Hypertension Education Research Articles

Knowledge exchange between patient and pharmacist: A mixed methods study to explore the role of pharmacists in patient education and counseling in asthma and pulmonary arterial hypertension

To better understand the role of pharmacists in patient education and counselling: describe the perception of knowledge exchange (KE) between asthma/pulmonary arterial hypertension patients and pharmacists (hospital/community) according to four dimensions (4C-typology): cure (C1), care (C2); coordination/supply chain (C3), characteristics of the pathophysiology/disease mechanisms (C4); factors correlated with KE. A mixed methods approach was used. Part A: data from semi-structured patient interviews were processed (thematic analysis), and a questionnaire developed. Part B: completed patient questionnaires were processed by correspondence factor analysis. KE (4C-typology) was correlated with pathology, disease severity, disease duration, age, hospital/community pharmacist. Patients expected pharmacists to provide C2/C3 services. KE with pharmacists covered C1/C2/C3, and with physicians, C1/C2/C4. While patients perceived KE as a means of self-learning to improve self-care skills, the two-way nature meant it provided specific experiential information feedback to pharmacists. This 4C-typology provides a holistic framework for optimising the pharmacists' role in education and counselling of patients with chronic diseases.

Strategies for improving the treatment and control of hypertension in Japan.

Despite the significant advancements in the diagnosis and treatment of hypertension, the burden of hypertension remains a major global health care concern. In Japan, estimates show that more than two-thirds of the population have uncontrolled hypertension, regardless of whether they were taking antihypertensive medication. To improve hypertension management, hypertension guidelines have been developed and updated regularly by hypertension societies across various countries and regions. The Japanese Society of Hypertension (JSH) updated the Guidelines for the Management of Hypertension in 2019 (JSH 2019). The JSH 2019 aims to establish a standard management strategy for hypertension and provide evidence to all health care providers. One of its updated main features is its proposal for multidisciplinary team-based care (TBC) involving physicians, pharmacists, nurses, dietitians, and other health care providers. The TBC will help initiate and intensify the management of hypertension, as well as combat clinical inertia, which is expected to contribute to uncontrolled blood pressure and subsequent development of cardiovascular diseases. This is consistent with the recommendations from recent major guidelines on hypertension management. Moreover, to reduce the evidence-practice gap in hypertension management, it is essential to disseminate the essence of the guidelines and provide hypertension education programs for all health care providers and patients. This review summarizes the points of the JSH 2019-based strategy for improving hypertension management and discusses guidelines for its implementation into actual clinical practice.

563-P: A Community Health Worker–Led Hypertension and Diabetes Management Program for South Asians in Atlanta: The DREAM Atlanta Study

Background: South Asians are disproportionately affected by type 2 diabetes (DMII) and comorbid hypertension (HTN) , which increases the risk of stroke and myocardial infarction. In Atlanta, South Asians represent one of the fastest growing immigrant populations. Community health worker (CHW) interventions have been shown to improve chronic disease outcomes, yet few tailored interventions have addressed the high burden of cardiovascular disease among South Asians. Objective: To test the effectiveness of an evidence-based, CHW-led, and culturally-tailored HTN and DMII management program for South Asian adults with DMII and comorbid HTN. Methods and Study Design: Randomized-Waitlist Controlled Trial Setting/intervention: The treatment group received 5 group virtual DMII and HTN education sessions as well as 2 one-on-one goal setting sessions. The waitlist control group received 3 group virtual sessions at the end of study. Measures: Primary outcomes included feasibility, acceptability, and change in BP control (systolic blood pressure (SBP) <130 and diastolic blood pressure (DBP) <80) . Secondary outcomes included changes in glycated hemoglobin (HbA1c) , weight, diabetes self-efficacy, healthy eating, and physical activity. Results: A total of 199 South Asian adults were randomized to treatment or control groups. At 6-month follow-up, 40.2% of the treatment group had controlled BP, compared to 24.2% of the control group (p=0.020) . Absolute change in mean SBP and DBP was significantly greater for the treatment group vs. control group. Weight change was -4.8lbs in the treatment group, compared to +0.6lbs in the control group (p=0.007) . The intervention had an overall retention of 95% (treatment = 92, control=91) . Conclusions: A culturally-tailored CHW-led intervention is feasible, acceptable, and can significantly improve diabetes and HTN among South Asians. Further study will evaluate the implementation and scalability of the intervention. Disclosure M.K.Shah: None. L.Wyatt: None. C.C.Gibbs: None. S.Mammen: None. F.M.Mohsin: None. N.Islam: None. Funding NIMHD: K23 MD015088-and 3U54MD000538-17S1

RELATIONSHIP BETWEEN SERUM OSTEOCALCIN AND BLOOD PRESSURE IN CHINESE ADOLESCENTS AGED 12–18 YEARS

Objective: The relationship between serum osteocalcin level and blood pressure remains unclear. The aim of this study was to determine whether osteocalcin would be associated with blood pressure in Chinese adolescents. Design and method: A total of 1686 subjects (1022 boys,60.6%) aged 12–18 years from Ningxia were randomly selected through a stratified cluster sampling. Serum osteocalcin levels were measured by ELISA. Blood pressure (BP) by using a calibrated electronic sphygmomanometer according to the standard method by the American Hypertension Education Project Working Group. Results: The proportions of Hypertension was highest in the< = 33th percentile subgroup (39.8%) and lowest in the > 66th percentile subgroup (26.3%) in boys, with statistically significant differences between groups (2 = 10.988, P = 0.027). Compared with the subgroup of the< = 33th percentile, the odds ratios (ORs) for abnormal blood pressure were 0.73(95% confidence interval (CI), 0.55—0.96) in the 34th–66th percentile subgroup, 0.64(95% CI, 0.48—0.84) in the > 66th percentile subgroup, respectively. Additionally, the corresponding ORs for high BP were 0.63(95%CI,0.45–0.89) in the 34th–66th percentile subgroup,0.59(95%CI,0.42–0.84) in the > 66th percentile subgroup, respectively. Similar results were found in boys (P all < 0.05). After Adjusting age, fasting blood glucose and BMI, the ORs for high BP were 0.60(95%CI,0.36–0.99) in the > 66th percentile subgroup compared with the reference subgroup. Conclusions: Serum osteocalcin is a protective factor for hypertension in Chinese adolescents, especially in boys.

