Blood Pressure-lowering Medication Research Articles

Abstract P419: Ultra-Processed Food Consumption and Risk of Hypertension in US Adults

Introduction: Ultra-processed food (UPF) consumption has an adverse impact on cardiovascular health. Current research is primarily based on non-US study populations. The purpose of our study was to estimate the association between UPF consumption and risk of incident hypertension in a population of middle-aged black and white men and women. Methods: Atherosclerosis Risk in Communities (ARIC) study participants who were hypertension free at baseline and had complete dietary, covariate, and hypertension data from visit 1 (1987 - 1989) were included (n = 8,866). Participants were followed through November 30, 2019 for the development of hypertension defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or recent patient-reported use of blood pressure lowering medication. Processing level was determined using the NOVA classification system. Data were analyzed using three progressively adjusted Cox proportional hazards regression models. Results: 6,960 participants developed hypertension during a median follow-up of 13 years. Participants in the highest quartile of UPF consumption were 9% more likely to develop incident hypertension than those in the lowest quartile (model 2 HR: 1.09; CI: 1.02-1.16; P for trend = 0.01) ( Table ). Participants who were in the highest quartile of sugar-sweetened beverages and red and processed meat consumption had a 20% higher risk of hypertension (model 2 HR, 1.20; CI, 1.12 - 1.28; P for trend <0.001) and 9% higher risk of hypertension (model 2 HR, 1.09; CI, 1.02 - 1.17; P for trend <0.001), respectively, when compared to the lowest quartile. Participants in the highest quartile of minimally or unprocessed food consumption had 9% lower incidence of hypertension (model 2 HR, 0.91; 95% CI, 0.85 - 0.97; P for trend 0.01). Conclusions: High UPF consumption, specifically sugar-sweetened beverages and red and processed meat, was associated with higher risk of hypertension, whereas minimally or unprocessed food consumption was associated with lower hypertension risk.

Hypertension Control Cascade and Regional Performance in India: A Repeated Cross-Sectional Analysis (2015-2021).

Background The weak control cascade of hypertension from the time of screening till the attainment of optimal blood pressure (BP) control is a public health challenge, particularly in resource-limited settings. The study objectives were to(1) estimate the change in the rate of prevalence of hypertension, the yield of newly diagnosed cases, initiation of treatment, and attainment of BP control in the age group15 to 49 years; (2)ascertain the magnitude and predictors of undiagnosed hypertension, lack of initiation of treatment, and poor control of those on antihypertensive therapy; and(3)estimate the regional variation and state-level performance of the hypertension control cascade in India. Methodology We analyzed demographic and health surveillance (DHS) data from India's National Family Health Survey Fifth Series (NFHS-5), 2019-2021, and NFHS-4 (2015-2016). The NFHS-5 sample comprised 695,707 women and 93,267 men in the age group of 15 to 49 years. Multiple logistic regressions were performed to find the associated predictors, and respective adjusted odds ratios (aORs) were reported. Results The prevalence of hypertension (cumulative previously diagnosed and new cases) amongindividuals aged 15 to 49 years was 22.8% (22.6%, 23.1%; n = 172,532), out of which 52.06% were newly diagnosed cases. In contrast, in NFHS-4, the prevalence of hypertension amongindividuals aged 15 to 49 years was 20.4% (20.2%, 20.6%; n = 153,384), of which 41.65% were newly diagnosed cases. In NFHS-5, 40.7% (39.8% and 41.6%) of the previously diagnosed cases were on BP-lowering medications compared to 32.6% (31.8%, 33.6%) in NFHS-4. Furthermore, in NFHS-5, controlled BP was observed in 73.7% (72.7% and 74.7%) of the patients on BP-lowering medication compared to 80.8% (80.0%, 81.6%) in NFHS-4.Females compared to males (aOR =0·72 and 0·007), residents of rural areas (aOR = 0·82 and 0·004), and those belonging to the socially disadvantaged groups were not initiated on treatment despite awareness of their hypertension status indicative of poor treatment-seeking behavior.Furthermore, increasing age (aOR = 0·49, P< 0·001), higher body mass index (aOR = 0·51, P< 0·001), and greater waist-to-hip ratio (aOR = 0·78, P= 0·047) were associated with uncontrolled hypertension in patients on antihypertensive drug therapy. Conclusions Hypertension control cascade in India is largely ineffectual although screening yieldand initiation of antihypertensive treatment have improved in NFHS-5 compared to NFHS-4. Identification of high-risk groups for opportunistic screening, implementing community-based screening, strengthening primary care, and sensitizing associated practitioners are urgently warranted.

