Blood Pressure Control In Patients Research Articles

Protocol for a randomized controlled trial of intensive blood pressure control on cardiovascular risk reduction in patients with atrial fibrillation: Rationale and design of the CRAFT trial

BackgroundCo-morbid hypertension is strong predictor of adverse cardiovascular (CV) outcomes in patients with atrial fibrillation (AF) but the optimal target for blood pressure (BP) control in this patient population has not been clearly defined. MethodsThe Cardiovascular Risk reduction in patients with Atrial Fibrillation Trial (CRAFT) is an investigator-initiated and conducted, international, multicenter, open-label, parallel-group, blinded outcome assessed, randomized controlled trial of intensive BP control in patients with AF. The aim is to determine whether intensive BP control (target home systolic blood pressure [SBP] <120 mmHg) is superior to standard BP control (home SBP <135 mmHg) on the hierarchical composite outcome of time to CV death, number of stroke events, time to the first stroke, number of myocardial infarction (MI) events, time to the first MI, number of heart failure hospitalization (HFH) events, and time to the first HFH. A sample size of 1,675 patients is estimated to provide 80% power to detect a win-ratio of 1.50 for intensive versus standard BP control on the primary composite outcome. Study visits are conducted at 1, 2, 3, and 6 months postrandomization, and every 6 months thereafter during the study. ConclusionsThis clinical trial aims to provide reliable evidence of the effects of intensive BP control in patients with AF. Trial registrationThe trial is registered at ClinicalTrials.gov (NCT04347330)

P108 DIFFERENCES IN BLOOD PRESSURE CONTROL BASED ON HYPERTENSION SUBTYPE IN PATIENTS WITH A DE NOVO DIAGNOSIS: A RETROSPECTIVE COHORT STUDY

Background and Objective: Currently, the selection of antihypertensive pharmacological treatment is carried out without considering whether only systolic or diastolic hypertension is present or both pressures are elevated. It is unknown whether the selection of individualized pharmacological treatment according to arterial hypertension (AH) subtype leads to greater blood pressure (BP) control. Therefore, this study aims to evaluate the association between the selection of pharmacological treatment based on AH subtype and BP control. Methods: This was a real-world cohort study that included 1,397 Latin American subjects with a de novo diagnosis of AH who received antihypertensive pharmacological treatment following current guidelines. Retrospectively, patients were classified by AH subtype according to the pattern of systolic or diastolic predominance of AH. Also, appropriateness of the pharmacological treatment was assessed based on AH subtype and the underlying hemodynamics of each subtype. BP control at the follow-up, within the first 12 weeks after diagnosis, was defined as &lt;140/90 mmHg. Results: Among the subjects included in the study (n=1,397), the mean age was 52.4±13.2, and body mass index 28.8±4.9 kg/m2; 56.7% were women and 50.6% achieved BP control. The median time to the follow-up after diagnosis was 55 days (IQR 32-89 days). Regarding hemodynamic variables, the mean heart rate was 76.1±7.4 beats per minute, systolic blood pressure 147±13.9 mmHg, diastolic blood pressure 86.4±11.2, mean arterial pressure 108.0±9.5 mmHg, and pulse pressure 61.1±16.1 mmHg. The most frequent AH subtype was isolated systolic hypertension (47.3%). Initiation of appropriate antihypertensive pharmacological treatment was associated with greater BP control (OR 2.17; 95% CI 1.49 to 3.15; P value &lt;0.001) (Figure). The patients who did not reach BP control presented a higher frequency of divergent systolic-diastolic hypertension subtype, and greater hemodynamic alterations. Conclusions: Appropriate selection of pharmacological treatment based on AH subtype is associated with better BP control in patients with newly diagnosed AH.

P146 EFFECT OF HOME BLOOD PRESSURE TELE-MONITORING PATHWAY WITH PHARMACIST CASE MANAGEMENT TO SUPPORT PATIENTS DISCHARGED FROM EMERGENCY DEPARTMENT WITH ASYMPTOMATIC HYPERTENSION: A STUDY PROTOCOL FOR MULTICENTRE RANDOMIZED CONTROLLED TRIAL (TEC4HOME-BP)

