Average Number Of Antihypertensive Drugs Research Articles

Edpidemiology, Clinical Profile and Short- Term Outcome of Hypertensive Crisis in N'Djamena (Chad)

Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 1, 4. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.

FRI127 Delay Of A Decade In The Diagnosis Of Primary Aldosteronism In Patients With Onset Of Hypertension ≤ 40 Yo

Abstract Disclosure: S. Parisien-La Salle: None. A. Lacroix: None. I. Bourdeau: None. Introduction: Primary aldosteronism (PA) is a frequent and underdiagnosed cause of secondary hypertension. Mean age at diagnosis is 50-55 years old (yo), however, hypertension often precedes the diagnosis of PA by many years [1,2]. Objective: To evaluate the delay between the diagnosis of hypertension and the diagnosis of PA in patients with onset of hypertension ≤ 40 yo. Methods: We retrospectively collected the clinical information of patients with PA who were diagnosed with hypertension at ≤ 40 yo from our specialized genetics adrenal clinic. Results: We identified 47 patients with PA who presented with hypertension at ≤ 40 yo. Twenty-one patients (44.7%) were female. At diagnosis of PA, 76.6% (36/47) had hypokalemia, 29.8% (14/47) had sleep apnea, 17% (8/47) had type 2 diabetes, 8.5% (4/47) had coronary artery disease and 4.3% (2/47) had atrial fibrillation. More than half of patients (53.2%) were on 3 or more anti-hypertensive drugs. Mean age at diagnosis of hypertension was 30.8 and mean age at diagnosis of PA was 43.5 yo with an average delay of 12.7 years and a median delay of 10 years (IQR: 4,10,19,37).In the group diagnosed with PA within 10 years of the diagnosis of hypertension (n: 24), the average number of anti-hypertensive drugs per patient was 2.3 and 79.2% (19/24) had hypokalemia. In the group diagnosed with PA more than 10 years after the diagnosis of hypertension (n: 23), the average number of anti-hypertensive drugs per patient was higher at 3.4 with a similar prevalence of hypokalemia (73.9% (17/23)).In patients with hypertension diagnosed ≤ 30 yo (n: 23), the mean age at diagnosis of hypertension was 25.3 yo with a median of 28, and the mean age at diagnosis of PA was of 39.2 yo with a median of 34. Thus, the average delay was 13.9 years and the median was 10 years (IQR: 1.5, 10, 26.5, 37). However, in patients with hypertension diagnosed ≤ 20 yo (n: 5), the mean age at diagnosis of hypertension was 16.8 yo with a median of 18, and the mean age at diagnosis of PA was of 25.4 yo with a median of 21 yo. Thus, the average delay was 8.6 years and the median was 3 years (IQR: 2,3,10,28). Conclusion: We demonstrate that in our cohort the median delay is approximately of 10 years between the diagnosis of hypertension and PA for patients diagnosed with hypertension between 30 and 40 yo. Neither the number of antihypertensive drugs, nor the presence of hypokalemia seemed to determine a shorter delay of diagnosis. However, patients diagnosed with hypertension ≤ 20 yo had shorter delays of diagnosis of PA with a median of 3 years. Bibliography: 1. Alam, S.; Kandasamy, D.; et al. High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension. Clin Endocrinol (Oxf)2021, 94, 895-903, doi:10.1111/cen.14409.2. Turcu, A.F.; Yang, J.; Vaidya, A. Primary aldosteronism - a multidimensional syndrome. Nat Rev Endocrinol2022, 18, 665-682, doi:10.1038/s41574-022-00730-2. Presentation: Friday, June 16, 2023

FEWER ANTIHYPERTENSIVE DRUGS ACHIEVE STRICTER BLOOD PRESSURE TARGET IN LESS SEVERE HYPERTENSIVE PATIENTS: A RETROSPECTIVE STUDY IN A COMMUNITY IN BEIJING

Objective: Nowadays, it is not clear how many antihypertensive drugs should be used to achieve treatment goals from real-world studies. This study aims to analyze the BP control situation and the burden of anti-hypertensive drugs in a big community in Beijing. Design and method: We conducted a retrospective study of 4991 residents living in the Majiapu community and collected the baseline and the follow-up data including blood pressure (BP) and drug prescription. BP was analyzed by the mean average value. Hypertension is defined as office systolic BP > = 140mmHg and/or diastolic BP > = 90mmHg. We divided the patient with antihypertensive treatment into a strict control group (BP<130/80mmHg) and a standard control group (BP range from 130-139/80-89mmHg). The comparison of baseline and follow-up data were used to recognize the burden of anti-hypertensive drugs for residents with hypertension and estimate the BP control rate in this population. Results: Of 4991 residents, the prevalence of hypertension was 54%, 34.80% (939) of the patients were under 140/90mmHg and 14.46% (390) were under 130/80mmHg. The control rate of standards of 140/90mmHg and 130/80mmHg among the whole population was 64.7% and 35.3%. And the treatment rate in the whole group of hypertension was 62.5%. In the standard control group, the average number of antihypertensive drugs was 1.66 keeping their BP range from 130-139/80-89mmHg, and the mean BP was 132.1±5.39/79.6±6.71mmHg. However, in the strict control group, the average number of antihypertensive drugs was 1.55, and the mean BP was controlled at 118.8±8.45/71.6±5.79mmHg (P<0.05). There were no differences between the two subgroups by age and smoking status. BMI in the strict group (24.6±3.3 kg/m2) was lower than the mild group (25.5±3.3kg/m2, p<0.01). About 49.2% in the strict control group and 47.0% in the standard control group were combined with lipid-lowing drugs. The LDL levels in the standard control group (2.8±0.8mmol/l) tended to be higher than that in the strict control group (2.7±0.9mmol/l, p = 0.06). Conclusions: In the Majiapu community where BP controls were insufficient, patients had fewer antihypertensive drugs to achieve stricter targets may be due to the lower risk profile of the patients.