2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society

Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.

Continuity of Medication Use by US Adults With Diabetes, 2005-2019

Consistent medication use is critical for diabetes management. Population surveillance of consistency of medication use may identify opportunities to improve diabetes care. To evaluate trends in longitudinal use of glucose-, blood pressure-, and lipid-lowering medications by adults with diabetes. This serial cross-sectional study assessed trends in longitudinal use of glucose-, blood pressure-, and lipid-lowering medications by adults with diagnosed diabetes participating in the Medical Expenditure Panel Survey (MEPS), which allows serial cross-sections and 2-year longitudinal follow-up, between the 2005 to 2006 panel and 2018 to 2019 panel. Population-weighted, nationally representative estimates for the US were reported. Included individuals were adult MEPS participants with diagnosed diabetes during both years (ie, during 2005 and 2006 or during 2018 and 2019) who participated in all survey rounds. Data were analyzed from August 2021 to November 2022. Longitudinal use over the 2 years was categorized as continued use (at least 1 fill per year), no use, inconsistent use, and new use by medication type (glucose-, blood pressure-, and lipid-lowering medications). New medications were defined as prescription fills for a medication type first prescribed and filled in year 2 of MEPS participation. A total of 15 237 participants with diabetes (7222 individuals aged 45-64 years [47.4%]; 8258 [54.2%] female participants; 3851 Latino [25.3%]; 3619 non-Latino Black (23.8%), and 6487 non-Latino White [42.6%]) were included in the analytical sample. A mean of 19.5% (95% CI, 18.6%-20.3%), 17.1% (95% CI, 16.2%-18.1%), and 43.3% (95% CI, 42.2%-44.3%) of participants did not maintain continuity in use of glucose-, blood pressure-, or lipid-lowering medications, respectively, during both years of follow-up. The proportion of participants who continued use of glucose-lowering medication in both years trended down from 84.5% (95% CI, 81.8%-87.3%) in 2005 to 2006 to 77.4% (95% CI, 74.8%-80.1%) in 2018 to 2019; this decrease coincided with rate increases in inconsistent use (3.3% [95% CI, 1.9%-4.7%] in 2005-2006 to 7.1% [95% CI, 5.6%-8.6%] in 2018-2019) and no use (8.1% [95% CI, 6.0%-10.1%] in 2005-2006 to 12.9% [95% CI, 10.9%-14.9%] in 2018-2019). Inconsistent use of blood pressure-lowering medications trended upward from 3.9% (95% CI, 1.8%-6.0%) in 2005 to 2006 to 9.0% (95% CI, 7.0%-11.0%) in 2016 to 2017. Inconsistent use of lipid-lowering medication trended up to a high of 9.9% (95% CI, 7.0%-12.7%) in 2017 to 2018. This study found that a mean of 19.5% of participants did not maintain continuity in use of glucose-lowering medication, with recent decreases, while a mean of 17.1% and 43.2% of participants did not maintain continuity of use of blood pressure- or lipid-lowering medications, respectively.

The association of BP with cardiovascular outcomes in patients with dipstick proteinuria and preserved kidney function.

