Control Of Hypertension In Patients Research Articles

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.

Seasonal variation in ambulatory blood pressure control in patients on clinic blood pressure-guided antihypertensive treatment.

We investigated seasonal variation in ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided antihypertensive treatment. The study participants were hypertensive patients enrolled in an 8-week therapeutic study. Antihypertensive treatment was initiated with long-acting dihydropyridine calcium channel blockers amlodipine 5 mg/day or the gastrointestinal therapeutic system (GITS) formulation of nifedipine 30 mg/day, with the possible up-titration to amlodipine 10 mg/day or nifedipine-GITS 60 mg/day at 4 weeks of follow-up. The proportion of up-titration to higher dosages of antihypertensive drugs at 4 weeks of follow-up was higher in patients who commenced treatment in autumn/winter ( n = 302) than those who commenced treatment in spring/summer ( n = 199, 24.5 vs. 12.0%, P < 0.001). The control rate of clinic blood pressure, however, was lower in autumn/winter than in spring/summer at 4 (56.7 vs. 70.7%, P = 0.003) and 8 weeks of follow-up (52.5 vs. 74.9%, P < 0.001). At 8 weeks, patients who commenced treatment in autumn/winter, compared with those who commenced treatment in spring/summer, had a significantly ( P ≤0.03) smaller daytime (mean between-season difference -3.2/-2.8 mmHg) but greater nighttime SBP/DBP reduction (3.6/1.6 mmHg). Accordingly, at 8 weeks, the prevalence of nondippers was significantly ( P < 0.001) higher in spring/summer than in autumn/winter for both SBP (54.8 vs. 30.0%) and DBP (53.4 vs. 28.8%). Clinic blood pressure-guided antihypertensive treatment requires a higher dosage of medication in cold than warm seasons, which may have led to over- and under-treatment of nighttime blood pressure, respectively.

Impact of exercise modalities on blood pressure control in hypertensive patients

Hypertension poses a significant health burden, necessitating effective interventions to manage blood pressure and mitigate associated cardiovascular risks. Exercise has emerged as a cornerstone non-pharmacological strategy in the management of hypertension. This comprehensive review synthesizes current evidence regarding the impact of various exercise modalities on blood pressure regulation in hypertensive individuals. The review commences by elucidating the physiological mechanisms underpinning exercise-induced blood pressure alterations, highlighting factors influencing blood pressure responses during different exercises. It delineates the differential impacts of aerobic and resistance training, examining their effectiveness in blood pressure reduction among diverse populations, considering age, fitness levels, and comorbidities. Moreover, the review explores the emerging prominence of high-intensity interval training (HIIT), showcasing its unique effects on blood pressure regulation and cardiorespiratory fitness improvement compared to traditional continuous aerobic exercises. Additionally, alternative mind-body exercises, including tai chi, qigong, and mindfulness-based interventions, are investigated for their potential to influence blood pressure levels among hypertensive populations. Furthermore, the review identifies novel exercise approaches such as deep breathing exercises and multi-modal isometric exercise training (MIET) as promising strategies for blood pressure control in hypertensive individuals, emphasizing their potential benefits and implications for tailored exercise prescriptions.

PENGARUH TELEHEALTH TERHADAP PENGENDALIAN TEKANAN DARAH

Hypertension is a chronic condition that attacks adults of all ages. Having an effective method or way to manage this condition is the key to successful treatment of hypertension. The design of this research is a cohort study that examines data on hypertensive patients obtained from health service databases. The research took place in October until December 2021. The inclusion criteria in this study were adults (≥45 years) with prehypertension and hypertension, residing in rural areas. An assessment was carried out on respondents who could access the telehealth application at home, and it was validated for monitoring blood pressure using mobile phone or other device with an internet connection that allows monitoring from the respondent's home and telehealth services. Respondents were asked to fill in the results of blood pressure measurements. Based on the results, 55 respondents (100%) carried out data collection. Linear regression analysis found an average reduction in systolic blood pressure of 19.2 mmHg. Respondents in the decreasing systolic blood pressure group had a higher frequency of self-measured blood pressure monitoring (OR = 0.85; 95% CI= 0.81 - 0.89; p = 0.002) than other patients. The use of telehealth at home combined with care management by health workers is considered effective in improving blood pressure control in hypertensive patients.

