Control Of High Blood Pressure Research Articles

Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda

BackgroundIndividuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda.MethodsWe randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥ 18 years to be screened for high BP. We used the World Health Organization’s STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP) ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP.ResultsWe trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD = 29.8) to 149 mmHg (SD = 29.8) (p < 0.001) and mean DBP from 97mmHg (SD = 14.3) to 92mmHg (p < 0.001). GEE showed decreases of -1.133 (SBP) and − 0.543 mmHg (DBP)/fortnight.ConclusionHigh BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.

Community intervention in patients with arterial hypertension

Healthy eating habits and lifestyle modifications play a vital role in the treatment and control of high blood pressure. Objective: evaluate community intervention to modify the knowledge of bad eating habits in the hypertensive population of office 149 of the Hermanos Cruz Polyclinic in the period 2021-2023. Material and method: an action research was carried out with the purpose of modifying the knowledge of the bad eating habits of the hypertensive population in office 149 of the Hermanos Cruz Polyclinic, from September 2021 to June 2023. The universe was made up of 128 hypertensive patients, adults, from the medical office under study. The sample was made up of 125 patients. Results: the age group of 40-49 years predominated with 32 %. Regarding nutritional status, a predominance of overweight and normal weight patients was demonstrated. Inadequate sodium intake also played a leading role. A community intervention was applied that decreased patients with inadequate sodium intake, increased normal weight, and increased the level of knowledge about high blood pressure. Conclusions: community intervention decreased risk factors in hypertensive patients.

Screening, Treatment and Control of High Blood Pressure on Five Sites in Mali

Screening, Treatment and Control of High Blood Pressure on Five Sites in Mali

THE CORRELATION BETWEEN FAMILY SUPPORT AND CONTROLLING HIGH BLOOD PRESSURE IN HYPERTENSION PATIENTS AT THE BAKAUHENI INPATIENT HEALTH CENTER IN 2022

Hypertension is one of the non-communicable diseases and is commonly known as the silent killer. If hypertension is not treated it can lead to complications up to death. In order for people with hypertension to keep their blood pressure stable, so it is necessary to control high blood pressure in people with hypertension. Family support is one of the most influential factors in controlling high blood pressure. Research Objectives To determine the relationship between family support and high blood pressure control in hypertension sufferers at the Bakauheni Inpatient Health Center in 2022. Research Methods The methods used by researchers are quantitative. The design in this study used Observational Analytics and used a Cross Sectional approach. The sample of this study was hypertension sufferers at the Bakauheni Inpatient Health Center, as many as 75 respondents. The sampling technique in this study used probability techniques and used a type of simple random sampling. Bivariate analysis using Chi Square statistical test. Research Results The Following p-value were obtained (0.000) &lt; (0.05). This shows that Ho was rejected and Ha was accepted. Obtained from bivariate results that showed that 58 respondents (77.3%) had family support in the good category, where respondents with high blood pressure control in the good category were 49 respondents (65.3%). Conclusion Based on the results of the study, there is a significant relationship between family support and high blood pressure control in hypertension sufferers at the Bakauheni Inpatient Health Center in 2022.

New Horizons in IgA Nephropathy: A Focus on Current Treatment and Emerging Solutions

