Control Of High Blood Pressure Research Articles

Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services.

Continuity of care (COC) has been associated with lower mortality and hospitalizations and higher high blood pressure (HBP) control rates. This evidence mainly came from high income countries. We aimed to identify conditions associated with controlled HBP, particularly COC, in primary care services (PCSs) affiliated to two health insurances in Colombia, a low-median income country. A longitudinal observational study was carried out using clinical records of hypertensive adults >18 years with ≥4 clinic visits attending a contributive and a subsidized PCS in Cali (Colombia) between 2013 and 2014. Subsidized PCSs were for unemployment people and those at low socio-economic position and contributive for formal workers. COC was measured using the Bice and Boxerman index. Logistic regression models were performed to quantify the relation between COC and controlled HBP (blood pressure <140/90 mmHg). Between 2013 and 2014, among 8797 hypertensive people identified, 1358 were included: 935 (68.8%) and 423 (31.1%) from the contributive and subsidized PCSs, respectively. 856 (62.3%) were women and had a mean age of 67.7 years (SD 11.7). All people were on antihypertensive treatment. Over the study period, 522 (38.4%) people had controlled HBP, 410 (43.9%) in the contributive and 112 (26.5%) in subsidized PCSs. An increase in 1 unit of the COC index is associated with a 161% higher probability of having HBP controlled (OR, 2.61; 95% CI, 1.25–5.44). The odds of having controlled HBP increased as the number of visits rose; for example, people at the fourth visit had a 34% (OR, 1.34; 95% CI, 1.08–1.66) higher probability of reaching the target. Continuity of care was positively associated with controlled HBP. The strengthening of COC can improve the observed low HBP control rates and reduce health inequalities.

Observational study of the prevalence of non-valvular atrial fibrillation and ischemic stroke and the factors associated with non-valvular atrial fibrillation in hypertensive patients: about 2887 cases

RésuméIntroductionl´hypertension artérielle (HTA), la fibrillation auriculaire (FA) et l´accident vasculaire cérébral (AVC) sont trois problèmes de santé publique. A travers cette étude nous avons cherché à déterminer la prévalence de la FA et de l´AVC ischémique chez les patients hypertendus et déterminer les facteurs associés à la survenue de la FA non valvulaire chez ces patients.Méthodesnous avons utilisé les données recueillies dans le service de cardiologie de l´hôpital universitaire de Sfax dans le cadre du registre national tunisien d´HTA. Nous avons étudié les associations entre les différentes variables sociodémographiques, cliniques, paracliniques et thérapeutiques et la FA chez les hypertendus en utilisant des modèles de régression logistique.Résultatsnotre échantillon comprenait 2887 patients avec un sexe ratio à 0,95. L´âge moyen était de 65 ans (±11). La FA était notée chez 230 patients (8%), alors que l´AVC ischémique chez 152 patients (5,3%). Au décours de l´analyse multivariée, les facteurs indépendants associés à une augmentation de la prévalence de la FA étaient: l´âge avancé (p=0,001, Odds Ratio(OR) = 1,647, Intervalle de confiance (IC) à 95%: 1,1227-2,213), la présence d´une hypertrophie ventriculaire gauche (HVG) à l´échographie cardiaque(p = 0,004, OR = 2,140, IC95%: 1,281-3,576), et la fraction d´éjection du ventricule gauche (FEVG) < 50% (p < 0,001, OR = 4,677, IC95%: 2,715-8,057).Conclusionnous avons confirmé qu´il existe une relation directe et indépendante entre l´HTA, l´âge avancé, l´HVG et la FA. L´installation d´une FA au cours de l´HTA constitue un tournant évolutif de la maladie par majoration du risque d´AVC ischémique. Un contrôle optimal de la pression artérielle tensionnelle être hautement prioritaire chez les hypertendus, en particulier âgés, afin de prévenir le risque de la FA et de l´AVC.

Suboptimal Management Status of Younger Hypertensive Population in Korea.