Adherence to ESC guidelines for antihypertensive drug therapy: real-world survey from an EU country

Abstract Background Achieving optimal BP control in hypertensive patients (pts) remains a continuous challenge worldwide. Multiple factors are responsible for the low rates of BP control with suboptimal drug choice playing a key role. Practice guidelines should serve as evidence based foundation for optimal antihypertensive drug therapy but their impact in the real-world is variable. Purpose This retrospective study aimed: 1. To assess the prescription pattern of main classes of antihypertensive drugs and its association with comorbidities. 2. To compare prescription before and after the publication of the 2018 ESC/ESH guidelines for management of arterial hypertension, translated into local language (in 2019). Thus, prescriptions in the years 2018 and 2020 were compared. Dual combination of ACEi/ARB + CCB/thiazide-like diuretics (THI) or triple combination of ACEi/ARB + CBB + THI were considered as guidelines directed first line drugs (FLAD) i.e. adherence to guideline. Spironolactone (MRA) was considered as recommended drug for patients requiring ≥4 drugs. Methods We analysed prescribed drug therapy in a large patient cohort from the years 2018 and 2020 with 264 237 and 272 934 hypertensive pts, respectively. Pts were considered hypertensive after meeting at least one of two criteria: 1. Having been prescribed ≥ 121 standard drug doses of antihypertensive drugs in the year before the studied period. 2. Having at least 2 medical visits with the diagnosis of hypertension within 2 years before the studied period. Following comorbidities were considered as potential modifiers of drug therapy: ischemic heart disease (IHD), chronic heart failure (CHF), atrial fibrillation (AF), diabetes (DM) and chronic kidney disease (CKD). Results Overall, first line therapy was prescribed to 21.5% and 22.4% of pts in the year 2018 and 2020, respectively (p&amp;lt;0.0001). In pts taking ≥3 drugs 30.4% did not use THI, in those taking ≥4 drugs only 10.7% used spironolactone (MRA). Selected results are in the attached table. Conclusion Adherence to guideline recommended FLAD in this large survey improved but remained low during the first year after publishing ESC 2018 guidelines: only 22.4% of pts received FLAD in this cohort where 58.6% were free of comorbidities. In pts with AF, the use of FLAD was the lowest with 7.3%. Preferred use of BB and low use of THI and MRA were mostly behind this trend. BB (alone or in combination) were the most prescribed drug group – to 57.3% of pts both in 2018 and 2020. Their prescription was high in all pts with comorbidities, notably worrisome for diabetic pts (66.0%). Continuous efforts to improve dissemination of knowledge of FLAD according to guidelines appear mandatory.Attached table

Effectiveness of Valsartan's Single-Pill Combination Therapies on Blood Pressure Control in Hypertensive Patients: Malaysian Single-Centre Real-World Experience.

Uncontrolled hypertension can cause cardiovascular disease and is an important public health issue. Single-pill combination (SPC) therapies possess combined blood pressure (BP)-lowering effect and may improve compliance to treatment. This study assessed the effectiveness of valsartan (Val)-based SPC therapies in achieving BP control in hypertensive patients. This was a retrospective study. Data were extracted from the hybrid medical records of patients from the Institut Jantung Negara (IJN), Malaysia. Adults with established diagnosis of hypertension and on prescription of Val-based SPC therapies as part of routine medical care from 1 January 2013 to 31 December 2018, with ≥ 1 year of follow-up were included. Primary endpoint was proportion of patients achieving therapeutic BP control (BP < 140/90 mmHg). Secondary outcomes included change from baseline (CFB) in systolic BP (SBP) and diastolic BP (DBP), and subgroup analysis was based on baseline SBP categories and presence of diabetes. Study included 409 hypertensive patients. The mean (standard deviation [SD]) age of the population was 65.1 (10.6) years old, with male predominance (61.6%). Proportion of patients achieving target BP between baseline and follow-up were 57.0% (P < 0.001). Mean CFB in SBP and DBP were recorded as 19.52 mmHg and 7.47 mmHg, respectively. Over half of the patients achieved the target BP in all subgroups categorised by SBP at baseline, except the subgroup of SBP 160 mmHg-179 mmHg. SPC therapies were continued in 97.3% of patients at 1-year follow-up. Patients using Val-based SPC therapies had significant reduction in BP with good tolerability, with 57% of patients achieving target BP over a prolonged 1-year follow-up period. Uptake of SPC therapy is warranted to improve patient care and outcomes in hypertension.