Little is known about the relationship between blood pressure (BP) and incident cardiovascular disease (CVD) in people with proteinuria and a preserved estimated glomerular filtration rate (eGFR). This study sought to investigate the association of BP with CVD risk in adults with proteinuria and preserved eGFR. We studied 188,837 individuals with proteinuria and preserved eGFR ≥60 mL/min/1.73 m2. We categorized individuals who were not taking BP-lowering medications into four groups based on the 2017 American College of Cardiology/American Heart Association BP guideline and categorized those who were taking BP-lowering medications using the same BP ranges. The primary outcome was a composite CVD endpoint that included myocardial infarction, angina pectoris, stroke, and heart failure. Over a mean follow-up of 1,050 days, 7,039 CVD events were identified. Compared with normal BP, stage 1 hypertension (hazard ratio [HR]: 1.30, 95% confidence interval [95% CI]: 1.21-1.40) and stage 2 hypertension (HR: 2.17, 95% CI: 2.01-2.34) were associated with an increased risk for CVD events among medication-naïve individuals. Only stage 2 hypertension range (HR: 1.19, 95% CI: 1.02-1.38) was associated with an increased CVD event risk among people taking BP-lowering medications. Restricted cubic spline analysis showed that the risk of CVD events increased monotonically with BP at an SBP/DBP > 120/80 mmHg among medication-naïve individuals, but risk increased only at an SBP/DBP > 140/90 mmHg among individuals taking BP-lowering medications. In conclusion, among people with proteinuria and preserved eGFR, stage 1 and stage 2 hypertension were associated with a greater risk of CVD among medication-naïve individuals, whereas only stage 2 hypertension was associated with an increased CVD risk among those taking BP-lowering medications.

PS-C19-4: NOCTURNAL HYPERTENSION AMONG TREATED HYPERTENSIVE PATIENTS

Nocturnal hypertension among treated hypertensive patients Pagmadulam sukhbaatar t, Burmaa Badrakh 2, Naranchimeg Sodovsuren, 2Tsolmon Unurjargal2 t Mongolia-Japan University Hospital of MNUMS 2 Mongolian National University of Medical Sciences Objectives of this study were to determine the prevalence of nocturnal hypertension in treated hypertensive patients and factors associated with its presence. Methods: This hospital based cross-sectional study included 160 hypertensive patients, who underwent 24-h ambulatory blood pressure monitoring. According to the national guideline for hypertension nocturnal hypertension was defined as mean night-time systolic blood pressur ≧ 120 mm Hg or mean night-time diastolic blood pressure ≧ 70 mm Hg. Cardiovascular risk factors (smoking, alcohol use, obesity, diabetes, lack of physical activity) were compared in hypertensive patients with and without nocturnal hypertension. Results: The mean age of the participants was 62.4 years and 42.5% were men. Approximately 15% and 16.2% of all patients were current smokers and alcohol over users. 61.2% and 75% had obesity and physical activity lacking and 11.2% had diabetes. All patients were on blood pressure lowering medications, but 43.7% of patients were taken only one medication for high blood pressure. Mean night-time systolic blood pressure and diastolic blood pressure were in men and women 140.6 ± 20.2 mm Hg and 86.5 ± 11.2 mm Hg and 145.6 ± 17.1 mm Hg and 79.8 ± 7.3 mm Hg respectively. The nocturnal hypertension was detected in 61.6% of patients (64% in male, 60% in female). Our study revealed that nocturnal hypertension was significantly higher in patients with diabetes and obesity than in patients without diabetes and obesity. Conclusion: The prevalence of nocturnal hypertension was high. Nocturnal hypertension among treated patients was associated with diabetes, obesity and mono therapy.