CLINICAL CONSEQUENCES IN POST COVID-19 HYPERTENSIVE PATIENTS

Objective: to evaluate the clinical consequences in hypertensive patients after 1.2 ± 0.3 years after COVID-19 recovery. Design and method: We studied 51 treated hypertensive patients, which were divided into 2 groups: 26 patients recovered from mild to moderate COVID-19 in 2020-2021 years (1st group) and 25 patients were not ill COVID-19 (2nd group). The clinical characteristics, laboratory finding, echocardiographic measurement and clinical outcomes were analyzed. Results: There were no significant differences in sex, age, duration of hypertension, frequency of family history of premature CVD and presence of concomitant obesity, DM, CAD, stroke/TIA, atrial fibrillation, heart failure, CKD, PAD and average number of antihypertensive drugs, office systolic BP between the 2 groups. Levels of office diastolic BP by 10 % (P = 0.001) and heart rate by 13 % (P = 0.01) were higher in post COVID-19 group. Low adherence was present at 81.8 % patients 1st group compared with 45 % of 2nd patients group (P = 0.03). Cognitive impairment by the MMSE scale was detected in 68.2 % of COVID-19 recovered patients and 25 % of 2nd patients group (P = 0.03). Fasting glucose by 7.5 % (P = 0.046), 24-h albuminuria in 1.8 times (P = 0.049), level of CRP by 38.5 % (P = 0.04) were higher and blood concentration of endothelial progenitor cells (CD133+CD31+CD45-/+) by 14, 9 % (P = 0.04), left ventricular ejection fraction by 10 % (P = 0.03) were lower in post COVID-19 patients than in patients of 2nd group. Conclusions: The study indicate that the changes were found in the hypertensive patients after 1.2 ± 0.3 years of recovery from COVID-19. In the future these may signal an increased risk for incidence of CV outcomes. Cognitive dysfunction and possibly as a consequence poor adherence to antihypertensive treatment contribute to negative outcomes.

Letter to the Editor Regarding “Natural History of Intracranial Arachnoid Cysts”

This study aims to observe and analyze the clinical efficacy of interventional therapy for patients with Takayasu arteritis (TA) experiencing renovascular hypertension (RH).Eight TA patients with RH underwent percutaneous transluminal renal artery stenting (PTRAS). Patients were followed up 1, 6, 12, and 24 months postoperatively for levels of blood pressure, number of antihypertensive drugs being taken, levels of serum creatinine, and the presence of renal artery restenosis.All 8 patients were successfully followed up 1, 6, and 12 months postoperatively, but 1 was lost to follow-up at 24 months. All patients had significantly lower average blood pressure levels compared with those at baseline (P < 0.05); treatment efficacy rates (recovery or improvement) at 1, 6, 12, and 24 months were 94%, 90%, 80%, and 80%, respectively. The average number of antihypertensive drugs being taken was 3.5 at baseline, 1.0 at 1 month, 0.5 at 6 months, 1.0 at 12 months, and 1.5 at 24 months. Serum creatinine levels during the follow-up period were not significantly different from those at the baseline. No patient developed renal artery restenosis during the follow-up period.PTRAS is a safe and effective treatment for TA-associated RH, with a high technical success rate and a low complication rate. This interventional therapy can effectively control TA-related hypertension and can also preserve and even improve kidney function.

