BP Readings Research Articles

The impact of atrial fibrillation on accuracy of oscillometric blood pressure measurement: effect of ventricular rate.

This study evaluated the impact of ventricular rate (VR) in atrial fibrillation (AF) patients with oscillometric BP measurements. This study included 138 patients with AF and 112 patients with sinus rhythm (SR) who underwent coronary angiography. Left arm BP was measured three times with an oscillometric device, and the average was recorded as the final oscillometric value. At the same time, the average of three intra-aortic BP readings was used as invasive values. Delta BP was the difference between intra-aortic and oscillometric BP. Meanwhile, the BP percentage difference (PD-BP) was calculated with the following formula: PD-BP = (delta BP/intra-aortic BP) × 100%. Based on the VR, four subgroups of AF and SR patients, <80, 80-99, 100-120, and >120 bpm, were created, and the mean PD-BP for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significantly higher in the AF group than in the SR group. Moreover, the mean PD-SBP values gradually increased as VR increased in both groups. More importantly, the difference in PD-SBP between the AF and SR groups increased as VR increased: when VR was <80 bpm, the levels were similar (-2.0 ± 3.5 vs. -1.4 ± 2.7 mm Hg, NS), but these values in AF patients were significantly higher when VR was 80-99 bpm (-3.7 ± 5.0 vs. -1.8 ± 2.3 mm Hg, p < 0.05), 100-120 bpm (-6.1 ± 4.3 vs. -2.3 ± 1.9 mm Hg, p < 0.05) and >120 bpm (-7.8 ± 4.9 vs. -2.9 ± 1.7 mm Hg, p < 0.05). The accuracy of oscillometric BP measurements are dependent on the ventricular rate in AF patients even after three measurements, and a higher ventricular rate may result in larger underestimations of oscillometric BP.

The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study.

The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results. A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings). A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)). Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.

Optimization of Metagenome Sequence Identification with Naive Bayes and Certainty Factor

Metagenome studies are an important step in taxonomic grouping. Taxonomic grouping can be done using the binning method. Binning is a process to determine the contigs of each group of phylogenetic species. In this study, Binning was carried out using the Supervise Learning approach. We use the Naïve Bayes Classifier method and Certainty Factor. The classification process is carried out on phylum taxon levels. many of the organisms used were 50 organisms and the length of the fragments used was 500 bp and many readings were 1000 readings. The accuracy results obtained by the Naive Bayes method are 62.5%. While the accuracy obtained in the Certainty Factor method is 54.45%. From the results of the two methods of testing, it can be concluded that Naive Bayes is the best method of classification compared to Certainty Factor.

34Efficacy and safety of various doses of the new dual endothelin receptor antagonist aprocitentan in the treatment of hypertension

Abstract Background Endothelin Receptor Antagonists (ERAs) have been investigated for the treatment of a variety of cardiovascular conditions because of their potent vasodilating properties. However, until now, ERAs have only been registered for the treatment of pulmonary arterial hypertension and scleroderma-induced digital ulcers. This class of drugs may also be useful in the treatment of difficult to control hypertension with a medical need. Purpose To investigate the efficacy and safety of various doses of the new dual ERA, aprocitentan, in the treatment of hypertension in order to determine the most appropriate dose(s) for further clinical development using an unattended, automated office BP (AOBP) device (BpTRU). This Phase 2 trial was registered at ClinicalTrials.gov [NCT02603809]. Methods Eligible patients with hypertension (mean sitting systolic/diastolic BP 149.7/97.6 mmHg) received aprocitentan 5, 10, 25 or 50 mg, matching placebo or lisinopril 20 mg as a positive control, once daily for 8 weeks using a randomised, double-blind, parallel-group study design. AOBP was assessed at baseline and weeks 2, 4, 8, and 10 (withdrawal) by recording multiple BP readings with the patient resting quietly. Additionally, 24 h ambulatory BP monitoring was performed at baseline and week 8. Results A total of 490 eligible patients were randomised to the double-blind phase with 430 subjects successfully completing 8 weeks of treatment. Decreases in sitting systolic/diastolic AOBP, from baseline to week 8 were 10.3/6.3, 15.0/9.9, 18.5/12.0 and 15.1/10.0 mmHg for aprocitentan 5, 10, 25, and 50 mg, respectively vs. 7.7/4.9 mmHg for placebo and 12.8/8.4 mmHg for lisinopril. No changes in heart rate or body weight were observed for any dose of aprocitentan. Modelling the dose-response suggested that the maximal effect of aprocitentan is achieved at a dose of approximately 25 mg and that 70% of this effect is already observed at a dose of 10 mg. Aprocitentan treatment was associated with decreases in haemoglobin, haematocrit, and albumin which exhibited a monotonic dose-response relationship, in line with its known vasodilating effects. Estimated increases in plasma volume were 3.0%, 5.1%, 6.9%, and 9.5% for aprocitentan 5, 10, 25, and 50 mg, respectively, vs. 1.6% for lisinopril and a decrease of 0.3% for placebo. All these values are below the accepted pathophysiological threshold of 10%. The overall incidence of adverse events observed in the aprocitentan groups (ranging from 22.0% to 40.2%) was similar to that seen in the placebo group (36.6%). Overall, the most common events were hypertension, headache, and nasopharyngitis. Conclusions These findings support the use of aprocitentan at doses between 10 and 25 mg for further investigation as a potential treatment for hypertension. Acknowledgement/Funding Actelion conducted study. Drug discovery &amp; early clinical pipeline demerged during Johnson &amp; Johnson acquisition. Idorsia supported abstract.