Hypertension (HTN) is the most contributable risk factor for cardiovascular disease. May Measurement Month (MMM) is a global initiative to raise awareness of HTN and act as a temporary solution to the lack of screening programs worldwide. An opportunistic cross-sectional survey of participants aged ≥18 was carried out in May 2019. Over 10,000 participants were recruited in the MMM 2019 Korea, with a slogan of "A simple measure to save lives - #checkyourpressure." A total of 9,950 participants with valid clinical blood pressure (BP) data were used for analysis. All participants were Korean in ethnicity. The mean age was 57.2±21.2 years, 57.8% were females, and the mean body mass index was 23.4±3.3 kg/m². Among the enrolled population, 20.1% were less than 30 years old, and 5.0% were 30-39 years old. 37.0% of the participants reported a previous diagnosis of HTN, and 91.3% of those diagnosed were on antihypertensive medications. Notably, more than 20% of the participants had not measured their BP during the last 12 months, and the awareness rate in the young hypertensive participants (aged <40) was less than 10%. Among hypertensive participants, the treatment rate was 69.3%, and the control rate among those taking medications was 61.2%. MMM 2019 Korea campaign reported high BP control rates in individuals with HTN, reaching 60%. However, the awareness rate in young hypertensive participants was less than 10% along with suboptimal management status. The MMM 2019 Korea again raised the importance of regular BP measurement in the younger population.

Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin-Angiotensin System.

Hypertension is a common comorbidity observed in individuals with epilepsy. Growing evidence suggests that lower blood pressure is associated with reduced frequency and severity of seizures. In this study, we sought to investigate whether the renin–angiotensin system (RAS), which is a critical regulator of blood pressure, is involved in the pathogenesis of audiogenic epilepsy-related seizures in a hypertensive rat model. Spontaneously hypertensive rats (SHRs) were given RAS inhibitors, angiotensin-converting enzyme (ACE) inhibitor or angiotensin II type I receptor (AT1R) antagonist, for 7 days prior to inducing epileptic seizures by acoustic stimulation. After the pretreatment phase, blood pressure (BP) of SHRs normalized as expected, and there was no difference in systolic and diastolic BP between the pretreated SHRs and normotensive rat group (Wistar). Next, treated and untreated SHRs (a high BP control) were individually subjected to acoustic stimuli twice a day for 2 weeks. The severity of tonic–clonic seizures and the severity of temporal lobe epilepsy seizures (product of forebrain recruitment) were evaluated by the mesencephalic severity index (Rossetti et al. scale) and the limbic index (Racine’s scale), respectively. Seizures were observed in both untreated (a high BP control) SHRs and in SHRs treated with AT1R antagonist and ACE inhibitor. There was no statistical difference in the mesencephalic severity and limbic index between these groups. Our results demonstrate that SHRs present seizure susceptibility with acoustic stimulation. Moreover, although RAS inhibitors effectively reduce blood pressure in SHR, they do not prevent developing epileptic seizures upon acoustic stimulation in SHR. In conclusion, our study shows that RAS is an unlikely link between hypertension and susceptibility to epileptic seizures induced by acoustic stimulation in SHRs, which is in contrast with the anticonvulsant effect of losartan in other animal models of epilepsy.

Drug non-adherence in hypertensive patients in Morocco, and its associated risk factors.

Hypertension is a widespread public health problem; unfortunately, non-adherence to the treatment hinders the control of high blood pressure. Drug non-adherence is the degree to which a patient does not follow the prescription. We aimed to assess the extent of drug non-adherence among hypertensive patients treated in Meknes and identify risk factors associated with inobservance. Between November and December 2017, we conducted a cross-sectional study enrolling 922 hypertensive patients managed at Meknes's primary healthcare facilities (PHCF) using the multistage sampling method. We interviewed patients face to face to collect their socio-demographic characteristics, lifestyle behaviours, clinical parameters, and the relationship between the care system, the patient, and the physician. A multivariate logistic regression analysis highlighted the risk factors associated with drug non-adherence. The prevalence of drug non-adherence was 91% with a mean age of 61 ± 11 years (mean ± standard deviation) and a male/female ratio of 1/3. Risk factors associated with drug non-adherence were: (i) male sex [adjusted odds ratio (AOR) = 2.5, 95% confidence interval (CI) (1.26-5.10)]; (ii) monthly income per household <150$ [AOR = 4.47, 95% CI (1.22-16.34)]; (iii) monthly income per household 150-200$ [AOR = 4.44, 95% CI (1.04-18.93)]; (iv) bad relationship with the healthcare system [AOR = 2.17, 95% CI (1.29-3.67)]; and (v) uncontrolled blood pressure [AOR = 1.87, 95% CI (1.15-3.02)]. The prevalence of drug non-adherence is general among hypertensive patients in Meknes. Prevention should: (i) ensure the availability of adequate stocks of the anti-hypertensive drug at the PHCF; (ii) secure sufficient drug stocks to treat the poorest patients first; and (iii) improve blood pressure control in patients.