IgA nephropathy (IgAN) is a common form of glomerular disease, with wide heterogeneity of symptom occurrence and progression. Diagnosis is based on kidney biopsy findings. IgAN initiates in the mucosa with development of galactose-deficient IgA1 (Gd-IgA1) and anti-Gd-IgA1 autoantibodies, leading to deposition of these complexes in glomerular mesangium with resulting fibrosis, inflammation, tubulointerstitial scarring, and glomerular injury. This can lead to chronic kidney disease (CKD), kidney failure, and death. IgAN treatment involves optimised supportive care, including individualised strategies to address symptoms, such as high blood pressure control and cardiovascular risks. Drug treatment includes renin-angiotensin-aldosterone system (RAAS) inhibitors and immunosuppressant therapies. While the latter can successfully lower proteinuria, and have a positive effect on estimated glomerular filtration rate (eGFR), adverse effects can limit treatment duration, and increasing proteinuria and decreasing eGFR can return following treatment discontinuation. New formulations of immunosuppressant therapies include delayed-release budesonide with targeted release in the lower part of the small intestine where Gd-IgA1 production occurs. Although treatment with this drug can reduce proteinuria and sustain eGFR levels, similar to other immunosuppressant therapies, effects seem to be predominantly limited to the active treatment period. Targeting a different mechanism, sparsentan is a dual endothelin A receptor (ETA) and angiotensin II receptor type 1 (AT1) blocker that targets endothelin-1 (ET-1) and angiotensin II, both involved in IgAN progression. Initial Phase III trial results show significant differences, favouring sparsentan, compared with the AT1 blocker irbesartan, on proteinuria, with similar adverse event profiles. These agents, and several other drugs in development, will widen the armamentarium of therapies for people with IgAN, which, when used in combination, can target different aspects of IgAN pathogenesis for a more individualised treatment approach.

Prevalence, awareness, treatment and control of high blood pressure in a cohort in Northern Andean Peru

ABSTRACT Background Gaps exist along the high blood pressure (HBP) diagnosis-treatment-control pathway in high, low and middle-income countries. Objective To determine the prevalence of HBP and to describe the levels of awareness, control and treatment of HBP in the rural Peruvian Andes. Methods This cross-sectional study is embedded into a multigenerational cohort. We analysed data of all adult participants aged ≥ 30 years (n = 2752) who answered a baseline health and lifestyle questionnaire and underwent a physical examination, which included three blood pressure readings. HBP was defined as measured systolic or diastolic blood pressure (BP) ≥140 and/or 90 mm Hg and/or self-reported physician-diagnosed hypertension and/or self-reported antihypertensive intake. The determinants of the prevalence of HBP, unawareness of HBP and uncontrolled HBP were assessed using mixed-effect logistic regressions. Results HBP was present in 18.9% of the participants. Of those with measured HBP, 72.2% were unaware of their HBP. Among those with a diagnosed or medically treated hypertension, 58.4% had uncontrolled HBP. The prevalence of HBP was higher in women (OR: 1.12, CI: 1.02–1.24), increased with age (OR: 1.01, CI: 1.01–1.01) and the presence of family history of hypertension (OR: 1.15, CI: 1.08–1.24), and decreased with healthier lifestyle score (OR: 0.93, CI: 0.91–0.95). Unawareness of HBP was lower among women (OR: 0.56, CI: 0.38–0.83), higher among participants living over 3000 m Above Sea Level (OR: 1.15, CI: 1.03–1.27) and decreased with age (OR: 0.99, CI: 0.98–0.99). Conclusions Unawareness of HBP was high, few HTN patients received treatment and BP remained high in the presence of antihypertensive treatment.

Synthesis and Pharmacological Properties of the Benzimidazole Scaffold: A Patent Review

AbstractBenzimidazole derivatives were first discovered in the late 19th and early 20th centuries, marking a significant milestone in the field of chemistry. These compounds have since played a pivotal role in pharmacology, demonstrating a wide array of pharmacological properties that have had a profound impact on medicine and healthcare. The significance of benzimidazole derivatives in pharmacology is undeniable. These compounds have been extensively studied and developed for their diverse and valuable properties. They exhibit potent anticancer activity, with some derivatives displaying the ability to hinder the growth of cancer cells, offering hope in the fight against this disease. Furthermore, benzimidazole derivatives have been involved in the management of cardiovascular conditions as antihypertensive agents, aiding in the control of high blood pressure. Their potential as antidiabetic agents, by influencing glucose metabolism and insulin secretion, holds promise in diabetes treatment. The recent patent literature has focused on structural modifications to the benzimidazole core to expand the arsenal of effective drugs. This review takes a disease‐centric perspective on patented benzimidazoles from 2016 to 2023. The relevant granted patent applications were located using patent databases, USPTO, Google Patents, EPO, WIPO, Lens and Espacenet.

