Average Diastolic Blood Pressure Research Articles

Pemberian Terapi Rebusan Daun Alpukat terhadap Penurunan Tekanan Darah Penderita Hipertensi

This study aims to determine the effect of the decoction of avocado leaves on reducing blood pressure in hypertensive patients in the Working Area of the West Lingkar Health Center in Bengkulu City. This type of research is a quasi-experiment with a two-group pre-test and post-test design. The results showed that the average systolic blood pressure before avocado leaf decoction was 143.27 mmHg with SD. 6,497, meaning that systolic blood pressure is included in the category of hypertension level 1. The average diastolic blood pressure before the avocado leaf decoction intervention was 84.33 mmHg with SD—4,865, where diastolic blood pressure is included in the prehypertension category. The bivariate analysis results showed that the p-value for systolic blood pressure was 0.000, and the p-value for diastolic blood pressure was 0.000. In conclusion, there was a significant effect between giving avocado leaf decoction intervention before and after reducing blood pressure.
 
 Keywords: Hypertension, Avocado Leaf Decoction, Blood Pressure

FEATURES OF AMBULATORY BLOOD PRESSURE MONITORING WITH DIFFERENT BLOOD PRESSURE PROFILES IN PATIENTS WITH HYPERTENSION DISEASE OF MIDDLE AND ELDERLY AGE

Background. Insufficient night-time reduction of blood pressure (BP) and night hypertension are associated with an increased risk of death regardless of the average daily BP. The study of daily BP profiles is very relevant in patients with hypertension of different age categories due to the high risk of thrombotic complications.
 Aim: of the study was to determine the peculiarities of ambulatory blood pressure monitoring (ABPM) indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.
 Materials and methods. ABPM indicators were determined in 125 patients who were divided into 2 groups. 1st group (n=82) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old). In the groups of middle-aged and elderly subjects 2 groups of daily BP profiles were distinguished: "dipper" and "non-dipper".
 Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily systolic BP (SBP) (mm Hg), the average daly diastolic BP (DBP) (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP.
 Results. The baseline BP level in the average daily SBP and DBP in middle-aged patients of dipper group was significantly higher by 49,6% and corresponded to 155,9±12,0 mm Hg (p<0,001) and 50,4% and was 97,3±6,1 mm Hg (p<0,01). Similar results are observed in the average BP and the maximal daily SBP and the maximal daily DBP values which were significantly higher than the control group by 21,5% (p<0,05) and equaled 110,0±3,6 mm Hg and 21,3% and amounted to 176,3±23,5 mm Hg (p<0,05) and 23,6% and amounted to 117,0±19,2 mm Hg (p<0,05). The baseline BP level in the average daily and maximal SBP, the average daily DBP and the average BP in patients of non-dipper group was significantly higher by 50,8% (p<0,01) and corresponded to 157,1±12,9 mm Hg and 27,4% and equal to 176,9±24,0 mm Hg (p<0,05), 63,8% and amounted to 106,0±1,0 mm Hg (p<0,05) and 44% and was 124,3±6,8 mm Hg (p<0,05) too. In the surveyed elderly patients only the average daily DBP was significantly different from the corresponding control indicator and was lower by 21,4% (p<0,05) and amounted to 91,5±0,7 mm Hg in dipper and 23,1% (p<0,01) and was 93,5±0,7 mm Hg in non-dipper group.
 Conclusion. Non-dipper group predominates in the structure of daily BP rhythm in elderly hypertensive patients (62,8% versus 37,2%). The average BP decreases in elderly patients of non-dipper group by 11,1% (p<0,05) reliably to patients of middle age.

Junk Food Consumption and Its Association with Anthropometric Indices and Cardiovascular Parameters among College Going Students

Background: Junk foods are defined as meals or beverages with little nutritional value that are made to be easily accessible for consumption with little to no thought to their nutritional potential. The present study has been objectively conducted to assess the association of consumption of junk foods with anthropometric indices and its impact on blood pressure levels. Methods: The present study was conducted on 200 medical students at Postgraduate Department of Physiology, Government Medical College, Jammu over a period of one year from November 2019 to October 2020. Results: Mean weight and mean height of studied individuals was 62.39±3.75 kg and 165.44 ± 9.50 cms respectively. The study population's mean body mass index (BMI), which ranged from 16.19 to 37.7 kg/m2, was 22.74±3.17 kg/m2. The average waist circumference, average hip circumference (HC) and the average waist-to-hip ratio of studied individuals was (79.83±9.30) cms, (93.25 ± 8.34) cms, and (0.85 ± 0.07) respectively. The study population's average systolic and diastolic blood pressure was 120.08 ± 8.85 mmHg and 79.06 ± 5.82 mmHg respectively. Conclusion: The findings of the present study revealed that there was no significant association of junk food/soda drinks consumption with BMI, WHR, systolic BP, and diastolic BP. Keywords: Junk Food Consumption, Anthropometric Indices, Cardiovascular Parameters, BMI, WHR, BP, College Going Students

Low sodium intake ameliorates hypertension and left ventricular hypertrophy in mice with primary aldosteronism.

