Determinants Of Blood Pressure Control Research Articles

Determinants of blood pressure control among hypertensive patients attending outpatient clinic at Thika Level 5 Hospital in Kiambu County, Kenya: a cross-sectional study design

Background: In 2019, global hypertension cases exceeded 1 billion, marking a twofold increase since 1990. In Kenya, hypertension affects 24% of the population and unfortunately, its control remains suboptimal and in particular, Kiambu County. Identifying the interconnected factors impacting hypertension control is crucial for developing effective interventions. This study aimed to evaluate these factors among Thika Level 5 Hospital patients in Kiambu County. Methods: A cross-sectional study design was used, utilizing mixed methods. The quantitative approach involved administering a structured questionnaire, while the qualitative aspect utilized a key informant interview guide. The sample size was determined using Cochran’s formula. An additional 30% of the calculated sample size (385) was included, resulting in a response rate of 98.6%. Systematic random sampling was employed to meet the required sample size. The study population consisted of hypertensive patients at Thika Level 5 Hospital in Kiambu County. Results: This study included 493 participants, with the largest proportion (32%) aged 55-65 years. The study identified a prevalence of uncontrolled hypertension at 73.6%. Factors strongly associated with uncontrolled blood pressure included respondents’ level of knowledge, choice of transport, and greater distance to healthcare facilities (χ2 (df=8), 78.67, p=0.001). The emerging theme from the key informants on patients’ knowledge about hypertension was “inadequate knowledge”. Conclusions: Recognizing that patient knowledge is a predictor of uncontrolled blood pressure, healthcare providers should consistently offer patient education. Additionally, the risk of uncontrolled blood pressure rises with greater distance from healthcare facilities, necessitating increased healthcare accessibility by the Ministry of Health.

The prevalence and determinants of blood pressure control among hypertension patients in eastern Zimbabwe: A cross-sectional study.

Uncontrolled blood pressure (BP), also known as hypertension, is a leading cause of morbidity and mortality globally. Lowering the elevated BP can significantly reduce one's risk for cardiovascular diseases. This study aimed to ascertain the determinants of BP control among hypertension patients. The data analyzed were from the exploratory survey of the Home Management of Hypertension (HoMHyper) project in eastern Zimbabwe. Hypertension patients were selected from the Chronic Disease Registers of five public health clinics using simple random sampling. A pretested interviewer-administered questionnaire was used to collect data, and the patient's BP was measured. The primary outcome, BP control, was used as a categorical variable (controlled vs. uncontrolled) to conduct a bivariate analysis. Variables significant at p<0.2 were included in the multivariable logistic regression analysis to control for confounding. Statistical significance in the final model was set at p<0.05. Data from 321 hypertension patients were analyzed; their mean age was 62.3±11.9 years. The prevalence of controlled BP was 41.4% (95% Confidence interval-CI = 36.0%-46.9%). After adjusting for confounding, patients' residence and medication stocks were associated with BP control. Patients who resided in high-density suburbs had higher odds of uncontrolled BP than those who resided in middle- and low-density suburbs (Adjusted odds ratios-AOR = 2.5; 95% CI = 1.4-4.4; p<0.01). Hypertension patients who experienced medication stockouts over the last six months had higher odds of uncontrolled BP than patients who did not experience stockouts (AOR = 1.8; 95% CI = 1.1-2.9). BP control among hypertension patients was suboptimal. Patient residence and antihypertensive medication stockouts were independent predictors of blood pressure control. We recommend exploring sustainable financing through private-public partnerships to ensure the availability of subsidized antihypertensive medication.

Blood Pressure Control among Adults with Hypertension at a Tertiary Hospital in Ethiopia.