Randomized Trial on the Effects of Dialysate Potassium Concentration on Intradialytic Hypertension

Intradialytic hypertension is not an uncommon condition during chronic hemodialysis. It is associated with unfavorable cardiovascular outcomes, including hospitalization and mortality. Several small studies have demonstrated the contradictory effects of different dialysate potassium concentrations on intradialytic blood pressure. This study is a randomized crossover trial aiming to evaluate the effects of different dialysate potassium concentrations on intradialytic hypertension. A 24-week, 2-treatment, 4-sequence, multicenter, double-blinded, randomized, crossover study was conducted at Maharaj Nakorn Chiang Mai Hospital and Lampang Hospital in Thailand among stable patients receiving chronic hemodialysis who experienced intradialytic hypertension >30% of their sessions over the past 3 months. Each participant was randomly assigned to 1 of 4 treatment sequences. During each intervention period, patients were dialyzed with dialysate potassium of either 2 mmol/l (D-K2) or 3 mmol/l (D-K3) for 4 weeks according to their preassigned sequence, separated by a 2-week washout period. The primary outcome was the incidence of intradialytic hypertension. Forty eligible patients were recruited. The mean age was 61.4 ± 14.2 years and the mean systolic blood pressure (SBP) was 146.6 ± 11.2 mmHg. Of the 40 patients, 95.5% had hypertension and their average number of antihypertensive drugs was 2.8 ± 1.9. A total of 1380 dialysis sessions were included in the analysis (695 sessions for D-K2 and 685 sessions for D-K3). The incidence of intradialytic hypertension was not significantly different between different dialysate potassium concentrations (D-K2 54.7% vs. D-K3 53.1%, P= 0.788). The changes in SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were not different between the 2 dialysate potassium groups. Dialysate potassium concentration of 2 or 3 mmol/l did not affect the incidence of intradialytic hypertension in patients receiving chronic hemodialysis who frequently developed intradialytic hypertension.

Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study.

Pediatric hypertension become an early marker of cardiovascular diseases, but their antihypertensive drug use patterns are rarely known. To investigate the epidemiological characteristics of pediatric hypertension and the use of antihypertensive drugs in the real world in China. In this study, the demographic, diagnosis, and medication prescription data including the antihypertensive drug types and comorbidities, were analyzed. The antihypertensive drugs use were evaluated according to the Chinese guidelines for hypertension. 1301 prescriptions (number of visits) containing 1880 antihypertensive medical orders were collected. The average number of antihypertensive drugs per prescription was 1.45 (±0.75). The patients aged 16 to 18 (70.18%) accounted for the highest proportion. Kidney diseases (33.28%) were the most common comorbidities. Calcium channel blocker (CCB), angiotensin II receptor blocker (ARB), and β receptor blocker (BB) were the most used antihypertensive drugs. The most frequent monotherapy was CCB, while that of two and three drugs combination were ARB+CCB and ARB+BB+CCB, respectively. Metoprolol (11.44%), nifedipine (10.64%), amlodipine (10.59%), valsartan (6.12%) were the most commonly used antihypertensive drugs. The utilization rate of fixed compound preparations was 7.34%. However, the percentage of recommended antihypertensive drugs was just 14.20%, while the recommended drug combination was 84.93% according to the guidelines. For the first time ever we reported the antihypertensive prescription analysis in children in a large area of China. Our data provided new insights into the epidemiological characteristics and drug use in hypertensive children. We found that the guidelines for medication management in hypertensive children were not routinely followed. The wide use of antihypertensive drugs in children and those with weak clinical evidence raised concerns regarding its rational use. The findings could lead to more effective management of hypertension in children.

ADHERENCE AND BLOOD PRESSURE CONTROL IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: To evaluate the adherence to MR antagonists and other antihypertensive therapy and blood pressure control in conservatively treated patients with primary aldosteronism. Design and method: We have consecutively investigated in an outpatient hypertension clinic conservatively treated subjects with previously confirmed primary aldosteronism (PA) (n- 50, 64,5 ± 9 years of age, 24% of women). The confirmation of PA was based on saline supression test in accordance with current guidelines. The PA patients were conservatively treated due to bilateral disease confirmed by adrenal venous sampling or refusal of the surgery. All subjects were regularly followed-up in our clinic. In addition to basic laboratory and clinical parameters, 24 hour ambulatory blood pressure monitoring (Spacelabs) was evaluated. Unplanned blood sampling for assesment of all serum antihypertensive drug concentrations by means of liquid chromatography-mass spectrometry was performed in all patients. The drug was considered positive when the concentration was at least at the lowest detectable level. Total noncompliance was defined as the absence of all measured antihypertensive drugs. Partial noncompliance was calculated as the absence of serum levels of at least one, but not all antihypertensive drugs apparently taken. Results: We have detected good blood pressure control (mean 24 h systolic/diastolic BP 130 ± 12/77 ± 9 mmHg). Average number of antihypertensive drugs was 3,9 ± 1,5. All subjects were treated by MR antagonists. 44% of patients received spironolactone (average daily dose 45 ± 20 mg) and in remaining 56% of subjects eplerenon was given (average daily dose 80 ± 30 mg) because of spironolactone side effects. Assesment of antihypertensive drug concentrations revealed full adherence in 80 %, partial nonadherence was noted in remaining 20 % of subjects. MR antagonists were detected in almost all subjects (49 out of 50). Conclusions: We have detected very good blood pressure control and adherence in conservatively treated patients with primary aldosteronism. Eplerenone had to be used due to spironolactone side effects quite often. Combination of MR antagonists with other antihypertensive drugs (mainly calcium channel blockers and thiazides) had to be used in majority of patients with PA.