Abstract P2053: Blood Pressure Variability is Higher When Pulse Rate is Lower, in a Large Outpatient Database

Historically, guidelines for blood pressure measurement recommended adjusting the cuff deflation rate to the patient's heart rate (2-3 mmHg per heartbeat).Current guidelines recommend a fixed cuff deflation rate of 2 mmHg/sec.. In this study, we assess the association between pulse rate (PR) and BP variability. All BP measurements in adult patients with corresponding PR documentation were reviewed in a large outpatient database. In each category (6 categories between 40 and 99 bpm), patients with at least 3 BP readings within that category were included. In each category, systolic and diastolic BP coefficient of variance (corrected for sample size) was plotted against the PR category. There were 551,595 unique patients with a total of 4,760,000 measurements, and 860,522 groups of 3 measurements or more per patient within a PR category. BP normalized coefficient of variance was inversely related to PR (Figure), ranging 0.0043 to 0.0003 (Systolic), and 0.0024 to 0.0002 (Diastolic), for the lowest to highest heart rate category, respectively. BP variability is inversely associated with PR, especially in lower PR, likely reflecting less precise BP measurements where the "sample size" of pulse is small. The observed effect compromising precision might be accompanied by a concomitant reduced accuracy of BP measurement which is another theoretical implication of a smaller "sample size", leading to a systematic bias towards measuring lower and higher than real systolic and diastolic BP respectively.

Abstract P163: Masked Uncontrolled Hypertension in Treated Hypertensive Patients Have Heightened Out-Of-Clinic Aldosterone Levels

Introduction: Masked uncontrolled hypertension in treated patients (MUCH) is defined as controlled automated office blood pressure (AOBP) in clinic but uncontrolled out-of-clinic 24-hr ABPM. Previously, we have shown that patients with MUCH have evidence of heightened out-of-clinic sympathetic activity (i.e. catecholamines &amp; metanephrines levels) compared to patients with true controlled hypertension (CHTN). Methods: In this prospective evaluation, 185 patients were recruited after having controlled BP readings at 3 or more clinic visits. Patients on mineralocorticoid receptor antagonists were excluded. All the patients were evaluated by in-clinic AOBP, &amp; morning serum aldosterone &amp; plasma renin activity. Out-of-clinic ABPM &amp; 24-hr urine aldosterone were also done. Fifty patients had true CHTN &amp; remaining 57 patients were MUCH. Results: The patients identified as having MUCH had significantly higher out-of-clinic levels of urinary aldosterone compared to true CHTN. The two groups did not differ in serum aldosterone, plasma renin activity &amp; aldosterone-renin ratio collected in clinic. In addition, 38.6% of MUCH patients had high out-of-clinic urine aldosterone levels (≥ 12 μg), but normal clinic serum aldosterone levels (&lt;16 ng/dL) &amp; an aldosterone-renin ratio (&lt;30). Conclusions: Patients with MUCH have higher aldosterone levels compared to patients with true CHTN. However, there was no difference in serum aldosterone levels between the two groups in clinic. These findings suggest that patients with MUCH likely have higher out-of-clinic sympathetic tone that increases aldosterone, catecholamines &amp; metanephrines levels contributing to their MUCH.