Background and Objectives: Severely elevated blood pressure (BP) in the emergency department (ED) has recently been associated with undiagnosed hypertension and adverse cardiovascular outcomes, regardless of the initial reason (e.g.: pain or anxiety) for the ED visit. Clinical uncertainty exists on how best to manage severe asymptomatic BP post-discharge from the ED. In this study protocol, we propose home BP telemonitoring with pharmacist case management intervention on participants discharged from the ED with severe asymptotic hypertension. The overall purpose of this trial is to evaluate whether home BP telemonitoring and pharmacist case management can improve BP management in participants discharged from the ED with severe asymptotic hypertension and whether participants find this intervention to be acceptable. Methods: The study is a multi-centre, randomized controlled trial of 408 participants discharged from the ED with severe hypertension (defined as average of 3 readings systolic blood pressure [SBP] ≥ 160 mm Hg and/or diastolic blood pressure [DBP] ≥ 100 mm Hg over 3 readings). Participants will be randomized to either usual care or home BP telemonitoring and pharmacist case management for 12-months. The primary outcome is proportion achieving disease specific SBP control using 24 h ambulatory BP monitoring (ABPM) at 12-months. Secondary outcomes are change in SBP and DBP based on 24 h ABPM and home BP averages at 6- and 12-months. Patient acceptability and satisfaction will be assessed using EuroQoL 5-level EQ5 version and patient Satisfaction Questionnaire Short Form. Exploratory outcomes include adverse events, prescription of anti-hypertensive medications, fidelity of interventions and health care utilization. Conclusions: Results from this study will advise the integration of home blood pressure telemonitoring and pharmacist case management pathway as key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with asymptomatic severe hypertension in the ED. Trial registration: ClinicalTrials.gov: NCT 06303206

Abstract P398: The effects of care by hypertension specialists on cardiovascular outcome, blood pressure control and cost-effectiveness among uncontrolled hypertensive patients

Background: Studies suggested that physician specialty had an impact on patient outcomes of cardiovascular disease. However, the effects of care by hypertension specialists on clinical outcomes and financial burden among uncontrolled hypertensive patients are unknown. Objective: This study was to assess the effects of care by hypertension specialists on risk of cardiovascular outcomes, blood pressure (BP) control, and cost-effectiveness among patients with uncontrolled hypertension. Methods: A retrospective cohort study of patients aged 45-79 years who were admitted for uncontrolled hypertension was conducted. We assessed the relationship between care by hypertension specialists and major adverse cardiovascular events (MACE), BP control, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) by the Cox regression, the generalized estimating equations (GEE) model, and the Markov model, respectively. Results: A total of 10680 patients with uncontrolled hypertension were followed up for a median of 4.0 years. Among the 5646 (52.9%) patients received care by hypertension specialists and had fewer MACE than the non-specialists group (21.5 vs 39.7 per 1000-person-year; hazard ratio 0.67; 95% CI: 0.57 to 0.79) according to multiple Cox regression after stabilized inverse probability of treatment weighting. At 4 years, the odds ratio between the hypertension specialist group and the non-specialist group was 0.83 (95% CI: 0.79 to 0.86). Odds ratios with declining trend were observed at 1, 2, and 3 years. Over a lifetime horizon, the ICERs of the hypertension specialists group was USD 6295.37 per QALY gained compared with the non-specialists group. Conclusions: This study provided some evidence that care by hypertension specialists was associated with reduced risk of MACE and improved BP control in patients with uncontrolled hypertension, and was cost-effective.

Abstract P326: Measuring Health Equity Gaps for a Blood Pressure Control Quality Improvement Program: Results from Cook County Health

Background: High blood pressure (BP) affects nearly half of U.S. adult population and was responsible for 13.0 deaths per 100,000 in 2022, with significant differences in age-adjusted mortality rates by sex, race, and ethnicity. Previous research has also highlighted that lower BP control rates are more prominent in Hispanic and Non-Hispanic Black patients, and well as those 60 years or older. This study assesses the role of the AMA MAP™ Hypertension quality improvement (QI) program to improve potential inequities in blood pressure control at a large public health care institution. Methods: 18,252 patients diagnosed with hypertension were identified at Cook County Health. BP values were obtained for patients in the 2 -years prior to implementation of the QI program (July 2019 to June 2021) compared to BP in the 2-years after implementation (July 2021 to July 2023). A multivariable logistic regression model of BP control status, paired t-tests, and ANCOVA analyses, stratified by race, ethnicity, sex, and age are conducted to assess SBP and measure the gaps by demographic characteristics. Results: Prior to the QI program, BP control (&lt;140/&lt;90) was significantly less for Black as compared to White patients (OR 0.82 [0.74-0.92]). The racial difference remained after the program, although it was slightly diminished (OR 0.86 [0.76 – 0.97]). Patients who were older were less likely to have controlled BP prior to the program, but these differences were no longer evident following the QI program. The QI program led to a decline in SBP in all demographic groups, including between ethnicity as shown in Figure 1 (Hispanic: -5.74 [CI:6.19- -5.29] vs Non-Hispanic -4.92 [-5.21- -4.63]), White (-5.96 [CI: -6.45- -5.47]) and Black (-4.80 [CI: -5.11- -4.49]) patients, and by age as shown in Figure 2 between 45-64 years ( -5.79 [CI: -6.12- -5.46] and 65-85 years (-4.31 [CI: -4.68- -3.94]). Conclusion: The results indicate an overall improvement in BP control and SBP, however, gaps persisted in SBP across ethnicity, race, and certain age groups. Quality improvement coaching and dashboards may support clinical care teams in addressing inequities in patient BP control.