Edukasi Dengan Pendekatan Fisioterapi Komunitas pada Komunitas Hipertensi Di Wilayah Puskesmas Gajahan Surakarta

Kauman is a village located in the Kliwon Market district of Surakarta. Hypertension is one of the most dangerous health problems in the world because it is a major risk factor that leads to cardiovascular diseases such as heart attack, heart failure, stroke and kidney disease. The goal of this program is to prevent, and control high blood pressure. The method used in this community service is health promotion related to hypertension targeted participants Posyandu Lansia Chasanah which is located in Kelurahan Kauman. The writer uses the lift to find out the level of understanding of the participants of Posyandu Chasanah. The results of the lift showed a pre-test average of 9.49, whereas the post-test averaged 9.84, which means an improvement of 0.35. The minimum pre-test score is 7 and the post test score is 9. The minimum score has an increase of 2.

High blood pressure prevalence, awareness, treatment, and blood pressure control among Ugandans with rheumatic and musculoskeletal disorders.

Rheumatic and musculoskeletal disorders (RMDs) are associated with cardiovascular diseases (CVDs), with hypertension being the most common. We aimed to determine the prevalence of high blood pressure (HBP), awareness, treatment, and blood pressure control among patients with RMDs seen in a Rheumatology clinic in Uganda. We conducted a cross-sectional study at the Rheumatology Clinic of Mulago National Referral Hospital (MNRH), Kampala, Uganda. Socio-demographic, clinical characteristics and anthropometric data were collected. Multivariable logistic regression was performed using STATA 16 to determine factors associated with HBP in patients with RMDs. A total of 100 participants were enrolled. Of these, majority were female (84%, n = 84) with mean age of 52.1 (standard deviation: 13.8) years and median body mass index of 28 kg/m2 (interquartile range (IQR): 24.8 kg/m2-32.9 kg/m2). The prevalence of HBP was 61% (n = 61, 95% CI: 51.5-70.5), with the majority (77%, n = 47, 95% CI: 66.5-87.6) being aware they had HTN. The prevalence of HTN was 47% (n = 47, 37.2-56.8), and none had it under control. Factors independently associated with HBP were age 46-55years (adjusted prevalence ratio (aPR): 2.5, 95% confidence interval (CI): 1.06-5.95), 56-65 years (aPR: 2.6, 95% CI: 1.09-6.15), >65 years (aPR: 2.5, 95% CI: 1.02-6.00), obesity (aPR: 3.7, 95% CI: 1.79-7.52), overweight (aPR: 2.7, 95% CI: 1.29-5.77). There was a high burden of HBP among people with RMDs in Uganda with poor blood pressure control, associated with high BMI and increasing age. There is a need for further assessment of the RMD specific drivers of HBP and meticulous follow up of patients with RMDs.

Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study.

Reducing excess body weight is important for control and management of high blood pressure (BP) in adults. Previous studies showed high prevalence of hypertension in River Nile State-north of Sudan, hence this study to establish whether obesity can be among the main risk factors and to study the prevalence of obesity related hypertension among Sudanese adults in River Nile State. This was a cross sectional community-based study conducted in River Nile State, Northern Sudan from January to June 2021. Obese and overweight, aged 18 years and above and accepted to participate in the study were included in the study. Convenience sampling method was used to select the participants. Data was collected through structured questionnaire filled by the patients after taking informed consent. Anthropometric measurements were taken. Two measurements of BP were obtained. Data was analyzed using SPSS version 23.0 (IBM, Chicago, USA). Chi-square test was used to determine the associations between categorical variables while logistic regression test was used to predict the presence of hypertension among studied population. A total of 1,295 participants were enrolled in this study. Obesity was reported in 1,118 (86.3%) of the participants. The prevalence of hypertension among the participants was 1,027 (79.3%). Central obesity was reported in 951 (92.6%) among hypertensive patients (P<0.001). Moreover, among hypertensive patients 470 (45.8%) were obese class I, 334 (32.5%) overweight, 139 (13.5%) obese class II and 84 (8.2%) obese class III (P<0.001). Obesity, BMI are risk factor of hypertension (P<0.001). Other risk factors were age above 40 years (P<0.001), unemployment (P<0.001), low education level (P<0.001) and being married (P<0.001). Logistic regression analysis showed that increasing age [P<0.001; odds ratio (OR) =1.055; 95% confidence interval (CI): 1.041-1.068], central obesity (P<0.001; OR =5.16; 95% CI: 3.4-7.8) and high body mass index (BMI) (P<0.001; OR =3.7; 95% CI: 1.7-7.9) were associated with uncontrolled hypertension. The study showed that the prevalence of obesity related hypertension was high. Common risk factors were age above 40 years, unemployment, and marriage. Importantly, central obesity, gross obesity and increasing age can be associated with uncontrolled BP management.

