Differences In Blood Pressure Control Research Articles

For Debate: The 2023 European Society of Hypertension guidelines - cause for concern.

Originally, the beta-blockers were equally ranked alongside the other antihypertensive drug classes. Things changed when two major long-term randomized controlled trials, ASCOT-BPLA and LIFE showed that the patients receiving the beta-blockers based regimes suffered 25-30% more strokes than those receiving a calcium channel blocker based regime or an angiotensin receptor blocker based regime. The inferiority of the beta-blockers at stroke prevention was not due to differences in blood pressure control during the follow-up period in both trials. The 2023 European Society of Hypertension (ESH) guidelines still argue in favour of beta-blockers that their clinical inferiority was simply to lesser blood pressure reduction rather than class effect. The analysis argues that the return of beta-blockers as a first-line option for the management of uncomplicated hypertension by the ESH is a cause for concern and should be reconsidered.

#217 Renin-angiotensin-aldosterone system blockers effect in CKD progression in hypertensive elderly patients without proteinuria: PROERCAN trial

Abstract Background and Aims Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. Method Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years (Figure). Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. Results 88 patients were included with a mean age of 77.9 ± 6.1 years and a follow up period of 3 years: 40 were randomised to RAAS group and 48 to standard treatment. Etiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown etiology. In the RAAS group eGFR slope during follow up was −4.3 ± 1.1 ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6 ± 0.4 ml/min), p = 0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. Conclusion In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression.

Sex Differences in Left Ventricular Stroke Volume During Muscle Metaboreflex Activation

Introduction: Muscle metaboreflex activation (MMA) increases blood pressure, possibly by disproportionate increases in left ventricular (LV) stroke volume (SV) in males compared to females due to greater grip strength and metabolite production. The purpose of this study was to determine the effect of sex on SV during isolated MMA using cardiac MRI in young healthy adults. We hypothesized that SV would increase during MMA to a greater degree in males compared to females, and that this effect would be negated by accounting for grip strength. Methods: Ten males [23(2) yrs] and 10 females [26(5) yrs] underwent cardiac MRI during rest, 30% maximal voluntary contraction (MVC) isometric handgrip exercise (6 min), and isolation of MMA with brachial cuff circulatory occlusion (6 min). SV, end-systolic (ESV) and end-diastolic volumes (EDV) were measured by 2- and 4-chamber cine images and indexed (i) to body surface area to account for body size. Heart rate (HR, ECG) and mean arterial pressure (MAP, brachial cuff) were recorded. Cardiac output index (COi) and total peripheral resistance (TPR) were calculated. Analyses included ANOVA (sex × condition), ANCOVA [100% MVC (M=49(13) kg, F=26(7) kg) covariate], and linear regression. Results: SVi decreased from rest to MMA in males [67(8) to 61(5) mL/m2, p=0.0001] but not females [59(9) to 59(7) mL/m2, p=0.998; interaction p=0.002]. Notably, the reduction in SVi during MMA in males ( p=0.002) but not females ( p=0.957) remained with ANCOVA using MVC as the covariate (interaction p=0.021). ESVi increased during MMA in males [39(5) to 48(10) mL/m2, p<0.0001] but not females [32(5) to 36(6) mL/m2, p=0.092; interaction p=0.029]. MMA decreased both EDVi ( p=0.004) and COi ( p=0.045) and increased both MAP ( p<0.0001) and TPR ( p<0.0001) pooled across sex. HR did not change with MMA in either sex (all p≥0.093). Linear regression revealed significant relationships between ΔSVi and ΔESVi in males ( p=0.002, R2=0.709) but not females ( p=0.223, R2=0.179) and between ΔSVi and ΔTPR in males ( p=0.005, R2=0.649) but not females ( p=0.522, R2=0.053). Conclusions: MMA lowers SVi in males but not females, even when accounting for grip strength and despite similar pressor responses in both groups. These findings from gold-standard MRI suggest differential LV responses to MMA between sexes, potentially related to greater sensitivity to increased TPR in males than females. Thus, sex differences in blood pressure control during MMA may be impacted by differences in LV afterload sensitivity. Further, the blood pressure response to MMA may be primarily mediated through TPR and not CO in healthy young adults. Heart and Stroke Foundation of Canada. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract 15757: Racial Disparities in Acute Respiratory Failure Incidence During Hypertensive Emergencies