Abstract P117: Provider Concordance to the Current 2017 High Blood Pressure (BP) Clinical Practice Guidelines and Patient Blood Pressure Control

Introduction: The AHA/ACC 2017 High BP guidelines introduced key changes, compared to previous guidelines, including a new hypertension definition (≥130/80 mm Hg) and lower medication thresholds for patients at cardiovascular risk. The impact of provider adherence to these guidelines on patient BP control has not been fully explored. Methods: We identified 3,749 new stage 1 hypertension patients (7,214 visits) and 11,013 new stage 2 hypertension patients (33,321 visits), aged ≥18, from the Vanderbilt University Medical Center database. We scrutinized outpatient BP levels, prescribed medications, follow-up visits, lab results, demographics, comorbid conditions, and physician notes from January 2018 to December 2022. This data was compared to hypertension treatment criteria developed from the 2017 guidelines that was validated by six hypertension experts. Active primary care patients (with 1 visit per year) were included. Mixed-effects Poisson regression and mixed-effects linear regression examined the relationship between guideline adherence and controlled BP (&lt;130/80 mm Hg) and continuous BP, respectively. Results: Among stage 1 hypertension visits, 12.2% were treated with at least one antihypertensive drug according to guidelines, resulting in a 13% increase in BP control and a reduction in systolic BP by 2.02 mm Hg. For stage 2 hypertension visits, 26% received treatment with at least two first-line antihypertensive drug classes, leading to a 45% increase in BP control and reductions in systolic and diastolic BP by 3.79 mm Hg and 1.93 mm Hg, respectively. No significant difference in BP control was observed among stage 2 patients treated with two versus one first-line drug. Adherence to follow-up guidelines resulted in a 24% improvement in BP control for stage 1 patients and stage 2 patients when their follow-up visit occurred within 1 month. Subsequent follow-up visits within 1-month improved BP control by 34% if BP was not controlled previously. Additionally, 42.4% of patients with uncontrolled BP for 1 month received an increase in medication dose or a change/addition of medication class and showed a 7% increase in BP control within next month. Conclusion: Provider adherence to recommended antihypertensive drug treatment guidelines (12%-26%), follow-up assessments guidelines (29%-37%), and treatment intensification (42.4%) were poor. However, patients treated according to the guidelines showed significant improved BP control.

Abstract P217: The Prevalence And Clinical Characteristics Of Apparent And True Resistant Hypertension

Objective: We enrolled patients with essential hypertension at 15 medical centers and design a prospective clinical study to investigate the prevalence and clinical characteristics of apparent and true resistant hypertension(ATRH). In addition, we explored the effect of duration of diuretic use on blood pressure(BP) control in ATRH patients. This study aims to provide evidence for further exploring the diagnosis and treatment of ATRH. Methods: At the beginning, the patient who met the inclusion criteria were included in the study and took one tablet of O/A (20/5mg) every day. Thereafter, ambulatory blood pressure monitoring(ABPM) were completed every four weeks. During the follow-up, the drug dose of patients with controlled BP remained unchanged. Patients with uncontrolled BP were given additional drugs, and so on, until the BP controlled. The longest follow-up period was 24 weeks. Statistical analysis was performed using SPSS26. Depending on the data distribution, baseline data were evaluated using Student's t test, Mann-Whitney U test, or χ2 test. Binary logistic regression was used to further analyze the independent risk factors of ATRH. Results: A total of 772 patients were screened in this study, and finally, 545 patients' completed follow-up datas were obtained. We conluded that the incidence of ATRH was 5.13%, and only 3.18% of the patients failed to control BP after further extension of diuretic use to 3 months. A baseline comparison showed that the proportion of males, overweight (25.68±3.22 kg/m2 vs 28.85±3.32 kg/m2, P &lt; 0.001) and eGFR &lt; 60% were higher in the ATRH group; the patients in the ATRH group had a higher BMI, RBC count, CREA, UR concentrations and a lower HDL-C concentrations; ATRH patients exhibited higher ABPM, SBP load and nighttime DBP load than the non-ATRH group; the non-ATRH group had a more obvious BP dipping at night, and the BP rhythm was more regular. Further binary logistic regression analysis found that BMI (OR 1.25, 95% CI 1.10-1.42) and a &lt; 10% decrease in nocturnal DBP (OR 3.24, 95% CI 1.19-8.79) were independent risk factors for ATRH. Conclusion: Under the stepwise titration of the standard treatment regimen, the prevalence of ATRH in the our study was 5.13%, and prolongs the duration of diuretic use can further promote the BP control of patients. ATRH is more common in male patients with obesity and kidney failure. Patients with a higher ABPM, BMI and a &lt; 10% decrease in nocturnal DBP were more likely to develop ATRH.