S-06-5: HYPERTENSION MANAGEMENT IN PATIENTS WITH CARDIOVASCULAR DISEASE

High blood pressure is a major risk factor for new-onset and recurrent cardiovascular disease, including coronary heart disease, stroke, and heart failure. Most of the early event-based trials of antihypertensive medication were primarily secondary prevention studies. For example, in the first randomized controlled trial (RCT) of antihypertensive medication versus placebo, 62% of the 87 trial participants had CVD at baseline. In subsequent antihypertensive drug treatment trials, with much larger sample sizes, stratified analysis suggested similar treatment benefits in those with or without CVD at baseline. Further, individual trials and meta-analyses in participants with CVD but without hypertension demonstrated that antihypertensive drug therapy was effective for the prevention of recurrent CVD. In recent trials of more intensive BP reduction, stratified analysis identified no difference in treatment benefit between those with or without CVD at baseline or between those with a higher or lower level of CVD risk at baseline. Clinical practice guidelines generally recommend a final SBP target of less than 130 mm Hg in adults with CVD. Diuretics, ACEI, ARB, and CCB are the best-proven drug classes for antihypertensive therapy in adults without a compelling indication for choice of a particular BP-lowering medication. However, specific combinations are recommended for the management of hypertension in adults with an underlying co-morbidity such as stable ischemic heart disease (SIHD), stroke, heart failure, or kidney disease. Beta-blockers are first-line agents in adults with SIHD, diuretics and CCBs are preferred agents in adults with prior stroke, and long-acting thiazide-like agents are especially useful in adults with heart failure. BP/hypertension clinical practice guidelines provide detailed recommendations for choice of agents and BP targets in adults with hypertension and co-morbidities, including various forms of CVD.

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population.

Hypertension (HTN) is known to be the leading cause of cardiovascular disease (CVD) and mortality. We aimed to assess the impact of changes in 3 years in different blood pressure (BP) categories on incident CVD. In this study, 3,685 Tehranians aged ≥30 years (42.2% men) free of prevalent CVD with BP level <140/90 mmHg and not on BP-lowering medications were enrolled. Participants were grouped according to baseline BP category using the 2017 ACC/AHA hypertension guideline definition: normal BP (<120/80 mmHg), elevated BP (120-129/<80), and stage 1 HTN (130-139 and/or 80-89). The hazard ratio of incident CVD by changes in the BP category was estimated after adjustment for traditional risk factors using Cox's proportional hazard model, with stable normotension as a reference. During a median follow-up of 11.7 years, 346 CVD events (men = 208) occurred. Compared to the reference group, among participants with normal BP at baseline, only those with BP rising to stage 1 HTN [1.47 (0.99-2.16)], and among those with stage 1 HTN at baseline, regression to elevated BP [1.80 (1.11-2.91)], remaining at stage 1 [1.80 (1.29-2.52)], and progression to stage 2 HTN [1.81 (1.25-2.61)] had a higher risk for CVD; however, regression to normal BP attenuated this risk [1.36 (0.88-2.12)]. Conversion from elevated BP to any other categories had no significant association with CVD risk. Generally, prevalent stage 1 HTN (regardless of changing category) and incident stage 1 HTN were significantly associated with a higher risk of CVD; even regression to elevated BP did not attenuate the risk. Accordingly, these populations are potential candidates for antihypertensive management.

PS-P03-9: CONTENT AND DELIVERY PREFERENCES FOR INFORMATION TO SUPPORT THE MANAGEMENT OF HIGH BLOOD PRESSURE

Blood pressure(BP) management interventions have been shown to be more effective when accompanied by appropriate patient education. As high BP remains poorly controlled, there may be gaps in patient knowledge and education. Therefore, this study aimed to identify specific content and delivery preferences for information to support BP management among Australian adults from the general public. Given that BP management is predominantly undertaken by general practitioners(GPs), information preferences to support BP management were also ascertained from a small sample of Australian GPs. An online survey of adults was conducted to identify areas of concern for BP management to inform content preferences and preferred format for information delivery. A separate online survey was also delivered to GPs to determine preferred information sources to support BP management. Participants were recruited via social media. General public participants (n = 465) were mostly female (68%), &gt; 60 years (57%) and 49% were taking BP-lowering medications. The management of BP without medications, and role of lifestyle in BP management were of concern among 30% and 26% of adults respectively. Most adults(73%) preferred to access BP management information from their GP. 57% of GPs (total n = 23) preferred information for supporting BP management to be delivered via one-page summaries. This study identified that Australian adults would prefer more information about the management of BP without medications and via lifestyle delivered by their GP. This could be achieved by providing GPs with one-page summaries on relevant topics to support patient education and ultimately improve BP management.

