Blood Pressure Control Rates Research Articles

New perspectives for hypertension management: progress in methodological and technological developments.

Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.

Abstract P311: Blood Pressure Control And Anti-hypertensive Drug Utilization Among Minorities In A Large Health Care System

Background: Hypertension (HTN) affects almost half of the adults in the US, and most do not have their blood pressure (BP) under control. Minorities and individuals living in rural areas experience health disparities. The goal of this study was to assess the rate of BP control among adults in a large health system that included minorities and adults living in rural areas. Methods: Clinical cohort study of adults with HTN who live in Southeast Minnesota and had at least one outpatient clinic encounter within the Mayo Clinic Health System in the last 12 months (5/2021-5/2022). Data was extracted through the HTN registry of the electronic health record and included age, race, ethnicity, last office BP and any active anti-hypertensives drug use. Results: The overall rate of HTN control among 127,644 individuals with HTN, defined as an office BP < 130/80 mmHg, was 25.7%. The rates of BP control between HTN subjects living in rural (64527, 67.3%) versus urban areas (41285, 32.3 %), were significantly lower at 24.9% vs. 27% respectively, p< 0.001. A total of 8,722 (6.8%) were non-white, including 2640 Black, 1919 Asian, and 2867 Hispanics A total of 5,734 (45%) had a SBP ≥ 140 or DBP ≥ 90 mmHg and 7178 (12.5%) did not have any anti-hypertensives in their medication list. The percentage of White and Asian persons who were not on anti-hypertensives was 12.4% and 12.5%, respectively, while a larger percentage of Black (13.8%) and Hispanic (14%) persons were not (p<0.001). The corresponding percentage was 16.7% among individuals who did not disclose their race (p<0.001). Conclusion: Among hypertensive adults, BP was not at goal in most patients based on their most recent office BP measurement with a higher rate among those living in rural areas. About 12.5% were not on anti-hypertensives with a disproportionate larger percentage of Black and Hispanic compared to White and Asian persons.

Abstract 036: Failure To Achieve Optimal Blood Pressure Control Among Stroke Patients In The Outpatient Setting

Introduction: Despite being an AHA Class 1 recommendation to achieve a blood pressure (BP) < 130/80 for secondary stroke prevention, only an estimated 20% of the general population can achieve this benchmark. Furthermore, it has been suggested that stroke patients may be at higher risk for an inability to achieve this goal. We aimed to examine real world clinic data to evaluate BP control among stroke patients. Methods: We conducted a population-based retrospective study using electronic health records collected during routine care at our institution for all adult patients 18 years or older with a diagnosis for stroke between January 2019 to November 2021. BP measurements were taken in an outpatient setting between 90 and 180 days from the index stroke. Descriptive statistics using R (R Core Team, 2022, r-project.org) were reported as the mean and standard deviation for continuous variables and frequencies and proportions for categorical variables. Results: Our review identified a total of 1,583 patients with a new diagnosis of acute ischemic stroke (AIS: 1,252; 79.1%) or intracerebral hemorrhage (ICH: 331; 20.9%). AIS patients were 45.7% female with a mean age of 68 years old, compared to 47.7% female and 59 years old for ICH patients. AIS patients had a higher proportion of secondary medical issues, including 34.7% with diabetes, 33.0% congestive heart failure, 19.2% cardiac disease, and 33.9% renal disease (compared to 22.2%, 16.1%, 8.8%, 19.2% respectively for ICH patients). In follow-up, only 11.7% of AIS patients were at goal (defined as a BP < 130/80) at 3 months, 17.3% at 6 months, 11.6% at 9 months, and 8.9% at 12 month follow-up. Conversely, ICH patients were slightly better controlled with 21.6%, 32.8%, 15.8%, and 12.2% controlled at 3, 6, 9, and 12 month follow-up respectively. Patients with stroke after March 2020 (post-COVID19 pandemic) had lower rates of blood pressure control compared to those diagnosed one year prior to the pandemic. Conclusion: Patients with AIS have lower rates of BP control compared to the general population, which was further amplified by the COVID19 pandemic. These results may suggest that stroke patients face unique barriers in BP management and highlight the need to perform targeted treatment for this especially vulnerable group.