A national campaign on ‘High Blood Pressure Control’ in Iran: A rapid evaluation

A national campaign on ‘High Blood Pressure Control’ in Iran: A rapid evaluation

The prevalence of hypertension and influencing factors among the employees of a university hospital.

Hypertension is a serious disease with increasing worldwide prevalence, leading to life-threatening complications. This cross-sectional study was carried out in a university hospital. The Occupational Health and Safety Unit data concerning the health examinations of employees were used to determine the prevalence of hypertension in a university hospital and to define the relationship between hypertension and sociodemographic and occupational parameters. Logistic regression analyses were performed for the variables having a significant association with high blood pressure. The data generated during the periodic examination of 3,480 (92%) of all employees (3,780) were analyzed. The prevalence of hypertension was 14.8%. The prevalence of hypertension was found to be 13.5%, 13.9%, and 23.7% among physicians, non-physician healthcare personnel and officers respectively. The logistic regression model revealed a statistically significant correlation between hypertension and male gender, age and BMI. The prevalence of hypertension was highest among staff members. Special programs would facilitate the diagnosis, control, and prevention of high blood pressure among the high-risk groups, especially men, the elderly and the obese hospital employees.

ROLE OF THE PHARMACIST IN MANAGING HIGH BLOOD PRESSURE OF HYPERTENSIVE PATIENTS IN PRIMARY CARE UNITS

Objective: The aim of this study was to evaluate the influence of pharmaceutical care on the control of high blood pressure (BP) in hypertensive patients.&#x0D; Methods: The study included thirty hypertensive patients from primary or secondary healthcare located in the south of São Paulo, Brazil.&#x0D; Results: The majority of patients was aged over 60 years (68.75%), non-smokers (90%), non-alcoholics (93.33%), did not practice physical activities (93.33%), and presented comorbidities and polypharmacy. The most common drug-related problems were drug-drug interactions, missed doses, incorrect frequency or time of administration, incorrect patient administration technique, and self-medication. The interventions used during the pharmaceutical consultations (PC) were based on the organization of medicines with tools such as a pillbox organizer (84.38%). A significant improvement in BP control (p&lt;0.05) was observed when comparing BP measurements before and after the PC; however, the number of PCs did not influence the BP reduction.&#x0D; Conclusion: Patient guidance and a simple intervention favor better patient understanding of medication administration schedules.

Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension.

The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a ‘secondary’ form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, therefore, markedly underestimated, although, they can involve as many as one-third of the cases among referred patients and up to half of those with difficult to treat hypertension. The early detection of a secondary form is crucial, because if diagnosed in a timely manner, these forms can be cured at long-term, and even when cure cannot be achieved, their diagnosis provides a better control of high blood pressure, and allows prevention of hypertension-mediated organ damage, and related cardiovascular complications. Enormous progress has been made in the understanding, diagnostic work-up, and management of secondary hypertension in the last decades. The aim of this minireview is, therefore, to provide updated concise information on the screening, diagnosis, and management of the most common forms, including primary aldosteronism, renovascular hypertension, pheochromocytoma and paraganglioma, Cushing’s syndrome, and obstructive sleep apnea.