The goal of this paper is to elucidate the effects of sodium restriction on hypertension and left ventricular (LV) hypertrophy in a mouse model with primary aldosteronism (PA). Mice with genetic deletion of TWIK-related acid-sensitive K (TASK)-1 and TASK-3 channels (TASK-/-) were used as the animal model of PA. Parameters of the LV were assessed using echocardiography and histomorphology analysis. Untargeted metabolomics analysis was conducted to reveal the mechanisms underlying the hypertrophic changes in the TASK-/- mice. The TASK-/- adult male mice exhibited the hallmarks of PA, including hypertension, hyperaldosteronism, hypernatremia, hypokalemia, and mild acid-base balance disorders. Two weeks of low sodium intake significantly reduced the 24-h average systolic and diastolic BP in TASK-/- but not TASK+/+ mice. In addition, TASK-/- mice showed increasing LV hypertrophy with age, and 2weeks of the low-sodium diet significantly reversed the increased BP and LV wall thickness in adult TASK-/- mice. Furthermore, a low-sodium diet beginning at 4weeks of age protected TASK-/- mice from LV hypertrophy at 8-12weeks of age. Untargeted metabolomics demonstrated that the disturbances in heart metabolism in the TASK-/- mice (e.g., Glutathione metabolism; biosynthesis of unsaturated fatty acids; amino sugar and nucleotide sugar metabolism; pantothenate and CoA biosynthesis; D-glutamine and D-glutamate metabolism), some of which were reversed after sodium restriction, might be involved in the development of LV hypertrophy. In conclusion, adult male TASK-/- mice exhibit spontaneous hypertension and LV hypertrophy, which are ameliorated by a low-sodium intake.

The effectiveness of atrial fibrillation special clinic on oral anticoagulant use for high risk atrial fibrillation patients managed in the community

BackgroundService gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.MethodQuasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥ 2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed.ResultsAmong the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P < 0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P = 0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P = 0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature.ConclusionAFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run.

S-44-3: GENDER DIFFERENCE IN THE ASSOCIATION OF DIETARY CALCIUM INTAKE WITH BLOOD PRESSURE: ANALYSIS OF THE NHANES 2017 - 2020

Background: Higher dietary calcium intake is associated with lower blood pressure. This association among different genders is unclear. Methods: A cross sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2018 included participants ≧18 years old. The Association between the quartile of the dietary calcium intake and systolic and diastolic hypertension defined as three average measured systolic blood pressure ≧130 and diastolic blood pressure ≧80 mmHg, respectively was examined by multiple logistic regression. Results: Of 11,137 study participants, the mean ± SD age was 50 ± 19 years old and 51% were female. Up to 35% were White followed by Black, Asian, and other races. Median (interquartile range; IQR) dietary calcium intake of quartile 1 to quartile 4 were 21 (13, 33), 120 (83, 183), 233 (220, 293), and 625 (500, 959) mg/day, respectively. Average systolic blood pressure and diastolic blood pressure were 124 ± 19 and 74 ± 12 mmHg, respectively. Systolic and diastolic blood pressure were significantly lower in women compared to men for every quartile 1 and 2 of dietary calcium intake, higher in quartile 3, and not different in quartile 4 (Figure 1A and 1B). Dietary calcium intake in quartiles 3 and 4 were significantly associated with 38% and 55% greater odds of systolic hypertension (odds ratio (OR) Q3 1.375, P 0.006, 95% confidence interval (CI) 1.095, 1.728 and OR Q4 1.550, P &lt; 0.0001, 95%CI 1.249, 1.923), but not with diastolic hypertension. After adjusting for age, gender, race, body mass index, serum creatinine, urine albumin:creatinine ratio, dietary sodium and potassium intakes, and the interaction term between gender and dietary calcium intake, only dietary calcium intake in quartile 3 was significantly associated with 82% lower odds of systolic hypertension (adjusted OR Q3 0.164, P 0.005, 95%CI 0.047, 0.578), while the association was greater and in the same direction for quartile 4, but it was not statistically significant (adjusted OR Q4 0.341, P 0.120, 95%CI 0.087, 1.326). Although there was an inverse association between dietary calcium intake and diastolic hypertension, it was not statistically significant. Gender was identified as an effect modifier, with a stronger positive association between the dietary calcium intake and systolic hypertension observed in female participants (Pinteraction 0.028). Conclusions: Dietary calcium intake and systolic hypertension, but not diastolic hypertension is inversely associated with a different magnitude between women and men. Additional longitudinal studies are required to further evaluate this relationship.