Abstract 028: Remote Health Monitoring Platform Reduces Blood Pressure and Crisis Hypertension

Introduction: We assessed the efficacy of mobile health hypertension monitoring for patients enrolled in Medicare’s Remote Physiologic Monitoring program. Hypothesis: Uncontrolled hypertension is an increasing epidemic associated with cardiovascular disease. Despite many available treatments, the average time to blood pressure control is slow. We hypothesized that mobile health monitoring and communication with clinicians in a Medicare cohort would decrease the hypertension burden and mitigate crisis blood pressure in patients. Methods: 337 patients who had contributed ≥ 20 blood pressure readings in a remote monitoring program were included in the study population, spanning clinics in Florida, Tennessee, and Arizona. Eligible patients carried a diagnosis of hypertension and had been seen by their doctor within the year they were referred. The mobile health platform was utilized to aggregate blood pressure data, which was analyzed by a remote care team and provided to clinicians on a monthly basis. Patients’ doctors and their teams reviewed and managed the patients based on the data provided by the mobile-cloud platform. The remote monitoring program provided alerts to clinic staff for patients who had blood pressures greater than 180mm Hg systolic (crisis hypertension) for expedited decision making. Results: 337 patients who provided &gt;20 BP readings from October 2018 to April 2019 were included in the study. A total of 51,125 blood pressure readings were included in this analysis. Patient readings were stratified by epoch chronologically. The first epoch (E1), represented the first 25% of readings in the remote monitoring system, and the fourth epoch (E4) represented the final 25% of readings. From E1 to E4, patients saw an average decrease of 4.7 mmHg in systolic blood pressure (133.0 vs. 128.3; p&lt;0.001). The proportion of readings in crisis hypertension range decreased from 3.3% to 1.9% (p&lt;0.001), while the amount of hypotensive readings did not substantially change (1.4 vs. 1.6%; p=0.14). Conclusions: In agreement with our hypothesis, patients in a Medicare cohort achieved a significant reduction in blood pressure via remote monitoring as well as a significant reduction in crisis blood pressure readings.

Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Retrospective chart audit. The National Early Warning Score (NEWS) is based on seven physiological parameters which can be altered in some individuals with spinal cord injuries (SCI). The aim was to start the development of adapted NEWS suitable for SCI population. The objective was to determine the SBP NEWS specificity based on neurological level of injury (NLI) and completeness of injury. Tertiary centre in the UK. Adult patients admitted for the first time to the National Spinal Injuries Centre between 1 January 2015 and 31 December 2016 were included if they were >6 months post injury. Data were extracted retrospectively including the last ten consecutive BP and heart rate readings before discharge. Data were analysed based on different AIS grades, completeness of injury and NLI. One hundred and ninety one patients were admitted in 2015 and 2016 and 142 patients were included in the primary analysis. The mean SBP ranged between 92 and 151 mmHg. Patients with the NLI of T6 and above (≥T6) motor complete lesions had a significantly lower SBP than motor incomplete lesions. The specificity of the SBP NEWS was 35.3% in ≥T6 motor complete individuals versus 80.3% in ≥T6 motor incomplete individuals. The baseline BP is significantly lower in the ≥T6 motor complete SCI individuals (>6 months post injury) resulting in a very low specificity of 35.3% to SBP NEWS, which could lead to mismatch between clinical deterioration and NEWS resulting in lack of timely clinical response.

30-YEAR TRENDS IN BLOOD PRESSURE, PREVALENCE, AWARENESS, TREATMENT AND CONTROL OF HYPERTENSION IN THE CZECH REPUBLIC. THE CZECH MONICA AND CZECH POST-MONICA STUDIES