Drug-induced oral lichenoid reactions in patients consuming antihypertensive drugs

Objectives: High blood pressure (HBP) is a persistent and widespread condition, and increasing numbers of patients are taking medication to reduce HBP symptoms and control blood pressure. Patients taking specific antihypertensive medications have been reported to experience oral lichenoid reactions. Various antihypertensive drugs have entered the market, and it is essential to study how they may affect the occurrence of oral lichenoid reactions. This study aimed at assessing the frequency of drug-induced oral lichenoid responses in patients receiving antihypertensive medications.&#x0D; Methods: Four hundred fifty patients who took hypertension medications referring to Seyed al-Shohdai Hospital in Urmia in 2021 were the subject of this cross-sectional study. After the patient's first visit to the hospital, a thorough medical history was obtained from them. The type, dose, and duration of antihypertensive medications taken at the study's time were questioned and documented together with demographic data. The diagnosis of the oral lichenoid reactions was then made by examining the patients. Chi-square and Spearman's correlation tests were used in SPSS version 26 to evaluate the data.&#x0D; Results: Oral lichenoid reaction was observed in about 3.3% of patients. The average age of patients who showed oral lichenoid reaction was 53.7 ± 7.1, they had taken medicine for an average of 1 to 30 months, and 66.7% were female.&#x0D; Conclusions: Patients taking antihypertensive drugs, e.g., hydrochlorothiazide, methyldopa, metoprolol, and propranolol, should be examined and followed up regarding oral lichenoid reactions.

Improving cardiovascular health in rural China and beyond

In 2021, high blood pressure claimed 11·3 million lives globally. 1 Vaduganathan M Mensah GA Turco JV Fuster V Roth GA The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol. 2022; 80: 2361-2371 Crossref PubMed Scopus (4) Google Scholar High blood pressure has ranked consistently as the top modifiable risk factor globally for over 20 years. Although its prevalence is universally high, awareness, management, and control of high blood pressure are particularly poor in low-income and middle-income countries. 2 Geldsetzer P Manne-Goehler J Marcus ME et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet. 2019; 394: 652-662 Summary Full Text Full Text PDF PubMed Scopus (199) Google Scholar Several cluster randomised controlled trials have shown that community health worker-led interventions were effective in significantly reducing blood pressure in Argentina (the HCPIA trial), 3 He J Irazola V Mills KT et al. Effect of a community health worker-led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA. 2017; 318: 1016-1025 Crossref PubMed Scopus (98) Google Scholar Malaysia and Colombia (the HOPE 4 trial), 4 Schwalm JD McCready T Lopez-Jaramillo P et al. A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster randomised controlled trial. Lancet. 2019; 394: 1231-1242 Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar and Bangladesh, Pakistan, and Sri Lanka (the COBRA-BPS trial). 5 Jafar TH Gandhi M de Silva HA et al. A community-based intervention for managing hypertension in rural South Asia. N Engl J Med. 2020; 382: 717-726 Crossref PubMed Scopus (68) Google Scholar More recently, in 2022, Sun and colleagues 6 Sun Y Mu J Wang DW et al. A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial. Lancet. 2022; 399: 1964-1975 Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar showed that in the China Rural Hypertension Control Project (the CRHCP trial), a village doctor-led intensive hypertension intervention increased hypertension control by 37% compared with usual care. The 18-month net reduction in systolic blood pressure was as large as 14·5 mm Hg. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trialThe non-physician community health-care provider-led intensive blood pressure intervention is effective in reducing cardiovascular disease and death. Full-Text PDF

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries.