Introduction: One of the most frequent complications of hypertensive emergency is pulmonary edema, which can ultimately lead to requiring mechanical ventilation because of respiratory failure. Additionally, epidemiologic studies have observed that certain races are disproportionately affected by hypertensive emergency. This analysis aimed to assess if race was also associated with increased likelihood of requiring mechanical ventilation during hypertensive emergencies. Methods: Using the 2020 National Inpatient Sample data, we identified patients admitted due to hypertensive emergencies. We excluded admissions for primary acute hypoxic respiratory failure necessitating invasive mechanical ventilation. To explore potential relationships, we employed logistic and linear regression analyses, accounting for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was <0.05. Results: In 2020, among 1,221,535 hypertensive emergency hospital admissions, 124,200 (10.2%) involved patients needing mechanical ventilation due to respiratory failure. After adjusting for factors such as age, gender, hospital attributes, insurance, income, and Elixhauser comorbidities, Black and Asian/Pacific Islander patients exhibited higher likelihoods of requiring mechanical ventilation due to respiratory failure. Compared to White patients, the adjusted odds ratios were 1.06 (95% CI 1.05-1.12) for Black patients and 1.18 (95% CI 1.06-1.32) for Asian/Pacific Islander patients. Conclusions: We have demonstrated that there are racial disparities associated with development of acute hypoxic respiratory failure in the setting of hypertensive emergencies. Further research needs to be undertaken to identify if these racial differences are due to differences in blood pressure control or if clinical management differs by race in the acute hospitalization contributing to adverse outcomes.

EVALUATION OF THE EFFICACY AND SAFETY OF MEDICAL TREATMENT WITH LOWER DOSES OF SPIRONOLACTONE IN A COHORT OF PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: Treatment with mineralocorticoid receptor antagonists is recommended for patients with bilateral forms of primary aldosteronism or with unilateral forms unwilling or unable to undergo surgery, using spironolactone as the primary choice, with a suggested dose of 1 to 2 mg/Kg/day. In clinical practice, however, the dose prescribed has been progressively decreased to achieve a better tolerance of the drug and, consequently, a higher compliance to treatment. Our aim was to evaluate how the lowering of spironolactone dose could have impacted on arterial blood pressure control and on the prevalence of adverse effects. Design and method: We retrospectively included 394 patients with primary aldosteronism receiving a medical treatment with spironolactone, with a minimum follow-up of 1 month after the initiation of medical treatment. Patients were divided into two groups, according to the median prescribed dose of spironolactone in our population (50 mg, 25 – 75): subjects treated with >50 mg and patients treated with < = 50 mg of spironolactone daily. Results: The median follow-up after the introduction of spironolactone was 6 months, and 135 patients experienced spironolactone-related adverse effects (34.3%), with a higher proportion in men than in women (76.30% vs. 23.70%). The most frequently reported adverse effect was gynecomastia, followed by erectile dysfunction. Subjects receiving a dose >50 mg of spironolactone daily displayed a significantly higher prevalence of side effects (42.2%), while a prevalence of 30.5% was described in the < = 50 mg group. Patients in the lower dose group were treated with a higher number of anti-hypertensive drugs, especially diuretics. No statistically significant differences were seen between the two subgroups in blood pressure measurements at follow-up. Conclusions: Treatment with low doses of spironolactone could help achieve a better adherence in patients with primary aldosteronism, with a lower rate of adverse effects compared to patients treated with higher doses, with no differences in blood pressure control at follow-up. This goal could be achieved by prescribing a higher number of anti-hypertensive drugs. These findings could help the clinician in choosing the best therapeutical option for each patient.

Mechanisms of sex and gender differences in hypertension.

The mechanisms that control blood pressure are multifaceted including the sympathetic nervous system and the renin-angiotensin system leading to vasoconstriction and sodium reabsorption that causes a shift in the pressure-natriuesis relationship to higher blood pressures. Sex steroids can affect these mechanisms either directly or indirectly, and the effects may be different depending on the sex of the individual. This review will discuss some of the major blood pressure-controlling mechanisms and how sex steroids may affect them and the need for future studies to better clarify the mechanisms responsible for sex and gender differences in blood pressure control. New mechanisms that are identified, along with what is already known, will provide better tools for treatment of hypertension in men and women of all ethnicities and decrease the risk of cardiovascular disease in the future.

Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys

BackgroundPatients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012–13; and EA-V, 2016–17) in Germany.MethodsThe EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V).Results384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%).ConclusionBetween 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

Racial Differences and Social Determinants of Health in Achieving Hypertension Control

ObjectiveTo investigate whether specific social determinants of health could be a “health barrier” toward achieving blood pressure (BP) control and to further evaluate any differences between Black patients and White patients. Patients and MethodsWe conducted a retrospective cohort study of 3305 patients with elevated BP who were enrolled in a hypertension digital medicine program for at least 60 days and followed up for up to 1 year. Patients were managed virtually by a dedicated hypertension team who provided guideline-based medication management and lifestyle support to achieve goal BP. ResultsCompared with individuals without any health barriers, the addition of 1 barrier was associated with lower probability of control at 1 year from 0.73 to 0.60 and to 0.55 in those with 2 or more barriers. Health barriers were more prevalent in Black patients than in those who were White (44.6% [482 of 1081] vs 31.3% [674 of 2150]; P<.001). There was no difference at all in BP control between Black individuals and those who were White if 2 or more barriers were present. ConclusionPatient-related health barriers are associated with BP control. Black patients with poorly controlled hypertension have a higher prevalence of health barriers than their White counterparts. When 2 or more health barriers were present, there was no differences in BP control between White and Black individuals.

Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018.

Multisociety guidelines recommend a goal systolic blood pressure (BP) <130 mm Hg and a hemoglobin A1c (HbA1c) <8% in patients with heart failure (HF), regardless of ejection fraction. Few studies have described BP and glycemic control in ambulatory patients with HF and racial and ethnic disparities in this subset of the population. We evaluated prevalence of uncontrolled BP and HbA1c in non-Hispanic Black, non-Hispanic White, and Mexican American adults aged ≥20 years with self-reported HF (National Health and Nutrition Examination Surveys: 2001-2018). Prevalence ratios (95% CI) for uncontrolled BP and HbA1c were calculated by race and ethnicity and adjusted for sex, age, treatment, and socioeconomic status. In secondary analyses, we examined trends in the prevalence of uncontrolled BP and HbA1c. Uncontrolled BP was present in 48% (95% CI, 49%-56%) of adults with HF (representing 2.3 million people). Non-Hispanic Black participants had a higher prevalence of uncontrolled BP compared with non-Hispanic White participants (53% [48%-58%] compared with 47% [43%-51%], P<0.05). In adjusted models, non-Hispanic Black participants were 1.19 (1.02-1.39) times more likely to have uncontrolled BP than non-Hispanic White participants. Overall, uncontrolled HbA1c was found in 8% (6%, 10%) with no differences by race and ethnicity. Prevalence of uncontrolled BP improved over time but uncontrolled risk factors remained high-2017 to 2018: 41% (36%, 47%) and 7% (5%, 12%) had uncontrolled BP and HbA1c, respectively. We document an unacceptably high prevalence of uncontrolled BP and HbA1c in a nationally representative, ambulatory HF sample with significant differences in BP control by race and ethnicity.

Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil Study.

ResumoFundamento Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos.Objetivos Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia.Métodos O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%.Resultados Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos.Conclusões Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.

Sex differences in TLR4 expression in SHR do not contribute to sex differences in blood pressure or the renal T cell profile.