Cardio-Renal Syndrome: Epidemiological, Clinical, Paraclinical, Etiological Aspects and Prognostic Factors in the Cardiology Department of the CHU Ignace Deen in Conakry

Introduction: Heart and kidney diseases are common among patients admitted to hospital and they coexist in a significant number of cases. The interactions between the cardiovascular system and the kidney have been known and described for many years and have led to the description of cardio-renal syndrome. The objective of this study was to determine the frequency; to describe the clinical, etiological and prognostic aspects of acute renal failure in patients hospitalized for chronic congestive heart failure. Method: This was a descriptive retrospective study from January 2, 2018 to December 31, 2022. Included in this study were all the complete records of patients hospitalized for chronic congestive heart failure with serum creatinine ≥120 μmol/I. We’re not included in this study, incomplete files, records of patients hospitalized for other pathologies, records of patients hospitalized for chronic congestive heart failure with normal renal function. Our study variables were qualitative and quantitative divided into clinical, paraclinical and prognostic data. Our data were analyzed using the EPI-info 7.2.2.6 software. Data entry and presentation were carried out using Word, Excel and PowerPoint from the 2016 Office Pack. Results: We collected 830 files of which 114 met our selection criteria, a frequency of 13.73%. The mean age of the patients was 47 ± 19 years. The F/M sex ratio was 1.23. The dominant etiologies were hypertension followed by diabetes with respectively 60.5% and 23.7%. Toxic factors including tobacco accounted for 7.9% of cases. Dyspnea accounted for 86.8%. Most of our patients were grade 3 or 36% based on systolic blood pressure on admission with an average of 164.16 ± 33.95 mmHg and an average diastolic blood pressure of 93.24 ± 20.40 mmHg. Biologically, the serum creatinine revealed a high frequency of 201 - 400 μmol/l (33% of cases) with an average value of 586.49 ± 631.44 μmol/l with the extremes 2.960 and 2448.68 μmol/I. Anemia was moderate in 34.2% of cases. Cardiac ultrasound was performed on 81 patients, the results of which showed dilated cardiomyopathy in 48.2% of cases. Renal ultrasound was performed only by 18 patients, renal suffering was found with 8.8%. Almost all (92.11%) of the patients had an acute renal failure of functional origin. More than half (65.80%) of our patients were at risk. Diuretics were the most prescribed antihypertensives with 87.71% followed by ACE inhibitors 78.94%. The average length of hospitalization was 13.81 ± 7.66 days with extremes of 24 hours and 41 days. Conclusion:The association of acute renal failure and chronic congestive heart failure is a frequent situation. The diagnostic approach must be guided by the context and the data of a meticulous examination supplemented by an appropriate paraclinical assessment. Kidney renal failure is mostly functional.

Pengaruh Pemberian Snack Fig Bar Tepung Kacang Kedelai Dan Ubi Jalar Kuning Terhadap Tekanan Darah Penderita Hipertensi Di Puskesmas Kertapati Palembang

Background: Hypertension that occurs in productive age in Indonesia is a serious health problem, the prevalence is above 34.1%. Lack of intake of macro and micro nutrients is the main cause of the lack of healthy snacks, especially for people with hypertension. nutritional intervention with Fig Bar Snack Formula which can significantly reduce the incidence of hypertension. Snack Fig Bar is a type of bakery when broken solid textured. Soybeans and Yellow Sweet Potatoes contain potassium and fiber which play a role in lowering systolic and diastolic blood pressure. Purpose: This study aims to determine the effect of giving FIG BAR snacks made from soybean flour and yellow sweet potato flour on reducing blood pressure in hypertension. Method: The type of research used is a quasi-experimental with a Control Group Pretest-Posttest design. This research was conducted from January to April 2022 at the Kertapati Health Center in Palembang. The sample in this study was selected by Systematic Random Sampling with a total sample of 30 treatment respondents and 30 comparison respondents.Result: Data analysis using t-dependent that the average systolic and diastolic blood pressure before treatment in the treatment group were 155.40 mmHg and 95.33 mmHg, in the comparison group 151.10 mmHg and 96.37 mmHg Conclusion: The average systolic and diastolic blood pressure after treatment in the treatment group was 151.97 mmHg and 93.23 mmHg, in the comparison group it was 157.53 mmHg and 96.60 mmHg with a p-value of 0.000 which indicates that there is an effect of giving snacks. Fig Bar Made from Soybean Flour and Yellow Sweet Potato Flour for Hypertension Patients' Blood Pressure.

