Changes In Blood Pressure Control Research Articles

Trends in blood pressure control in US adults with hypertension, 2013-2014 to 2021-2023.

Prior studies have reported a decrease in the proportion of US adults with hypertension that had controlled blood pressure (BP). We analyzed data from the National Health and Nutrition Examination Survey (n=25,128, ≥18 years of age) to determine changes in BP control from 2013-2014 to 2021-2023. Hypertension was defined as systolic BP ≥140 mmHg, diastolic BP ≥90 mmHg or antihypertensive medication use. BP control was defined as systolic BP <140 mmHg and diastolic BP <90 mmHg. The age-adjusted prevalence of hypertension (95%CI) was 32.8% (31.2%-34.4%) in 2013-2014 and 32.0% (30.1%-33.9%) in 2021-2023. Among US adults with hypertension, the age-adjusted proportion (95%CI) with controlled BP was 54.1% (49.1%-59.2%), 48.6% (44.5%-52.7%), and 48.3% (45.8%-50.8%) in 2013-2014, 2015-2016 and 2017-2020, respectively (p-trend=0.058), and 51.1% (47.9%-54.3%) in 2021-2023 (p-value=0.184 comparing 2021-2023 versus 2017-2020). The proportion (95%CI) of US adults taking antihypertensive medication with controlled BP was 72.0% (68.5%-75.5%), 66.7% (62.9%-70.5%), and 67.8% (65.3%-70.3%) in 2013-2014, 2015-2016, and 2017-2020, respectively (p-trend=0.085), and 68.3% (64.8%-71.9%) in 2021-2023 (p-value=0.654 comparing 2021-2023 versus 2017-2020). Among non-Hispanic Black adults, BP control increased from 37.4% (95%CI 33.6%-41.1%) to 49.6% (95%CI 42.3%-56.9%) between 2017-2020 and 2021-2023 for those with hypertension (p-value=0.005), and from 52.6% (95%CI 47.4%-57.8%) to 62.6% (95%CI 55.6%-69.7%) for those taking antihypertensive medication (p-value=0.033). There was no difference in BP control across race/ethnicity groups in 2021-2023. The decline in BP control from 2013-2014 to 2017-2020 did not continue through 2021-2023. An increase in BP control occurred from 2017-2020 and 2021-2023 among non-Hispanic Black adults.

Comparison of Effects of Interactive Health Education and Self-Reading Learning on Blood Pressure Control in Hypertensive Patients: A Non-Randomised Controlled Trial

Context/Background: Hypertension is a major contributor to cardiovascular mortality and morbidity worldwide and in India. Educational interventions can create opportunities for patients to better understand their conditions and the role of therapies, as well as heighten awareness about disease progression and complications. This study was conducted to evaluate the effectiveness of an interactive health education program in comparison with self-reading learning on blood pressure control. Methodology: This study was a non-randomised controlled trial, involving 66 hypertensive patients from the eight villages in Kamjong district, Manipur. Participants were allocated to one of the two groups; intervention group (interactive health education) and control group (self-reading learning). Changes in blood pressure, Hypertension-related knowledge, attitude, lifestyle, adherence to medications and anthropometric parameters at three months post intervention from baseline were measured. Data was analysed using SPSS for Windows (Version 26.0). Results: Three months post intervention, intervention group had more knowledge and adherence and better attitude as compared to the control. There was no significant change in the proportion of participants with controlled blood pressure in both the groups. Changes in lifestyle and anthropometric parameters were not significant. Conclusions: Interactive health education is effective in terms of improvement in knowledge about hypertension, adherence to medication and attitude towards hypertension. A longer follow up might be needed to see changes in blood pressure control.

Evaluating the Impact of the Prime Time Sister Circles® Intervention on Reducing Depressive Symptoms Among African American Women with Uncontrolled Hypertension.