Effects of telemedicine interventions on essential hypertension: a protocol for a systematic review and meta-analysis

IntroductionEssential hypertension is a major preventable risk factor for early cardiovascular disease, premature death and disability. It has been reported that telemedicine interventions can provide an innovative solution to essential...

Abstract P018: A Little Goes A Long Way: Improving Blood Pressure Control Through A Loaner BP Cuff Program

Introduction: Out-of-office blood pressure (BP) measurement is key to diagnosing and improving hypertension (HTN). Effective out-of-office BP measurements depend on owning a home BP device. By loaning BP cuffs to patients with HTN, we aimed to improve rates of BP control at our residency clinic by 10% in 12 months. Methods: Root Cause Analysis identified barriers to out-of-office BP testing. BP cuffs obtained via a QI grant were loaned to patients through our Hypertension Clinic. We also provided education on proper technique, lifestyle, and medication management. Patients were referred by residents and attendings, or recruited via telephone outreach targeting those with BP > 160 mmHg. Patients of the HTN clinic served as our experimental cohort. Workflows and outreach were revised via PDSA cycles. Resident engagement was assessed by survey. Results: In our experimental cohort, BP control for severe hypertension (<160 mmHg) improved from 76% to 84% and overall BP control (< 140 mmHg) from 47% to 54% at 5 months. For the whole clinic, BP control for severe hypertension improved from 85% to 91% at 1 month and 87% at 5 months; overall blood pressure control decreased from 75% to 67%. Surveyed residents reported regular follow up, medication titration and getting a BP cuff loaner as top reasons for referral. Conclusions: We successfully implemented a BP cuff loaner program within a hypertension clinic. Initial data shows improvement of severe and overall BP control for enrolled patients. The program was well-received by involved providers and patients. Providing BP cuff loaners is an effective low-cost intervention that improved BP control and decreases disparity for low-income patients.

Don't Let Perfect Be the Enemy of Good: A Proof of Concept for a Custom National Data Repository of Quality Measures for Free and Charitable Clinics.

Purpose:Free and charitable clinics (FCCs), nonprofits that utilize volunteer licensed health care professionals to provide health services at no cost or a small fee to low-income uninsured patients who are disproportionately from underrepresented communities, have been part of the safety net for over a century. Approximately 1400 known FCCs serve two million patients annually. Despite their longevity and sizable number, evidence regarding the quality of care in FCCs is lacking. We report new evidence generated by a national initiative, the Roadmap to Health Equity. Established in 2017, this consortium is co-led by two national organizations serving FCCs and an academic institution. It has involved more than 150 FCC stakeholders with the shared goal of improving the quality of care and reducing inequities. The centerpiece is a custom national data repository of 15 validated clinical quality measures and patient-level characteristics.Methods:Fifty FCCs pilot tested the data repository. Clinics submitted patient-level data on two blood pressure (BP) measures and at least one additional measure. Descriptive statistics were stratified by sex, race, ethnicity, and language.Results:In 2021, 33 pilot FCCs from 21 states reported data across 13 of the 15 clinical measures, representing 34,359 unique patients. For example, on average, 60% of patients had controlled BP, but Black patients had lower rates of BP control than Hispanic and White patients (55.9% vs. 62.1% and 63.0%, respectively).Conclusion:Our findings demonstrate a proof of concept. By standardizing quality measures alongside patient characteristics, clinics can become aware of racial/ethnic inequalities in health outcomes. This information can motivate clinics to investigate the causes and implement solutions. In an environment where outcome data from FCCs are scarce, the new national data repository lays the foundation for routine stratified reporting of a range of quality outcomes for an important safety net for the uninsured.

Cost-effectiveness of hypertension therapy based on 2020 International Society of Hypertension guidelines in Ethiopia from a societal perspective.