Evaluation of the effectiveness of personal electronic health assistants in monitoring patients with chronic diseases

Introduction: Chronic diseases pose significant challenges in healthcare, which has driven the development of electronic health solutions. The effectiveness of these solutions in the management of diseases such as hypertension has generated interest, but further in-depth, evidence-based evaluation is required.Objective: The study aims to comprehensively evaluate how a customizable web platform, called "HyperVigilance", influences blood pressure control in hypertensive patients, considering additional variables such as patient satisfaction, quality of life and costs associated with treatment. In addition, the aim is to explore possible demographic factors that could moderate the results.Methodology: The study was conducted with a quasi-experimental research design that included an intervention group using the "HyperVigilance" platform and a control group receiving standard medical care. Statistical tests were applied and demographic factors such as age, gender and socioeconomic status were considered.Results: The use of the "HyperVigilance" platform resulted in a significant reduction in blood pressure, increased patient satisfaction and a marked improvement in quality of life, as well as a reduction in the costs associated with the treatment of hypertension.Conclusions: The study concludes that the "HyperVigilance" platform is effective in controlling blood pressure and improving quality of life in patients with hypertension. The results support the growing role of digital interventions in chronic disease management, but highlight the need for long-term studies and exploration of different populations for a more complete understanding of their impact.

THU568 The Impact of Surgical versus Medical Therapy on Renin Plasma Activity, Renal Function, and Hypertension Control in Patients with Primary Aldosteronism

Abstract Disclosure: S. Rolak: None. N. Venkatesan: None. R. Gregg Garcia: None. W.F. Young: None. I. Bancos: None. Background: Bilateral primary hyperaldosteronism (PA) is treated with mineralocorticoid receptor antagonist (MRA) therapy. However, the best way to monitor the success of MRA therapy is unclear. Aims: To compare the impact of curative adrenalectomy versus MRA therapy in patients with PA on plasma renin activity (PRA), renal function, and hypertension control. Methods: Single center retrospective study of patients with unilateral PA treated with adrenalectomy or bilateral PA treated with MRAs, 2017-2021. Patients underwent adrenal vein sampling to confirm laterality. Hypertension control was defined based on blood pressure measurements and the standardized hypertension daily dose (HDD). Minimum follow-up was defined as first nonsuppressed PRA or &amp;gt;1 month from therapy. Results: Of 73 patients, 53 underwent unilateral adrenalectomy for unilateral PA (median age 57, range 25-71 years, 36% women) and 20 had bilateral PA treated with MRA (median age 49, range 30-70 years, 70% women). At baseline, when compared to the bilateral PA, patients with unilateral PA had higher plasma aldosterone concentrations (median 31 ng/dL vs 19 ng/dL, P= 0.001), similarly suppressed PRA, and similar estimated glomerular filtration rate (eGFR). Uncontrolled hypertension (&amp;gt;130/90 mmHg) was seen in 40 (75%) of patients with unilateral PA and 14 (70%) patients with bilateral PA, despite a more intensive antihypertensive regimen in unilateral PA (median HDD 5, range 1-18 vs median HDD 3.5 in bilateral PA, range 0.5-9; P=0.016). Hypokalemia was present in 50 (94%) patients with unilateral PA and 15 (75%) in bilateral PA, P = 0.02.Following treatment, hyperkalemia developed in 10 (19%) patients post-adrenalectomy and in 2 (10%) patients treated with MRAs, P = 0.36. At a median follow up of 108 days, 24 (45%) patients treated with adrenalectomy and 16 (80%) patients treated with MRAs demonstrated PRA &amp;gt;1.5 ng/mL/hr, P = 0.008. eGFR decreased by at least 10 points in 15 (30%) patients treated with adrenalectomy vs in 11 (59%) patients treated with MRAs (P=0.033). Post-adrenalectomy, antihypertensive management lessened by a median of 2.5 HDD, while HDD increased in patients treated with MRAs by a median of 1.25, P&amp;lt;0.0001. Hypertension control improved, with a mean decrease in systolic blood pressure of -11 mmHg (95%CI -16.5-(-5.5)) without between group differences. Diastolic blood pressure decreased by a mean of -4.7 mmHg (95%CI -8.7-(-0.7)) in the adrenalectomy group but did not change in those treated with MRAs. Conclusions: Following curative adrenalectomy in unilateral PA, more than half of patients continue to have suppressed PRA. Despite less severe PA at baseline, patients treated with MRAs, as compared to those treated with adrenalectomy, demonstrate a higher prevalence of non-suppressed PRA, lower eGFR, similar hypertension control, and a more intense antihypertensive regimen during follow up. Presentation: Thursday, June 15, 2023

Metabolomic Profile, Plasmatic Levels of Losartan and EXP3174, Blood Pressure Control in Hypertensive Patients and Their Correlation with COVID-19.