The Prime Time Sister Circles®, a randomized controlled trial (PTSC-RCT), assessed the impact of a community-based peer support program on hypertension management among African American women 40-75years of age. While the PTSC-RCT was designed to evaluate changes in blood pressure control, subsequent sub-analyses revealed a high proportion of self-reported depressive symptoms in our sample. Accordingly, we conducted an ancillary investigation of the PTSC intervention on depression to ascertain its impact on reduced depressive symptoms in the study population. Depressive symptoms were measured using an adapted version of the Center for Epidemiologic Studies Depression Scale Revised (CES-D-10). We used unadjusted and adjusted fixed effect models. Data for this study came from the PTSC-RCT. We collected data between 2017 and 2018 in Washington, DC. We used a balanced analytical sample of 172 African American, English-speaking women between 40 to 75years old with uncontrolled hypertension. The intervention group participated in a 2-h, peer-based support group once a week for 13weeks. A trained PTSC facilitator facilitated sessions with experts who delivered content on various topics, including psychosocial wellness (e.g., stress, depressive symptoms, anxiety management, and self-esteem), physical health (e.g., hypertension, inflammation, and heart disease), physical activity, and healthy nutrition. Results from the fixed-effects models indicated that participants in the PTSC program exhibited a greater reduction in CES-D-10 score at three months (Coeff: -1.99, 95% CI: -3.49, -0.49) and at 15months (Coeff: -2.38, 95% CI: -3.94, -0.83), as compared to those in the control group. Evidence suggests that the Prime Time Sister Circles® intervention reduced depressive symptoms among African American women with low socioeconomic status and hypertension. NCT04371614.

Seasonal variation in blood pressure control across US health systems.

We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation. We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures. Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment. In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.

Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System

A higher percentage of non-Hispanic Black (hereinafter, Black) adults vs non-Hispanic White (hereinafter, White) adults with hypertension have uncontrolled blood pressure (BP) contributing to racial and ethnic disparities in cardiovascular disease. In 2010, Kaiser Permanente Southern California began implementing quality improvement (QI) strategies aimed at reducing this disparity. To examine the change in BP control between Black and White patients before and after the implementation of a QI program. A QI quasi-experimental, difference-in-difference analysis was conducted of Kaiser Permanente Southern California patients 18 years or older included in the population care management hypertension registry. The study was conducted from December 31, 2008, to December 31, 2019. Data analysis was performed from November 20, 2020, to November 7, 2022. Quality improvement program implementation began in 2010. Blood pressure control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) was assessed using the last outpatient BP measurement in each calendar year. Changes in BP control between Black and White patients from before (2008-2009) to after (2016-2019) implementation of the QI program were examined using a difference-in-difference analysis. Blood pressure control disparities from 2008 through 2019 by age, sex, race and ethnicity, and factors associated with BP control were examined. The number of patients with hypertension increased from 624 094 in 2008 (mean [SD] age, 61.8 [13.5] years; 330 551 [53.0%] female patients; 89 407 [14.3%] Black and 284 116 [45.5%] White patients) to 855 257 in 2019 (mean [SD] age, 64.5 [13.6] years; 444 422 [52.0%] female patients; 107 054 [12.5%] Black and 331 932 [38.8%] White patients). Blood pressure control increased an absolute 4.6% (95% CI, 4.3%-4.8%) among Black patients and 2.1% (95% CI, 2.0%-2.2%) among White patients from before to after the QI program implementation (difference-in-difference: 2.5%; 95% CI, 2.2%-2.8%). The largest reduction in BP control disparity between Black and White female patients was for those aged 50 to 64 years (difference-in-difference: 3.8%; 95% CI, 3.2%-4.4%) and for those aged 18 to 49 years between Black and White male patients (difference-in-difference: 4.2%; 95% CI, 3.0%-5.5%). The proportion of BP control among Black male patients aged 18 to 49 years was the lowest throughout 2008-2019 compared with male and female patients in other age and racial and ethnic groups. In 2019, uncontrolled BP was more common among Black vs White patients (prevalence ratio: 1.13; 95% CI, 1.12-1.14). This QI program noted that disparities in BP control between Black and White patients were decreased but not eliminated following implementation of QI strategies aimed at reducing disparities in BP control. These findings suggest that more focused interventions may be needed to increase BP control among Black individuals.