PS-B09-5: THE LANDSCAPE OF HIGH-CONFIDENCE MICRORNA - GENE INTERACTIONS OPERATING IN THE HUMAN KIDNEY AND THEIR ROLE IN HYPERTENSION

Objectives: MicroRNAs (miRNAs) are short non-coding RNAs acting as post-transcriptional regulators of mRNAs. It is becoming increasingly clear that they play an important role as molecular drivers/mediators of complex human diseases including hypertension. Given the key role of the kidney in the pathogenesis and treatment of hypertension we sought (i) to comprehensively characterise the network of renal miRNA-mRNA interactions and (ii) evaluate their relevance to human hypertension. Design and method: Using poly-A RNA-sequencing and small RNA-sequencing we have identified 22,558 genes and 1,604 miRNAs in the discovery analysis of 328 human kidney samples (Human Kidney Tissue Resource). The outputs from these experiments have been normalised and adjusted by linear regression. We conducted a replication analysis of the identified miRNA-gene pairs in normal control kidney samples from two National Institutes of Health cohorts - CPTAC (n = 66) and TCGA (n = 83). We then examined the extent to which the expression of kidney genes known as targets of blood pressure lowering medications can be modulated by microRNAs. Finally, we investigated whether the effects of these interactions are observed at the protein level (CPTAC dataset). Results: We identified 186,192 unique statistically significant inverse miRNA-gene correlations in our discovery resource. Of these, 4,319 were replicated in both NIH kidney resources. 32.5% of kidney protein-coding genes and 12.2% of kidney long non-coding RNAs had at least one such high-confidence miRNA associated with their expression. SLC12A3 (Solute Carrier Family 12 Member 3) - kidney gene target for thiazides, SLC12A1 (Solute Carrier Family 12 Member 1) - gene target for loop diuretics and SLC5A2 (Solute Carrier Family 12 Member 2) - gene target for SGLT2 inhibitors showed consistent, negative correlations with four, five and five kidney miRNAs in each of three independent datasets, respectively. Some of the identified miRNAs showed negative correlations with more than one gene-drug targets. For example, miR-31-5p showed a strong, significant inverse association with SLC5A2 (R = -0.67, P = 9.41E-10) and SLC12A3 (R = -0.70, P = 5.80E-11) in the CPTAC resource. We confirmed that miRNA-31-5p also negatively correlates with the renal expressions of SLC12A3 and SLC5A2 at the protein level (R = -0.58, P = 3.5E-7 and R = -0.45, P = 1.51E-4, respectively). Conclusion: We characterised highly credible miRNA-gene interactions in the human kidney and mapped them onto genes and proteins of established relevance to blood pressure lowering treatment. These kidney miRNAs represent exciting targets for the development of novel antihypertensives.