Systemic arterial hypertension (SAH) is one of the most prevalent chronic diseases worldwide and is related to serious health complications. It has been pointed out as a major risk factor for COVID-19. This study aimed to determine the impact of COVID-19 on the metabolomic profile, the correlation with the plasmatic levels of losartan and its active metabolite (EXP3174), biochemical markers, and blood pressure (BP) control in hypertensive patients. 1H NMR metabolomic profiles of hypertensive and normotensive patients with and without previous COVID-19 diagnosis were identified. Plasmatic levels of LOS and EXP3174 were correlated with BP, biochemical markers, and the metabolomic fingerprint of the groups. Biomarkers linked to important aspects of SAH and COVID-19 were identified, such as glucose, glutamine, arginine, creatinine, alanine, choline, erythritol, homogentisate, 0-tyrosine, and 2-hydroxybutyrate. Those metabolites are indicative of metabolic alterations, kidney damage, pulmonary dysfunction, and persistent inflammation, which can be found in both diseases. Some hypertensive patients did not reach the therapeutic levels of LOS and EXP3174, while the BP control was also limited among the normotensive patients with previous COVID-19 diagnoses. Metabolomics proved to be an important tool for assessing the effectiveness of losartan pharmacotherapy and the damage caused by SAH and COVID-19 in hypertensive patients.

Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events.

Chronic pressure overload determines functional and structural alterations, leading to hypertension-mediated organ damage (HMOD), affecting multiple districts. We aim at evaluating the prognostic impact of the absence vs. presence of HMOD in one or more sites and of blood pressure (BP) and metabolic control in hypertensive patients. The study included 7237 hypertensive patients from the Campania Salute Network Registry, followed up for 5.3 ± 4.5 years. As HMOD, we analysed the presence of left ventricular hypertrophy, carotid plaques, and chronic kidney disease (CKD-EPI ≥3 stage) and evaluated the impact of zero vs. one vs. two vs. three sites of HMOD on the occurrence of major adverse cardiovascular events (MACEs). Blood pressure control and Metabolic Score for Insulin Resistance (METS-IR) were also considered. Optimal BP control was achieved in 57.3% patients. Major adverse cardiovascular events occurred in 351 (4.8%) patients. The MACE rate in patients without HMOD was 2.7%, whereas it was 4.7, 7.9, and 9.8% in patients with one, two, and three sites with HMOD, respectively. By using Cox multivariate models, adjusted for age, BP control, mean heart rate, mean METS-IR, number of HMOD sites, and drugs, MACE was found to be significantly associated with ageing, mean METS-IR, anti-platelet therapy, and multiple sites with HMOD, whereas a negative association was found with renin-angiotensin system inhibitor drugs. In hypertensive patients, the risk of MACE increases with the incremental number of districts involved by HMOD, independent of BP control and despite the significant impact of metabolic dysregulation. Hypertension-mediated organ damage involving multiple sites is the deleterious consequence of hypertension and dysmetabolism but, when established, it represents an independent cardiovascular risk factor for MACE occurrence.

Effects of blood pressure and antihypertensive drugs on osteoarthritis: a mendelian randomized study

BackgroundPrevious studies have suggested that antihypertensive drugs may play a role in the treatment of osteoarthritis, but these studies may be limited by confounding factors and lead to biased results. Therefore, we conducted a Mendelian randomization study to investigate the effects of blood pressure and antihypertensive drugs on osteoarthritis.MethodsWe used published large-scale genome-wide association data and applied univariate and multivariate Mendelian randomization methods. The main analysis model was inverse variance weighting, and the reliability of the results was tested using MR-Egger intercept analysis, Cochran's Q test, and leave-one-out analysis. We comprehensively evaluated the relationship between systolic blood pressure, diastolic blood pressure, 12 antihypertensive drugs, and osteoarthritis. We also conducted verification in the independent queue of UK Biobank and built a simple linear regression model to obtain an independent comparison.ResultsWe found no evidence that systolic and diastolic blood pressure significantly affected osteoarthritis. However, among antihypertensive drugs, we observed a significant positive correlation between potassium-preserving diuretics and aldosterone antagonists and all osteoarthritis (OR: 0.560, 95% CI 0.406–0.772, P = 0.0004). Sensitivity analysis showed no horizontal pleiotropy or heterogeneity, and the leave-one-out analysis demonstrated the reliability of the results. This result was replicated with nominally statistical significance in the validation cohort and exhibited significant correlation in the linear regression analysis.ConclusionsOur study suggested that controlling the protein targets of potassium-sparing diuretics and aldosterone antagonists may have beneficial results for osteoarthritis. These findings provide valuable medication strategies for the control of hypertension in patients with osteoarthritis.