PS-P05-5: CHANGES IN BLOOD PRESSURE CONTROL, TARGET ORGAN DAMAGE AND CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVE SUBJECTS UNDER ANTIHYPERTENSIVES DURING 9 YEARS

Objective: Since an increase in blood pressure is one of the most important risk factors for cardiovascular morbidity and mortality, appropriate blood pressure control is necessary to prevent target organ damages and cardiovascular diseases. We investigated changes in blood pressure control, target organ damage and cardiovascular risk factors of hypertensive subjects under antihypertensive medications from 2010 to 2019. Design and Methods: A total of 1679 and 1884 hypertensive subjects under antihypertensive medications (62.8 ± 9.8 and 65.8 ± 9.4 year-old, respectively) who visited our hospital for physical checkup in 2010 and 1019, respectively, were enrolled. Subjects were divided into two groups; controlled (blood pressure &lt; 140/90mmHg) and not-controlled groups (blood pressure &gt; = 140/90mmHg). Target organ damage defined as left ventricular hypertrophy (LVH) on electrocardiogram (Sokolow-Lyon voltage &gt; 3.8 mV and/or Cornell product &gt; 2440 mm ms) or decline of estimated glomerular filtration rate (eGFR; &lt; 60 mL/min per 1.73 m2) and other cardiovascular risk factors were investigated. Results: The results are summarized in the table. Blood pressure control was generally improved during the 9 years though the mean age of subjects was increased. The prevalence of impaired kidney function but not LVH and the number of subjects with risk factors were increased during the period. Sub-analysis in 537 subjects who visited in both 2010 and 2019 were performed and similar results were obtained (data not shown). Conclusions: Although blood pressure control was improved, total management of hypertensive subjects was not appropriate. Management of risk factors other than hypertension as well as blood pressure control is necessary in hypertensive subjects for extension of healthy life expectancy.

Controlling Blood Pressure During a Pandemic: The Impact of Telepharmacy for Primary Care Patients

Introduction: Studies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control. Methods: A retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated. Results: A total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits (P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg (P = .481), medication adherence (P = 1.00), or antihypertensive adverse events (P = .344). Conclusion: Telepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension.

POS-096 ACUTE ONSET SECONDARY HYPERTENSION AND HYPOKALEMIA IN AN ELDERLY PATIENT

Secondary etiologies for hypertension should be suspected in individuals with resistant hypertension, those with early onset hypertension, and those with abrupt changes in blood pressure control. Unprovoked or excessive hypokalemia should also increase suspicion. An important part of the evaluation of these patients is a thorough social history and a comprehensive review of medications and supplements.

Intersectional Discrimination and Change in Blood Pressure Control Among Older Adults: The Health and Retirement Study.

Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished. Participants were 14 582 noninstitutionalized individuals (59% women) in the Health and Retirement Study aged at least 51 years (76% non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the life span. We assessed whether discrimination was associated with a change in measured hypertension status (N = 14 582) and concurrent medication use among reported hypertensives (N = 9 086) over 4 years (2008-2014). There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension 4 years later among men (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.08-1.36) but not women (OR: 0.98, 95% CI: 0.86-1.13). Only among men, everyday discrimination due to at least 2 reasons was associated with a 1.44-fold (95% CI: 1.03-2.01) odds of hypertension than reporting no everyday discrimination, reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95% CI: 0.70-1.20). All 3 discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (eg, OR for everyday discrimination-antihypertensive use associations: 0.85, 95% CI: 0.77-0.94). Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall.

Native nephrectomy in the management of hypertension in children with kidney disease: a tool to improve blood pressure control.

Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension. Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy. During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control. Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension.

Improving Regional Blood Pressure Control: a Positive Deviance Tiered Intensity Approach.

Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities. To determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems. Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017). Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative. Identification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching). We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics. BP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3). Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.

Changes in Hypertension Control in a Community-Based Population of Older Adults, 2011-2013 to 2016-2017.

