uncontrolled BP were higher number of antihypertensive medications prescribed adjusted odds ratio of 1.45 (95% CI: 1.27–1.66), and having diabetes 2.56 (1.99–3.28). Among the elderly, there were 0 stroke events/100py for BP < 120/80 mmHg, 1.98 (95%CI: 1.26–2.98) for BP between 120 and 159/80-99 mmHg and 2.46 events/100py (95% CI: 1.20–4.52 at BP > 160/100 mmHg. ConclusionA lower BP target <120/80 mmHg among elderly Ghanaians with hypertension is associated with a signal of lower incident stroke risk. Pragmatic trials are needed to evaluate lower BP targets on stroke incidence in Africa.

Blood pressure control practice and determinants among ambulatory hypertensive patients attending primary health care facilities in Addis Ababa.

Background:Hypertension is the major risk factor for cardiovascular diseases related morbidity and mortality. Blood pressure is often not adequately controlled in clinical practice. Information regarding blood pressure control in primary care settings is limited in Ethiopia.Objectives:This study aimed to assess blood pressure control practice and determinates among hypertensive patients attending primary health care facilities in Addis Ababa.Methods:A cross-sectional study was conducted on 616 hypertension patients in 12 health centers in Addis Ababa city. Data were collected by interviewing patients and reviewing their medical records. Data were collected from 3 August to 30 October 2015.Results:A complete information was obtained from 616 patients’ medical records, and patients were then interviewed. The mean age was 58.90 (SD ± 13.04) years, and most of them (n = 321, 52.1%) were 60 years old or above, and more than three-fourth (n = 485) were on monotherapy. Methyldopa was the most monotherapy medication prescribed, 128 (20.8%). Only 31% (n = 191) of the patients had controlled blood pressure. Determinants for poor blood pressure control were age less than 60 years (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI): 1.96, 4.78); work status: government employee (AOR = 2.41, 95% CI: 1.18, 4.90), retired (AOR = 1.79, 95% CI: 1.01, 3.18), and private business (AOR = 2.09, 95% CI: 1.17, 3.74); and being hypertensive for 10 or more years (AOR = 1.96, 95% CI: 1.11, 3.43). Significant predictors of achieving controlled blood pressure were weekly blood pressure measurement practice (AOR = 0.57, 95% CI: 0.36, 0.90) and tertiary-level education (AOR = 0.26, 95% CI: 0.13, 0.54).Conclusions:Only one-third of the patients had controlled blood pressure. Efforts should be made to address identified determinants including age, regular blood pressure monitoring practice, and level of education.

Blood Pressure Control among Adult African Chronic Kidney (CKD) Patients—How Close Are We to Target?

Background: Chronic kidney disease (CKD) is usually progressive, often resulting in end-stage renal disease (ESRD). The two most common causes of renal disease, hypertension and diabetes mellitus contribute greatly to the mobility and mortality associated with CKD. It has been found that lowering BP is effective in reducing cardiovascular events in patient with a moderate reduction in GFR and in those with ESRD on dialysis. The aim of this study was to assess blood pressure control among adult African CKD patients. Method: The case notes of chronic kidney patients who assess care in the renal unit of our Teaching Hospital were retrieved for the study after obtaining informed consent from the ethical unit of the hospital. To be eligible for the study, the patient, must have been attending the renal clinic and on anti-hypertensives for a minimum period of 6 months. Results: Eighty-seven CKD patients (46 males and 41 females) with a mean age of 50.9 ± 13.3 years. The proportion of patients who achieved blood pressure control was 13.79% (95% CI 7.34% - 22.85%). Among the pre-dialysis patients, BP control was achieved in 13.64% compared to 14.29% among the patients on dialysis. Nineteen (21.84%) of the patients were on one blood pressure lowering agent; 26 (29.89%) on two; 33 (37.93%) on three; 7 (8.05%) on four and 2 (2.30%) on five. Conclusion: Blood pressure control among African adult CKD patients is difficult with many of them requiring more than two antihypertensive drugs.

COMPARISON OF INTRAVENOUS LABETALOL AND ORAL NIFEDIPINE IN MANAGEMENT OF BLOOD PRESSURE IN PATIENTS WITH SEVERE PREGNANCY INDUCED HYPERTENSION

ABSTRACT:It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective.&#x0D; OBJECTIVE: To compare the mean time to achieve blood pressure control of oral Nifedipine with intravenous Labetalol for management of severe pregnancy induced hypertension.&#x0D; METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t- test and consider significant at p value &lt;5%.RESULTS: Patients were ranged between 20-40 years. Mean age of the patients was calculated as 26.98+4.54 and 27.36+4.43 years in group-A and B respectively. Gestational age shows that 64%(n=32) in Group-A 74%(37%) in Group–B were between 20-30 weeks of gestation while 36%(n=18) in Group-A were between 31-40 weeks of gestation mean±SD was calculated as 28.92+4.91 and 28.94+4.72 weeks in Group-A and B respectively. Mean time to achieve B.P control in group A was 31.24+5.62 and in group B 45.5+4.63 with p value &lt;0.05.&#x0D; CONCLUSION: Mean time to achieve blood pressure control was shorter with oral Nifedipine when compared to I/V Labetalol for management of female presenting with severe pregnancy induced hypertension.