To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Nationally representative samples of 30 455 adults aged 25-65 years. HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Randomized Controlled Trial of Home Telemonitoring of Blood Pressure with an Adapted Tensiometer with SMS Capability

Despite being a public health problem, less than a third of hypertensive patients manage to control blood pressure (BP). In this paper, we conducted a two-arm randomized controlled trial to investigate the efficacy of an SMS-based home BP telemonitoring system compared to usual care in patients with uncontrolled hypertension from a primary care center. This study was conducted between April and August 2018. Participants in the intervention arm used a custom-designed telemonitoring device for two weeks and were followed up for two additional weeks; controls were followed for 4 weeks. The main objective of this study is to evaluate the impact on blood pressure of a telemonitoring system using a blood pressure monitor adapted to send data via SMS to health providers in primary care centers for 4 weeks. In this trial, 38 patients were included in the analysis (18 in each arm), 68% were women, and the mean age was 68.1 [SD: 10.8 years], with no differences between arms. Among the results we found was that There was no significant difference in the change in systolic BP values between the control and intervention arm (-7.2 [14.9] mmHg vs. -16.3 [16.7] mmHg; p = 0.09). However, we found a significant difference in the change of diastolic BP (-1.2 [6.4] mmHg vs. -7.2 [9.8] mmHg; for the control and intervention arms, respectively p = 0.03). With all this, we conclude that an SMS-based home BP telemonitoring system is effective in reducing diastolic BP by working in conjunction with primary care centers. Our findings represent one of the first interventions of this type in our environment, being an important alternative for the control of high blood pressure.

Current status of the rapid decline in renal function due to diabetes mellitus and its associated factors: analysis using the National Database of Health Checkups in Japan

The increasing number of patients undergoing dialysis due to diabetes mellitus (DM) is causing serious economic problems, and its reduction is an urgent policy issue in developed countries, including Japan. We aimed to assess the association between the annual rapid decline in renal function and health checkup measures, including blood pressure, to identify health guidance targets for preventing diabetic nephropathy (DN) and diabetic kidney disease (DKD) among individuals in a medical checkup system (“Tokuteikenshin” program) in 2018. This longitudinal analysis included 3,673,829 individuals who participated in the “Tokuteikenshin” program in 2018, had hemoglobin A1c (HbA1c) levels ≥5.6%, were available for follow-up, and underwent estimated glomerular filtration rate (eGFR) evaluation. We estimated the incidence of the relative annual decrease in eGFR ≥10% per 1000 person-years and odds ratios to evaluate the rapid decline in renal function and determine health guidance goals and their role in preventing DN and DKD. Overall, 20.83% of patients with DM had a rapid decline in renal function within the observation period. A rapid decline in renal function was associated with high systolic blood pressure, poor or strict DM control, increased urinary protein excretion, and decreased blood hemoglobin levels. The incidence of rapid decline in renal function is higher in DM, and appropriate systolic blood pressure and glycemic control are important to prevent the progression to DN or DKD. Our findings will be useful for researchers, clinicians, and other public health care members in establishing effective health guidance and guidelines for CKD prevention.

Patient-Facing Clinical Decision Support for High Blood Pressure Control: Patient Survey.

High blood pressure (HBP) affects nearly half of adults in the United States and is a major factor in heart attacks, strokes, kidney disease, and other morbidities. To reduce risk, guidelines for HBP contain more than 70 recommendations, including many related to patient behaviors, such as home monitoring and lifestyle changes. Thus, the patient's role in controlling HBP is crucial. Patient-facing clinical decision support (CDS) tools may help patients adhere to evidence-based care, but customization is required. Our objective was to understand how to adapt CDS to best engage patients in controlling HBP. We conducted a mixed methods study with two phases: (1) survey-guided interviews with a limited cohort and (2) a nationwide web-based survey. Participation in each phase was limited to adults aged between 18 and 85 years who had been diagnosed with hypertension. The survey included general questions that assessed goal setting, treatment priorities, medication load, comorbid conditions, satisfaction with blood pressure (BP) management, and attitudes toward CDS, and also a series of questions regarding A/B preferences using paired information displays to assess perceived trustworthiness of potential CDS user interface options. We conducted 17 survey-guided interviews to gather patient needs from CDS, then analyzed results and created a second survey of 519 adults with clinically diagnosed HBP. A large majority of participants reported that BP control was a high priority (83%), had monitored BP at home (82%), and felt comfortable using technology (88%). Survey respondents found displays with more detailed recommendations more trustworthy (56%-77% of them preferred simpler displays), especially when incorporating social trust and priorities from providers and patients like them, but had no differences in action taken. Respondents to the survey felt that CDS capabilities could help them with HBP control. The more detailed design options for BP display and recommendations messaging were considered the most trustworthy yet did not differentiate perceived actions.