HUBUNGAN KEPATUHAN MINUM OBAT TERHADAP KONTROL TEKANAN DARAH PASIEN HIPERTENSI DI PUSKESMAS MANGGIS PROVINSI BALI

Hypertension is a chronic disease that requires long-term treatment. This has an impact on the size of national health financing. In an effort to anticipate costs related to complications, it is necessary to evaluate treatment adherence in the short and long term. This study aims to analyze the relationship between medication adherence and blood pressure control as a short-term outcome of hypertension management at the primary care level. The research method uses a cross sectional design. The research was conducted at the Manggis Health Center with a total sample of 32 people. The sampling technique used is purposive sampling. The measurements used demographic questionnaires, observation sheets for blood pressure checks, and the MMAS-8 questionnaire in Indonesian. Statistical test resultsusing Chi square found p = 0,016 (p&lt;0,05) so there is a relationship between medication adherence and blood pressure control in hypertensive patients. The therapeutic effect of ACE inhibitor and calcium channel blocker directly make the blood vessels relax and wider. The characteristics of hypertensive patients at the Manggis Health Center are mostly the elderly population, women, most do not smoke, and do not have comorbid diabetes. However, proactive prognosis projection is needed. The conclusion in this study is that there is a relationship between medication adherence and blood pressure control in hypertensive patients at the Manggis Health Center.&#x0D;

The Relationship Between Knowledge and Long Suffering from Hypertension with Low-Salt Diet Control for Hypertension Patients at the Antang Makassar Health Centre

Hypertension at a young age should not be underestimated because of its increasing prevalence so it is necessary to do prevention early, especially related to low-salt diet control. Public knowledge about a low-salt diet to lower blood pressure is still minimal even though a low-salt diet is very necessary because high salt intake can be detrimental to health, especially in the cardiovascular system. Purpose: The purpose of this study was to know the relationship between knowledge and duration of suffering from hypertension with low-salt diet control in patients with hypertension in the Working Area of Antang Health Center Makassar City. This study used quantitative research methods with a cross sectional study research design. Sampling using purposive sampling with the number of samples obtained as many as 50 respondents. Data were collected using knowledge, long suffering, and low-salt diet control questionnaires. Data analysis using SPSS 24 with chi square statistical test found a relationship between knowledge of low-salt diet control with a value of ρ=0.001&lt;α=0.05, and no relationship between the length of suffering from hypertension to low-salt diet control with a value of ρ=0.000&lt;α=0.48. The conclusion in this study is that there is a relationship between knowledge and low-salt diet control in hypertensive patients and there is no relationship between long suffering from hypertension and low-salt diet control at Antang Health Center Makassar City. It is expected that people with hypertension can control a low-salt diet as one way to prevent an increase in blood pressure. For nurses, it is expected to provide information or health education about low-salt diet control in people with hypertension. Keywords: Hypertension, Knowledge, long suffering from hypertension, Low Salt Diet Control

BLOODLETING ON EAR APEX FOR ARTERIAL BLOOD PRESSURE CONTROL IN DENTAL PATIENTS. A CASE SERIES

Objective: Evaluate the effectiveness of blood pressure control in hypertensive patients using bloodletting on ear apex technique before tooth extraction. Methods: This observational prospective case series carried out on 65 volunteers who needed simple tooth extraction and had blood pressure above 140 / 90mmHg. The blood pressure measurement occurred 5 minutes after the baseline and after bleeding. Subsequently, the blood pressure measurement occurred in three moments: 15 minutes after bleeding, after anesthesia, and at the end of the procedure. Results: There were significantly more successes than failures. Every patient who presented successful results had the pressure remained at the recommended levels after anesthesia and at the end of the procedure. Also, there was sex influence with higher failure rates in men. Conclusion: The bloodletting on ear apex technique reduced the blood pressure satisfactorily in most cases, remaining at the recommended mean levels even when verified after anesthesia and at the end of the procedure.