2014 hypertension guidelines raised treatment goals in older adults. The objective was to examine changes in blood pressure (BP) control (<140/90 mm Hg) from 2011-2013 to 2016-2017 among Black and white older adults with treated hypertension. Participants were 1,600 white and 650 Black adults aged 71-90 years in the Atherosclerosis Risk in Communities (ARIC) Study with treated hypertension in 2011-2013 (baseline) who had BP measured in 2016-2017 (follow-up). Predictors of changes in BP control were examined by race. BP was controlled among 75.3% of white and 65.7% of Black participants at baseline and 59.0% of white and 56.5% of Black participants at follow-up. Among those with baseline BP control, risk factors for incident uncontrolled BP included age (relative risk [RR] 1.15 per 5 years, 95% confidence interval [CI] 1.07-1.25), female sex (RR 1.36, 95% CI 1.16-1.60), and chronic kidney disease (RR 1.19, 95% CI 1.01-1.40) among white participants, and hypertension duration (RR 1.14 per 5 years, 95% CI 1.03-1.27) and diabetes (RR 1.48, 95% CI 1.15-1.91) among Black participants. Among those with uncontrolled BP at baseline, white females vs. males (RR 0.60, 95% CI 0.46-0.78) and Black participants with chronic kidney disease vs. without (RR 0.58, 95% CI 0.36-0.93) were less likely to have incident controlled BP. BP control decreased among white and Black older adults. Black individuals with diabetes or chronic kidney disease were less likely to have controlled BP at follow-up. Higher treatment goals may have contributed to these findings and unintended differences by race.

Effectiveness of Lifestyle and Drug Intervention on Hypertensive Patients: a Randomized Community Intervention Trial in Rural China.

Strict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow. To evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients. Randomized community intervention trial. The control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China. Data on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention. BP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1month to 87.6% at 1year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001). The addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone.

Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older

Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and multimorbidity when the benefits of continued treatment may not outweigh the harms. This study aimed to establish whether antihypertensive medication reduction is possible without significant changes in systolic blood pressure control or adverse events during 12-week follow-up. The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) study was a randomized, unblinded, noninferiority trial conducted in 69 primary care sites in England. Participants, whose primary care physician considered them appropriate for medication reduction, were aged 80 years and older, had systolic blood pressure lower than 150 mm Hg, and were receiving at least 2 antihypertensive medications were included. Participants enrolled between April 2017 and September 2018 and underwent follow-up until January 2019. Participants were randomized (1:1 ratio) to a strategy of antihypertensive medication reduction (removal of 1 drug [intervention], n = 282) or usual care (control, n = 287), in which no medication changes were mandated. The primary outcome was systolic blood pressure lower than 150 mm Hg at 12-week follow-up. The prespecified noninferiority margin was a relative risk (RR) of 0.90. Secondary outcomes included the proportion of participants maintaining medication reduction and differences in blood pressure, frailty, quality of life, adverse effects, and serious adverse events. Among 569 patients randomized (mean age, 84.8 years; 276 [48.5%] women; median of 2 antihypertensive medications prescribed at baseline), 534 (93.8%) completed the trial. Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had a systolic blood pressure lower than 150 mm Hg at 12 weeks (adjusted RR, 0.98 [97.5% 1-sided CI, 0.92 to ∞]). Of 7 prespecified secondary end points, 5 showed no significant difference. Medication reduction was sustained in 187 (66.3%) participants at 12 weeks. Mean change in systolic blood pressure was 3.4 mm Hg (95% CI, 1.1 to 5.8 mm Hg) higher in the intervention group compared with the control group. Twelve (4.3%) participants in the intervention group and 7 (2.4%) in the control group reported at least 1 serious adverse event (adjusted RR, 1.72 [95% CI, 0.7 to 4.3]). Among older patients treated with multiple antihypertensive medications, a strategy of medication reduction, compared with usual care, was noninferior with regard to systolic blood pressure control at 12 weeks. The findings suggest antihypertensive medication reduction in some older patients with hypertension is not associated with substantial change in blood pressure control, although further research is needed to understand long-term clinical outcomes. EudraCT Identifier: 2016-004236-38; ISRCTN identifier: 97503221.

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure

Introduction: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients’ compliance with treatment and, thus, clinical outcomes. Objective: We aimed to evaluate the clinical outcomes of patients with a remote access program. Methods: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and health-related quality of life during the 6 months of follow-up. Results: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500–1,000] and 752 mL [490–986] vs. 824 mL [537–1,183]). The daily antihypertensive pill need (4 [0–7] vs. 2 [0–6]) and alarms received from the device decreased (from 4 [3–8] to 2 [0–3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months. Conclusion: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs.