MINIMUM NUMBER OF READINGS NEEDED TO DETERMINE LONG-TERM VISIT-TO-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY FOR PREDICTING CARDIOVASCULAR OUTCOMES IN DIABETIC PATIENTS

Objective: In clinical practice, office blood pressure (BP) measurements are used for assessing long-term, visit-to-visit variability (VVV) of BP and the consistency of BP control in patients treated for hypertension. We aimed to determine the reproducibility of VVV and the minimum number of BP measurements required to estimate VVV for predicting cardiovascular outcomes. Design and method: This multicenter, retrospective study used data from the Korea University Medical Center database built on electronic health records. A total of 10,475 diabetic patients with &gt;9 readings of BP during a minimum of two years were identified. Patients were followed up for 3 years after determining the coefficient of variation (CV), and the primary outcome was major adverse cardiovascular events (MACE), including cardiovascular mortality, myocardial infarction, stroke, and hospitalization for heart failure. Results: In diabetic patients, the average age of the patients was 65.2 years; 53.2% were men; and 87.4% had hypertension. The mean CV of systolic BP (SBP) was 9.0 ± 3.6. The mean CV of multiple readings that best predicted 3-year MACE were 8.4 for the 3 SBP readings (area under the curve [AUC], 0.57), 9.5 for the 5 readings (AUC, 0.61), 9.0 for the 7 readings (AUC, 0.63), 9.0 for the 9 readings (AUC, 0.64), and 9.7 for all readings (AUC, 0.66). In univariable analysis, 3-year MACE was significantly associated with high VVV from all SBP readings (HR 2.44, p&lt;0.001) and 5 SBP readings (HR 2.03, p&lt;0.001). Hence, a minimum of 5 SBP readings (median time 252 days) is needed for determining intraindividual VVV. Conclusions: In clinical practice, long-term VVV is reliably reproducible in diabetic patients. We recommend a minimum of five BP measurements for the estimation of intraindividual VVV. It is important to consider the number and duration of BP measurements used to calculate VVV when predicting cardiovascular outcomes.

Control of blood pressure in hypertensive children and adolescents assessed by ambulatory blood pressure monitoring

BackgroundThere have been few studies evaluating the control of hypertension (HT) in children. This study aimed to assess the control of HT using ambulatory blood pressure monitoring (ABPM) and to compare the parameters between the uncontrolled HT and controlled HT groups.MethodsHypertensive patients aged ≥ 5 years who underwent ABPM to assess the control of HT were enrolled. Demographics, office blood pressure (BP), ABPM, and echocardiographic data were collected. Controlled HT was defined using a BP goal recommended by the 2016 European Society of Hypertension guidelines.ResultsThere were 108 patients (64.8% males) with a mean age of 14.3 years and 51.9% had primary HT. Controlled HT was detected in 41.1% and 33.3% by office BP and ABPM, respectively. Based on ABPM, there was a greater prevalence of controlled HT in the primary HT than the secondary HT group (44.6% vs. 21.2%, P = 0.01). In the primary HT group, BMI z-score at the last follow-up had a significant decrease in the controlled HT than the uncontrolled HT group (-0.39 vs. 0.01, P = 0.032). Primary HT was negatively associated with uncontrolled HT by ABPM. In addition, ABPM showed greater sensitivity (77.8% vs. 55.8%) and negative predictive value (80.9% vs. 70.8%) to predict LVH than those of office BP measurement.ConclusionOnly one-third of patients achieved the BP goal by ABPM and most were in the primary HT group. Weight reduction is an important measure of BP control in patients with primary HT to attenuate the risk of LVH.