Hypertension Control in Patients Attending Outpatient Department: A Hospital Based Study from Lumbini Province Nepal

Background: Systemic hypertension is major public health problem. It is easy to diagnose and initiate treatment. But still it remains under detected, undertreated and less well controlled throughout the world. We wanted to know control of hypertension in patients attending outpatient department in a cardiac center. Methods: This is a cross-sectional observational study conducted at Gautam Buddha Community Heart Hospital. One hundred newly detected hypertensive patients attending outpatient department were evaluated in this study. Results: Distribution of patients was males 56% and females 44%. Most patients (55%) were in the age group 45 to 65 years. Headache (42%) and dizziness (39%) were common symptoms at presentation. Majority of hypertensive pa-tients had blood pressure range 140 to 160 SBP (49%) and 90 to 100 DBP (56%). Hypertension control target reached in 69% for SBP and 90% for DBP at one month. Target blood pressure was present in 82% for SBP and 84% for DBP at three months follow up. Conclusion: Hypertension management in short term appears promising but long term control is more important to prevent complications. So long term fol-low up study or national registry database is important.

THE IMPACT OF OBESITY ON THE CONTROL OF TREATED HYPERTENSIVE PATIENTS

Objective: Obesity is as a risk factor for hypertension, but there are few studies evaluating its impact on the response to antihypertensive drug and on the control of hypertensive patients. The aim of our study was to determine the effect of obesity on the control of treated hypertension. Design and method: We analyzed recordings of ambulatory blood pressure measurement (ABPM) in 84 treated hypertensive patients aged &gt; 18 years, in the cardiology department of Mohamed Taher Maamouri University hospital in Nabeul. Patients were stratified into two groups: obese (Body Mass Index (BMI) &gt;30 kg/m2) and non-obese. Hypertension control is defined by 24-hour ambulatory blood pressure (BP) = &lt; 130/80 mmHg, daytime = &lt; 135/85 mmHg and nighttime = &lt; 120/70 mmHg. The comparisons of percentages were carried out by the Chi-square test. Results: Our Population was composed of 33 obese and 51 non-obese patients. The mean age of our population was 59.37±13.1 years. BMI in obese was significantly higher than in non-obese (34.47±5.4 versus 25.36±2.5; p&lt;0.001). The prevalence of uncontrolled patients was significantly higher in obese patients detected in 24-hour ABPM (75.8% versus 51%; p = 0.039), in daytime ABPM (69.7% versus 41.2%; p = 0.014) and in night-time ABPM (90.9% versus 68.6%; p = 0.018) than in normal weight patients. Conclusions: Prevalence of uncontrolled hypertension was higher with higher BMI values. The level of blood pressure control in our sample remains relatively insufficient. To achieve a better control of hypertension, we must insist on therapeutic compliance and on the correction of risk factors, particularly obesity, which is significantly associated with an increase in BP.

PREVALENCE, COMORBIDITIES AND CONTROL OF HYPERTENSION IN A WEST AFRICAN PERI-URBAN POPULATION

Objective: In sub-Saharan Africa, hypertension has become a major public health problem that contributes to the increase in premature deaths in this region. The objective of this survey was to investigate comorbidities and determine the level of hypertension control in hypertensive patients in a West African population Design and method: This cross-sectional survey concerned adults aged 18 and over and was conducted in a peri-urban population in West Africa (Côte d’Ivoire). Sociodemographic data (age, sex, marital status, education level, occupation) were collected. A history of diabetes and hypertension was sought. Lifestyle data (tobacco and alcohol consumption) and some cardiovascular risk factors were collected. Blood pressure was measured with an OMRON M6 electronic blood pressure monitor in the sitting position after 5 minutes of rest. Capillary blood glucose was measured with a glucometer in fasting participants. Weight was measured by a scale and catch on the identity document. Hypertension was defined as systolic blood pressure greater than or equal to 140 mm Hg and/or diastolic blood pressure greater than or equal to 90 mm Hg and/or antihypertensive treatment during Results: Three hundred and eighty (380) people were surveyed, 39.8% were men and 60.2% women. The average age was 40.4 ± 13.8 years. The 35-44 age group represented more than a quarter of the population. The mean systolic blood pressure was 128.6 ± 25.3 mmHg. The mean diastolic blood pressure was 80.6 ± 13.7 mmHg. The prevalence of hypertension was 39.2%, more than half of the population were women. Hypertension affected 41.6% of men and 58.4% of women; women were more hypertensive than men (p = 0.03). Among those with known hypertension, 31.6% had controlled blood pressure. The prevalence of diabetes was approximately 10%. Nine percent (9%) of individuals had both hypertension and obesity and less than two percent had the comorbidity hypertension, diabetes, and obesity. Conclusions: In this African population, less than half of the hypertensive individuals had their blood pressure controlled. The focus should be on awareness to avoid complications