Uncontrolled hypertension is a leading modifiable risk factor for cardiovascular disease morbidity and mortality. Despite the availability of several effective blood pressure lowering drugs, hypertension control rates remain poor globally. This study aimed to define the level of blood pressure control and to determine the factors associated with poor hypertension control. A hospital-based cross-sectional study was conducted from January to March 2019 at Tikur Anbessa Specialized Hospital among randomly selected 369 patients with hypertension. Data were collected using a pre-tested structured questionnaire. Multivariate binary logistic regression was used to identify determinants of blood pressure control. The mean (SD) age of the study participants was 55.5 (13.2) years; 188 (50.9%) were males and 28 (7.6%) were active smokers. More than half of the patients (56.0%) were overweight or obese. The most commonly identified comorbidities were diabetes mellitus (48.0%), dyslipidemia (50.9%), and chronic kidney disease (56.1%). The mean (SD) systolic blood pressure was 140.6 (22) mmHg, and diastolic blood pressure was 85.8 (14) mmHg. About two-thirds of the patients (60.2%) had uncontrolled blood pressure. The factors associated with poor blood pressure control with an AOR (95% CI) were increasing age: 1.05 (1.00-1.11), increasing household income: 1.25 (1.04-1.49), being physically inactive: 7.64 (1.14-51.13), chronic kidney disease: 5.36 (1.14-5.16), and use of home blood pressure monitoring: 0.31 (0.102-0.94). The rate of blood pressure control in patients with hypertension was suboptimal. Age, household income, level of physical activity, chronic kidney disease, and use of home blood pressure monitoring were independent predictors of blood pressure control. It is important to optimize the treatment of hypertension in this high-risk group by implementing effective strategies.

Determinants of blood pressure control among hypertensive patients of rural areas in a South Indian State: A community based cross sectional study.

Optimum blood pressure (BP) control is essential to prevent complications and improve the quality of life of patients with hypertension. This study aimed to explore the determinants of BP control in patients with hypertension on treatment without any other comorbidities. The study was conducted among 429 patients with essential hypertension aged > 30 years residing in four villages of a taluk/tahsil in a South Indian state. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic characteristics, diagnosis and treatment of hypertension, lifestyle factors (e.g. diet and substance use), facilitators and barriers of BP control and anthropometric measurements. BP was measured using World Health Organization standards and classified using the Joint National Committee 8 Guidelines. Descriptive statistics were measured in terms of numbers and percentages. Univariate and multivariate logistic regression analyses were used to determine the significant determinants of BP control. Approximately 64.3% of the participants had their BP under control. The participants aged 46-59 years were more likely to have uncontrolled BP than those aged ≥60 years. The participants with <80% adherence to medication (non-adherent) had a five fold higher odds of having uncontrolled BP than those with >80% adherence. Adherence to medication was the only significant factor for BP control in the present study. Hence, adherence to medication should be addressed with interventions targeted to improve BP control in patients with hypertension.

Social determinants of blood pressure control in a middle-income country in Latin America.

Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.

Determinants of blood pressure control among hypertensive patients attending a rural teaching hospital in Southern Nigeria.

Hypertension (HTN) is the commonest cardiovascular risk factor in sub-Saharan Africa. It is a global public health threat, often associated with significant morbidities and mortality with rising prevalence both in rural and semi-urban areas of economically disadvantaged countries. This study aimed to assess the determinants of blood pressure control among patients with hypertension receiving care at the Irrua Specialist Teaching Hospital in Southern Nigeria. A cross-sectional study of 502 consenting hypertensive adults receiving care at the Irrua Specialist Teaching Hospital, Irrua in Edo State, South-south Nigeria. A pre-tested semi-structured interviewer-administered questionnaire was used to collect data which was analyzed using SPSS version 21 and the level of significance was set at P < 0.05. Five hundred and two participants (226 males, 276 females) completed the study with a mean age of 52.98 ± 12.82 years. Optimal blood pressure control was found in 15.5% of the study participants. Blood pressure control was significantly associated with being married (OR 1.549, CI: 1.040-2.309), having a monthly household income of over N50,000 (OR 1.691, CI: 0.999-2.863), engaging in physical activity (OR = 1.537, CI: 0.989-2.388), and not being obese evidenced by a normal Waist Hip Ratio (OR = 2.276, CI: 1.555-3.332). Blood pressure control to target goal was low in the study population and achieved only in less than one-fifth of respondents on antihypertensive therapy. Numerous socio-demographic and lifestyle variables were shown to be associated with blood pressure control. Physicians should emphasize medication adherence and lifestyle modification approaches in hypertensive adults.