Hypertension is a primary risk factor for the development of cardiovascular disease. Mechanisms controlling blood pressure (BP) in men and women are still being investigated; however, there is increasing evidence supporting a role for the innate immune system. Specifically, Toll-like receptors (TLRs), and TLR4 in particular, have been implicated in the development of hypertension in male spontaneously hypertensive rats (SHR). Despite established sex differences in BP control and inflammatory markers in hypertensive males and females, little is known regarding the role of TLR4 in hypertension in females. Our hypotheses were that male SHR have greater TLR4 expression compared with females, and that sex differences in TLR4 contribute to sex differences in BP and the T cell profile. To test these hypotheses, initial studies measured renal TLR4 protein expression in 13-wk-old male and female SHR. Additional SHR were implanted with telemetry devices and randomized to treatment with either IgG or TLR4 neutralizing antibodies. Untreated control male SHR have greater TLR4 protein expression in the kidney compared with females. However, treatment with TLR4 neutralizing antibody for 2 wk did not significantly alter BP in either male or female SHR. Interestingly, neutralization of TLR4 increased renal CD3+ T cells in female SHR, with no alteration in CD4+ T cells or CD8+ T cells in either sex. Taken together, our data indicate that although male SHR have greater renal TLR4 expression than females, TLR4 does not contribute to the higher BP and more proinflammatory renal T cell profile in males versus females.

Racial Differences in Blood Pressure Control Following Stroke: The REGARDS Study.

In the general population, Black adults are less likely than White adults to have controlled blood pressure (BP), and when not controlled, they are at greater risk for stroke compared with White adults. High BP is a major modifiable risk factor for recurrent stroke, but few studies have examined racial differences in BP control among stroke survivors. We used data from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) to examine disparities in BP control between Black and White adults, with and without a history of stroke. We studied participants taking antihypertensive medication who did and did not experience an adjudicated stroke (n=306 and 7693 participants, respectively) between baseline (2003-2007) and a second study visit (2013-2016). BP control at the second study visit was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg except for low-risk adults ≥65 years of age (ie, those without diabetes, chronic kidney disease, history of cardiovascular disease, and with a 10-year predicted atherosclerotic cardiovascular disease risk <10%) for whom BP control was defined as systolic BP <130 mm Hg. Among participants with a history of stroke, 50.3% of White compared with 39.3% of Black participants had controlled BP. Among participants without a history of stroke, 56.0% of White compared with 50.2% of Black participants had controlled BP. After multivariable adjustment, there was a tendency for Black participants to be less likely than White participants to have controlled BP (prevalence ratio, 0.77 [95% CI, 0.59-1.02] for those with a history of stroke and 0.92 [95% CI, 0.88-0.97] for those without a history of stroke). There was a lower proportion of controlled BP among Black compared with White adults with or without stroke, with no statistically significant differences after multivariable adjustment.

Abstract 54: Gender Differences In Blood Pressure Control Is Mediated By Age In United States Adults

Introduction: Blood pressure (BP) control remains a major public health challenge. Little is known about the gender differences in BP control across the age spectrum. We determined the age-stratified associations between gender and uncontrolled HTN. Methods: We included adults ≥20 years who reported HTN diagnosis and antihypertensive medication use from the 1999-2018 National Health and Nutrition Examination Surveys. Mean BP was calculated as the average of 3 consecutive BP readings 30 seconds apart. Uncontrolled HTN was considered as BP ≥140/90. We used survey design-adjusted multivariable logistic regression to determine the odds of uncontrolled HTN in women vs. men, adjusting for demographic, sociobehavioral, metabolic, and comorbid factors. Results: Among 13,253 participants taking antihypertensive medications (mean age 57, 52% female, 71% White), 34% had HTN (35% women, 33% men). Upon stratifying by 10-year age groups, men had higher odds of uncontrolled HTN from age 20 to 49 years, followed by a period of insignificantly different odds of uncontrolled HTN from age 50-69 years (Table). Among participants ≥70 years, females had significantly higher adjusted odds of uncontrolled HTN. These associations persisted when using the 2017 ACC/AHA guidelines. Conclusion: Women have significantly higher odds (&gt;20%) of uncontrolled HTN compared to men starting age 70. This may suggest that interventions to improve BP control in older women are warranted. The changes in the gender differences across the age spectrum warrant further evaluation.

Sex differences in hypertension: lessons from spontaneously hypertensive rats (SHR).