Same-Day Primary Care Referral Versus Usual Care for Patients With Elevated Blood Pressures Seen in a Preoperative Clinic.

Background While several studies have suggested that anesthesia and surgical care episodes provide an opportunity to improve the diagnosis and treatment of hypertension, few studies have implemented and tested pragmatic care coordination efforts for this population. The present study aimed to examine the effects of same-day primary care referral vs. usual care on outpatient hypertension treatment among patients with elevated preoperative clinic blood pressure (BP). Methodology With institutional review board approval of the project as a quality improvement (QI) initiative not requiring consent, we conducted a prospective QI project comparing same-day preoperative primary care referral vs. usual care within comparable cohorts of US Veterans presenting to a preoperative evaluation clinic with elevated BP for whom treatment assignment was based on prior primary care clinic affiliation. Outpatient BP, antihypertensive medications, and antihypertensive dosages at the initial visit and for one year after the initial preoperative clinic visit were followed in the electronic health record. Results Between June 1, 2018, and June 1, 2019, one of the two on-site primary care groups (Firm A) at our facility agreed to accommodate same-day BP referrals. Patients in the second primary care group received standard preoperative care (Firm B). Charts for the pseudo-randomized cohort of Firm A and B patients were compared after 12 months to assess for changes in BP and hypertension treatment. Firm A and B patients were similar in demographics. Overall, 68 (91%) Firm A patients were correctly referred for primary care appointments. Moreover, 28 of 68 (41.2%) patients adhered to the same-day referral recommendation, with the remainder declining to attend the primary care visit. BPs were similar between Firm A and Firm B groups at 3, 6, 9, and 12 months post-intervention. Firm A adherent patients (i.e., those attending the referral) received hypertension treatment intensification sooner than Firm A non-adherent and Firm B patients (median (interquartile range) days to intensification = 21 (0.5-103.5) vs. 154 (45.5-239) and 170 (48-220), respectively; p = 0.038 and p = 0.048, respectively). Conclusions Our protocol achieved a high degree of same-day primary care referral (91%) in hypertensive patients presenting at the preoperative clinic. Although this limited study did not demonstrate improved BP control in patients who received same-day primary care, this group did show increased rates of rapid treatment intensification which may infer improved long-term health outcomes. Further work examining logistical barriers to patients attending same-day referrals is warranted.

Non-Pharmacological Therapy To Control Blood Pressure in Patients with Hypertension: Literature Review

Hypertension has a significant negative impact on cardiovascular morbidity and mortality. It is associated with many cardiovascular complications and is responsible for 10.4 million deaths and 208.1 million life expectancy-adjusted disabilities. Target blood pressure levels and blood pressure control remain poor despite the availability of numerous pharmacological therapy options. When anti-hypertensive medicine cannot achieve blood pressure targets due to various factors, other alternative treatments are needed so that optimal patient health status can be achieved, one of which is non-pharmacological therapy. The purpose of this study was to identify non-pharmacological therapies to control blood pressure in patients with hypertension. The method used in this study is literature review. The study results of 8 articles obtained non-pharmacological therapies used are low sodium diet, lifestyle modification (conventionally and with the help of applications), reflexology, and exercise. Out of the available non-pharmacological therapies, reflexology was found to have the most significant blood pressure lowering effect in patients with hypertension. This suggests that non-pharmacological therapies are effective in controlling the BP of hypertensive patients.

Associations between estimation of salt intake and salt-restriction spoons and hypertension status in patients with poorly controlled hypertension: a community-based study from Huzhou City, Eastern China