Correlation between body mass index and blood pressure in seafarers

ABSTRACT Background High blood pressure is a serious medical condition that significantly increases the risk of cardiovascular disease. Although overweight and high blood pressure are frequent consequences for the health of life at sea, there is a paucity of information on the contribution of body mass index (BMI) to high blood pressure (HBP) in seafarers. Objective The present study was aimed to examine the relationship between BMI and blood pressure and to analyze further BMI as a risk factor for high blood pressure through a modeling approach. Materials and Methods A retrospective analysis was performed on 603 seafarers’ medical examination records. The seafarer’s blood pressure and BMI were recorded and interpreted according to the WHO criteria. Pearson product-moment correlation was examined to determine the association between BMI and blood pressure. Multinomial logistic regression models were performed to estimate the strength of association between the BMI and the HBP. Results Out of a total of 603 seafarers under study, 44.4% and 55.6% were officers and non-officers, respectively. Mean SBP, DBP, and BMI were significantly higher among non-officers than officers. BMI was positively correlated (p < .01) with both SBP (r = 0.336) and DBP (r = 0.344). About 39% and 16.6% of the study subjects were prehypertension and hypertensive, respectively. The risk of prehypertension and hypertension was higher in individuals who were overweight and obese. Conclusions Mean blood pressure levels increase parallel to the rise of BMI. Thus, emphasis should be given on a weight management program in relation to the prevention and control of high blood pressure.

Vaccines against components of the renin-angiotensin system.

Even though effective drugs for treating hypertension are available, a great percentage of patients have inadequate control of their blood pressure. Unwanted side effects and inappropriate oral drug adherence are important factors that contribute to the global problem of uncontrolled hypertension. Vaccination could provide a revolutionary therapy with long-lasting effects, increasing patient compliance and therefore better control of high blood pressure. Nowadays, current immunization approaches against hypertension target renin, angiotensin I, angiotensin II, and angiotensin II type 1 receptor, key elements of the renin–angiotensin system. This article reviews the different vaccination attempts with proteins and peptides against the different molecules of the renin–angiotensin system in the last two decades, safety issues, and other novel prospects biomarkers in hypertension, and summarizes the potential of this immunomodulatory approach in clinical practice.

Factors influencing knowledge levels among hypertensive patients receiving treatment at the Komfo Anokye Teaching Hospital in Kumasi, Ghana: a cross-sectional study.

Background&#x0D; Basic knowledge about hypertension and its treatment can have a positive impact on high blood pressure control reducing cardiovascular morbidity and mortality. This study aimed at assessing the knowledge levels and to determine the factors that influenced knowledge levels among hypertensive patients receiving treatment at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.&#x0D; Methods&#x0D; A cross-sectional study was conducted at the outpatient hypertensive clinic of KATH between April and May 2019. Three hundred and ninety-seven (397) hypertensive patients aged 18 years and above who had been diagnosed with hypertension for at least six months and currently taking at least one antihypertensive drug completed a self-administered questionnaire. The questionnaire consisted of basic socio-demographic profile, patient-related information on hypertension and its treatment and knowledge on hypertension. The Hypertension Knowledge-Level Scale (HK-L) was used to determine the level of knowledge among patients receiving treatment at the Komfo Anokye Teaching Hospital (KATH), Kumasi.&#x0D; Results&#x0D; Out of the 397 patients, 199 (50.1%) had high knowledge level on hypertension and its treatment. Binary logistic regression analysis was conducted for hypertension knowledge level. Respondents with a junior level of education, paid for their antihypertensive drugs by themselves, had asthma as a comorbidity and took non-prescribed drugs had a significant association with knowledge level on hypertension and its treatment.&#x0D; Conclusion&#x0D; Knowledge about hypertension in hypertensive patients is moderate and therefore much effort should be made in educating and involving them in the condition to help them gain control over the disease and improve adherence rates.

Urinary vanin-1 associated with chronic kidney disease in hypertensive patients: A pilot study.