Abstract 055: Neighborhood-Wide Association Study Of Hypertension In The Health And Retirement Study

Background: Systematic evaluation of neighborhood factors which capture an array of characteristics -analogous to genome-wide-association studies- may identify important patterns in spatial determinants of blood pressure control. Methods: Our sample included Health and Retirement Study participants (N=13180; 58% women, 13% non-Hispanic Black, 4% Hispanic/Latino) with at least one sphygmomanometer reading taken between 2006 and 2016. Our main study outcome was at least one hypertensive blood pressure measurement over the study period. Participants were randomly assigned to either a training or test dataset. Using generalized estimating equations, we summarized multivariable associations between each of 51 standardized American Community Survey sociodemographic, housing, and income-related census tract variables (2005-09) and the period prevalence of measured hypertension. We adjusted for individual factors and accounted for multiple comparisons in the training set using the Simes significance test. Neighborhood-based factors that revealed statistically significant associations (Simes-adjusted p-value&lt;=0.05) with hypertension in the training dataset were rerun in the test dataset to replicate findings. Lastly, in the full cohort, we evaluated main and race/ethnicity-stratified independent effects of each significant neighborhood factor on the likelihood of at least one hypertensive sphygmomanometer reading between 2006 and 2016. We hypothesized that residence in neighborhoods with worse housing or socioeconomic characteristics would be associated with a higher odds of hypertension, and that associations in the full sample would differ by racial/ethnic designation. Results: Thirty-two percent (4218 out of 13180) of participants had at least one hypertensive sphygmomanometer reading between 2006 and 2016. In the training set, two of the 51 census-tract level variables were independently associated with period prevalence of hypertension. In the full sample, we observed a lower likelihood of prevalent hypertension (OR: 0.95; 95% CI: 0.92, 0.99) among participants residing in a census tract with recent (since 2000) in-migration. A higher proportion of relatively recent (since 2000) renters in the census tract was associated with a lower hypertension prevalence (OR: 0.95; 95% CI: 0.91, 0.98). When stratified by racial/ethnic designation, these patterns were apparent among Non-Hispanic White and to some extent Hispanic/Latino but not Non-Hispanic Black participants. However, differences were not statistically significant by race or ethnicity. Conclusion: In conclusion, relatively more recent relocation to an area appears to be modestly associated with reduced prevalence of hypertension. These findings support possible differential cardiovascular health impacts of gentrification. Further investigation is needed to confirm these findings.

Sleep Duration and Hypertension: Epidemiological Evidence and Underlying Mechanisms.

While the contribution of several physiological systems to arterial blood pressure regulation has been studied extensively, the role of normal and disrupted sleep as a modifiable determinant of blood pressure control, and in the pathophysiology of hypertension, has only recently emerged. Several sleep disorders, including sleep apnea and insomnia, are thought to contribute to the development of hypertension, although less attention is paid to the relationship between sleep duration and blood pressure independent of sleep disorders per se. Accordingly, this review focuses principally on the physiology of sleep and the consequences of abnormal sleep duration both experimentally and at the population level. Clinical implications for patients with insomnia who may or may not have abbreviated sleep duration are explored. As a corollary, we further review studies of the effects of sleep extension on blood pressure regulation. We also discuss epidemiological evidence suggesting that long sleep may also be associated with hypertension and describe the parabolic relationship between total sleep time and blood pressure. We conclude by highlighting gaps in the literature regarding the potential role of gut microbial health in the cross-communication of lifestyle patterns (exercise, diet, and sleep) with blood pressure regulation. Additionally, we discuss populations at increased risk of short sleep, and specifically the need to understand mechanisms and therapeutic opportunities in women, pregnancy, the elderly, and in African Americans.