PS-BPP05-2: TREATMENT STATUS OF HYPERTENSION DETECTED IN HEALTH CHECKUPS: AN OBSERVATIONAL STUDY OF JAPANESE EMPLOYEES

Objective: Despite the clear evidence for lowering blood pressure in hypertensive patients, control rates are insufficient, especially among younger adults. The first step in improving control rates is patient behavior to visit an outpatient when hypertension is detected at annual health checkups. The present study aims to explore the demographic and lifestyle characteristics related to the outpatient visits among employees who had untreated grade II or grade III hypertension. Design and method: An observational study was conducted using the data of annual health checkups and medical claims from 2012 to 2020 in an employee's health insurance society in Japan. We included participants if they were 20–69 years of age and had untreated grade II or grade III hypertension (blood pressure (BP)&gt; = 160/100 mmHg and no use of BP-lowering medications) at the time of health checkups (first measurement) and had BP &gt; = 140/90 mmHg in the previous years, to exclude transient hypertension. If more than one year of data met the criteria, the data from the first year was used to remove duplicates of individuals. Multilevel logistic regression with random effects of health checkup years was used to estimate odds ratios (ORs) with 95% confidence intervals (95%CIs) of demographics and lifestyle characteristics for newly outpatient visits (completing a clinic visit within 6 months). Results: The number of employees who had annual health checkups was approximately 10,000, and the number of applicable individuals for the present study was approximately 6% each year. In 2013–2020, after duplicate removal, 993 individuals (mean age 51.5 years, 63% women) had untreated grade II or grade III hypertension. Of these, 200 (20%) had an outpatient visit within 6 months. Among the independent variables, diabetes (ORs and 95% CI: 1.97, 1.19–3.26), body mass index (per 1-BMI increment: 1.04, 1.00–1.08), age (per 1-year increment: 1.03, 1.00–1.05), and systolic BP (per 1- mmHg increment: 1.04, 1.03–1.06) had significantly positive ORs for outpatient visits. The results of a similar analysis for antihypertensive medication after outpatient visits, no other factors besides systolic BP were associated with medication. Conclusion: Only 20% of individuals who detected grade II or grade III hypertension in annual health checkups visited outpatients within 6 months. The present findings suggested the necessity for more aggressive promotion of outpatient visits to younger adults without chronic illnesses or obesity.

PS-C20-1: NIGHT-TIME BLOOD PRESSURE-LOWERING DRUG TREATMENT FOR THE PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES: A PROPOSED RANDOMISED CONTROLLED TRIAL

Rationale: An increase of 20 mmHg in night-time blood pressure (BP) and a pattern of a higher BP at night than during the day was independently associated with an increased risk of 21% and 48% cardiovascular disease respectively. This association was more likely to present in type 2 diabetes mellitus (DM) patients. Objectives: This proposed study aims to examine the effect of taking night-time BP lowering drug treatment targeting night-time BP profile as compared to the conventional once-daily morning dose on the prevention of cardiovascular disease event in diabetes. Design: A Prospective Randomized Open-label with Blinding of Endpoint assessment. Methods: Men and women diagnosed with type 2 DM patients who are 60 years or over in Australia will be included in the trial. As per the current Australia guideline, these individuals meet the criteria to initiate BP lowering drug treatment for CVD prevention. The trial will be conducted as a “digital clinical trial” for participant recruitment, retention and data collection through an interactive web page platform. Participants will be referred by their health practitioners. Eligible participants will be randomised to either night-time or morning dosing treatments with a 1:1 ratio: a) Taking all of their usual once-daily dose of BP-lowering medications at bedtime (between 20:00 and midnight) or b) Taking a once-daily dose of BP-lowering medications upon awakening (between 06:00 and 10:00). The primary endpoint is the occurrence of any first major CVD events after randomisation. We expect to complete the participant recruitment over the first two years and finalise the analysis after an average follow-up of 5 years. Results: We are finalising the project protocol and have applied the proposed project to relevant research grants. An ethics application has also been prepared. We plan to run a one -year pilot trial and then transfer to the full study. Conclusion: The outcomes of this study will contribute to Level 1 evidence on the effect of night-time BP-lowering drug treatment in the prevention of cardiovascular disease in diabetes. Due to the nature of pragmatic design, our research outcomes are straightforward and could be adopted in current practice without any further cost. Changing the ingestion time of BP-lowering drug treatment from morning to night-time is very cost-effective and promises to reduce the financial and clinical burden of CVD and DM on the healthcare system.

FUNCTIONAL AGING TRAJECTORIES AND DRUG INTERACTIONS

Abstract Markers of functional aging can be used to track biological aging longitudinally and how it changes in response to the environment, e.g., drugs. We aimed to investigate how different drug classes may alter functional aging trajectories using data from the National E-infrastructure of Aging Research (NEAR) in Sweden. Data were harmonized across several longitudinal cohorts of aging for general cognitive performance, grip strength, walking speed, sensory ability (visual and hearing), lung function and assessment of frailty using the accumulation deficit model known as the frailty index. Selected drug classes were lipid lowering, glucose lowering and blood pressure lowering medications that are commonly used in old adults. Preliminary analysis using data from one longitudinal cohort shows that using glucose lowering drugs was associated with lower frailty. Additional analyses are ongoing to increase sample sizes. We anticipate that several drug classes may be important for changing functional aging trajectories in late life.