BackgroundAs the prevalence of hypertension increases in China, it is advised to use salt-restriction spoons (SRS) as a lifestyle modification. This study aimed to examine the associations between estimated salt consumption, SRS usage, and the hypertension status in individuals with poorly controlled hypertension.MethodsData was collected in Huzhou City, Zhejiang Province, in 2021 using convenience sampling. The analysis involved ordinal logistic regression and restricted cubic splines to assess the relevant factors.ResultsThe study found that 73.34% of the 1215 patients had uncontrolled blood pressure (BP). Urinary excretion was assessed through the utilization of the Kawasaki, INTERSALT, and Tanaka formulas. The outcomes of these three methodologies revealed average daily sodium excretion values of 208.70 (65.65), 154.78 (33.91), and 162.61 (40.87) mmol, respectively. The prevalence of utilizing SRS was found to be 37.78% in this study. Despite the acknowledgment among SRS users of the potential hazards associated with excessive salt consumption, there exists a contradictory pattern of attitudes and behaviors concerning salt reduction. Among individuals with different levels of salt intake (quartiles 1–4, Q1 vs Q4), there was a positive association between limiting salt and hypertension status when controlling for other variables (Kawasaki adjusted OR = 0.58, 95% CI = 0.43–0.79; INTERSALT adjusted OR = 0.62, 95% CI = 0.41–0.92; Tanaka adjusted OR = 0.61, 95% CI = 0.45–0.92, p < 0.05). Our research also revealed that using or used SRS was a protective factor for blood BP control (adjusted OR = 0.79, 95% CI = 0.64–0.99, P < 0.05). The restricted cubic spline plots illustrated a monotonic upward relationship between estimated 24-h urinary Na and BP (P-overall association < 0.05; P-non-linear association > 0.05).ConclusionsThe use of dietary SRS could result in decrease in daily salt intake for BP control in patients with poorly controlled hypertension. To reduce the impact of high BP in China, additional studies are required to create interventions that can enhance the results for patients.

Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients With Mild Autonomous Cortisol Secretion: Results of an Randomized Controlled Trial by the Co-work of Adrenal Research (COAR) Study.

To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only 2 randomized prospective studies with some limitations to date. A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing syndrome but with serum cortisol >50 nmol/L after a 1 mg overnight dexamethasone suppression test into an adrenalectomy group (n = 66) or control group (n = 66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP). Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n = 46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared with the control group (n = 46; 6.5%, P = 0.002; 15.2%, P = 0.002; and 23.9%, P = 0.029, respectively) after matching for age and sex. Adrenalectomy [odds ratio (OR) = 10.38, 95% CI = 2.09-51.52, P = 0.004], body mass index (OR = 1.39, 95% CI = 1.08-1.79, P = 0.010), and cortisol after a 1 mg overnight dexamethasone suppression test levels (OR = 92.21, 95% CI = 5.30-1604.07, P = 0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR = 5.30, 95% CI = 1.63-17.25, P = 0.006) and diabetes (OR = 8.05, 95% CI = 2.34-27.65, P = 0.001) were independently associated with improved glucose control. Adrenalectomy (OR = 2.27, 95% CI = 0.87-5.94, P = 0.095) and hypertension (OR = 10.77, 95% CI = 3.65-31.81, P < 0.001) demonstrated associations with improved BP control. adrenalectomy improved weight, glucose, and BP control in patients with MACS.

Association of uncontrolled blood pressure in apparent treatment-resistant hypertension with increased risk of major adverse cardiovascular events plus.

Patients with apparent treatment-resistant hypertension (aTRH) are at increased risk of end-organ damage and cardiovascular events. Little is known about the effects of blood pressure (BP) control in this population. Using a national claims database integrated with electronic medical records, the authors evaluated the relationships between uncontrolled BP (UBP; ≥130/80mmHg) or controlled BP (CBP; <130/80mmHg) and risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure requiring hospitalization) and end-stage renal disease (ESRD) in adult patients with aTRH (taking ≥3 antihypertensive medication classes concurrently within 30 days between January 1, 2015 and June 30, 2021). MACE+ components were also evaluated separately. Multivariable regression models were used to adjust for baseline differences in demographic and clinical characteristics, and sensitivity analyses using CBP<140/90mmHg were conducted. Patients with UBP (n=22333) were younger and had fewer comorbidities at baseline than those with CBP (n=11427). In the primary analysis, which adjusted for these baseline differences, UBP versus CBP patients were at an 8% increased risk of MACE+ (driven by a 31% increased risk of stroke) and a 53% increased risk of ESRD after 2.7 years of follow-up. Greater MACE+ (22%) and ESRD (98%) risk increases with UBP versus CBP were seen in the sensitivity analysis. These real-world data showed an association between suboptimal BP control in patients with aTRH and higher incidence of MACE+ and ESRD linked with UBP despite the use of multidrug regimens. Thus, there remains a need for improved aTRH management.

Determinants of blood pressure control among hypertensive patients of rural areas in a South Indian State: A community based cross sectional study.