Dampak Implementasi Pembayaran Berbasis Kinerja (Pay-For-Performance) Pada Fasilitas Kesehatan Tingkat Pertama (FKTP) Terhadap Kualitas Layanan Kesehatan Di Berbagai Negara

The pay-for-performance (P4P) mechanism is a strategy in the health sector to increase the availability, quality and utilization of health services. In P4P, incentives are given after achieving a series of agreed outcomes by improving the performance of health workers in health facilities. This literature review was conducted with the aim of knowing the impact of implementing pay-for-performance at primary care (FKTP) on the quality of health services in various countries. The method is carried out by searching several databases, namely Pubmed, Embase, and Proquest with the main intervention being the implementation of pay-for-performance. The results of the review focused on the impact of implementing pay-for-performance at First Level Health Facilities on the quality of health services in various countries. From this study it can be concluded that pay-for-performance has been used in various countries with different numbers and areas (domains) of indicators adapted to the characteristics of primary care in a country. Some of the benefits of implementing pay-for-performance are that it can stimulate quality improvement in clinical care and improve patient experience of the role of general practitioners and the system of care. P4P can improve the process and outcome of cardiovascular treatment. Providing incentives can have an effect on improving the quality of performance in clinical practice. Providing P4P incentives can meet the quality measures of hypertension care recommended by the guidelines. In the United States, the provision of P4P incentives can increase physician compliance to provide hypertension drugs according to guidelines. Providing incentives can also have an impact on improving blood pressure control in hypertensive patients.

Blood pressure control and its associated factors in patients with hypertension and type 2 diabetes

In this retrospective study, the medical records of hypertensive patients with type 2 diabetes attending two major hospitals were reviewed to find the factors associated with poor blood pressure control in patients who have diabetes as a comorbid disease with hypertension. Binary regression analysis was conducted to find the factors independently associated with BP control. A total of 522 participants were included in the study. Most of the participants had uncontrolled hypertension (63.4%) and uncontrolled type 2 diabetes (51.3%). Regression results revealed that having retinopathy (OR=1.468 (95% CI: 1.020-2.113), p&amp;lt;0.05), and not receiving dipeptidyl-peptidase 4 (DPP4) inhibitors were independently associated with uncontrolled BP (OR=0.633 (95%CI 0.423-0.946), p&amp;lt;0.05). Therefore, greater efforts should be exerted to improve BP control in hypertensive patients with type 2 diabetes, particularly in those suffering from retinopathy.

Effects of ADIPOQ and NOS3 SNPs/haplotypes on blood pressure control in patients with adherence to antihypertensive therapy.

Aim: We examined whether ADIPOQ (rs266729 and rs1501299) and NOS3 (rs3918226 and rs1799983) SNPs or the haplotypes formed by them, affect blood pressure (BP) control in 196 patients with adherence to antihypertensive therapy grouped into controlled (BP <140/90mmHg) and uncontrolled (BP ≥140/90mmHg) hypertension. Materials & methods: The average of the three most recent BP measurements was retrieved from thepatients' electronic medical records. Adherence to antihypertensive therapy was evaluated using the Morisky-Green test. Haplotype frequencies were estimated using Haplo.stats. Multiple logistic/linear regression analyses were adjusted for the covariates ethnicity, dyslipidemia, obesity, cardiovascular disease and uric acid. Results: ADIPOQ rs266729 genotypes CG (additive model) and CG+GG (dominant model) were associated with uncontrolled hypertension and CG was associated with higher systolic BP and mean arterial pressure (p <0.05). ADIPOQ haplotypes 'GT' and 'GG' were associated with uncontrolled hypertension and 'GT' was associated with higher diastolic BP and mean arterial pressure (p <0.05). Conclusion: ADIPOQ SNPs and haplotypes affect BP control in hypertensive patients undergoing treatment.