Objective: Unlike most former East Bloc countries, the Czech Republic has seen a decrease in total, and cardiovascular (CV) mortality; the decrease, since 1985, was most pronounced in cerebrovascular mortality (77%). Objective: To assess trends in BP levels, prevalence, awareness, treatment and control of hypertension in the Czech population from 1985 to 2016/17. Design and method: A total of seven independent cross-sectional population surveys of major CV risk factors were performed in 1985, 1988, 1992, 1997/98, 2000/01, 2007/08 and 2016/17 in a 1% random population sample aged 25–64 years (7,606 males; 8,050 females) in six districts of the Czech Republic. Hypertension was defined as a mean of 2 BP readings =>140/90 mmHg taken at one visit or being on antihypertensive medication. Results: Over a period of 31/32 years, there was a significant reduction in both systolic BP (males: from 135.8 ± 19.2 to 131.1 ± 14.9 mmHg; females: from 131.6 ± 20.9 to 124.7 ± 16.9 mmHg; p < 0.001) and diastolic BP (males: from 85.9 ± 11.0 to 84.7 ± 9.0 mmHg; females: from 82.5 ± 11.3 to 80.0 ± 9.4 mmHg; p < 0.001) in both genders, while the prevalence of hypertension decreased only in females (from 42.5% to 33.5%; p < 0.001; males: from 51.9% to 50.8%; n.s.). Within the same period, BMI increased in males (from 27.0 ± 4.0 to 29.2 ± 5.1 kg/m2; p < 0.001) while not changing in females (27.3 ± 5.4 vs 27.3 ± 6.0 kg/m2; n.s.). There was also an increase in the awareness of hypertension (males: from 41.4% to 74.6%; p < 0.001; females: from 58.9% to 77.7%; p < 0.001) and the proportion of individuals treated by antihypertensive drugs (males: from 21.1% to 60.4%; p < 0.001; females: from 38.9% to 64.3%; p < 0.001). Hypertension control improved in both genders (males: from 2.8% to 29.8%; p < 0.001; females: from 5.2% to 37.0%; p < 0.001). Conclusions: A favorable trend in population mean BP and improved hypertension control were found in a representative sample of the Czech population over the years 1985–2016/17, most likely contributing to the remarkable decrease in CV mortality. However, a substantial proportion of the hypertensive population remains uncontrolled.

ARE UNSCHEDULED HOME BLOOD PRESSURE MEASUREMENTS RELEVANT FOR THE PRACTICE

Objective: To assess the correlation between “protocolized” and “non-protocolized” home blood pressure self-measurements in treated hypertensive patients. Design and method: The study was prospective and observational. We included consecutive outpatients managed in our center for hypertension, who consent to participate to the study and had a semiautomatic validated blood pressure monitor. In the first step, patients were instructed to perform home blood pressure measurements (HBPM) when they wanted to, without specific protocol, before the next clinic visit. In the second step, they had to follow a strict protocol: BP readings performed for 5 consecutive days before the next clinic visit, with readings in the morning and in the evening, and two measurements should be taken at each measurement session, performed 1 to 2 minutes apart. Intra- class Correlation Coefficient (ICC) between the two phase measurements was calculated. Results: For hundred seventy-eight (478) patients were included, with a mean age of 66.3 ± 13.9 years, and 51.7% of men. The proportions of diabetes, persistant smoking and dyslipidemia (or statins intake) were 29.9%, 16.5% and 55.2% respectively. We found a good ICC between “protocolized” HBPM and” non-protocolized” HBPM (= 0.74). In contrast, ICC between HBPM (“protocolized” or not) and office BP was bad (0.36 and 0.17 respectively). Conclusions: HBPM, even without adherence to recommended measurement protocol, seems to be more relevant than office BP in the management of hypertensive patients.

GREATER VARIABILITY IN DIASTOLIC- THAN SYSTOLIC AMBULATORY BLOOD PRESSURE IS ASSOCIATED WITH HIGH RISK FOR CARDIOVASCULAR MORTALITY WITHIN 5 YEARS IN SUBJECTS OVER 50 YEARS OF AGE

Objective: Evaluating the risk for cardiovascular mortality within 5 years in middle-age and older subjects, who displayed 24-hour diastolic BP variability (DBPV) greater than the systolic BP variability (SBPV).Design and method: Study population was a subgroup of Dublin Outcome Study that included 3,815 participants older than 50 years (age 65 ± 9, males 47%, hypertension 72%, diabetes 12%) not on antihypertensive medications at referral, who underwent 24-hour ambulatory BP monitoring and followed up for 5 years, of whom 315 died from cardiovascular cause (CV), including 195 from cardiac illness (CARD), and 88 from stroke (STRK). Variability was expressed by standard deviation of the BP readings. We marked the groups of participants with DBPV>SBPV and DBPV<=SBPV by the variable Index equals to 1 and 0, respectively, Odd ratio (OR) was determined using multiple logistic regression, in which the outcome was 1 for death from a specific cause, and 0 otherwise. The independent variables were Index, age, sex, body mass index (BMI), current smoking status, presence of diabetes mellitus, past cardiovascular diseases, 24-hour mean arterial pressure (MAP) and heart rate, and MAP nocturnal dipping. Results: Both groups displayed similar characteristics, but %mortality for the DBPV>SBPV group (N=165) was much higher than for the DBPV<=SBPV group (N = 3650): CV (27.9% vs 11.9%); CARD (18.2% vs 4.5%), and STRK (8.5% vs 2.0%). The odd ratios for DBPV>SBPV (see table) demonstrated high clinical and statistical significance for the tested mortality causes, and insensitivity to adjustment. For age<=50 did not display comparable association with CV death, but the small sample number did not permit a fair evaluation. Conclusions: Greater ambulatory diastolic BP variability than the systolic one for age>50 years is associated with high risk for CV death within 5 years.