PS-R04-10: MALIGNANT HYPERTENSION AFTER COVD-19 VACCINE INJECTION

Case; 40 y/o male. Clinical course; The patient was transferred to our university hospital because of DOE and severe headache. He had been well and had no history of hypertension or obesity. He had experienced the COVID-19 vaccine injection two week before this visit. After the injection he had been experienced high fever and general fatigue as well as 7 kg of weight loss. On examnation, it was found that he had severe hypertension (190/110 mmHg) and hypertensive optic fundi. On chest X-ray, cardiomegaly and bilateral lung infiltrations was evident and biochemical data indicated renal dysfunction (serum creatinine 2.35 mg/dl), high levels of plasma renin activity (39.1 ng/ml/hour normal; 0.6–3.9) and aldosterone concentration (176 pg/ml normal; 4.0–82.1), and inflammatory changes (CRP = 23 mg/dl). We also found that increased levels of LDH and decreased levels of hemoglobin which indicated hemolytic anemia and thrombotic microangiopathy. After the control of high blood pressure by intravenous administration of Calcium channel blockades, We performed renal biopsy, which had a finding of diffuse findings of onion skin lesion and global glomerular sclerosis compatible with the diagnosis of malignant hypertension. Any secondary etiologies including renal artery disease or collagen disease had not been identified. Seven days after the admission, we started hemodialysis for this patient because of the renal failure was not resolved. We also had startred ACE inhibitors. We stopped the diuretics and minimized the ultrafiltration. Twenty-five days after the admission the patients was withdrawn from dialysis with the urine volume around 2000 ml/day and the serum creatinine concentration 5.29 mg/dl. He was discharged without any aid of dialysis and with small number of anti-hypertensives. Four months after the discharge, his serum creatinine concentration was 3.36 mg/dl and his blood pressure was 139/85 mmHg with the ACE inhibitor and calcium channel blockades. Conclusions; The case suggested that the malignant hypertension might be triggered by COVID-19 vaccine injection, which is of clinical importance.

PS-BPC03-9: EFFECTIVENESS OF MAY MEASUREMENT MONTH EDUCATIONAL PROGRAM ON KNOWLEDGE AWARENESS AND LIFESTYLE PRACTICES OF PATIENT WITH HYPERTENSION

Background: Hypertension is not only an important risk factor for noncommunicable disease but also is a major cause of mortality and morbidity all over the world. Barriers to high blood pressure (BP) awareness and control are exacerbated by poor knowledge of the consequences and uncertainty regarding how to and who should direct care. Aim: To evaluates the effectiveness of educational program for improving knowledge awareness and health promoting lifestyle practices among patients with hypertension. Objective: 1. to examine the knowledge and awareness about hypertension.in patient with hypertension. 2. To find out whether educational program is an effective tool for improving knowledge and promoting healthy lifestyle in patient with hypertension. Methods: This study was a case control intervention study on 100 patients with hypertension that were selected during may measurement month camp in our institute. Before the intervention both groups (50 subjects in each group) completed the HKLP questionnaire. (Hypertension knowledge and lifestyle practice scale).after completing the HKLP questionnaire case group an educational program was delivered through PPT and that group was provide one educational booklet. One month after the intervention both the group again completed the same questionnaire. Results: There was no significant difference in the mean age of both the groups. The mean of the total HKLP scores was significantly increased in the case group compared with the control group (p value is less than 0.05). Showed that mean score regarding hypertension knowledge and health promoting lifestyle behavior were significantly higher after than before program in case control group. Conclusion: In this study Hypertension educational program was effective in promoting knowledge and healthy lifestyle among patients with hypertension. Based on the relationship between lifestyle and hypertension it seems that implementing educational programs is essential to improve disease knowledge and lifestyle modification among patients with hypertension