1019: SURGICAL PHARMACISTS PERI-OP[EN] THE DOOR TO IMPROVED TRANSITIONS OF CARE

Introduction: Surgical patients pass through a myriad of transitions of care during their hospitalization. Often in elective procedures, patients will undergo surgery and immediate post-operative care prior to pharmacist profile review. Many patients, however, may be on high-risk medications per the Institute for Safe Medication Practices (ISMP) that need immediate attention in the perioperative setting. Additionally, intensive care units (ICU) are consistently at capacity, and therefore ways to decrease this burden should be optimized. Recognizing this, subspecialty surgical pharmacists began preoperatively reviewing patients. Methods: A pilot process of preemptive patient review of 412 elective surgical patients was established to assess home medications and pertinent past medical history. The goal was to prevent intra- and post-operative medication-related complications that may translate to poor surgical outcomes, admission to the ICU, or increased length of stay. The service line pharmacist would work with the perioperative pharmacist, surgeons, and anesthesiologists to optimize care, discuss potential barriers, and develop a plan. Results: 295 patients (71.6%) were identified to have 1 or more high-risk medications, with a range of 0-6 medications per patient, that required intervention or coordination of care. Some examples of interventions include: reducing missed doses of seizure mediations, identifying patients that may need intra-operative insulin drips to prevent DKA, identifying the need for stress dose steroids perioperatively to avoid shock, preventing post-operative atrial fibrillation by resuming home beta blockers, identifying intrathecal baclofen pumps, facilitating initiation of heart rate and blood pressure lowering medications in patients with strict hemodynamic goals, and coordinating with anesthesiologists and surgeons regarding intraoperative pain management for chronic pain patients. Conclusions: Preoperative review of elective surgical patients’ home medications and pertinent past medical history by a pharmacist can aid in improved transitions of care. Developing care plans and facilitating these transitions has the potential to decrease poor surgical outcomes, avoid unnecessary admission to the ICU, and decrease length of stay.

Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: a qualitative study

ObjectivesAlthough substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information...

Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.

Reduction in blood pressure for people with isolated diastolic hypertension and cardiovascular outcomes.

Isolated diastolic hypertension (IDH) is a largely underrated risk factor for cardiovascular disease (CVD). It is currently unclear whether a reduction in blood pressure (BP) is associated with CVD events among adults with IDH. We aimed to elucidate the relationship between BP reduction and incident CVD in individuals with IDH. We retrospectively analysed the data of 71 297 individuals with IDH. Isolated diastolic hypertension was defined as systolic BP of < 140 mmHg and diastolic BP (DBP) of ≥90 mmHg (median age, 48 years; 83.1% men; median DBP, 92 mmHg). None of the participants took BP-lowering medications or had a history of CVD at baseline. Blood pressure was measured at baseline and 1-year follow-up, and participants were categorized into two groups based on DBP at 1 year (≥90 or < 90 mmHg). The primary outcome was a composite endpoint that included myocardial infarction, stroke, and all-cause death. Over a mean follow-up period of 1100 ± 859 days, 1317 composite CVD endpoints were recorded. Participants with DBP of < 90 mmHg at 1 year were at a lower risk of composite CVD events [hazard ratio (HR): 0.75, 95% confidence interval (CI): 0.67-0.83] than those with DBP of ≥90 mmHg at 1 year. A reduction in DBP per 5 mmHg during the 1-year follow-up was associated with a lower composite CVD event risk (HR: 0.92, 95% CI: 0.89-0.95). The results remained consistent across a multitude of sensitivity analyses. Our analysis of a large-scale epidemiological dataset demonstrated a relationship of reduction in DBP with a reduced risk for CVD events in individuals with IDH.