There is inadequate information on the cost-effectiveness of hypertension based on evidence-based guidelines. Therefore, this study was conducted to evaluate the cost-effectiveness of hypertension treatment based on 2020 International Society of Hypertension (ISH) guidelines from a societal perspective. We developed a state-transition Markov model based on the cardiovascular disease policy model adapted to the Sub-Saharan African perspective to simulate costs of treated and untreated hypertension and disability-adjusted life-years (DALYs) averted by treating previously untreated adults above 30 years from a societal perspective for a lifetime. The full implementation of the ISH 2020 hypertension guidelines can prevent approximately 22,348.66 total productive life-year losses annually. The incremental net monetary benefit of treating hypertension based was $128,520,077.61 US by considering a willingness-to-pay threshold of $50,000 US per DALY averted. The incremental cost-effectiveness ratio (ICER) of treating hypertension when compared with null was $1,125.44 US per DALY averted. Treating hypertension among adults aged 40-64 years was very cost-effective 625.27 USD per DALY averted. Treating hypertensive adults aged 40-64 years with diabetes and CKD is very cost-effective in both women and men (i.e., 559.48 USD and 905.40 USD/DALY averted respectively). The implementation of the ISH 2020 guidelines among hypertensive adults in Southern Ethiopia could result in $9,574,118.47 US economic savings. Controlling hypertension in all patients with or with diabetes and or CKD could be effective and cost-saving. Therefore, improving treatment coverage, blood pressure control rate, and adherence to treatment by involving all relevant stakeholders is critical to saving scarce health resources.

ROSuvastatin and Amlodipine as free or fixed combination on theRApeutic taRgets and treatment Adherence in hypertensive, hypercholesterolemic individuals. ROSA RARA: a spontaneous, observational study conducted by italian outpatient cardiologists

Background: Hypertension and LDL hypercholesterolemia often coexist, and their effective treatment has favorable implications for cardiovascular health. We aimed at defining the impact of amlodipine and rosuvastatin as free or fixed combinations on blood pressure (BP) and LDL-cholesterol, and the satisfaction with treatment, in hypertensive individuals with LDL hypercholesterolemia. Methods: A spontaneous longitudinal observational study was conducted at Italian cardiology outpatients clinics. Eligible individuals (age ≥ 18y, informed consent, stable 5 or 10 mg amlodipine therapy in addition to a RAAS inhibitor, stable 10 or 20 mg rosuvastatin therapy) underwent home and office BP and LDL-cholesterol assessment at 12 and 24 weeks. BP and LDL-cholesterol control rates and satisfaction with the fixed combination were assessed. Results: 285 participants were enrolled (51%M; 67 ± 10y; 94 on the free combination). At 12 weeks, mean BP and LDL-cholesterol were reduced in both groups, with higher hypertension control rates in the fixed combination group; at 24 weeks they were further reduced compared with baseline, and home systolic BP was lower in the fixed than the free combination group (121.9 ± 17.6 vs 129.4 ± 8.5 mmHg; p = 0.03). Patients in the fixed combination reported higher satisfaction with this regimen than with the free combination. Conclusions: The fixed combination of calcium channel blocker and statin appears to have advantages in terms of clinical efficacy and patients’ satisfaction.

May Measurement Month: beyond boosting hypertension awareness

May Measurement Month: beyond boosting hypertension awareness

Antihypertensive prescribing pattern, prescriber adherence to ISH 2020 guidelines, and implication of outpatient drug price on blood pressure control at selected hospitals in Southern Ethiopia.

To determine the impact of drug prescribing pattern, outpatient drug price of medicines, and level of adherence to evidence-based international guidelines on blood pressure (BP) control at selected hospitals in Southern Ethiopia. Hospital-based cross-sectional study was conducted. The data entry and analysis were done by using SPSS version 21.0. A mean age of participants was 55.87 ± 11.02years. The rate of BP control was 17.5% based on International Society of Hypertension (ISH) guidelines 2020. In about two-thirds of patients, 270 (66.5%) were taking combination therapy. Mean annual cost of drugs for hypertension was 11.39 ± 3.98 US dollar (USD). Treatment was affordable for only 91 (22.4%) of patients. There was considerable variation on prescriber's adherence to evidence-based guidelines. Body mass index (BMI) of 18-24.9kg/m2, adjusted odds ratio (AOR) = 3.63 (95% confidence interval (C.I), 1.169-11.251, p = 0.026), physically activity, AOR = 12.69 (95% C.I, 1.424-113.17, p = 0.023), presence of no comorbidity, AOR = 12.82 (95% C.I, 4.128-39.816, p = 0.000), and taking affordable antihypertensive regimen, AOR = 3.493 (95% C.I, 1.4242-9.826, p = 0.018), were positively associated BP control. The level of BP control, affordability of drugs for the management of hypertension and related comorbidities, and the prescriber's adherence to evidence-based guidelines were inadequate. Therefore, addressing factors associated with good BP control including affordability and clinician adherence to evidence-based guidelines by responsible stakeholders could improve BP control and reduce associated complications.