Treatment of White Coat HYpertension in the Very Elderly Trial (HYVET 2) - Feasibility of a Randomized Controlled Trial (Study Protocol)

The results of HYpertension in the Very Elderly Trial (HYVET) were crucial in providing evidence of benefit of the treatment of hypertension in those 80 years or older. Following a subsequent sub study analysis of the HYVET data there is a suggestion that 50% of patients in the main study had White Coat Hypertension (WCH), defined as clinic BP readings >140/90 mmHg and ambulatory BP readings <135/85 mmHg. Currently, definitive evidence in support of treatment for such individuals is not available. HYVET 2 has been designed in order to assess the feasibility of conducting a randomized controlled trial which might determine whether the treatment of WCH in the very elderly is clinically beneficial. One hundred participants aged ≥75 years diagnosed with WCH will be recruited from General Practices (GPs) in UK. Randomization will be 1:1 to a treatment arm (indapamide and perindopril) and control arm (no treatment) and follow up will be for 52 weeks. HYVET 2 will report on feasibility outcomes including participant recruitment, adherence and withdrawal rates, willingness of GPs to recruit and randomize patients and the frequency of a composite of cardiovascular events. Simple descriptive statistics will be presented.

SAT-056 Primary Aldosteronism Has a Distinctive Twenty-four Hour Blood Pressure Profile

Background: Primary aldosteronism (PA) has a reported prevalence of up to 30% in cases of resistant hypertension and is associated with worse cardiovascular outcomes than BP-matched essential hypertension (EH), but is substantially under-diagnosed due to the lack of specific symptoms and signs. Ambulatory blood pressure monitoring (ABPM) provides a non-invasive method for evaluating circadian BP variations, offers valuable prognostic information and may help to differentiate PA from EH in patients referred with non-specific hypertension for investigation. Aims: To compare AMBP parameters in hypertensive patients with established PA and those without, and correlate these parameters with cardiovascular outcomes. Methods: AMBP readings were evaluated retrospectively in 453 patients assessed at Monash Heart (the largest cardiology service in Victoria, Australia). Patient demographics, screening aldosterone and renin concentrations and medications were retrieved from medical records. 414 hypertensive patients with presumed EH and 39 PA patients were identified and their cardiovascular events (myocardial infarction, left ventricular hypertrophy, coronary artery disease, atrial fibrillation) were recorded. All parameters are reported as the median [interquartile range], unless stated otherwise. Statistical significance was set at p<0.05. Results: Compared to hypertensive patients who are presumed to have EH, PA patients were significantly younger (55 yr [50, 66] vs 63 yr [53, 72]), had higher systolic (149 mmHg [134, 156] vs 133 mmHg [124, 145]) and diastolic BP readings (87 mmHg [82, 92] vs 75 mmHg [68, 82]) with similar patterns observed for average daytime and night-time BP. BP load (% daytime and night-time SBP/DBP readings over 135/85 and 120/70 mmHg, respectively) was significantly higher for both systolic and diastolic in PA (83% [61, 92] and 57% [35, 76]) compared with the non-PA group (48% [23, 75] and 14% [5, 35]). 77% of patients with PA (30/39) had loss of physiological nocturnal BP dipping compared with 44% of the non-PA group (184/414). Rates of cardiovascular events were similar in both groups but may be confounded by the retrospective nature of this study and lack of long-term follow-up. Conclusion: In our study, PA is associated with a distinctive 24-hour BP profile, including a significant increase in BP load and loss of nocturnal BP dipping which are known risk factors for adverse cardiovascular events. A prospective study is needed to better define AMBP parameters in PA and evaluate their ability to unveil underlying PA amongst hypertensive patients.