Although numerous clinical and experimental studies have clearly identified a sexual dimorphism in blood pressure control, the mechanism(s) underlying gender differences in blood pressure remain unclear. Over the past two decades, numerous laboratories have utilized the spontaneously hypertensive rats (SHR) as an experimental model of essential hypertension to increase our understanding of the mechanisms regulating blood pressure in males and females. Previous work by our group and others have implicated that differential regulation of adrenergic receptors, the renin–angiotensin system, oxidative stress, nitric oxide bioavailability and immune cells contribute to sex differences in blood pressure control in SHR. The purpose of this review is to summarize previous findings to date regarding the mechanisms of blood pressure control in male versus female SHR.

A mixed-method feasibility study of a novel transitional regime of incremental haemodialysis: study design and protocol

BackgroundIncremental haemodialysis/haemodiafiltration (HD) may help reduce early mortality rates in patients starting HD. This mixed-method feasibility study aims to test the acceptability, tolerance and safety of a novel incremental HD regime, and to study its impact on parameters of patient wellbeing.MethodWe aim to enrol 20 patients who will commence HD twice-weekly with progressive increases in duration and frequency, achieving conventional treatment times over 15 weeks (incremental group). Participants will be followed-up for 6 months and will undergo regular tests including urine collections, bio-impedance analyses and quality-of-life questionnaires. Semi-structured interviews will be conducted to explore patients’ prior expectations from HD, their motivations for participation and experiences of receiving incremental HD. For comparison of safety and indicators of dialysis adequacy, a cohort of 40 matched patients who previously received conventional HD will be constructed from local dialysis records (historical controls).ResultsData will be recorded on the numbers screened and proportions consented and completing the study (primary outcome). Incremental and conventional groups will be compared in terms of differences in blood pressure control, interdialytic weight changes, indicators of dialysis adequacy and differences in adverse and serious adverse events. In analyses restricted to incremental group, measurements of RRF, fluid load and quality-of-life during follow-up will be compared with baseline values. From patient interviews, a narrative description of key themes along with anonymised quotes will be presented.ConclusionResults from this study will address a significant knowledge gap in the prescription HD therapy and inform the development novel future therapy regimens.

Evaluation of a collaborative VA network initiative to reduce racial disparities in blood pressure control among veterans with severe hypertension

BackgroundCompared to White patients in the United States, Black patients have a higher prevalence of hypertension and more severe forms of this condition. ObjectiveTo decrease racial disparities in blood pressure (BP) control among Black veterans with severe hypertension within a regional network of Veterans Affairs Medical Centers (VAMCs). MethodsHealth system leaders, clinicians, and health services researchers collaborated on a 12-month quality improvement (QI) project to: (1) examine project implementation and the QI strategies used to improve BP control and (2) assess the effect of the initiative on Black-White differences in BP control among veterans with severe hypertension. ResultsWithin 9 participating VAMCs, the most frequently used QI strategies involved provider education (n=9), provider audit and feedback (n=8), and health care team change (n=7). Among 141,124 veterans with a diagnosis of hypertension, 9,913 had severe hypertension [2,533 (25.6%) Black and 7380 (74.4%) White]. Over the course of the project, the proportion of Black veterans with severe hypertension decreased from 7.5% to 6.6% (p=.002) and the racial difference in proportions for this condition decreased 0.9 percentage points, from 2.9% to 2.0% (p=.01). ConclusionsA multicenter, equity-focused QI project in VA reduced the proportion of Black veterans with severe hypertension and ameliorated observed racial disparities for this condition. Embedding health services researchers within a QI team facilitated an evaluation of the processes and effectiveness of our initiative, providing a successful model for QI within a learning health care system.

Abstract P193: Psychosocial Profiles And Hypertension Control: Results From The Multi-ethnic Study Of Atherosclerosis (MESA)