Optimum blood pressure (BP) control is essential to prevent complications and improve the quality of life of patients with hypertension. This study aimed to explore the determinants of BP control in patients with hypertension on treatment without any other comorbidities. The study was conducted among 429 patients with essential hypertension aged > 30 years residing in four villages of a taluk/tahsil in a South Indian state. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic characteristics, diagnosis and treatment of hypertension, lifestyle factors (e.g. diet and substance use), facilitators and barriers of BP control and anthropometric measurements. BP was measured using World Health Organization standards and classified using the Joint National Committee 8 Guidelines. Descriptive statistics were measured in terms of numbers and percentages. Univariate and multivariate logistic regression analyses were used to determine the significant determinants of BP control. Approximately 64.3% of the participants had their BP under control. The participants aged 46-59 years were more likely to have uncontrolled BP than those aged ≥60 years. The participants with <80% adherence to medication (non-adherent) had a five fold higher odds of having uncontrolled BP than those with >80% adherence. Adherence to medication was the only significant factor for BP control in the present study. Hence, adherence to medication should be addressed with interventions targeted to improve BP control in patients with hypertension.

PARACETAMOL AND BLOOD PRESSURE CONTROL IN 45211 PATIENTS TREATED FOR HYPERTENSION: A CROSS-SECTIONAL STUDY FROM THE SWEDISH PRIMARY CARE CARDIOVASCULAR DATABASE

Objective: Paracetamol (acetaminophen) is widely recommended for analgetic and antipyretic indications due to its perceived high safety. However, studies have shown contradicting results regarding the effect of paracetamol on blood pressure (BP). We aimed to study how regular paracetamol use could affect BP control in patients on antihypertensive mediation. Design and method: Data for 42 511 patients attending primary care and a documented diagnosis of hypertension before 2007 (to rule out new onset of hypertension) and with 1 or more BP measurements recorded 2007–2008 were collected from the Swedish primary care cardiovascular database (SPCCD). There were 8 367 paracetamol users, defined as 1 or more dispensed prescriptions 6 months prior to the last BP recorded, and 34 144 non-users of paracetamol. Target BP was set to &lt;140/90 mm Hg. Dose-response relationships were examined by the number of defined daily doses (DDD) dispensed. Multivariate linear regression analyses accounted for potential confounders. Results: Paracetamol users were older, had higher creatinine levels, more often diabetes, cardiovascular diseases and musculoskeletal diseases, and lower educational level than non-users (all P &lt; 0.001), but attained target systolic and diastolic BP to similar degrees (58 and 93% vs 58 and 92%, respectively). There were no relations between number of DDD and systolic and diastolic BP in paracetamol users, also when DDD deciles were evaluated to account for the low proportion of patients with high DDD dispensed (all R2 &lt;0.001). Sensitivity analyses including dispensed prescriptions of paracetamol 3 months before and 6 months after the first BP measurement provided similar results. Paracetamol had no impact on attaining target BP in subgroup analyses on patients with diabetes, musculoskeletal diseases, with concomitant use of NSAID, or in relation to number of antihypertensive medications (suggesting severity of hypertensive disease). Conclusions: Concomitant use of paracetamol does not impair the ability to reach target BP in hypertensive patients. No dose-response relationship was observed between dispensed prescriptions of paracetamol and BP.

The therapeutic concordance approach reduces adverse drug reactions in patients with resistant hypertension.

Adverse drug reactions (ADRs) remain among the leading causes of therapy-resistant hypertension (TRH) and uncontrolled blood pressure (BP). We have recently reported beneficial results in BP control in patients with TRH adopting an innovative approach, defined as therapeutic concordance, in which trained physicians and pharmacists reach a concordance with patients to make them more involved in the therapeutic decision-making process. The main scope of this study was to investigate whether the therapeutic concordance approach could lead to a reduction in ADR occurrence in TRH patients. The study was performed in a large population of hypertensive subjects of the Campania Salute Network in Italy (ClinicalTrials.gov Identifier: NCT02211365). We enrolled 4,943 patients who were firstly followed-up for 77.64 ± 34.44 months, allowing us to identify 564 subjects with TRH. Then, 282 of these patients agreed to participate in an investigation to test the impact of the therapeutic concordance approach on ADRs. At the end of this investigation, which had a follow-up of 91.91 ± 54.7 months, 213 patients (75.5%) remained uncontrolled while 69 patients (24.5%, p < 0.0001) reached an optimal BP control. Strikingly, during the first follow-up, patients had complained of a total of 194 ADRs, with an occurrence rate of 68.1% and the therapeutic concordance approach significantly reduced ADRs to 72 (25.5%). Our findings indicate that the therapeutic concordance approach significantly reduces ADRs in TRH patients.