EFFECT OF A WEB-BASED MANAGEMENT PLATFORM ON HYPERTENSION CONTROL IN COMMUNITY: A RANDOMIZED CLINICAL TRIAL

Objective: To assess the effect of multi-component intervention delivered by a web-based platform on improving blood pressure control rate. Design and method: A cluster andomised clinical trial of a hypertension management program was conducted from January 1 to December 31, 2018 in 66 communities. Communities were andomised to either the intervention group (usual care combined with multi-component intervention delivered by a web-based platform) or control group (usual care only). The intervention included health education, lifestyle modification, self-monitoring and treatment. In order to support the implementation of intervention program, a web based-platform was established. Automated classification and personalized follow-up schedule would be generated by prespecified algorithm according to the patients’ information. The primary outcome was the change in blood pressure control rate from baseline to 12 months among hypertension patients in the intervention and control group. The secondary outcomes were the changes in blood pressure and lifestyle factors. Results: A total of 3,872 participants (2,994 in the intervention group and 878 in control group) were included in the analysis. Blood pressure control rate at baseline was 31.4% in the intervention group and 30.2% in the control group. After 12 months of the intervention, the blood pressure control rate for the intervention group compared with the control group was significantly higher (65.9% vs 42.0%; odds ratio, 1.25; 95%CI,1.19–1.32; P < 0.001). The intervention effect on systolic blood pressure was -8.0 mmHg (95%CI, -9.8 to -6.2 mmHg; P < 0.001) and on diastolic blood pressure was -1.7 mmHg (95%CI, -2.8 to -0.6 mmHg, P = 0.003). The blood pressure control rate showed a gradual increment throughout the whole intervention duration. What's more, greater improvement was observed in the proportion of regular exercise (17.8%; 95%CI, 15.3%-20.3%; P < 0.001). Conclusions: This trial found that a multi-component intervention delivered by a web-based platform appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. Telemedicine may be a better way to manage hypertension patients in community.

SIMPLIFIED REGIMEN FOR THE MANAGEMENT OF HYPERTENSION WITH TELEMEDICINE AND BLOOD PRESSURE SELF-MONITORING (SIMPLE): STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Objective: Telemedicine and blood pressure (BP) self-monitoring conduces to management of hypertension. Recent hypertension guidelines highly recommended single-pill-combination (SPC) for the initial treatment of essential hypertension. Based on this fact, an SPC-based telemedicine titration regimen with BP self-monitoring could be a better way in managing hypertension. This trial aims to elucidate whether telemedicine combined with BP self-monitoring is superior to self-monitoring alone during hypertension management. Design and method: This study will be a multi-centered, open-labelled, randomized controlled trial. A minimum sample of 358 hypertensive patients with uncontrolled BP from four centers will be included. The intervention group will include BP self-monitoring and tele-monitoring plus a free SPC-based telemedicine titration therapy for 6 months, they will be recommended to take BP measurements at least once every seven days, in the meantime, researchers will call to give a consultation on lifestyle or titration advice once a fortnight. The control group will be required to self-monitor BP at the same time interval as intervention group, without any therapy change. Primary outcome of the trial will be the difference in SBP at 6-month follow-up between intervention and control group, adjusted for baseline variables. Secondary outcomes such as BP control rate, major adverse cardiovascular events, medication adherence, quality of life will be investigated. Results: Ongoing study, no further results to share at this time. Conclusions: Ongoing study, no further results to share at this time.