Pilot Study of Home Vitals and Activity Monitoring for Allogeneic Hematopoietic Cell Transplant Recipients

Can leveraging fast growing technology assist with improving patient outcomes and streamline workflows at the same time? We piloted remote monitoring technologies to find out. In partnership with our hospital's Digital Health team, we provided 39 allogeneic blood and marrow transplant (BMT) recipients with a Bluetooth enabled blood pressure, temperature and activity tracking device. After a one-time set up and pairing with the patient's smartphone, the devices automatically transmitted real-time readings into the patient's permanent electronic medical record (EMR). The patient's transplant care team had the ability to view a dashboard with at home readings. Abnormal readings were also delivered directly to their EMR's inbox. Patients were asked to monitor these readings for at least 100 days post BMT, with the option to continue using the remote devices longer, if desired. Approximately 60% of patients had consistent at home BP and temperature readings recorded in their EMR but only 16% had activity tracking data. We observed the following advantages of remote monitoring: (1) Ease of use by BMT team: The transplant nurse coordinators found it relatively simple to view normal and abnormal at home readings from the EMR. (2) Enhanced patient monitoring: Transplant nurse coordinators were able to see trends before the patient's office visits. For one patient, monitoring prompted a cardiology appointment, where they were able to route home readings to the cardiologist through the EMR. (3) Patient experience: Patients who were able to successfully use the devices generally had positive feedback about them. However, some challenges and opportunities for improvement were identified: (1) Need for better hardware: The activity device used in this pilot was a basic device, future efforts may be better focused on other activity devices. The functionality of our platform was not seamless for Android users. (2) False positive readings: False positive temperature and heart rate readings were an issue (e.g., temperature of 105 recorded due to a family member playing with thermometer, recording heart rate from wife's Apple watch . (3) Patient expectations: Despite educating patients to call their care team with abnormal readings, many patients did not and expected an immediate phone call from their nurse coordinator. (4) Patient experience: Some patients stated that the devices were not easy to use and troubleshooting issues was difficult. We found that remote monitoring of vitals and activity in allogeneic transplant recipients is feasible but has opportunities for improvement before it can be more widely adopted. Workflows were not negatively impacted and visualizing the data was easy. We can see the benefit that at home monitoring could bring, but would need to see improvements with integration, software and hardware before it can be used routinely to care for patients.

A13859 Discarding the First dayʼs Home Blood Pressure Measurements

Objectives: Guidelines recommend that the first day's home blood pressure (HBP) be discarded and the remaining BP readings done over a week be averaged to derive the mean awake BP. However patients were not compliance due to time consuming. Hence our study to identify the difference in mean awake BP between discarding or retaining the first day's BP readings. Methods: This is a cross-sectional study done in a primary care clinic in Malaysia. A convenience sampling method was used to recruit patients. Patients were educated on how to measure HBP using a validated oscillometric BP device according to standardised procedure. Patients performed three consecutive BP measurements three times a day (morning, evening before dinner and at bedtime for seven days). We used only the first two readings at each sitting and only the morning and evening BP readings to derive the mean awake BP. Our mean awake BP was based on a total of three days of BP readings. We included the first day's HBPM (from day 1–3) and compared it to the mean awake BP when the first day's BP readings were discarded (from day 2–4). Results: A total number of 306 patients were enrolled. The mean age was 67 ± 10 years, 46.6% were males. The mean duration of hypertension was 15 ± 10 years. The mean and its mean difference of the Home Systolic BP (HSBP) and Home Diastolic BP (HDBP) were summarized in the table below. Conclusion: The mean awake HSBP and HDBP were higher when the first day's BP measurements were not discarded. This difference is statistically significant but likely not to be clinically significant. We recommend that it is perhaps of not necessary to discard the first day's measurements as it will be less time consuming and improve patients’ adherence in doing HBPM. However larger randomized studies are needed to confirm our findings.

404. A nationwide prospective study of aortic dissection in pregnancy using the UK Obstetric Surveillance System (UKOSS)

Background Aortic dissection (AD) in pregnancy is a life-threatening event and 50% of cases in women aged 40 years occur during pregnancy.1 Patients with AD present with a wide array of symptoms and the condition may be missed and patients treated for other diseases.2 This study estimated the UK incidence of AD in pregnancy and provided insight into presentation and management practices. Methods A national prospective population-based study was undertaken across 229 hospitals over a 2-year period. Participants were diagnosed (a) using suitable imaging (echocardiography, CT or MRI) or (b) at surgery/postmortem. Results The estimated UK incidence of AD in pregnancy was 1.31 per 100,000 maternities (95% CI 0.69–1.93 per 100,000) with 17 cases confirmed by diagnostic criteria. The mean [SD] age of women was 32.5[7.2]years. Fourteen cases were due to type-A dissection (involving ascending aorta), the remainder type-B (no involvement of ascending aorta). Nine women died, all of whom with type-A dissection, giving a case fatality rate of 53%. We compared the UKOSS data for survivors to information available for 21 women with confirmed AD who died (during and just after the UKOSS study period). There were no differences in age, BMI or ethnicity but increased prevalence of pre-existing co-morbidities in women who died. On initial presentation all survivors complained of anterior chest pain (compared to 66% who died). Survivors were more likely to have recorded bilateral BP and pulse readings, prompt imaging (87.5% underwent echocardiography + either CT/MRI aorta). In the survivor group (n = 8), 5 women successfully underwent surgical aortic root replacement (for type-A dissection) after appropriate BP control usually β -blockade. 3 were conservatively managed for type-B dissection. Discussion AD is a rare but serious illness. Thorough physical examination and prompt imaging with quick access to surgery (type-A) or conservative management (typeB) could prevent mortality from AD.