The Effectiveness of Family-Based Dash Education on Older People's Blood Pressure at the Public Health Center of Kutalimbaru

Hypertension cases continue to increase worldwide and are the biggest cause of death. In Medan, North Sumatra, the number of hypertensive patients is 7,174 people, and the cause of death is the 4th cause of death. The study aimed to formulate the effectiveness of family-based Dash education on elderly blood pressure at the Kutalimbaru Health Center. This research is a Quasi-Experimental design with one group pretest and posttest design. The population is hypertensive clients at the Kutalimbaru Health Center with a sample of 31 respondents, taken through a purposive sampling technique with the criteria of elderly hypertensive 2-4 years, blood pressure &gt; 140/90 mmHg, age 55 years to 65 years, living with family, receiving medication the same antihypertensive and willing to be a respondent. The instrument used was a sphygmomanometer, a 24-hour Recall observation sheet, and a booklet—analysis with a Wilcoxon sign rank test. Research shows the average systolic blood pressure before 155.16 mmHg after 147.74 mmHg. The average diastolic blood pressure before 85.81 mmHg after 82.26 mmHg. The results of statistical tests showed an effect of family-based education on the blood pressure of older people at the Kutalimbaru Health Center (p = 0.000). The conclusion of family-based education is effective in reducing blood pressure in older people. Suggestions for families are expected to control eating patterns routinely and for older people to have their blood pressure checked regularly at the public health center.

Potentials for patients with severe arterial hypertension, by using antihypertensive pharmacotherapy combined with ozone therapy and nasal laser therapy.

Background: More people die each year from cardiovascular diseases than from any other cause. Arterial hypertension (AH) is a particularly important public health issue in Mongolia which has one of the highest mortality rates from hemorrhagic stroke in the world. Antihypertensive pharmacological therapy combined by other non-medication therapy is well-studied in patients with mild and moderate AH. However, studies that have investigated combination of low intensity laser irradiation and ozone therapy in patients with severe AH are lacking. The objective of the present work was to develop methods using low intensity laser irradiation therapy (LLLT) combined with major autohemotherapy (MAH) for the patients presenting with AH. &#x0D; Studies have shown that LLLT is capable of inducing a photobiological response within the cells which modifies the micro and macrovascular response; this accompanies evidence showing the systemic effects even using in nasal laser irradiation (NLI). &#x0D; Oxygen-ozone therapy exerts a positive effect on the platelet aggregation, cell remodeling, cytoskeletal elements organization and mitochondria structure. Due to O2-O3 therapy is an effective method in hypertension, and it diminishes the hypoxia state of various tissues. &#x0D; In recent years, scientists have made great progress in the area of pharmacotherapy for patients with AH. Drugs help to achieve the target level of arterial blood pressure, particularly in patients with mild and moderate AH. With a higher degree of AH (severe arterial hypertension – the 3rd degree of arterial hypertension) the effectiveness of pharmacological therapy decreases and to achieve the target level of arterial blood pressure it is necessary to use a combination of all major groups of antihypertensive medicines.&#x0D; &#x0D; Method and Result: The study was held at Wellness Med Hospital Mongolia since the beginning of 2021 until the end of year. The study included a total of 60 patients of any age (63% of men and 37% of women) having AH associated with coronary heart disease and abnormal blood lipid spectrum. Initially, clinical-instrumental and laboratory examination, blood pressure registration and daily arterial blood pressure monitoring were carried out. Suitable drugs were selected for all the patients. 3 months after starting drug treatment the patients were divided in 2 groups each comprising 30 patients matched for age, sex, severity of clinical conditions, and character. The patients of the first group were prescribed combination with NLI and ozone therapy (MAH) in addition to drugs. For ozone therapy used Ozomed smartline ozone generator by Hansler Medical, Germany. The total dose of ozone to be given at each session will vary according to the general condition of the patient. Intervals from daily to weekly and twice a week. Ten to twelve treatments are considered as one course of treatment. Also, as cycles to be given once or more times per year. It may vary from less than 1000 µg to 3000 µg. This procedure is in line with the Madrid Declaration (ISCO3/QAU/01/03). The ozone concentration in the O2-O3 gas mixture were between 20 µg/ml to 35 µg/ml. The volume of blood to use varies between 50 mL and 100 ml. For NLI therapy we used Semiconductor laser Therapeutic apparatus Model W-001 by Fithope, China. The laser watch with nasal laser irradiation with 650nm (5mW) of lights. Used this equipment same day with Ozone therapy for about 30-40 minutes each time. If AH was higher used the laser therapy longer time. &#x0D; The second group of patients continued receiving drugs alone. 3 months later, average daily blood pressure (BP), systolic BP and diastolic BP were compared in both groups. Three months after both groups demonstrated a significant decrease in SBP and DBP, but these indicators remained higher than normal and did not reach the target level. Three months after the inclusion of MAH+NLI in the comprehensive treatment, the first group demonstrated a significant decrease in BP (systolic and diastolic), not only in comparison with the initial data, but also with the data observed three months after PT. After 6 months SBP and DBP in the first group were significantly lower compared with those of patients in the second group. The inclusion of MAH+NLI in addition to multicomponent antihypertensive drugs is a promising treatment option for severe AH. &#x0D; &#x0D; Discussion: Drug therapy is not sufficient for the elimination of cellular-tissue and microcirculatory disorders in case of severe AH, it should be advisable to include MAH+NLI into the multicomponent treatment, and positive changes in the indicators of the 1st group of patients after the inclusion of MAH+NLI are suggestive of it. &#x0D; The oxygen-ozone therapy and LLLT seem to have no adverse events or side effects. Moreover, it is very cost-effective, as standard treatment costs can be reduced by 25% also.