BLOOD PRESSURE CONTROL RATES PREVIOUS AND DURING THE COVID-19 PANDEMIC IN BRAZIL

Objective: to compare the previous blood pressure control rates with those assessed during the COVID-19 pandemic. Design and method: two cross-sectional studies (march to November 2019 and march to November 2020). Participated patients from health centers of five Brazilian regions that used the TeleMRPA platform to report tests on people diagnosed with and under control of arterial hypertension, aged between 18 and 100 years, included. Data from patients with duplicate or inaccurate information excluded. Blood pressure control measures < or = 140/90 mmHg considered for casual measurements and/or < or = 130/80 for residential measurements. Results: 38.698 patients evaluated, 54.7% in 2019 and 43.9% from northeastern Brazil. There was an increase in patients not using antihypertensive drugs from 52.5% in 2019 to 61.3% in 2020 (p < 0.001) and BMI from 28.1 (± 4.5) to 28.3 (± 4.5) p = 0.010. We did not identify differences in the comparison of SBP (office and MRPA) between the two periods evaluated. There was an increase in DBP both in the office from 83.8 (±11.8) to 84.5 (±11.9), p < 0.001 as that obtained by the MRPA from 79.25 (±9.58) to 79.57 (±9.68), p = 0.001. The variability of DBP reduced from 5.9 (±2.49) to 5.9 (±2.43), p < 0.001, and the mean Pulse Pressure was 50.7 (±14.4) in 2019 to 50.3 (±14.3) in 2020, p = 0.009. There was no change in the control rates considering the office measure which was from 68.9% to 68.6% and the MRPA from 52.4% to 51.4% from 2019 to 2020. Conclusions: blood pressure control remained stable during the COVID-19 pandemic when compared to the previous year. Assessing and monitoring blood pressure control through telemonitoring using home blood pressure monitoring is a simple, easy-to-access, and effective method.

Evaluation of the Community-Based Hypertension Management Programs in China.

PurposeThe National Essential Public Health Services Package (NEPHSP), a set of community-based hypertension management programs, was launched by the Chinese government in 2009. However, the data are limited for the comprehensive evaluation of NEPHSP on hypertension management. This study was to estimate the effect of NEPHSP on hypertension control nationwide in China.MethodsData were from China Hypertension Survey (CHS). The participants (n = 119,412) aged ≥35 years with hypertension were included in the analysis. Further, a subset of 64,188 diagnosed hypertensive patients were analyzed to evaluate the effect of NEPHSP by comparing the ones covered and not covered by NEPHSP. Blood pressure (BP) was measured by trained staff using a validated digital portable monitor in local communities or clinics.ResultsAmong adults aged ≥35 years with hypertension, the coverage of NEPHSP was 25.6% and increased with age. The coverage was significantly higher in women than in men (P < 0.001). Among the 64, 188 diagnosed hypertensive patients, compared to the control group (not covered by NEPHSP), the mean systolic and diastolic BPs were 2 mmHg and 1.6 mmHg lower in NEPHSP group, respectively. The rate of treatment for hypertension was significantly higher in NEPHSP group than the control group (93.0% vs. 81.4%, P < 0.001), and the rate of BP control was also significantly higher in NEPHSP group than the control group (35.9% vs. 29.6%, P < 0.001). Furthermore, similar trends were found in rural and urban, as well as in men and women.ConclusionsOur results showed that NEPHSP is effective in improving hypertension treatment and control in hypertensive patients in China. However, the coverage of NEPHSP was still low.

Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension

Greater difficulty in controlling blood pressure (BP) and adverse lifestyle practices such as higher salt intake or less physical activity may account for some of the differences between BP control rates in Black vs White adults, thereby exposing Black adults to a higher risk of vascular events. To determine whether a lifestyle coaching intervention or an enhanced pharmacotherapy protocol is more effective than usual care in improving BP control rates in Black adults treated within an integrated health care delivery system. Shake, Rattle & Roll, a cluster randomized clinical trial, was conducted from June 5, 2013, to June 11, 2018, in a large integrated health care delivery system. Enrollment was completed during a 12-month period and interventions were implemented for 12 months. Follow-up lasted 48 months after enrollment. Panels of Black adult members of the health care delivery system with BP of at least 140/90 mm Hg from 98 adult primary care physicians were randomly assigned at the primary care physician level to usual care (UC group [n = 1129]), enhanced pharmacotherapy monitoring (EP group [n = 346]) of current BP management protocol, or diet and lifestyle coaching consisting of photographs, stories, and recipes, for example, that are appropriate for Black adults (LC group [n = 286]) focused on the Dietary Approaches to Stop Hypertension (DASH) diet. Data were analyzed from June 1, 2016, to March 25, 2022. The UC group received care per customary protocol. The EP group was contacted by a research nurse and/or a clinical pharmacist to discuss barriers to hypertension control, and drug therapy emphasized the use of thiazide diuretic intensification and addition of spironolactone as needed. The LC group received as many as 16 telephone sessions with a lifestyle coach and an emphasis on implementing reduction of sodium intake and the DASH diet. Intention-to-treat analysis of BP control rates at end of the 12-month intervention. Among the 1761 participants, the mean (SD) age was 61 (13) years, and 1214 (68.9%) were women. At the end of the 12-month intervention period, there was no significant difference in BP control rate among study groups (UC, 61.8% [95% CI, 58.8%-64.9%]; EP, 64.5% [95% CI, 59.0%-69.4%]; LC, 67.8% [95% CI, 62.1%-73.2%]; LC vs EP, P = .07). However, greater BP control was present in the LC group vs UC at 24 months (UC, 61.2% [95% CI, 57.3%-64.7%]; EP, 67.6% [95% CI, 61.9%-72.8%]; LC, 72.4% [95% CI, 66.9%-78.1%]; LC vs UC, P = .001), and 48 months (UC, 64.5% [95% CI, 61.6%-67.2%]; EP, 66.5% [95% CI, 61.3%-71.3%]; LC, 73.1% [95% CI, 67.6%-77.9%]; LC vs UC, P = .006) after enrollment. The contribution of BP medication adherence to explain group differences was inconclusive. In this cluster randomized clinical trial including Black adults with persistent uncontrolled hypertension, a 12-month LC intervention was more effective at controlling BP than UC at 24 and 48 months after enrollment. Further research is needed to explore the potential implementation of this intervention into clinical practice. ClinicalTrials.gov Identifier: NCT01892592.

The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study

BackgroundTo evaluate the effectiveness of a cardiovascular polypill including aspirin, ramipril and atorvastatin (CNIC-Polypill), on the incidence of recurrent major cardiovascular events (MACE) and risk factor control in patients with established atherosclerotic cardiovascular disease (ASCVD) vs different pharmacological therapeutic strategies. MethodsRetrospective, observational study using data from electronic-health records. Patients were distributed into 4 different cohorts: CNIC-Polypill (case cohort) vs 3 control cohorts: same monocomponents taken separately (Monocomponents), equipotent drugs (Equipotent) and other drugs not included in the previous cohorts (Other therapies). Patients were followed for 2 years or until MACE or death. ResultsAfter propensity score matching, a total of 6456 patients (1614 patients per cohort) were analysed. After 2 years, the risk of recurrent MACE was lower in the CNIC-Polypill cohort compared to the control groups (22%; p = 0.017, 25%; p = 0.002, 27%; p = 0.001, higher in the Monocomponents, Equipotent and Other therapies cohorts, respectively). The incremental proportion of patients who achieved blood pressure (BP) and low-density lipoprotein cholesterol (LDLc) control from baseline was higher in the CNIC-Polypill cohort vs control cohorts (BP controlled patients: +12.5% vs + 6.3%; p < 0.05, +2.2%; p < 0.01, +2.4%; p < 0.01, LDLc controlled patients: +10.3% vs + 4.9%; p < 0.001, +5.7%; p < 0.001, +4.9%; p < 0.001, respectively). Medication persistence was higher in patients treated with the CNIC-Polypill (72.1% vs 62.2%, 60.0% and 54.2%, respectively; p < 0.001) at study end. ConclusionsIn secondary prevention patients, compared with control groups, treatment with the CNIC-Polypill was associated with significant reductions in the accumulated incidence of recurrent MACE, improved BP and LDLc control rates, and increased medication persistence.