Transfer or tailor? Implementing a technology‐supported intervention for noncommunicable diseases across contexts

Transfer or tailor? Implementing a technology‐supported intervention for noncommunicable diseases across contexts

Abstract 12066: Older Age and Higher Number of Comorbidities Are Associated With Therapeutic Inertia for Blood Pressure Control

Introduction: Therapeutic inertia, defined as failure to initiate or escalate dose of blood pressure (BP) lowering medications when BP goals are not achieved, remains a major barrier to improving BP control rates. This study examines factors associated with therapeutic inertia for hypertensive ambulatory patients receiving care in university-affiliated primary care clinics. Methods: This retrospective cohort study included 8,451 hypertensive adults age &gt; 65 years with &gt; 1 primary care follow-up visit within one year between January 1, 2017 and January 31, 2021. Sociodemographic and clinical data, including comorbidities of diabetes, obesity, and cardiovascular disease, were extracted from the electronic health record. Generalized linear mixed models with a binomial distribution were used to calculate adjusted odds of therapeutic inertia during a clinic visit when BP was elevated by age group (65-74, ≥ 75 years) and number of comorbidities (0, 1, 2, 3-4, &gt; 5), after adjustment for covariates. An interaction term of age group * number of comorbidities in the adjusted model was statistically significant (P&lt;0.001), so marginal effects were used to calculate adjusted probabilities of therapeutic inertia at a clinic visit by age group and by number of comorbidities. Results: Mean age was 75 ± 8 years old, 42% were male, and race was 72% White, 17% Black, and 11% other. Across 28,585 clinic visits when BP was elevated, mean SBP and DBP were 152 ± 13 and 78 ± 11 mmHg, respectively, and therapeutic inertia occurred in 75% (21,325) of visits. Figure 1 shows that mean adjusted probability of therapeutic inertia among adults with 0 to &gt; 5 comorbidities ranged from 64 ± 15 % to 81 ± 12% with age 65-74 years, respectively, and 70 ± 15% to 82 ± 11% with age ≥ 75 years. Conclusions: Therapeutic inertia is common among older hypertensive adults with multiple comorbidities, and interventions are needed to address lack of medication escalation when BP remains uncontrolled.

Abstract 10335: Implementation of a Population Health Infrastructure for Hypertension in a Primary Care Clinic Setting

Introduction: In 2021, 48% of patients in the Hartford Hospital Adult Primary Care (APC) Clinic with a diagnosis of hypertension had controlled blood pressures of &lt;140/90 compared to 63% in Hartford Healthcare (HHC) as a whole. This demonstrates potential healthcare disparities within the APC clinic, whose patient panel consists primarily of an underserved Hispanic population with Medicare, Medicaid or are uninsured and lack overall health literacy. The aim of this project is to have 75% of APC patients with hypertension to have blood pressures of &lt;140/90 by 2023. Methods: The team implemented standardized staff and resident training regarding blood pressure measurement and ACC/AHA Hypertension Guidelines with pre- and post- training surveys. Residents reviewed their patient roster to schedule appointments for those with uncontrolled hypertension. The team created an Epic SmartPhrase to incorporate standard work by all providers for initial and follow-up hypertension visits. This included blood pressure-lowering medications, environmental risk factors, evaluation for obstructive sleep apnea, and recommendations for nonpharmacological interventions. Staff implemented standardized workflow which included: repeat blood pressure measurement after 5 minutes of rest for blood pressures &gt;140/90, ensuring proper documentation of repeat blood pressure in correct field in Epic, and scheduling 3-week follow-up appointments for blood pressure management. The clinic has been approved for a grant for BP monitors for those without health insurance. Results: In May 2022, 52% (727/1409) of patients at APC had blood pressures of &lt;140/90 compared to 38% (104453/272615) at HHC. Conclusion: Implementation of standardized staff and resident training, Epic SmartPhrases, and clinic workflow may lead to improved blood pressure control in an academic primary care clinic. Future direction includes assessing if optimizing BP control leads to improved patient outcomes.