Arterial stiffness in postmenopausal women with arterial hypertension

Background. It was established that the prevalence of reduced bone mineral density is significantly higher among patients with arterial hypertension compared to healthy subjects. The purpose of the research was to study arterial stiffness and central aortic pressure in women with arterial hypertension combined with osteoporosis. Materials and methods. 88 postmenopausal women with arterial hypertension (average age 62.7±3.8 years) were included in the study, of which 35 women with osteoporosis (OP) according to dual-energy X-ray absorptiometry (DXA) data (group 1) and 33 without it (group 2). The control group consisted of 20practically healthy women without arterial hypertension and OP. Before the start of the study, the patients did not regularly receive antihypertensive drugs. In addition to conventional studies, daily blood pressure monitoring, applanation tonometry, and DXA were performed. Statistical processing was performed using the Statistica 10.0 software package using standard variational statistics algorithms. Results. It was found that in group 1, the levels of office systolic (SBP) and diastolic blood pressure (DBP) were by 3.7 and 4.9% (p &lt; 0.05) higher than in group 2. According to daily blood pressure monitoring, a more pronounced increase in average daily SBP and DBP by 4.1 and 6.6% (p &lt; 0.05) was observed in group 1 compared to group 2. It was found that in group 1, compared to the control group and group 2, an increase in pulse wave velocity was detected by 37.2 and 26.4%, respectively. Conclusions. In women with postmenopausal osteoporosis in combination with arterial hypertension according to data of office measurement, daily monitoring blood pressure and data of applanation tonometry, blood pressure levels and parameters of arterial stiffness were significantly higher than in patients with arterial hypertension without osteoporosis.

Telehealth System Based on the Ontology Design of a Diabetes Management Pathway Model in China: Development and Usability Study

Diabetes needs to be under control through management and intervention. Management of diabetes through mobile health is a practical approach; however, most diabetes mobile health management systems do not meet expectations, which may be because of the lack of standardized management processes in the systems and the lack of intervention implementation recommendations in the management knowledge base. In this study, we aimed to construct a diabetes management care pathway suitable for the actual situation in China to express the diabetes management care pathway using ontology and develop a diabetes closed-loop system based on the construction results of the diabetes management pathway and apply it practically. This study proposes a diabetes management care pathway model in which the management process of diabetes is divided into 9 management tasks, and the Diabetes Care Pathway Ontology (DCPO) is constructed to represent the knowledge contained in this pathway model. A telehealth system, which can support the comprehensive management of patients with diabetes while providing active intervention by physicians, was designed and developed based on the DCPO. A retrospective study was performed based on the data records extracted from the system to analyze the usability and treatment effects of the DCPO. The diabetes management pathway ontology constructed in this study contains 119 newly added classes, 28 object properties, 58 data properties, 81 individuals, 426 axioms, and 192 Semantic Web Rule Language rules. The developed mobile medical system was applied to 272 patients with diabetes. Within 3 months, the average fasting blood glucose of the patients decreased by 1.34 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.63 mmol/L (P=.003); the average systolic and diastolic blood pressures decreased by 11.84 mmHg (P=.02) and 8.8 mmHg (P=.02), respectively. In patients who received physician interventions owing to abnormal attention or low-compliance warnings, the average fasting blood glucose decreased by 2.45 mmol/L (P=.003), and the average 2-hour postprandial blood glucose decreased by 2.89 mmol/L (P=.003) in all patients with diabetes; the average systolic and diastolic blood pressure decreased by 20.06 mmHg (P=.02) and 17.37 mmHg (P=.02), respectively, in patients with both hypertension and diabetes during the 3-month management period. This study helps guide the timing and content of interactive interventions between physicians and patients and regulates physicians' medical service behavior. Different management plans are formulated for physicians and patients according to different characteristics to comprehensively manage various cardiovascular risk factors. The application of the DCPO in the diabetes management system can provide effective and adequate management support for patients with diabetes and those with both diabetes and hypertension.

Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study

Since 2010, China has made vast financial investments and policy changes to the primary care system. We aimed to assess how hypertension awareness, treatment, and control might be used to assess quality of primary care systems, which reflect the outcomes of public health services and medical care. We used The China Patient-centred Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health project that focuses on cardiovascular disease risk in China. We linked primary care institution characteristics that were captured in the survey between 2016 and 2017 to the participant-level data gathered in baseline visits between 2014 and 2021. Participants were included if they had hypertension and lived in the towns or streets that took part in the primary care survey. Participants were excluded if they had missing data for blood pressure measurement, history of hypertension, sex, or age. Primary care institutions were excluded if the catchment area had fewer than 100 participants with hypertension. Hypertension awareness was defined as the proportion of participants with hypertension who self-reported a hypertension diagnosis. Hypertension treatment was defined as the proportion of participants who currently use antihypertensive medications among those who were aware. Hypertension control was defined as the proportion of participants with an average systolic blood pressure less than 140 mm Hg and an average diastolic blood pressure less than 90 mm Hg over two readings among those who were treated during the study. All patients were included in the analysis. This trial was registered at ClinicalTrials.gov, NCT02536456. Between Sept 15, 2014, and March 16, 2021, we assessed 503 township-level primary care institutions for eligibility. 70 institutions were excluded as they could not be linked with individual data or because their catchment area had fewer than 100 participants with hypertension. We analysed 433 township-level primary care institutions across all 31 provinces of mainland China, including 660 565 individuals with hypertension in their catchment areas. Across townships, age-sex standardised hypertension awareness varied from 8·2% to 81·0%, treatment varied from 2·6% to 96·5%, and control proportions varied from 0% to 62·4%. Hypertension awareness, treatment, and control were significantly associated with the following institutional characteristics: government funding through balance allocation (ie, institutions have their human resources funded by local government, but need to be self-supporting in other aspects; awareness odds ratio 0·88, 95% CI 0·78-0·99; p=0·027), having financial problems that interrupted routine service delivery (awareness 0·81, 0·72-0·92; p=0·0007, control 0·84; 0·75-0·94, p=0·0034), setting performance-based bonus (treatment 1·39, 1·07-1·80; p=0·013), basic salary defined by number of patient visits (control 0·85, 0·76-0·95; p=0·0053), using electronic referrals (treatment 1·41, 1·14-1·73; p=0·0012, control 1·17; 1·03-1·33, p=0·014), implementing family physician contract services (awareness 1·13, 1·00-1·28; p=0·045, control 1·30; 1·15-1·46, p<0·0001), and proportion of physicians who are formally licensed (awareness per 10% increase 1·04, 1·01-1·08; p=0·019, treatment 1·08; 1·02-1·14, p=0·0077; control per 10% increase 1·07, 1·03-1·10; p=0·0006). The role of primary care role in hypertension management might benefit from new strategies that promote best practices in institutional financing, performance appraisal, service delivery, and information technology. Chinese Academy of Medical Sciences Innovation Fund for Medical Science, and the National High Level Hospital Clinical Research Funding. For the Chinese translation of the abstract see Supplementary Materials section.

The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip.

Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.

Correlation of Serum Sodium Levels with Blood Pressure in Adolescents in Amurang, South Minahasa District

Sodium intake is very important in the mechanism of increasing blood pressure [1]. The effect of sodium intake in increasing blood pressure is through an increase in plasma volume (body fluid) and blood pressure [2]. The research was conducted in the form of an analytic survey with a cross-sectional study design. The data were processed using the SPSS program. The population is all students of SMAN 1 Amurang, South Minahasa District, the sample is taken by total sampling. From 67 samples, the minimum sodium content was 137 mEq/L and the maximum sodium content was 164. The average Na content was 143.54 mEq/L. The average systolic blood pressure was 119.04 mmHg and the average diastolic blood pressure was 79.70 mmHg. Based on the results of the Spearman correlation test, the correlation coefficient value (R = 0.069) with a significance of 0.579 for the correlation between sodium levels and systolic pressure. These results indicate that there is no statistically significant relationship between Na levels and systolic blood pressure. For the other Spearman correlation test results, the correlation coefficient value (R=-0.089) with a significance of 0.473 for the correlation between sodium levels and diastolic pressure. These results also show that there is no statistically significant relationship between sodium levels and diastolic blood pressure. It can be concluded that there is no relationship between serum sodium levels and blood pressure in adolescents in Amurang, South Minahasa District.