Hypertension and chronic kidney disease (CKD) are serious interrelated public health problems. Despite the monitoring and control of high blood pressure, symptoms of CKD are not usually apparent in its early stages. Previously, we reported the utility of urinary vanin-1 as an early biomarker of kidney injury in spontaneously hypertensive rats, but it remains unknown whether urinary vanin-1 is associated with CKD in humans. In this study, we estimated associations between urinary vanin-1 and parameters of kidney function in a cross-sectional study of hypertensive patients. We measured concentrations of vanin-1 using spot urine from 147 adult hypertensive patients (mean age, 72.8years; 39.5% women). Patients were divided into 2 groups based on the median of the estimated glomerular filtration rate (eGFR). The group with eGFR<60mL/min per 1.73 m2 showed significantly higher levels of urinary vanin-1 than those with eGFR≥60mL/min per 1.73 m2. On univariate analysis, urinary vanin-1 as well as neutrophil gelatinase-associated lipocalin (NGAL) showed significant negative correlations with eGFR; however, multivariate analysis revealed that urinary vanin-1, but not NGAL, significantly correlated with eGFR. In addition, urinary vanin-1 had a significant positive correlation with the urinary protein-to-creatinine ratio (UPCR) (r=0.21; P=.021) and albumin-to-creatinine ratio (UACR) (r=0.61; P<.01). In conclusion, urinary vanin-1 is associated with lower eGFR and higher UPCR and UACR, and might be a potential marker of decreased kidney function in hypertensive patients. Further studies are needed to confirm these findings.

Prevalence, Pattern and Risk Factors of Retinal Diseases Among an Elderly Population in Nepal: The Bhaktapur Retina Study.

IntroductionRetinal diseases are an emerging cause of visual impairment in the developing world. The aim of this study was to explore the prevalence, pattern, and risk factors of retinal diseases in Nepal.MethodsThis is a population-based, cross-sectional study conducted from 2013 to 2015. The sample size was 2100 subjects age 60 years and above from 30 clusters of Bhaktapur district, Nepal. Detailed history, visual acuity, and anterior and posterior segment examinations were performed. Blood sugar and blood pressure were measured.ResultsComplete information was available for 1860 (88.57%) subjects. Mean age was 69.64±7.31 years, ranging from 60 to 95 years. The prevalence of any retinal disorder was 52.37% (95% confidence interval (CI): 50.07–54.66%). The prevalence of retinal disorders increased with ageing: 51.26% between 60 and 69 years and 53.05% among those age 80 years and above. Age-related macular degeneration (AMD) was the most common retinal disease (35.43%), followed by hypertensive retinopathy (4.35%), epiretinal membrane (ERM) (3.66%), branch retinal vein occlusion (BRVO) (2.90%), and diabetic retinopathy (DR) (2.15%). Other rare retinal disorders included myopic fundus (0.86%), chorioretinal scar (0.54%), retinal holes (0.32%), retinitis pigmentosa (0.32%), retinal detachment (0.16%), and coloboma (0.11%). In multivariate logistic regression analysis, those with prior cataract surgery (odds ratio (OR), 1.71; 95% CI: 1.32–2.22, p < 0.001) and systemic hypertension (OR, 1.21; 95% CI: 1.001–1.47, p = 0.049) had significantly increased retinal disorders.ConclusionPrevalence of retinal disorder was 52.37% at age 60 years and above. AMD, hypertensive retinopathy, ERM, BRVO, and DR were the most common retinal disorders. Retinal disorders increased with ageing. Retinal disorders were found associated with hypertension and prior cataract surgery. Timely screening, control of blood sugar and high blood pressure, and regular eye check-ups could help to save vision from retinal diseases.