Management of patients with type 2 diabetes mellitus in the Grand-Aides Program

Objective: To evaluate the Grand-Aides Program for patients with type 2 diabetes mellitus (T2DM) according to the variables of body weight, blood pressure, medication adherence, and hospital consultation and readmissions.Methods: Patients ages 18 years or older with a past medical history of T2DM, hypertension (HTN), and/or obesity and who were recently seen in the emergency department (ED) or recently admitted to the hospital were eligible to enroll in the Grand-Aides Program. Eligible patients were identified after hospital or ED discharge and were asked to enroll in the in-home based program from March 2016 through June 2018. In-home visit protocol was defined prior to patient enrollment with intense in-home visits during the first weeks of enrollment followed by monthly visits for the duration of enrollment in the program. In-home visit frequency was adjusted on as needed basis so that patients at higher risk for ED visits or hospitalization were seen more frequently. In-home visits were performed by trained Grand-Aide who for the purpose of this study was a certified nursing assistant (CNA). The Grand-Aide underwent eighty hours of didactic training which included visit protocols, visit schedules, and data collection. The one-on-one in-home patient with every visit were supervised by a registered nurse (RN) or nurse practitioner (NP) via video or telephone contact near the conclusion of the visit. Active patients at the University of Virginia Family Medicine clinic were eligible for enrollment. Fifty-seven patients with T2DM worked with Grand-Aides for three months and an additional forty-eight T2DM patients worked with Grand-Aides for twelve months. Emergency department visits, all 30-day hospital readmissions, as well as blood pressure readings, medication adherence, weights, and glycated hemoglobin (HbA1c) were compared with the prior twelve months.Results: Systolic (p &lt; .001) and diastolic (p &lt; .01) blood pressures decreased (p &lt; .01) at 1 year. At baseline 56 percent of the patients had a systolic blood pressure of &gt;130 mmHg despite treatment; after 12 months, 48 percent of these were &lt; 130. In those whose baseline diastolic blood pressure was &gt; 90 mmHg, 100 percent had diastolic blood pressure &lt; 90 mmHg at 1 year. Medication adherence by ARMS test at 1 year was 94 percent. Despite trending downward, weight and HbA1c did not change significantly. In the preceding, 58 percent had at least one ED visit, which was reduced by 50 percent (p &lt; .01) with Grand-Aides; 30-day all-cause readmissions reduced by 50 percent to 6.3 percent. Conclusions: The Grand-Aides program was associated with a significant change in blood pressure control, high medication adherence and reductions in ED visits and readmissions that compare favorably with published comparative data. For systems “at risk” for preventable increased health care expense burden, the Grand-Aides program can result in significant savings.

The Role of Pharmacist in Managing Hypertension in the Community: Findings from a Community Based Study

Abstract: Introduction: Pharmacist led health education programs have been initiated to improve Blood Pressure (BP) control in the community and patients’ knowledge on a disease and therapy, lifestyle changes and medication adherence among hypertensive patients. This study aimed to evaluate pharmacist led health education program among hypertensive patients, in local community-based setting, by assessing the changes in blood pressure control, beliefs about medicine, antihypertensive medications adherence and quality use of medication. Methods: This study was prospective convenient sampling, with communitybased health education study involving 45 participants at the Community Service Hall in Bukit Mertajam, Penang, Malaysia. Participants received health education program over 4 months period: Introduction of hypertension, pharmacological management of hypertension, quality use of medication and diet and lifestyle changes. Outcomes included the changes Blood Pressure (BP) level, Malaysian Medication Adherence Assessment (MALMAS), Beliefs about Medicines Questionnaire (BMQ) and Quality Use of Medication (QUM). Results: Both systolic BP (146.6 ± 11.1 mmHg, P<0.001) and diastolic BP (87.6 ± 9.6 mmHg, P=0.002) decreased significantly after the 2-months intervention. Systolic BP was successfully reduced significantly to 140.1 ± 10.7 mmHg (P<0.001) after the 4-months intervention. Medication adherents increased significantly from baseline (29.3%) to 2-months interventions (58.5%, P=0.005) and 4-months interventions (70.7%, P<0.001). Significant improvement was also noticed in BMQ and QUM. Conclusion: Pharmacist led health education program has significantly desirable effects on improvement of blood pressure, better beliefs about medicine, improvement of medication adherence and better rational use of medication Key words: Pharmacist led education program, Hypertension, Medication adherence, Beliefs about medicine, Quality use of medication.

OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE): protocol for a randomised controlled non-inferiority trial

IntroductionRecent evidence suggests that larger blood pressure reductions and multiple antihypertensive drugs may be harmful in older people, particularly frail individuals with polypharmacy and multimorbidity. However, there is a lack...

Abstract P195: Digital Health Tool Use and Outcomes in People With Uncontrolled Hypertension

Background: Digital health applications are increasingly ubiquitous, however the effectiveness remains mixed. Using a large working age cohort we sought to evaluate use of a digital health intervention (DHI) in people with uncontrolled hypertension and their changes in blood pressure control. Methods: We analyzed usage of DHI and change in blood pressure control and other CVD risk factors over one year in 9,724 participants of a work health program across 81 organizations in 42 states. Patients were selected from a larger cohort based on a previous ICD-9 diagnosis of hypertension. Patients with uncontrolled hypertension, systolic blood pressure (SBP) greater than 140 mmHg, at the initial visit were included. Application users, defined as at least one login, were compared to non-users. Changes in blood pressure, weight, and lipids were compared at one year. Results: Users and non-users were similar in age, weight, blood pressure and lipids at baseline, though users were more likely to be female. At one year users had 16.44 mmHg reduction in SBP and 7.16 mmHg reduction in diastolic blood pressure (DBP), both statistically significantly more than non-users (Table 1). Both users and non-users had an improvement in LDL from baseline, while non-users also had an improvement in BMI and TG from baseline. Discussion: These results show that the use of a DHI is associated with improved systolic and diastolic blood pressure control compared to a workplace health program alone.

Abstract P183: Minimal Impact of JAMA 2014 Guidelines on Blood Pressure Control in a Large Health System

Background: JAMA 2014 blood pressure (BP) guidelines raised BP goals for adults older than 60 years (from &lt;140/90 to &lt;150/90) and adults with chronic kidney disease (CKD) or diabetes (from &lt; 130/80 to &lt;140/90). It is unknown whether there were changes in BP control at the health system level after guideline publication. Methods: Using data from 288,962 adults receiving primary care in the Geisinger Health System, we compared blood pressure control over 1-year time periods before and after the February 2014 publication of the JAMA 2014 BP guidelines (i.e. Aug 2012-July 2013 vs Aug 2014-July 2015). Mixed effects models were used, allowing intercepts to vary by individual, adjusted for age, gender, and race. Results: Mean age was 49.2 ± 18.3 y, 56.7% were female, and 2.5% were black. Prevalence of diagnoses for hypertension, diabetes, and CKD were 40.0%, 15.1%, and 11.4%, respectively. Overall, distributions of systolic BP were similar before and after JAMA 2014 BP guidelines (Figure). BP control &lt;140/90 was also similar between the two periods for adults 18-59 y (90.9% vs. 90.3%; OR 1.01, 95% CI: 0.99-1.02; p=0.3), adults ≥ 60 y (81.8% vs 82.2%; OR 1.01, 95% CI: 1.00-1.03; p=0.05), and adults with diabetes (83.2% vs. 82.7%; OR 1.00, 95% CI: 0.99-1.02; p=0.7) whereas BP control &lt;140/90 improved slightly for adults with CKD (81.7% vs. 82.1%; OR 1.06, 95% CI: 1.04-1.08; p&lt;0.001). BP control &lt;130/80 was marginally worse after JAMA 2014 BP guidelines in patients with diabetes (53.5% vs. 51.8%; OR 0.98, 95% CI: 0.96-0.99; p=0.01). Trends were similar in analyses only including patients with hypertension diagnoses (overall 78.6% vs. 78.2%, OR 1.00, 95% CI: 0.99-1.02; p=0.5), and when using a goal of &lt; 130/80 for patients with CKD (53.3% vs. 53.5%; OR 1.06, 95% CI: 1.04-1.08; p&lt;0.001). Conclusion: There was little change in blood pressure control in a large integrated health system after publication of the JAMA 2014 BP guidelines. These findings are reassuring given recent findings from the SPRINT trial supporting lower BP goals.