Effect of blood pressure on the prognosis of acute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization

PurposeTo explore the effect of blood pressure on the prognosis of acute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization. MethodsAcute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization were retrospectively collected. All patients were divided into the functional independent group and non-functional independent group, death group and non-death group based on the 90-day mRS score. Logistic regression was applied to analyze the relationship between the highest systolic blood pressure, the average systolic blood pressure, the lowest systolic blood pressure, the highest diastolic blood pressure, the average diastolic blood pressure, the lowest diastolic blood pressure in the first 24 h after admission and the functional prognosis as well as the complications after 90 days. The independent impact factors selected from regression analysis were used to investigate the blood pressure with prognostic value by receiver operating characteristic curve (ROC). ResultsA total of 70 patients were recruited in this study. Among them, 39 cases (55.71%) were male and 31 cases (44.29%) were female, with a mean age of 61.83 ± 15.24 years old. 15 cases (21.43%) had a favorable 90-day outcome, and the other 55 cases (78.57%) had a higher mRS Score. After a 90-day follow-up, univariate analysis showed that hypertension and hyperlipidemia, highest systolic blood pressure, mean systolic blood pressure and NIHSS score were statistically significant in two groups with or without functional independence, while the NIHSS score at admission, systolic blood pressure at admission, average systolic blood pressure, highest systolic blood pressure and diastolic blood pressure were statistically significant in patients with death outcomes (P < 0.05). Multivariate regression analysis suggested that the highest systolic blood pressure was statistically significant (P < 0.05), the further ROC curve results showed the cut-off value of the highest systolic blood pressure was 180.5 mmHg, with a sensitivity of 82.35% and a specificity of 81.13%. The highest Youden's index was 0.6348. ConclusionFor acute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization, the appropriate reduction of blood pressure within 24 h after admission may have a positive effect on the clinical prognosis. The 90-day mortality of acute ischemic stroke patients without revascularization was independently related to the highest systolic blood pressure. The risk of death was increased when the highest systolic blood pressure was greater than 180.5 mmHg.

Proceedings of the 2022 IDACO/IDHOCO/IDCARS/UPRIGHT-HTM Consortium Meeting, 1-3 December 2022, Lamot Congress and Heritage Centre, Mechelen, Belgium Meeting Chairpersons: Kei Asayama and Jan A. Staessen.

Background: Home blood pressure telemonitoring (HTM) is recommended by several guidelines in the management of hypertension with its benefits widely documented. HTM enables patients’ active participation in their management and also assists in the diagnoses of white coat and masked hypertension. The feasibility of HTM in poor resource settings such as in Nigeria is unknown. Aim: To determine the feasibility of HTM in Nigeria Methods: We evaluated HTM among Nigerians recruited under the framework of Urinary Proteomics combined with Home Blood Pressure Telemonitoring for Health Care Reforms trial (UPRIGHT-HTM), a multi-centre global clinical trial involving three centres in Nigeria. Eligible patients, aged 55-75 years old with ≥5 cardiovascular diseases risk factors but asymptomatic were trained to collect HTM data using Bluetooth-enabled automated blood pressure (BP) monitors aided with web-based applications that run on android smartphones. Results: Of the 171 patients screened over a 17-month period (May 2021 to September 2022), 1 (0.6%) withdrew consent, 8 (4.8%) without android smart phones, 3 (1.8%) inconsistent with BP measurement over a 5-week run-in period, and 23 (11.3%) who did not meet the inclusion criteria were excluded from this analysis. Of the 136 subjects randomised, 75 (54.4%) were women, 68 (50.0) were obese and 66 (48.5%) had uncontrolled office BP. The time taken to train subjects on HTM averaged at 8.1±3.4 minutes. So far, 44, 236 BP measurements were taken. Overall, the median annual number of BP measurements in the first and second year were 36 and 127 respectively, with monthly median measurements ranging from 12 in August of the first year to 49 measurements in November of the same year. More than 50% of the subjects measured their BP at least 2 times weekly in all but the first quarter of the first year. The average monthly systolic and diastolic BP in each of the 18 months were less than 135mmHg and 85 mmHg respectively. Conclusion: HTM is feasible in clinical trial settings and thus can be integrated into the routine clinical practice in Nigeria.

Abstract 14194: Risk Factors of Hypokalemia and Hyperkalemia in Hypertensive Emergency

Introduction: Potassium disorders are common among hypertensive patients. There is a paucity of data on the prevalence and risk factors of dyskalemia in patients with hypertensive emergency. Hypothesis: We sought to investigate the prevalence and risk factors of potassium disorders in patients presenting with hypertensive emergency. Methods: A retrospective, cross-sectional study was employed by retrieving electronic medical records (EMR) of patients with a diagnosis of hypertensive emergency admitted from September 2016–December 2021 under Yale New Haven Health system. Hypertensive emergency patients were identified using the International Classification of Diseases, Tenth Edition (ICD-10) diagnosis. We selected patients who carried the diagnosis code of hypertensive emergency (I16.1) and at least 1 additional diagnosis for concurrent end organ damage (EOD). We manually examined all the electronic medical record (EMR) (n = 2664) to assure the correct establishment of diagnosis and removed 345 patients who are hypertensive urgency misclassified as hypertensive emergency. Hypokalemia is defined as serum potassium &lt;3.5 mg/dL and hyperkalemia is defined as &gt;5.5 mg/dL. Results: Among a total of 2,319 patients included in the study, 1,157(49.9%) were women and 1162(50.1%) were men. The mean age of the patients was 67.3 years. We have941(40.6%) African Americans, , 1048( 45.2%) Caucasian, and the rest of 240 (14.2%) are either Asians or unspecified. Average systolic blood pressure on presentation was 193 mmHg and average diastolic blood pressure was 106 mmHg. 143 (6.2%) patients had hyperkalemia and 260 (11.2%) patients had hypokalemia. After multivariable adjustment, older age, lower serum bicarbonate, elevated serum sodium and elevated serum creatinine were independently associated with hyperkalemia, and younger age, African American, higher serum bicarbonate, lower serum sodium, and lower serum creatinine were independently associated with hypokalemia. Conclusions: We identify a potential clinical phenotype of hypertensive emergency patients who present with potassium disorder. The risk for hypo- and hyperkalemia in hypertensive emergency can be stratified with common laboratory results and socio-demographic variable.