Characteristics of Aerobic Exercise as Determinants of Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-Analysis

The purpose of this study was to evaluate the effect on blood pressure (BP) and heart rate (HR) according to aerobic exercise characteristics in adults with hypertension using a systematic review and meta-analysis. The related researches were selected from PubMed, EMBASE, Cochrane library, CINAHL, PsycINFO, SPORTDiscus and 5 domestic databases up to September 4, 2019. To estimate the effect size, random effect models were used to derive weighted mean differences (WMD) and their 95% confidence intervals (CI) of aerobic exercise on BP and HR. A total of 37 RCTs with 1,813 samples were included. Aerobic exercise was found to significantly reduce systolic BP (WMD, - 8.29 mmHg; 95% CI, - 10.12 to - 6.46), diastolic BP (WMD, - 5.19 mmHg; 95% CI, - 6.24 to - 4.14) and HR (WMD, - 4.22 beats/min; 95% CI, - 5.36 to -3.09). In detail, systolic BP and diastolic BP were significantly decreased in all groups of exercise types, frequency and duration. Systolic BP and diastolic BP were significantly decreased in the moderate and vigorous-intensity group. Exercise characteristics with the most dramatical change in systolic BP were water-based training, moderate-intensity, 3 times a week and 8 to 11 weeks of duration. In diastolic BP, the greatest effect size was over 24 weeks of exercise. Moderate aerobic exercise, especially water-based exercise can be an important part of lifestyle modification for hypertensive patients. Also, it can be recommended in a variety of clinical settings for lowering BP and HR. However, there is insufficient evidence that low-intensity exercise is effective in lowering BP.

A2270 Social determinants of blood pressure control in a middle-income country

A2270 Social determinants of blood pressure control in a middle-income country

Determinants of Blood Pressure Control and Prevalence of Hypertension in Adults in 2017: A Population-Based Study in West Jakarta

Background:The high prevalence of hypertension in developing countries underlines the need for accurate data on the prevalence of adult hypertension, as well as patient characteristics and determinants of blood pressure control. As this information is currently not available, our aim was to collect such data from a population of patients in the Tegal Alur Administrative Village, West Jakarta Indonesia.Objective:We conducted a case-control study (n = 152) to identify determinants of hypertension and a cross-sectional study (n = 3842) to determine hypertension prevalence and investigate determinants of blood pressure control in hypertensive adults (≥18 years old).Methods:The cross-sectional design involved the diagnosis of hypertension via home visits (active detection) and routine clinical examinations at the Tegal Alur II Community Health Center (passive detection). In the case-control design, the groups were sex-matched.Results:In 2017, the prevalence of hypertension in adults in Tegal Alur was 16.8% (n = 646), and the rate of uncontrolled hypertension was 89% (n = 572). A multivariate analysis showed that the adjusted prevalence ratio for comorbidities was 2.1 (95% confidence interval [CI]: 1.48–3.12;p= 0.005). A body mass index indicative of being overweight (≥23 kg/m2) had an odds ratio of 2.25 (95% CI: 1.14–4.44;p= 0.016).Conclusion:Comorbidities were the strongest predictor of uncontrolled blood pressure in hypertensive adults of Tegal Alur. Being overweight (BMI ≥23 kg/m2) was significantly associated with hypertension.

BLOOD PRESSURE CONTROL, TREATMENT AND THERAPEUTIC ADHERENCE IN HYPERTENSION, NON-VALVULAR ATRIAL FIBRILLATION AND ORAL ANTICOAGULANT TREATMENT. TAO-PRES PROYECT