Abstract P351: Improving the Management of Hypertension for Adults: The Impact of Home Blood Pressure Monitoring and Lessons Learned from a System-Level Hypertension Control Initiative

Purpose: To examine the effects of a pragmatic HBPM program on improving HTN control. Methods: SWHP commercial and Medicare members 18-85 y/o with persistently uncontrolled HTN were given a free home BP monitor and related educational tools to effective engage in and document HBPM via 3 separate cohorts: • Provider distribution during an office visit • Based on medical record reviews, mailed to the patient with PCP’s permission • Patient’s request at various health fairs Using the office-based BP readings in the EHR, we calculated the change in BP control for each subsequent visit and end of year. Results: From Sept 2016 through May 2017, with no undue burden placed on providers or their staff, 2550 members received the tools necessary to engage in HBPM. By the 3 rd office visit, 66.79% [±3.7%; 95% CI] achieved office-based BP readings of less than 140/90 mmHg. It was also noted that by the 3 rd office visit many providers were able to reduce the patient’s medications and still maintain control. The retrospective review, like that of previous studies, found HTN control rates continued to climb with 79.03% (78.18%-88.57%) [± 3.7%; 95%CI] achieving HTN control per HEDIS 2018 standards. The average sustained change in BP control was an 18.3 mmHg (11.9-19.0 mmHg) reduction in SBP and a 7.0 mmHg (4.2-9.5 mmHg) reduction in DBP. It is also worth noting 72.6% (71.1-77.14%) [± 3.7%; 95%CI] achieved HTN control per the new AHA/ACC guidelines. Conclusions: Clinical guidelines recommend HBPM to evaluate and treat HTN. Our HTN Control Initiative supports a multi-modality approach as being cost-effective and sets the groundwork for further QI efforts to better discern each process regarding the use of HBPM.

Abstract P228: Text-Facilitated Home Blood Pressure Monitoring: A Qualitative Analysis of Health Behavior Change

Uncontrolled hypertension constitutes a major challenge for healthcare systems. Home blood pressure monitoring (HBPM) is widely recommended and may lower BP when combined with other supports. However, scalable and systematic HBPM interventions are lacking and the behavioral mechanism(s) through which BP is lowered remain poorly understood. Our team designed the MyBP program with video-based education and a fully automated, bi-directional texting to facilitate longitudinal HBPM. Exit interviews conducted after six-weeks of MyBP revealed that most participants made at least one healthy behavior change. The current study examines why participants made healthy behavior changes, and what specific components of the MyBP program facilitated those changes. Adults with hypertension were recruited from either an urban emergency department, a primary care office, or a hypertension referral center. The 40 enrolled participants were widely representative: age range 34-70, 23 women, 24 minority, 14 completed only high school, BP range 110-250/70-130 mm Hg, and prescribed BP medications range 0-5. A thematic analysis of transcribed exit interview audio-recordings identified three themes contributing to patients’ decision to initiate a behavior change: 1) improved hypertension literacy from viewing educational videos; 2) increased day-to-day salience of one’s BP as a result of consistent HBPM; and 3) use of BP readings as feedback on participants’ health behaviors, with high readings often triggering intrinsic motivations to make behavior changes. These themes and associated sub-themes were found to have analogous constructs in the Health Belief Model and Social Cognitive Theory. The presentation of educational materials at baseline, followed by regular BP self-monitoring, increased confidence and motivation to initiate changes in health behaviors. The receipt of bi-weekly reports then acted as feedback fueling participants’ motivation to maintain or add healthy behaviors. Facilitation of HBPM with automated texting, in conjunction with educational videos and regular feedback, appears to stimulate improvements in hypertension self-management via mechanisms consistent with recognized models of behavior change.