WOMEN WITH HYPERTENSIVE STATES OF PREGNANCY FOLLOW IN NEPHROLOGY: CHARACTERISTICS AND EVOLUTION AFTER DELIVERY

Objective: Descriptive analysis of the profile of pregnant women who develop some type of hypertensive disorders of pregnancy (HDP). Review the possible factors involved in its appearance, know the maximum proteinuria at the time of diagnosis and how it evolves after delivery, and the medication used for its control. Design and method: An observational, prospective study of pregnant women with HDP referred to nephrology consultation after hospital discharge post-delivery in 2020. Results: We recruited 55 patients with a mean age of 35.5 years, BMI of 26.12, 18.2% met obesity criteria. 54.7% were primiparous and of the multiparas, 17.4% had had previous HDP. 18.9% were in vitro pregnancies, 5.7% were twins and 47.2% required cesarean section. The average weight of the newborn was 2858.82 gr. 94.3% of the women were not diabetic and 18.9% developed gestational DM. 86.8% started breastfeeding. Regarding the type of HDP (Graph 1): 81% presented a clinical profile of pre-eclampsia (PE) / eclampsia; 3.8% chronic hypertension, 13.2% chronic hypertension with superimposed PE and 1.9% gestational hypertension. The diagnosis of PE was in 90.6% of the cases due to the appearance of proteinuria, 1.9% due to plaquetopenia, 1.9% due to neurological alterations and 5.7% due to only BP figures &gt; 160/110 (Graph 2). No acute renal failure was recorded. The average proteinuria was 1345.52 mg/gr, which decreased to 65.62 mg/gr after one month of treatment, persisting with proteinuria in only 18.8% of the patients. The average number of antihypertensive drugs taken at the moment of the diagnosis was 1.77, and 0.9 at 10 days. 100% go home with medication but in the 10-day control, 28.3% no longer needed any. As concerns the evolution of medication intake, see (Graph 3). Conclusions: Hypertensive disorders during pregnancy are the most frequent medical complication, affect 5–10% of pregnant women and continue to be an important cause of fetal and neonatal morbidity and mortality throughout the world, due to low birth weight or prematurity. Maternal complications can range from acute kidney failure to HELLP syndrome, liver failure, cerebral edema, seizures, or death

ASSESSMENT OF ADHERENCE TO ANTIHYPERTENSIVE MEDICATION IN A POPULATION OF ARGENTINA DURING THE COVID-19 PANDEMIC

Objective: The objective was to assess the adherence to antihypertensive treatment and its determinants in patients during the pandemic by COVID-19 Design and method: A multicenter, prospective, observational cohort study included outpatients from the Cuyo region of Argentina from March to July 2021 that met the following inclusion criteria: 1- patients over 16 years old under antihypertensive treatment; 2- informed consent signature 3- complete 35-dimensional questionnaire. Results: From 512 enrolled patients, 468 met the inclusion criteria. The average age was 50.1 ± 0.1 years, 56.8% were women. At least 39% had 1 CV risk factor. COVID-19 was documented in 35% and 3.6% presented a severe form. The most widely used vaccine was Sputnik V and 70% had at least 1 dose of vaccination for COVID-19. Average adherence was 69%. The average of systolic blood pressure was 139.3 ± 1.0 mmHg and diastolic blood pressure was 85.9 ± 0.6 mmHg. The average number of antihypertensive drugs was 1.26. Table 1 shows the results of multivariate analysis. Conclusions: In a population with intermediate cardiovascular risk, adherence was low, and blood pressure control was suboptimal. The most important predictive variables of low adherence were age, the number of antihypertensive drug tablets, level of education, and smoking.

Adherence and blood pressure control in patients with primary aldosteronism

Purpose The aim of our study was to evaluate the adherence to mineralocorticoid receptor (MR) antagonists and other antihypertensive therapy and blood pressure control in conservatively treated patients with primary aldosteronism (PA). Materials and methods Conservatively treated subjects with previously confirmed PA (n-50, 64.5 ± 9 years of age, 24% women) were investigated via our outpatient hypertension clinic. All subjects underwent regular examinations in our clinic. In addition to basic laboratory and clinical parameters, 24 h ambulatory blood pressure monitoring (ABPM) (Spacelabs) was evaluated. Unplanned blood sampling for assessment of serum antihypertensive drug concentrations by the means of liquid chromatography–mass spectrometry was performed in all patients. In case of spironolactone, its active metabolite canrenone was also evaluated. Total non-compliance was then defined as the absence of all measured antihypertensive drugs. Partial non-compliance was calculated as the absence of serum levels of at least one, but not all antihypertensive drugs prescribed. Results Good blood pressure control was detected (mean 24 h systolic/diastolic BP 130 ± 12/77 ± 9 mmHg). The average number of antihypertensive drugs was 3.9 ± 1.5. All subjects were treated by MR antagonists. 44% of patients received spironolactone (average daily dose 45 ± 20 mg) and in the remaining 56% of subjects eplerenone was administered (average daily dose 80 ± 30 mg) due to spironolactone side effects. Assessment of antihypertensive drug concentrations revealed full adherence in 80% of all subjects, partial nonadherence was noted in the remaining 20% of subjects. MR antagonist levels were detected in almost all subjects (49 out of 50). Conclusions Good blood pressure control and adherence to therapy were detected in conservatively treated patients with PA. Eplerenone had to be used quite often as male subjects did not tolerate dose escalation due to spironolactone side effects.