Objective: To analyze the degree of blood pressure control in patients over 65 years, with hypertension (HT), non-valvular atrial fibrillation (NVAF) and oral anticoagulant therapy (OAC) in Primary Care (PC). To analyze the clinical profile in this type of patients, coexistence with other cardiovascular risk factors (CVRF), differences by gender and age, as well as possible determinants of blood pressure control. Design and method: Multicenter, descriptive, transversal, retrospective study. Tree urban and one rural PC centers collaborated in the proyect. All patients attended in any of the centers over 65 years, with diagnoses HT, NVAF and OAC were included. A systematic review of computerized medical history was made, taking anthropometric and analytical measurements, office blood pressure measurementS, pharmacotherapy, risk scales and pharmacotherapeutic adherence. Results: 1038 patients were included. Women 54.7%. The mean age was 81.4 years (SD 7.1), mean body mass index (BMI) 28.7 (SD 5.4), smoking 4.8%, enolism 5%, sedentary lifestyle 35.4%, cognitive impairment 12.3% Coexistence with other CVRF: dyslipemia 53.7%, diabetes 30.2%. Target organ injury: Nephropathy 32.8%, left ventricular hypertrophy 20.1%, peripheral artery disease 8%. Cardiovascular events: stroke 19.8%, coronary heart disease 16.3%, heart failure 26.7%. Mean systolic blood pressure (SBP) 132.6 (SD 13.4), mean diastolic blood pressure (DBP) 74.4 (SD 9.2). Controlled blood pressure (BP) in 66.7% of patients according to global mean measurements, in 54.7% according to total registered measurements. Statistically significant differences: mean age of patients with controlled BP (82.1) vs uncontrolled BP (78.4) p 0.0001; mean BMI of controlled patients (28.5) vs uncontrolled (29.4) p 0.04; % diabetic patients controlled (74.5) vs uncontrolled (25.5) p 0.005. The number of drugs was significantly higher in DM (p0.005), coronary heart disease (p0.002) and heart failure (p0.001). Most prescribed drugs were acenocumarol (65.7%) and beta blockers (43.5%). The overall pharmacotherapeutic adherence rate was significantly higher in women (p0.003) and nephropathy (p0.001). Conclusions: The degree of blood pressure control was high respect to mean blood pressure measurements but suboptimal respect to total measurements. There is a high coexistence with other CVRF. Blood pressure control was better in older patients, lower BMI and DM.

Prevalence and Determinants of Blood Pressure Control among Hypertensive Patients in Primary Care Centers, Najran, Saudi Arabia

Hypertension is a typical example of long-term condition posing formidable challenges to health care. Among hypertensive patients, insufficient adherence to drug therapy is one of the common causes of poor control of blood pressure. The objective of our study was to estimate the prevalence of blood pressure control among hypertensive patients and their determinants in primary care centers in Najran area. We conducted a retrospective analysis of administrative data from adult patients with hypertension followed in primary care clinics in Najran area. A representative sample of patients was randomly selected among eligible hypertensive patients from primary care clinics in Najran area. A total of 382 patients completed the survey and had data available for a 1 year medical record review. Their mean age was 62.71±14.16 years, 51.8% were male. The majority of the studied populations were married (96.6%). More than 50% of them were analphabetic (56.2%). The prevalence of patients with controlled blood pressure was 51.3% among the studied population despite ongoing hypertension treatments. Older age more than 60 years was a significant predictor of non-controlled hypertension. We conclude that targeted intervention to improve management of hypertension in primary care setting could make a substantial difference in the improvement of hypertensive patient prognosis.

Prevalence and Determinants of Blood Pressure Control Among Patients with Hypertension in Primary Care Settings, Najran Area, Saudi Arabia

Prevalence and Determinants of Blood Pressure Control Among Patients with Hypertension in Primary Care Settings, Najran Area, Saudi Arabia

Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia.