FIVE CONSECUTIVE OFFICE BLOOD PRESSURE MEASUREMENTS VERSUS CURRENT PRACTICE. HOW AGE, GENDER, DIABETES AND HYPERTENSION AFFECT BLOOD PRESSURE

Objective: Recently, new data from trials conducted on hypertension have been surging, leading to changes in the management of patients with arterial hypertension, and subsequently giving rise to modifications of practice guidelines. Yet, there is no consensus on the number of readings that should be considered to measure the accurate BP. The study aimed to determine the impact of age, gender, diabetes mellitus and hypertension on the systolic (SBP) and diastolic blood pressure (DBP) variability patterns in cardiac patients. Moreover, we highlighted the variability that occurs in percentage of patients diagnosed with hypertension according to different current guidelines Vs using mean of 5 consecutive BP readings.Methods: 1389 cardiac patients (median age, 54 (18, 87 y)) presenting at Alhyatt Heart and Vascular Center were studied. Five consecutive blood pressure measurements were taken, with one-minute interval. High SBP and DBP were classified according to the mean of the 5 readings as SBP >140 and DBP >90 mmHg according to different guidelines and SBP>130 and DBP>80 as per to new AHA/ACC cutoffs. Young subjects were defined as those <50y of age. A decrease in BP over 5 readings were defined as a difference between BP-reading 5 (R5) and R1 of -1 mmHg or more, while an increase was defined as R5-R1 ≥ 1 mmHg. Result: Number of patients diagnosed with hypertension varied among different guidelines and protocols, we found that this number was significantly altered when comparing different guidelines to the mean of five BP readings as follows: 560 (40.3%) patient as per to ESC (P < 0.001), 518 (37.3%) patient as per to CHEP (p < 0.001), 862 (62%) patients according to new AHA/ACC (p < 0.001). SBP decreased from R1 to R5 in 66% of patients by a mean of 6 mmHg. The decrease was greater in younger subjects (8 mmHg) compared to older patients (4 mmHg, P < 0.001). Sex, age, DM and hypertension significantly affected the SBP pattern. DBP declined in 55% of the population (mean decrease = 3 mmHg). Only hypertension and gender, but not DM or age affected the DBP pattern. The second reading of the SBP was notably higher than the other readings in hypertensive patients, diabetic patients, and older individuals with an average of 3–5 mmHg. Conclusion: Subject characteristics such as age, gender, DM and HTN have an impact on blood pressure which might alter the diagnosis of hypertension. The study suggests that relying on the average of 5 BP measurements is more appropriate as the second reading often shows the greatest divergence based on subject characteristics and because 5 readings reflects an individual's daily life blood pressure variability more closely.

Abstract 137: A Community Initiative to Reduce Blood Pressure in Latinos: The San Antonio AHA Check.Change.Control Initiative

Background: Hypertension remains one of the most important, modifiable cardiovascular risk factors. Yet, the largest minority ethnic group (Hispanics/Latinos) often have different health outcomes and behavior, making hypertension management more difficult. In this study, we explore the effects of one large community-based intervention. Methods and Results: The American Heart Association sponsored an initiative targeted towards Hispanics called the Check.Change.Control program in San Antonio Texas (7 th largest city in the U.S.; nearly 56% Hispanic population). The initiative was funded by a gift from the Max and Minnie Tomerlin Voelcker Fund. There have been 5,800 patients enrolled to-date, and 4,598 have completed the intervention from July 2016 to December 2017. Three ambulatory clinics provided geographic distribution across the region (Figure 1). Patient navigators helped to enroll and follow-up with hypertensive patients (&gt;130 mmHg) over a 90-day period. The first and final BP readings were performed in the physician’s office, and 4 interim measurements were recorded telephonically by provided cuffs for a total of 6 BP readings. The intervention consisted of self-engagement in home BP monitoring, fitness and nutritional counseling sessions, and provider coaching and follow-up. Primary outcomes included BP systolic change between first and last reading, and health-related quality of life assessment. Average patient age was 57 years (±11.7) and 59% were female. Using univariate paired samples pre-post design, we found an average of 6 mmHg reduction in systolic BP across the sample (139 vs. 133, t=10.32, p&lt;.001). Quality of life (EQ- 5D VAS) indicated a mean change after intervention from .80 to .82 (t=31.03, p&lt;.001). Conclusions: Community-based interventions which extends hypertension management outside of the provider’s office can be effective at patient self-engagement and BP reductions for Latino populations. Figure 1: Geospatial Analysis of Study Participants