Introduction: Increasing research demonstrates psychosocial factors are associated with blood pressure control (BPC) among individuals with hypertension. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing profiles among individuals with hypertension. The association of psychosocial profiles and BPC remains unknown. Thus, the goal of this study was to characterize the psychosocial profiles of individuals with hypertension and assess whether they are associated with BPC over 14 years. Hypothesis: We hypothesize that discrete psychosocial profiles will emerge, and they will be associated with BPC longitudinally. Methods: We included 2,665 MESA participants (38.57% Black; 55.43% Female) with prevalent hypertension in 2002-2004. Latent Profile Analysis (LPA) was used to identify distinct psychosocial profiles based on a combination of nine psychosocial variables (Table). We used generalized estimating equations to determine associations of the psychosocial profiles with BPC, defined as systolic blood pressure (SBP) &lt; 140 mm Hg and diastolic blood pressure (DBP) &lt; 90 mm Hg. Results: The LPA revealed an optimal model of three psychosocial profile groups (AIC 121,229; entropy = .88) namely “Healthy”, “Depressed Mood” and “Discriminated Against”. There were no significant differences in BPC of both targets (SBP and DBP) combined across the profiles. Examining SBP and DBP separately, participants in the “Depressed Mood” profile group were 60% less likely [95% CI: 0.43, 0.84] to have their DBP &lt; 90 mm Hg as compared to the “Healthy” profile in the unadjusted model, but there was no association with covariate adjustment. Conclusions: Discrete psychosocial profiles exist among individuals with hypertension, but were not associated with BPC after full covariate adjustment.

Antihypertensive medication use and blood pressure control among treated older adults.

The association of different antihypertensive regimens with blood pressure (BP) control is not well-described among community-dwelling older adults with low comorbidity. We examined antihypertensive use and BP control in 10062 treated hypertensives from Australia and the United States (US) using baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Renin-angiotensin system (RAS) drugs were the most prevalently used antihypertensive in both countries (Australia: 81.7% of all regimens; US: 62.9% of all regimens; P<.001). Diuretics were the next most commonly used antihypertensive in both countries, but were more often included in regimens of US participants (48.9%, vs 33.3% of regimens in Australia; P<.001). Among all antihypertensive classes and possible combinations, monotherapy with a RAS drug was the most common regimen in both countries, but with higher prevalence in Australian than US participants (35.9% vs 20.9%; P<.001). For both monotherapy and combination users, BP control rates across age, ethnicity, and sex were consistently lower in Australian than US participants. After adjustment for age, sex, ethnicity, and BMI, significantly lower BP control rates remained in Australian compared to US participants for the most commonly used classes and regimens (RAS blocker monotherapy: BP control=45.5% vs 54.2%; P=.002; diuretic monotherapy: BP control=45.2% vs 64.5%; P=.001; and RAS blocker/diuretic combo: BP control=50.2% vs 65.6%; P=.001). Our findings highlight variation in antihypertensive use in older adults treated for hypertension, with implications for BP control. Differences in BP control that were observed may be influenced, in part, by reasons other than choice of specific regimens.

Blood pressure control in chronic kidney disease according to underlying renal disease: the Fukushima CKD cohort.

Inadequate blood pressure control is one of the important causes of chronic kidney disease (CKD), but only a limited number of reports have examined blood pressure control in Japanese patients with pre-dialysis CKD. Differences in blood pressure control due to underlying renal disease in pre-dialysis patients with CKD were investigated in the present study using the baseline data of the Fukushima CKD cohort study. The study involved 1351 CKD patients, classified by underlying disease of primary renal disease, hypertensive nephropathy, diabetic nephropathy, other nephropathies, or unknown. Target blood pressure of CKD patients was defined as < 130/80mmHg in patients under 75years old with diabetes and/or proteinuria, and < 140/90mmHg in other patients. The achievement rate of target systolic blood pressure was lower in the diabetic and hypertensive nephropathy groups than in the primary renal disease group (33.3%, 46.0% vs. 68.1%, p < 0.001). However, the number of antihypertensive medications increased in the diabetic and hypertensive nephropathy groups compared to the primary renal disease group (2.16, 2.04 vs. 1.55, p < 0.001). Inadequate blood pressure control was independently related to the underlying renal disease, with a significant difference between diabetic nephropathy and primary renal disease (odds ratio 3.19; 95% confidence interval, 2.16-4.69; p < 0.001). This study showed that blood pressure control differs by the underlying renal disease. Blood pressure control was poor especially in diabetic nephropathy despite multidrug combination antihypertensive treatment. It is necessary to verify whether strict blood pressure control improves patients' prognosis in diabetic nephropathy.

Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.

Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. Randomized comparative effectiveness trial. One hundred fifty-nine African Americans at an urban primary care clinic. Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. ClinicalTrials.gov Identifier: NCT01902719.