Trends in blood pressure diagnosis, treatment, and control among VA nursing home residents, 2007-2018.

Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long-term care residents aged ≥65 years from October 2006 through September 2018 (FY2007-2018). Hypertension prevalence at admission was identified by ICD code(s) in the year prior, and antihypertensive medication use was defined as administration ≥50% of days. BP measures were averaged over 2-year epochs. The age-standardized prevalence of hypertension diagnosis at admission increased from 75.2% in FY2007-2008 to 85.1% in FY2017-2018 (p-value for trend <0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (p-values for trend <0.001) but remained high (80.3% treated in FY2017-2018, 80.1% with average BP <140/90 mmHg). The age-adjusted prevalence of chronic low BP (average <90/60 mmHg) also declined from 11.1% in FY2007-2008 to 4.7% in FY2017-2018 (p-value for trend <0.001). Persons identified as Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have an average BP <140/90 mmHg. Hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by a lower prevalence of chronic low BP. Nonetheless, some high-risk populations have average BP levels >140/90 mmHg. Future research is needed to better understand the benefits and harms of BP control in nursing home residents.

MO090: Diagnostic Performance of Pre-Dialysis And Ambulatory Blood Pressure Levels in Men and Women Hemodialysis Patients

Abstract BACKGROUND AND AIMS Ambulatory blood pressure (BP) control is worse in men than in women with chronic kidney disease or kidney transplantation. So far no study assessed in parallel possible effects of sex differences on the prevalence, control and BP phenotypes according to pre-dialysis and 48-h ABPM in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of pre-dialysis BP levels in men and women hemodialysis patients. METHOD 129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Hypertension was defined as follows: (1) pre-dialysis BP ≥ 140/90 mmHg or use of antihypertensive agents, (2) 48-h BP ≥ 130/80 mmHg or use of antihypertensive agents. RESULTS The prevalence of hypertension was not different between men and women with the use of pre-dialysis BP (92.2% versus 92.3%, P = 0.987, respectively) or 48-h ABPM (92.2% versus 89%, P = 0.411). With the use of pre-dialysis BP men had significantly lower control rates than women (18.5% versus 32.1%, P = 0.025); a similar pattern of worse control in men was apparent with the use of ABPM, but the difference was not statistically significant (22.7% versus 28.4%, P = 0.360). The rate of patients with concordant lack of control by pre-dialysis and ABPM readings was significantly higher in men than women (65.3% versus 49.4%, P = 0.023); white-coat (14.9% versus 17.6%, P = 0.593) and masked hypertension (10.7% versus 18.8%, P = 0.101) did not differ between groups. However, the misclassifation rate with the use of pre-dialysis BP was lower in men than women. There was moderate or at best fair agreement between pre-dialysis and ambulatory BP with regards to the prevalence (men: κ-statistics = 0.39, P &amp;lt; 0.001 and women: 0.27, P = 0.011) and control rates (κ-statistics = 0.25, P = 0.005 and 0.17, P = 0.124, respectively). Pre-dialysis BP ≥ 140/90 mmHg had sensitivity/specificity of 85.9%/51.4% in men and 72.4%/54.5% in women for the diagnosis of 48-h BP ≥ 130/80 mmHg. Receiver-operating-curve analyses confirmed this poor diagnostic performance. CONCLUSION The prevalence of hypertension is similar between men and women hemodialysis patients, but men have worse rates of office BP control. The diagnostic accuracy of pre-dialysis BP levels was equally poor in men and women hemodialysis patients.