PS-BPC05-7: HEMODYNAMIC MANAGEMENT OF RESISTANT HYPERTENSION

Background: Hypertension is the most prevalent chronic disease worldwide and is related to a high probability of cardiac disease, kidney disease and cerebrovascular events. Blood pressure measurement was used in the last decades to diagnose and guide antihypertensive therapy; however blood pressure is the result of the interaction of more complex hemodynamic parameters previously reserved for experimental studies or critical care patients management using invasive methods. Since 1996 few studies have proposed the use of hemodynamic parameters to classify and guide hypertension therapy with good results. Purpose: The present study's purpose was to measure hemodynamic parameters in patients with non-controlled resistant hypertension and use it to guide pharmacologic treatment to archive control blood pressure values according to the European Society of Cardiology guidelines. Methods: A total of 84 patients between 32 and 95 years old diagnosed with non-controlled primary resistant hypertension were recruited and after previous therapy washout hemodynamic parameters were measured using noninvasive Methods: preload by central venous pressure (CVP) using inferior vena cava diameter, cardiac index and systemic vascular resistance using Lyljestrand &amp; Zander modified formula. Patients were classified into 3 basic groups depending on which parameter was above normal value: hyperdynamic (HD) for high cardiac index &gt; 3.5 L/min/m2, fluid overload (FO) for CVP &gt; 8cmH2O and high systemic vascular resistance index (HSVRi) &gt; 2500 dynes/sec/m2/cm5, also 3 combined groups were a patient had 2 simultaneous hemodynamic alterations (HD+FO, HD+HSVRi and FO+HSRVi), according to this classification pharmacotherapy was guided indicating Bisoprolol in HD group, Amlodipine to HSVR patients and Hydrochlorothiazide to FO patients, in combined groups, combined therapy was given. Patients were observed for 6 months period taking as primary endpoint blood pressure control, acute cardiovascular events and hypotension. Results: A significant reduction of hemodynamic parameters and blood pressure was observed in the first month of treatment obtaining a 100% hemodynamic and blood pressure goals in all patients in the third month of therapy without hypotension or acute cardiovascular event during this period, the HD+FO group reach goals at the 6th month of treatment without reported complications. Conclusions: In this preliminary study we observed that hemodynamic guided high blood pressure control may be a valuable tool for a better understanding, classification and treatment in patients with resistant hypertension; however larger outcome studies confirm this hypothesis.

Identifying factors associated with of blood pressure using Structural Equation Modeling: evidence from a large Kurdish cohort study in Iran

BackgroundIdentifying the risk factors leading to hypertension can help explain why some populations are at a greater risk for developing hypertension than others. The present study seeks to identify the association between the risk factors of hypertension in 35- to 65-year-old participants in western Iran.MethodsThis cross-sectional study was conducted on 9705 adults from baseline data of Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west region of Iran. Each of the latent variables were confirmed by confirmatory factor analysis. Using Structural Equation Modeling (SEM), we assessed the direct and indirect effects of factors associated with blood pressure.ResultsSocioeconomic status (SES), physical activity, mean of serum lipids, obesity, diabetes and family history of hypertension had a diverse impact on the blood pressure, directly and (or) indirectly. The standardized total effect of SES, physical activity, mean of serum lipids, and obesity were -0.09 vs. -0.14, -0.04 vs. -0.04, 0.13 vs. 0.13 and 0.24 vs. 0.15 in men and women, respectively. Diabetes had a direct relationship with the blood pressure in women (0.03).ConclusionWith regard to control of high blood pressure, public health interventions must target obesity, lifestyle and other risk related to nutritional status such as hyperlipidemia and hyperglycemia in Iranian population and among those with higher SES.