Prevalence and determinants of self-reported high blood pressure among women of reproductive age in Benin: a population-based study

BackgroundAddressing chronic diseases is a challenge for healthcare systems worldwide, which have largely developed to deal with acute episodic care, rather than to provide organized care for people with age-long conditions. Therefore, exploring the prevalence and identifying the risk factors is a major approach to prevention and control of chronic diseases. The aim of this study was to examine the prevalence and factors associated with self-reported high blood pressure among women of reproductive age in Benin.MethodsWe utilized population-based cross-sectional data from Benin Demographic and Health Survey (BDHS). BDHS 2017–18 is the round V of the survey. A total of 7712 women of reproductive age were included in this study. The outcome variable was self-reported high blood pressure. Percentages, chi-square test and multivariable logistic regression model were used to analyze the data. Results from the multivariable logistic model were presented as adjusted odds ratio (aOR) and confidence interval (95%CI). The significance level was set at p < 0.05.ResultsThe total prevalence of self-reported high blood pressure among women of reproductive age in The Gambia was about one-tenth (9.9%). Furthermore, geographical region was associated with high blood pressure. Women aged 45–49 years had increased odds of high blood pressure, when compared with women aged 15–19 years (aOR = 2.73; 95%CI: 1.10, 6.79). In addition, increased maternal enlightenment gave higher odds of high blood pressure, when compared to women with low maternal enlightenment (aOR = 1.41; 95%CI: 1.08, 1.84). Women with highest neighbourhood socioeconomic disadvantaged status (poor women) had 30% reduction in the odds of high blood pressure, when compared with women of low neighbourhood socioeconomic disadvantaged status (aOR = 0.70; 0.50, 0.99). Women having increased lifetime number of sex partners (total of 3 lifetime number of sex partners: aOR = 1.40; 95%CI: 1.01, 1.94; more than 3 total lifetime number of sex partners: aOR = 1.53; 95%CI: 1.01, 2.32) were more likely to have high blood pressure, when compared to women with only one lifetime number of sex partner.ConclusionsEmphasis on high blood pressure prevention methods and involvement of multiple sectors could help to disseminate health care interventions widely. Also, a concerted effort from the stakeholders in health care system and decision-makers is needed to address the drivers of high blood pressure while maintaining health system improvement strategies. The findings could prompt appropriate policy responses towards improving the knowledge and control of high blood pressure in Benin.

Effects of Four Noble Truths Practice on Hypertension Control

Objective: To examine the effects of Four Noble Truths practice in controlling blood pressure with three-group comparison, involving a Mobile Web group, Guidebook group and usual care group in patients with stage 1 hypertension.Methods: This randomized controlled trial was conducted in one university hospital setting. 145 participants were recruited into the study by randomized selection and were randomly assigning to the three groups. Of these, 45 participated as Mobile Web users, 50 as Guidebook users and 50 in the control group. The Mobile Web and Guidebook were developed using the guidance of the Four Noble Truths and received a phone call every two weeks for three times while control received a usual care. Then, the outcomes were measured including blood pressure and satisfaction at two-month after recruitment. The average blood pressure and satisfaction were compared by comparative descriptive statistic. Finally, analysis of covariance (ANCOVA) was used to analyze the covariate that may influence the outcomes with the post hoc analysis by Bonferroni. Results: Participants who received Mobile Web and Guidebook had reduced their blood pressure more than those receiving usual care, with statistical significance (P &lt; 0.05). It was found that blood pressures could be lowered to a maximum level of 5.09 ± 9.62mmHg within 8 weeks of treatment. Altogether, both groups were satisfied with healthcare services more than those receiving usual care, with statistical significance (P &lt; 0.05).Conclusion: The program could be applied to control high blood pressure in patients with stage 1 hypertension. The outstanding of this program could support overall difference in healthcare of each patient with fast efficacy.

Impact of self-measured blood pressure monitoring on hypertension management.

An estimated 31% of adults in the USA have hypertension. The American Heart Association's Check. Change. (CCC) program is an ongoing evidence-based hypertension management program that encourages participants to use remote blood pressure (BP) monitoring to take control of their cardiovascular health. The purpose of this study was to identify the effectiveness of self-measured blood pressure (SMBP) monitoring and tracking on high BP control among participants of the CCC program. We performed a retrospective cohort study among hypertensive men (n = 912) and women (n = 2021) using the 2016-2017 CCC national data. Demographics were examined among participants who checked their BP readings frequently, with a minimum of eight BP readings over four months, versus those who did not check their BP as often. Multivariable logistic regression evaluated the association of SMBP monitoring and BP reduction. A greater proportion of participants who frequently checked their BP readings had BP reduction (17.7%), compared to participants who did not check their BP readings frequently (3.9%, P < 0.001). Men were 40% less likely to have BP reduction compared to women (P = 0.02); African Americans and Hispanic Americans were 63% (P < 0.0001) and 37% (P = 0.07) less likely to have BP reduction as compared to Caucasian Americans, respectively. After adjusting for sex and race/ethnicity, the odds of BP reduction was 4.88 times (95% confidence interval, 2.66-8.95) higher for participants who checked their BP readings frequently, compared to those who did not frequently check their BP readings. Hypertensive participants who monitor their BP readings frequently using a self-management program have better BP control.