PS-C08-4: TEC4HOMEBP: DEVELOPING A HOME BLOOD PRESSURE TELE-MONITORING PATHWAY TO SUPPORT PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT WITH ELEVATED BLOOD PRESSURE

Objectives: Elevated blood pressure (BP) in the emergency department (ED) is common, but clinical uncertainty exists on how best to manage asymptomatic hypertension. Telehealth for Emergency-Community Continuity of Care Connectivity via Home Blood Pressure Telemonitoring (TEC4Home BP) evaluates how home blood pressure telemonitoring (HBPTM) can support patients with elevated BP manage their health at home after visiting the ED. The aim of this study is to assess the effect of HBPTM on BP control among those discharged home from the ED with severely elevated BP. We also examined adherence to HBPTM, medical therapy and patient satisfaction. Methods: We conducted a prospective, single-centre, observational study and recruited 50 participants from Vancouver General Hospital (VGH), ED with hypertensive urgency, asymptomatic severely uncontrolled BP (&gt; 160/100 mm Hg averaged over 3 readings) or referred to the VGH Hypertension Clinic from the ED for high BP. All participants received a validated home BP monitor (A&amp;D UA-651BLE) and App (Sphygmo App, Calgary, AB) to automatically teletransmit 2 readings in the morning and evening daily for 3 months. Proportion of patients diagnosed with hypertension with controlled home BP defined as less than 135/85 mmHg, adherence to HBPTM, and medication therapy using the Hill Bone medication adherence scale, at 1and 3 months following discharge from the ED. Results: From May to December 2021, 50 participants (60 years old, 61% females, average baseline BP (SD) in ED 191 +/−26/ 99 +/−15 mm Hg) were recruited. Our recruitment and enrollment rate were 41% and 88%, respectively. At 1 and 3 months, average home BP (SD) was 136 +/−15/80 +/−11 and 128 +/−10 /77 +/−10 mm Hg. At 3 months, there was a 66% improvement in proportion of those who achieved target BP control. Adherence to HBPTM at 1 and 3 months was 84 and 54%, respectively. There were no differences in medication adherence at baseline and 3 months of study. Participants were highly satisfied with the HBPTM program and 79% would highly recommend the program. More detailed data analysis is currently underway and will be presented. Conclusions: HBPTM is a feasible, effective, and acceptable strategy to triage and monitor patients with significantly elevated BP when discharged from the ED. Future studies are need to advise the integration of HBPTM pathway a key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with hypertension.

The rationale, protocol and preliminary results of the ESH ABPM COVID-19 study.

The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The traditional risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. The ESH ABPM COVID-19 Study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes assessed with ambulatory BP monitoring (ABPM). This is a multi-center, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data office BP, 24-hour ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e., after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within similar a 9-15 month interval between the recordings. We will analyze BP variables and phenotypes (including averaged daytime and nighttime BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the groups. Hypertension is one of the major risk factors for established cardiovascular disease (CVD). By extending our knowledge about effects of COVID-19 pandemic on BP control in patients with hypertension, we can propose appropriately effective strategies for providing adequate medical care in case of new pandemic waves and for long-term care, which will reduce incidence of CVD as a consequence of the current pandemic.

Association between Dietary Carbohydrate Intake and Control of Blood Pressure in Patients with Essential Hypertension.

Both high and low percentages of carbohydrate diets were associated with increased mortality and new-onset hypertension. However, few studies have aggregated to explore the association between carbohydrate intake and blood pressure (BP) control in patients with hypertension. This study aimed to explore the association between carbohydrate-to-energy proportion (CEP) and the rate of poorly controlled BP in patients with hypertension. A cross-sectional survey was conducted in one comprehensive hospital and one community clinic in China. Dietary CEP was obtained through two-24 h dietary recalls. According to the quintiles of CEP, the participants were divided into Q1-Q5 groups. The average of two BP values was adopted as the final BP value, and poorly controlled BP was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥ 90 mmHg. A total of 459 hypertensive patients were recruited. In univariate analyses, CEP was associated with the control of SBP and DBP. After the covariates were adjusted for, fewer CEPs in Q1 (OR, 4.335; 95% CI, 1.663, 11.299) and Q2 (OR, 2.482; 95% CI, 1.234, 4.989) were significantly associated with higher rates of poor SBP control. A lower dietary CEP is a risk factor for SBP control, whereas an appropriate CEP of 56% to 66% is beneficial for BP control in patients with essential hypertension.