Impact of hospitalization for checking medication adherence due to resistant and refractory hypertension suspicious on short and mid-term blood pressure control

Abstract Background Resistant (HR) and refractory hypertension (HRef) are associated with increased cardiovascular events and target-organ damage. However, appropriate HR and HRef diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake in clinical practice. Purpose To evaluate whether hospitalization for confirming anti-hypertensive adherence in patients with HR and HRef may impact blood pressure (BP) control after hospital discharge in patients with HR or HRef suspicious at a tertiary outpatient clinic. Methods We recruited consecutive patients with HR or HRef suspicious admitted to the Hospital for confirming treatment adherence. HR was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. HRef was defined as no BP control despite using ≥5 antihypertensive drugs. Patients with suspected HRef who did not meet the criteria but full field the HR definition were named HRNoRef. During hospitalization, all patients used low sodium diet and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and HF/HRef status but also BP and number of antihypertensive drugs at hospital discharge and in the two first return outpatient's visits. Results We studied a total of 83 patients with suspected HR/HRef (age 53±14 years; 76% females; pre-hospitalization systolic and diastolic BP: 177±28 and 106±21mmHg, respectively). Of these, 68.7% (57 patients) had suspected HRef in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of HR fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p&amp;lt;0.001 vs. pre-hospitalization for all comparisons). Among the HR types, HRef was confirmed in only 27 patients (32.5%). During the outpatient follow-up, the patients remained with lower number of antihypertensive drugs as well as lower systolic and diastolic BP at first outpatient visit (mean returned time: 2.1±1.7months) and second outpatient visit post-discharge (mean returned time 7.1±2.6months) as compared to pre-hospitalization data: First visit: 4.3±1.2 classes, systolic: 152±24mmHg, diastolic BP: 89±17mmHg; second visit: 4.5±1.3 classes, systolic: 150±26mmHg, diastolic BP: 89±15mmHg; (p&amp;lt;0.001 vs. pre-hospitalization for all comparisons). Conclusion Supervised medication intake during hospitalization may help not only to define the HR and HRef status but also to have impact on the number of antihypertensive drugs and lower BP values at short and mid-term follow-up. Funding Acknowledgement Type of funding source: None

P0153IS THERE ANY VALUE FOR HOSPITALIZATION FOR CHECKING MEDICATION ADHERENCE DUE TO RESISTANT AND REFRACTORY HYPERTENSION SUSPICIOUS? IMPLICATIONS FOR MID-TERM FOR BLOOD PRESSURE CONTROL

Abstract Background and Aims Resistant hypertension (RH) and refractory hypertension (RefH, an extreme phenotype of RH) are associated with increased cardiovascular events and target-organ damage. However, appropriate RH and RefH diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake during a hospital stay. Therefore, this study was aimed to evaluate whether hospitalization for confirming antihypertensive adherence in patients with RH and RefH may impact blood pressure (BP) values and BP control after hospital discharge in patients with RH or RefH suspicious at a tertiary outpatient clinic. Method From June 2015 to June 2017, we recruited consecutive patients with RH or RefH suspicious admitted to the Hospital for confirming treatment adherence and the respective diagnosis. We excluded patients with secondary forms of hypertension. RH was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. RefH was defined as no BP control despite using ≥5 antihypertensive drugs. During hospitalization, all patients used low sodium diet (∼3grs of salt/day) and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and RH/RefH status but also BP and number of antihypertensive drugs at hospital discharge and in the two first outpatients visits returns. Results We studied a total of 83 patients with suspected RH/RefH (age 53±14 years; 76% female gender; body mass index 28.8±6.2 Kg/m2; pre-hospitalization systolic 177±28mmHg and diastolic BP 106±21mmHg). Of these, 68.7% (57 patients) had suspected RefH in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of RH fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p&amp;lt;0.001 vs. pre-hospitalization for all comparisons). Among the RH types, RefH was confirmed in only 27 patients (32.5%). As compared to pre-hospitalization data, we noticed consistent lower number of antihypertensive drugs and lower levels of systolic and diastolic BP both at first outpatient visit post-discharge (mean returned time 2.1±1.7 months) and second outpatient visit post-discharge (mean returned time 7.1±2.6 months): First visit: 4.3±1.2 classes, systolic BP: 152±24 mmHg, diastolic BP: 89±17 mmHg; second visit: 4.5±1.3 classes, systolic BP: 150±26 mmHg, diastolic BP: 89±15 mmHg; (p&amp;lt;0.001 vs. pre-hospitalization for all comparisons). As a consequence, the rate of patients that reached at least 140x90mmHg increased from 0% to 35% (first visit post-discharge) and 38.5% (second visit post-discharge). Conclusion Supervised medication intake with controlled salt diet during hospitalization may help not only to define the RH and RefH status in uncontrolled hypertensive outpatients but also to have impact on the number of antihypertensive drugs and lower BP values in the mid-term follow-up.