Genesis of Antibiotic Resistance (AR) LXXXVIII: Turbulence Modeling(TM) of Hemodynamics in Simplified Severe Sepsis Protocol‐2 (SSSP‐2)‐NCT01663701: “Hypnotic Trance Ameliorate Turbulence to Laminar Flow (Homeostasis)”: A Neuropsychiatric Basis

An effort is made to substantiate that vascular abnormalities (fluid dynamic/mechanical properties) could be restored to homeostasis by an appropriate hypnotic trance. Clinical Background:Sepsis: Clinical data/Record(observation): decreased capillary density ref Fig 4 c., PMID: 34055944, hypovolemia, endothelial dysfunction, increased WBC accumulation, thrombi deposition, altered CCP, NFP gradient, shunting, degradation of endothelial glycocalyx, vascular hyper permeability (PMID: 23566729; PMID: 20179590; PMID: 24067428), as an indicator of sepsis progress to septic shock. Neuropsychiatry diagnostic index: HAND (HIV associate neurodegenerative disorder), PTSD, psychosis, depression, mania, ANI, MND, HIV associated dementia (HAD), possible multifocal leukoencephalopathy (CMV origin, Toxoplasmaencephalitis, diffused myelin pallor, opportunistic infections, and neurosyphilis (Jarisch Herxheimer reaction). Geometry: Part I: RBC, Platelets, WBC: p47‐56; Part II: blood velocity, and function, Table 2.1; 2,2; 2.3; p63; ISBN 9780128024089; Governing Equations: Part A: CD, https://www.grc.nasa.gov/www/k‐12/airplane/shaped.html;; Part B: Keulegan – Carpenter Number equation: □=Vm/ƒoscD; Clinical Data: Hemodynamics Hypnotic Trance:Before hypnotic induction: 120.65 mmHg / 79.84 mmHg (Derived →PP= 41 mmHg Normal;Derived →MAP=93mmHg); After hypnotic induction: 115.92 mmHg /76.16 mmHg; (Derived →PP= 40 mmHg Normal;Derived →MAP= 89 mmHG)).Heart rate before hypnotic induction: 86.16 / beats per minute (Derived →CO= 86.16/ beats per minute x 70ml/min=6029.8 ml/min); After hypnotic induction, to 78.89 beats per minute (Derived →CO=78.89/ beats per minute x 70 ml/min=5522.3ml/min). (Kurnia S, et.al., (2021). Blood Pressure Control and Heart Rate: Effectiveness Brief Hypnotic Induction Methods on Adults. 10.2991/assehr.k.210423.004). Spirometry (Homeostasis): VT: 500 ml; IRV: 3100 ml; ERV: 1200 ml; VC: 4800 ml; RV: 1200 ml; A respiratory rate of 12 breaths/ minute, the minute ventilation = 12 x 500 = 6000 ml. alveoli alveolar ventilation (volume of air/min that actually reaches the alveoli) = 12 x 350 = 4200ml. Clinical correlation:The basis for correlating the sepsis, neurological(physiological/psychiatric) and hypnotic trance is that the hypnotic trance subject recovers to homeostasis provided abreaction not encountered by the subject as much as the sepsis, neurological ‐ physiological/psychiatric patients with appropriate Dx, and Tx. Taken together, it is suggested that a decrease in capillary density observed in sepsis and en route to septic shock is a transient phenomenon implicit of a reversible loss of hemodynamic function, for patients Txwith SSSP‐ERP‐EGDT similar to that of SSSP‐2 NCT0166370. Such patient cohort could possibly be reverted to sustain homeostasis in a patient‐specific hypnotic suggestion(s), re‐alert concluding with a reassuring‐post hypnotic trans conversation (devoid of abreaction).

Village doctors managing hypertension in rural China

High blood pressure is the leading attributable risk factor for preventable deaths globally. 1 GBD 2019 Risk Factors CollaboratorsGlobal burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1223-1249 Summary Full Text Full Text PDF PubMed Scopus (1527) Google Scholar About 1·4 billion people have hypertension worldwide, one-quarter of whom live in China where blood pressure control rates are poor, especially in rural areas (<10% among those with hypertension). 2 Li Y Yang L Wang L et al. Burden of hypertension in China: a nationally representative survey of 174 621 adults. Int J Cardiol. 2017; 227: 516-523 Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar , 3 Lu J Lu Y Wang X et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017; 390: 2549-2558 Summary Full Text Full Text PDF PubMed Scopus (521) Google Scholar , 4 Qin VM McPake B Raban MZ et al. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res. 2020; 20: 372 Crossref PubMed Scopus (10) Google Scholar A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trialCompared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. Full-Text PDF