BackgroundControlling blood pressure (BP) leads to significant reduction in cardiovascular risks and associated deaths. In Ethiopia, data is scarce about the level and determinants of optimal BP control among hypertensive patients. This study aimed to assess the prevalence and associated factors of optimal BP control among hypertensive patients attending at a district hospital.MethodsA hospital-based, cross-sectional study was conducted among 392 hypertensive patients who were on treatment and follow-up at a district hospital. A structured questionnaire adopted from WHO approach was prepared to collect the data. Medication adherence was measured by the four-item Morisky Green Levine Scale, with a score ≥3 defined as “good adherence”. Blood pressure was measured, and optimal BP control was 0DEFined as systolic BP < 140 mmHg and diastolic BP<90 mmHg. Both binary and multivariable logistic regressions models were fitted to identify correlates of optimal BP control. All statistical tests were two-sided and a p values <0.05 was considered for statistical significance.ResultsThe mean age of the participants was 58 years (SD±13 years). Over half (53.8%) were females. Three quarters (77.3%) of the participants were adherent to their medications. The overall proportion of participants with optimally controlled BP was 42.9%.Female sex (Adjusted Odd Ratio(AOR) = 1.94, 95% CI: 1.15, 3.26), age older than 60 years (AOR = 2.95, 95% CI: 1.18, 7.40), consumption of vegetables on most days of the week (AOR = 2.16, 95% CI: 1.25, 3.73), physical activity (AOR = 4.85, 95% CI: 2.39, 9.83), and taking less than three drugs per day (AOR = 3.04, 95% CI: 1.51, 6.14) were positively associated with optimally controlled BP. Poor adherence to medications (AOR = 0.18, 95% CI: 0.09, 0.35), having asthma comorbidity (AOR = 0.33, 95% CI:0.12, 0.88) and use of top added salt on a plate (AOR = 0.20, 95% CI:0.11, 0.36) were negatively associated with optimal BP control.ConclusionA higher proportion of hypertensive patients remain with un-controlled BP. Modifiable risk factors including poor adherence to medications, lack of physical exercise, adding salt into meals, being on multiple medications and comorbidities were significantly and independently associated with poor BP control. Evidence-based, adherence-enhancing and healthy life style interventions should be implemented.

The effect of treatment for sleep apnoea on determinants of blood pressure control.

Our aim was to assess the effect of continuous positive airway pressure (CPAP) on the nocturnal evolution of peripheral chemosensitivity, renin-angiotensin-aldosterone system activity, sympathetic tone and endothelial biomarkers in obstructive sleep apnoea (OSA) patients with isolated nocturnal hypertension (INH) or day-night sustained hypertension (D-NSH).In a crossover randomised trial, 32 OSA patients newly diagnosed with hypertension and without antihypertensive treatment were randomly assigned to 12 weeks of CPAP or sham CPAP. Peripheral chemosensitivity was evaluated before and after sleep using the hypoxic withdrawal test (%ΔVI).At baseline, D-NSH patients showed higher %ΔVI before sleep and higher levels of aldosterone and diurnal catecholamines. CPAP only reduced the nocturnal increase of %ΔVI in INH patients (6.9%, 95% CI 1.0-12.8%; p=0.026). CPAP-induced change from baseline in %ΔVI after sleep was 7.5% (95% CI 2.6-12.2%, p=0.005) in the INH group and 5.7% (95% CI 2.2-9.3%, p=0.004) in the D-NSH group. In contrast, %ΔVI before sleep only decreased with CPAP in the D-NSH patients (3.0%, 95% CI 0.5-5.6%; p=0.023).In conclusion, CPAP reduces the nocturnal increase of peripheral chemosensitivity experienced by INH patients and corrects the high daytime sensitivity of patients with D-NSH. Differences in response to CPAP between these patients can help better understand the mechanisms of perpetuation of hypertension in sleep apnoea.

Abstract WMP59: Premorbid Blood Pressure Control of Incident Transient Ischaemic Attacks and Strokes; Prevalence and Determinants; Analysis of Individual Patient Data over 10 Years

Background: Uncontrolled blood pressure is the most important modifiable risk factor for strokes. Aims and Methods: We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP&lt;140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex. Results: Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p&lt;0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p&lt;0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p&lt;0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p&lt;0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale&gt;2; 1.54, 1.15-2.06, p&lt;0.001) were positively associated with controlled BP. Conclusions: Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.