Eye Hydrodynamics after Combined Treatment of Primary Open-Angle Glaucoma and Complicated Cataract

Aim: To study hydrodynamics of the eye after combined treatment – a combination of laser activation of trabecula and cataract phacoemulsification – in a comparative aspect.Material and methods. The study included 65 patients (65 eyes) with initial and advanced stages (I–II stages) of primary open-angle glaucoma (POAG) and complicated cataract. Among the patients there were 38 women (58.5 %) and 27 men (41.5 %), the average age was 68.8 ± 8.2 years. The follow-up period is 12 months after the treatment. The patients were divided into two groups: the main one – 33 patients (33 eyes) who underwent combined treatment – YAG-laser activation of trabecula (YAG-LAT) and phacoemulsification of cataract with intraocular lens (IOL) implantation, the control group – 32 patients (32 eyes) who underwent only phacoemulsification.Initially, the average intraocular pressure (IOP) (P0) in the main and control groups was 20.72 ± 3.39 mm Hg and 21.02 ± 3.55 mm Hg respectively. The average number of antihypertensive drugs used in the study group was 1.53 ± 0.64, in the control group – 1.34 ± 0.55.Results. There were no intraand postoperative complications. By the end of the follow-up period, a significant decrease in the average IOP level compared to its preoperative value by 29.2 % was determined in the main group, and 9.8 % in the control. The average number of antihypertensive drugs used in the study group decreased from 1.53 ± 0.64 to 0.67 ± 0.59 (p &lt; 0.05), in the control group of patients, on the contrary, the average number of antihypertensive agents increased from 1.34 ± 0.55 to 1.91 ± 0.70 (p &lt; 0.05).Conclusion. In the long-term postoperative period after combined treatment (YAG-LAT + phaco), IOP normalization was achieved in 96.9 % of cases, as well as a significant increase in visual acuity of patients. The developed method of treatment is safe, has a minimal risk of complications and can be used for the treatment of patients with initial stages of POAG in combination with complicated cataracts with increased IOP level, inefficiency of antihypertensive therapy.

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

BackgroundThis study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. MethodsPrimary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. ResultsA total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p < 0.001). WCH phenomenon (high OBP with low HBP) was observed in 22.7% of the patients, MUCH (low OBP with high HBP) in 15.8%, uncontrolled hypertension (high OBP with high HBP) in 29.9%, and controlled hypertension (low OBP with low HBP) in 31.6%. In multivariate logistic regression analysis, WCH was determined by stage-1 systolic hypertension (odds ratio [OR] 8.6, 95% confidence intervals [CI] 5.7, 13.1) and female gender (OR 1.6, 95% CI 1.1, 2.4), whereas MUCH was determined by high-normal systolic OBP (OR 6.2, 95% CI 3.8, 10.1) and male gender (OR 2.0, 95% CI 1.2, 3.1). ConclusionsIn primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH.

MASKED UNCONTROLLED HYPERTENSION (MUCH) IN PRIMARY CARE

Objective: To assess the prevalence and features of MUCH in primary care. Design and method: Primary-care physicians nationwide assessed consecutive treated hypertensives using office (OBP, 1 visit) and home blood pressure (HBP) measurements (7 days). All measurements were performed using validated oscillometric devices with Bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as > = 140/90 mmHg and uncontrolled HBP > = 135/85 mmHg. The study was sponsored by Servier Hellas. Results: 128 doctors assessed 872 subjects and 749 with complete data were analyzed (age 62 ± 11 years, OBP 137 ± 9/84 ± 8 mmHg, systolic/diastolic, HBP 130 ± 11/80 ± 8 [difference 7 ± 12/5 ± 8 mmHg, p < 0.001], diabetics 22%, smokers 21%, cardiovascular disease 8%, average number of antihypertensive drugs 1.6 ± 0.7). MUCH (low OBP, high HBP) was observed in 16%, white-coat hypertension (WCH) phenomenon (high OBP, low HBP) 23%, uncontrolled hypertension (high OBP/HBP) 29% and controlled hypertension (low OBP/HBP) 32%. Determinants of MUCH (multivariate logistic regression) were high-normal systolic OBP (odds ratio 5.9) and male gender (2.1). MUCH subjects received more drugs (average 1.8) than the other groups (p < 0.01). 36% of MUCH subjects had > = 5 mmHg higher morning than evening HBP (systolic and/or diastolic), suggesting incomplete duration of antihypertensive drug action. 10% of MUCH subjects believed that they were overtreated and 32% reported that occasionally forgot drug dose. Conclusions: In treated hypertensives in primary care, if OBP measurements are used alone the assessment of hypertension control is inaccurate in 39%, due to WCH and MUCH phenomena. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon, and to prevent undertreatment and subsequent excess cardiovascular disease in MUCH.