Hypertension in Workers: The Role of Physical Activity and its Different Dimensions.

ResumoFundamento A atividade física, em diferentes dimensões (ocupacional, doméstica e de lazer), pode ter papel relevante sobre a hipertensão arterial (HA). Praticar atividade física apenas no lazer, ou isoladamente nas outras dimensões, pode ser insuficiente para o controle efetivo da HA.Objetivo Analisar o efeito isolado e cumulativo das dimensões da atividade física sobre a ocorrência de hipertensão arterial em trabalhadores.Métodos Estudo transversal com 1.070 trabalhadores de Limpeza Urbana e Indústria de Calçados, na Bahia, utilizando questionário aplicado por entrevistador acerca de aspectos sociodemográficos, ocupacionais, de estilo de vida e morbidade hipertensiva.Foram medidos peso, altura, circunferência abdominal e pressão arterial. Caso de HA: pressão arterial sistólica ≥140 ou diastólica ≥90, ou tratamento regular de Hipertensão. Foram investigadas as dimensões ocupacional, doméstica e de lazer da atividade física. Realizou-se análise multivariada com Regressão de Cox para estudos transversais.Resultados A prevalência de HA foi de 24%, sendo 37% dentre pacientes com idades entre 35 e 44 anos, e 51% entre 45 e 54 anos. O modelo multivariado evidenciou que ativos em uma dimensão ou em nenhuma tiveram 62% mais HA, e um valor 25% mais elevado de HA foi observado dentre aqueles trabalhadores ativos em duas das três dimensões, na comparação com os ativos nas três dimensões. Sexo masculino, maior idade (> 31 anos) e excesso de peso se associaram à HA, com razões de prevalência de 1,62, 2,10 e 2,26, respectivamente.Conclusões Verificou-se efeito cumulativo das dimensões da atividade física sobre a ocorrência de HA. Classificar sujeitos ativos no trabalho ou no ambiente doméstico como inativos ao se basear apenas na dimensão do lazer pode implicar em erro metodológico. (Arq Bras Cardiol. 2020; 114(5):755-761)

Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction.

ABSTRACTAlthough population salt reduction is considered a “best buy” in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.

Abstract 306: Guideline-based Strategies for Improving Control of High Blood Pressure: The 2019 Acc/Aha Performance and Quality Measures for Adults With High Blood Pressure

Despite a 27% reduction in all-cause mortality from targeting a systolic blood pressure of &amp;lt 120 mm Hg, as compared with &amp;lt 140 mm Hg, existing quality measures from the NCQA for controlling HBP (for hypertensive adults 18-59 years of age whose blood pressure was &amp;lt 140/90 mm Hg) have not changed substantially over the past several years for a variety of insured populations, including commercial, Medicaid, Medicare Fee for Service and Medicare Advantage. Re-examining both the targets and processes of managing HBP are thus warranted to help support the use of the latest evidence in optimizing the quality of care and outcomes for patients with HBP. The recently published 2019 ACC/AHA Clinical Performance and Quality Measures for Adults with High Blood Pressure are designed to promote improvements in diagnosis and control of high blood pressure, including a new emphasis on “structural” quality measures that focus on a comprehensive system of care as outlined in the 2017 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. The purpose of this presentation will be to provide a detailed overview of this new measure set as a “Blueprint for Change” necessary to overcome current health system inertia and ensure the achievement of better quality of care for people with High Blood Pressure.