Abstract 15047: Survival With Favorable Neurological Outcome and Quality of CPR Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared to Non-Cardiac Disease

Introduction: Children with cardiac disease have higher rates of in hospital cardiac arrest (IHCA) compared to non-cardiac disease. We aimed to determine differences in survival in children with medical and surgical cardiac compared to non-cardiac disease following IHCA and to assess whether CPR quality was different between groups. Hypothesis: We hypothesized: 1) medical cardiac have worse and surgical cardiac have improved outcomes compared to non-cardiac patients, and 2) CPR quality is similar between groups. Methods: A secondary analysis of the ICU-RESUS citation project ( ICU-RESUS ; NCT02837497) was conducted. The primary outcome was survival to hospital discharge with favorable neurological outcome defined as a Pediatric Cerebral Performance Category score of 1 - 3 or no change from baseline. Secondary outcomes included physiologic measures of intra-arrest quality. Results: Of 1100 children with IHCA, 273 (25%) were medical cardiac, 383 (35%) were surgical cardiac, and 444 (40%) were non-cardiac. The medical cardiac group was less likely to survive with favorable outcome compared to the non-cardiac group (48% vs. 55%, aOR 0.59, CI 95 0.40, 0.88). There was no difference in outcome between the surgical cardiac (58%) and non-cardiac group. There were no differences in chest compression (CC) rate, CC fraction, ventilation rate, intra-arrest average target diastolic blood pressure or average target systolic blood pressure between medical cardiac vs. non-cardiac and surgical cardiac vs. non-cardiac groups. The surgical cardiac group was less likely to achieve target CC depth compared to non-cardiac group (OR 0.15, CI 95 0.02, 0.52). There was no difference in CC depth in medical cardiac vs. non-cardiac groups. Conclusions: In this large study of pediatric IHCA, medical cardiac patients had lower survival with favorable neurologic outcome compared to non-cardiac patients. Surgical cardiac patients had similar outcome to non-cardiac patients. CPR quality was similar in medical-cardiac and non-cardiac patients, however delivered CC depths were lower in surgical cardiac compared to non-cardiac patients.

Impact of multivessel versus single-vessel disease on the association between low diastolic blood pressure and mortality after acute myocardial infarction with revascularization

Abstract Background Previous studies demonstrated a J-shaped relationship between low diastolic blood pressure (DBP) and adverse clinical outcomes in patients with acute myocardial infarction (AMI) that was sensitive to revascularization. We hypothesized that this relationship differs between patients with multivessel disease (MVD) and those with single-vessel disease due to differing degrees of myocardial ischemic burden. Methods Among 9,983 AMI patients from the Korea Acute Myocardial Infarction Registry database who underwent percutaneous coronary intervention and were followed up for a median duration of 3.2 years, average on-treatment DBP was calculated at admission, discharge, and every scheduled visit and divided into &amp;lt;70 mmHg, 70–74 mmHg, 75–79 mmHg, and ≥80 mmHg. The relationship between average on-treatment DBP and clinical outcomes including all-cause death, cardiovascular (CV) death, non-CV death, and _hospitalization for heart failure was analyzed using Cox regression models adjusted for clinical covariates. Results In patients with MVD, all-cause death (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.06–2.04) and CV death (HR: 1.59; 95% CI: 1.02–2.46) were significantly increased in patients with a DBP &amp;lt;70 mmHg, showing a J-shaped relationship. However, these findings were not significant for single-vessel disease. On a sensitivity analysis excluding subjects with a baseline SBP &amp;lt;120 mmHg, an increased risk of a low DBP &amp;lt;70 mmHg remained in MVD. Conclusions The J-shaped relationship between low DBP and adverse clinical outcomes in AMI patients who underwent revascularization persisted in MVD, which has a high ischemic burden. These high-risk patients require cautious treatment. Funding Acknowledgement Type of funding sources: None.