Sex Differences in Renal Sodium Transporter Gene Expression

Regulation of sodium balance and blood volume by the kidneys is an important determinant of blood pressure control. Although the causative mechanisms remain unclear, it is well established that male sex is associated with higher blood pressure and increased cardiovascular risk compared to female sex. In order to determine a possible role for renal sodium transporters in sex‐dependent blood pressure regulation, we examined a number of renal transport genes in the kidney cortex of male and female mice. Under normal conditions, the circadian clock protein Per1 is a positive regulator of sodium transport genes including αENaC (α subunit of the epithelial sodium channel), Wnk1(with‐no‐lysine kinase 1), and NCC (sodium‐chloride cotransporter). Using qPCR and western blot analysis, we found significant differences between the sexes in a number of renal sodium transport genes and clock genes. Interestingly, Per1 (Period 1), Sgk1 (serum and glucocorticoid kinase 1), αENaC, Edn‐1 (Endothelin‐1), and NCC expression was higher in females compared to males whereas Wnk1 expression was equivalent between the sexes. These data show significant sex‐dependent differences in gene expression of distinct sodium transport genes and circadian clock genes. Whether or not these differences are related to sex‐dependent differences in blood pressure remains to be determined.Support or Funding InformationThis work was supported by NIH DK085193 and DK098460, the ASN Foundation for Kidney Research to MLG and 2T32HL083810 to KS.

Determinants of blood pressure control in rural KwaZulu-Natal, South Africa

Background: Hypertension is a common problem in South Africa and is known to be inadequately treated and poorly controlled.Objectives: The objective of the study was to investigate what proportion of patients prescribed antihypertensive medication had controlled blood pressure (BP) and to identify factors associated with poor control.Method: In May and June 2012, clinic-attending adults who had been prescribed antihypertensive medication were recruited into this cross-sectional study. A questionnaire administered by field assistants investigated participants’ socio-demographic characteristics, medical history, perception of health, use of traditional healers, illness perceptions, beliefs about medication, compliance with the medication and suggestions as to how to improve hypertensive treatment. BP measurements were taken. Logistic regression analysis identified the determinants of poor BP control.Results: Of the 500 participants, the mean age was 58 years, 78% were female and the majority had never been to school, or had only attended primary school. One third had adequately controlled BP (< 140/90 mmHg). Factors associated with poor BP control included being prescribed more than one antihypertensive medication, self-reported asthma and poor compliance with the medication, although the latter was not significant after adjusting for other variables. Participants with diabetes and those with a family history of a stroke were more likely to have good BP control.Conclusion: Only one third of participants had adequately controlled BP, and almost half did not understand their high BP at all. Many had concerns about taking medication, but most felt that it was necessary. Participants suggested that better health education and ensuring that medication was available in the clinics could improve BP control.

Validation of Uromodulin as a Candidate Gene for Human Essential Hypertension

A recent genome-wide association study identified a locus on chromosome 16 in the promoter region of the uromodulin (UMOD) gene that is associated with hypertension. Here, we examined the hypertension signal with functional studies in Umod knockout (KO) mice. Systolic blood pressure was significantly lower in KO versus wild-type (WT) mice under basal conditions (KO: 116.6±0.3 mm Hg versus WT: 136.2±0.4 mm Hg; P<0.0001). Administration of 2% NaCl did not alter systolic blood pressure in KO mice, whereas it increased in WT mice by ≈33%, P<0.001. The average 24-hour urinary sodium excretion in the KO was greater than that of WT mice (P<0.001). Chronic renal function curves demonstrate a leftward shift in KO mice, suggesting that the relationship between UMOD and blood pressure is affected by sodium. Creatinine clearance was increased during salt loading with 2% NaCl in the KO mice, leading to augmented filtered Na(+) excretion and further Na(+) loss. The difference in sodium uptake that exists between WT and KO strains was explored at the molecular level. Urinary tumor necrosis factor-α levels were significantly higher in KO mice compared with WT mice (P<0.0001). Stimulation of primary thick ascending limb of the loop of Henle cells with exogenous tumor necrosis factor-α caused a reduction in NKCC2A expression (P<0.001) with a concurrent rise in the levels of UMOD mRNA (P<0.001). Collectively, we demonstrate that UMOD regulates sodium uptake in the thick ascending limb of the loop of Henle by modulating the effect of tumor necrosis factor-α on NKCC2A expression, making UMOD an important determinant of blood pressure control.