ERYTHROPOIETIN THERAPY IS NOT RELATED TO NON-DIPPING PATTERN AND INCREASED CARDIOVASCULAR MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS

Objective: ABPM is superior to dialysis center measurements in predicting cardiovasular (CV) events in patients undergoing chronic hemodialysis (HD). It was found that non-dipping pattern is assocated with poor prognosis. There is currently no evidence linking erythropoiesis-stimating agents (ESAs)-induced hypertension with increased CV morbidity and mortality. It was proposed that long-acting ESA may have a lower hypertensive effect than short-acting ESAs. Our aim was to analyze association of non-dipping pattern, ESA therapy and CV mortality in patients undergoing chronic HD. Design and method: 164 patients (103 M, 61 F; averaged age 65.2), who had been on intermittent HD treatment for more than 6 months, were enrolled in (88.5% hypertensives, 28.6% diabetics, 19.5% smokers) and followed up for average 25.7 months. Patients received HD treatment 4 hr/session 3 times a week during the study period. Average number of antihypertensive drugs was 2.63 (the most prescribed were CaB followed by beta-blockers, ACEi/ARBs, diuretics, central-acting drugs, urapidil and direct vasodilatators: 60.7%, 54.4%, 38.9%, 34.8%, 30.3%, 26.9% and 6.9%, respectively). There were 43.9% of patients on short- and 56.1% of patients on long-acting ESAs. At basal 24 h ABPM (Spacelab) was performed following the ESH/ESC guidelines on non-dialysis midweek day. Data of subjects with more than 70% successful ABPM readings were analyzed. Nondipping was defined as nighttime BP aver Results: Non-dipping pattern was found in 77.4% patients. No differences were found in age, dialysis parameters, comorbidity, chronic HD therapy and laboratory parameters between dippers and non-dippers. However, CV mortality was significantly higher in non-dippers (28.9% vs.16.0%, p = 0.02). Deceased patients were significantly older, had higher serum calcium and iPTH levels and day-time mean arterial pressure levels. There were no differences in number of antihypertensive drugs, proportion of patients with hypertension, diabetes or smokers.No difference was found between patients treated with short- and long-acting ESAs. Conclusions: Observed increased CV mortality in patients undergoing chronic HD is related to non-dipping pattern and is not associated with the type of used ESAs. Mechanisms of increased non-dipping pattern and associated poor prognosis should be evaluated in larger prospective cohorts.

BP.02.05] FEASIBILITY AND EFFICACY OF RENAL DENERVATION THERAPY IN HEMODIALYSIS PATIENTS WITH RESISTANT HYPERTENSION.

Objective: Nephrectomy has been considered for patients with malignant hypertension on dialysis to remove the pressor effects reflexly induced by afferent fibers originating in the renal structure and still active in nonfunctioning kidneys. Because the morbidity and mortality associated with the surgical procedures has limited its adoption, endovascular procedures that might denervate the native nonfunctioning kidney much less invasively has been proposed as an alternative therapeutic strategy. Design and method: we enrolled 5 consecutive dialised patients affected by resistant hypertension (RH,4 men, 1 women, mean age 50 years). The average duration of dialysis was of 5,4 years and the average number of antihypertensive drugs for each patient was 3.5. The renal arteries average diameter was 3.96 mm. The cohort underwent bilateral percutaneous trans-catheter renal denervation (RDT) with the EnligHTN System (St. Jude Medical, St Paul, MN, USA). Measurements included intra-arterial Systolic blood pressure (SBP), diastolic (D) BP, mean (M) BP and heart rate (HR). Results: The small basket device of the EnligHTN was used in all patients. RDT was performed without complications, with an average number of ablations of 33,8. SBP was reduced by the procedure from 162,7 to 130,4 mmHg (p-value 0.02) with also a reduction of DBP (from 97,6 to 83,6 mmHg,p-value 0.04) and MBP (from 119,3 to 99,2 mmHg, p-value 0.03) and no significant HR changes (from 78 to 72 bpm, p-value 0.74). Conclusions: the bilateral RDT procedure in dialised patients with RH was feasible without complications and produced an acute statistically significant decrease in BP.. Diseased kidneys might be the source of a persistently elevated activity of afferent signals to the central sympathetic nervous system, the interruption of which may favour BP reduction. This may be obtain by renal denervation with no need of surgical kidney removal.

PP.10.11] RADIOFREQUENCY RENAL SYMPATHETIC DENERVATION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION – 12-MONTH FOLLOW-UP

Objective: To evaluate safety and efficacy of radiofrequency renal sympathetic denervation (RDN) in patients with resistant arterial hypertension (AH) in mid-term follow-up period. Design and method: In the group of 21 patients (54 ± 10 years, M:F 13:8) with inadequately controlled AH on 3 or more antihypertensives including diuretics (average office blood pressure /BP/ 187/112 > mmHg with average number of antihypertensive drugs 7 ± 1), we realized RDN intervention with the use of Symplicity (Medtronic) or EnligHTN (St. Jude) catheters. During the 12-month follow-up we analyzed changes in office BP, ambulatory BP monitoring (ABPM), and presence of complications after intervention. As responders to RDN were defined patients with decrease in office systolic (s)BP > 10 > mmHg. Results: Global or local complications linked to intervention were not detected. The change in renal filtration did not occur, and we did not register renal artery stenosis on control CT angiography after 3 months. One patient died 11 months after RDN due to acute myocardial infarction. In 20 observed patients a significant decrease in office BP 12 months after RDN was present (sBP 187 ± 20 vs 162 ± 32 > mmHg, p = 0.002; dBP 112 ± 20 vs 97 ± 20 > mmHg, p = 0.0006), however only a borderline decrease of ABPM values was reached (sTK 169 ± 16 vs 163 ± 30 > mmHg, p = 0.13). Target decrease in office BP 12 months after RDN was achieved in 15/20 patients (75%). The number or dosage of antihypertensive drugs were reduced in 10/20 patients (50%). In the subgroup of 11 “super-responders” (55%) the decrease in office sBP > 20 mmHg, and ABPM sBP > 15 mmHg was achieved, with average drop in office BP −51/−26 > mmHg and ABPM −23/−9 > mmHg. Responders were characterized by higher office sBP before RDN (191 ± 21 vs 175 ± 15 > mmHg, p = 0.04), lower night-time ABPM before RDN (149/80 vs 165/97 > mmHg, p < 0.05), and by a higher number of ablation points (12.5 ± 2.7 vs 10.2 ± 1.1, p = 0.009), compared to non-responders. Conclusions: Radiofrequency RDN is a safe method of achievement decrease in BP in patients with resistant AH. Higher office sBP, lower night-time ABPM values, and higher number of ablation points are important predictors of RDN clinical success. An increase in number of responders could be expected after the introduction of a newer generation of ablation catheters.

The results of the pharmacoepidemiological study PIFAGOR IV concerning arterial hypertension (AH patients survey)

Group of researchers analytical group of PIFAGOR IV study The aim is to study the next step of pharmacoepidemiology of arterial hypertension (AH) in Russia to evaluate the structure and frequency of different classes of antihypertensive drugs (AHD) usage in clinical practice.Material and methods. The prospective pharmacoepidemiological multicenter study (PIFAGOR IV). We interrogated AH patients using special prepared questionnaires. The collection of questionnaires took place from February to July, 2013. The study included 2533 valid questionnaires from 52 cities and towns of Russia.Results. 80% of the patients regularly take AHD; 32.8% of patients receive monotherapy, 38.6% receive two AHD combinations, 28.4% - 3 or more AHD combinations. The average number of AHD was 2.02 per patient. The structure of AHD consisted of 5 recommended classes: ACE inhibitors (27.8%), -adrenergic receptor blocking agents (21.7%), diuretics (15.7%), calcium antagonists (11.3%) and angiotensin II receptor blockers (10.7%), fixed combination - 10.8%. Additional proportion of classes: central-acting agents - 2.3% and b-adrenoceptor blocking agents - 0.1%. Among the ACE inhibitors the main share had 3 drugs: enalapril (33.6%), perindopril (16%), and lisinopril (13%). In b-blockers class the main share had 2 drugs - bisoprolol (64.4%), and usual form of release and modified release dosage form of metoprolol (the total share 21,4%). Indapamide of standard and retard form took the first place in the structure of diuretics (the total share 75%). In calcium antagonists class the main share had amlodipine (55.8%). The main drug in ARBs II was losartan (55.4%). Central-acting agent class was consisted of moxonidine (66%), methyldopa (17%) and clonidine (5%). For about 76% of cases were presented by combinations containing diuretics and 24% - by combinations containing calcium antagonists among the fixed combinations. The proportion of original drugs in the structure of AHD was 38.3%. The average BP level in patients was 140.4/86.4 mm Hg and the blood pressure targets were determined in 50.2% of cases. A high degree of compliance according to the Morisky-Green test indicated in 32%, low compliance - in 49% of cases.Conclusions. We noted the reduction of ACE inhibitors proportion and increase of ARBs II proportion, increase of fixed combinations in the structure of AHD. However, we noticed the decrease of the treatment efficacy in patients with AH using average BP level and achievement of the target BP, as well as the average number of AHD.