A behavior change wheel-based interactive pictorial health education program for hypertensive patients with low blood pressure health literacy: study protocol for a randomized controlled trial

BackgroundThe prevalence of hypertension is increasing worldwide. Hypertension self-management usually involves the application and consideration of oral, written, or quantitative information. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL), which may lead to poorer clinical outcomes. This study aims to determine the feasibility and effectiveness of an interactive pictorial health education program based on behavior change wheel (BCW) theory and its effect on HBP-HL, self-efficacy, self-management ability, and health-related quality of life (HRQOL) in hypertensive patients with low HBP-HL.MethodsThis study is a randomized controlled trial (RCT). One of the municipal districts in Huzhou, China, will be randomly selected, and two communities with similar conditions within this district will be screened and selected. A total of 120 hypertensive patients aged 18 years and older will be recruited from these two community settings. One of the communities will be randomly allocated to an interactive pictorial health education program conducted by a comprehensive health literacy strategy that includes (i) training participants in effective health communication skills that address issues encountered in seeking medical care and (ii) the use of self-developed interactive pictorial hypertension education to improve patient understanding and behaviors versus a control group (routine community lecture health education only). The primary outcome measure is HBP-HL. Secondary outcomes are self-efficacy, self-management ability, HRQOL, social support, and improvement in blood pressure. Outcomes will be collected at 6, 9, and 12 months from trial entry.DiscussionThe strengths of this study are the establishment of a new health management program for hypertensive patients that closely combines BCW theory and health literacy. This trial has the potential to improve HBP-HL in hypertensive Chinese patients with low health literacy to improve the self-management of hypertension and help control blood pressure.Trial registrationClinical Trials.gov Protocol Registration and Results System ID NCT04327102. Prospectively registered on February 29, 2020

Association between body composition and blood pressure in normal-weight Chinese children and adolescents

BackgroundThe aim of this study was to assess the associations of body fat distribution and lean body mass (LBM) with blood pressure (BP) in normal-weight Chinese children and adolescents.MethodsA total of 898 normal-weight Chinese children and adolescents, aged 10–18 years, were included this cross-sectional study via a cluster sampling method. The bioelectrical impedance analysis (BIA) was used to measure body composition. The participants were measured for blood pressure (BP) using a calibrated electronic sphygmomanometer according to the standard method by the "American Hypertension Education Project Working Group".ResultsBody composition was related to abnormal BP in normal-weight children and adolescents. After the model adjusted for age, smoking, and drinking, regression analysis showed that fat mass percentage (FMP) was negatively associated with abnormal BP, while LBM was positively associated with abnormal BP in boys(P < 0.05). Whereas FMP and visceral fat level (VFL) were positively associated with abnormal BP in girls (P < 0.05).ConclusionsThere are sex differences in the relationships between total body fat, visceral fat and lean body mass with abnormal BP in normal-weight youths. Therefore, it is of great significance to pay attention to the relative influence of the body composition of the boys and girls in the prevention and treatment of hypertension in youths.

Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments

BackgroundHypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension.MethodsWe searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted.ResultsThirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients’ metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was − 5.34 mmHg (95% confidence interval [CI], − 7.35 to − 3.33) and in diastolic blood pressure was − 3.23 mmHg (95% CI, − 5.51 to − 0.96).ConclusionsInterventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.

143 A Youth-Led Digital Education Intervention to Improve Blood Pressure for Adults Who Present to the Emergency Department with Hypertension

OBJECTIVES/GOALS: To describe a study to develop, test, and collect implementation data on a youth-led hypertension (HTN) education digital intervention that acts as an electronic tool to guide youth through learning and then teaching adults on how to achieve better HTN control. Adults with uncontrolled HTN are recruited from a New Jersey emergency department (ED). METHODS/STUDY POPULATION: Adults with HTN and youth (15-18 years) participate in a remote user-centered design session focus group to provide input in the development of the youth-led HTN education digital intervention. 100 adult ED patients with uncontrolled HTN (blood pressure (BP) ≥130/80 mm Hg) who live with a youth (15-18 years) and the youth themselves are recruited for a randomized control trial (RCT). The adult-youth dyad is randomized to one of two arms, each a 6-week program with youth earning a digital badge: 1) intervention- youth-led HTN education with the adult, or 2) control- youth learn life skills (such as job readiness/resume building). Implementation metrics are collected through a post-intervention survey and qualitative interviews on the digital badge intervention including acceptability, feasibility, and fidelity. RESULTS/ANTICIPATED RESULTS: We completed two youth focus groups (total of 8 participants) and data collection is ongoing. Youth have shown great interest in the intervention prototype and thought their peers would find it acceptable. They suggested additions to nutrition education activities, such as adding a sodium tracker and examples of high sodium foods. For the RCT, the primary study outcome is adult BP change (from baseline to 1 week and 2-months post-intervention), with secondary outcomes of HTN knowledge and youth self-efficacy. We anticipate that intervention arm adults will have a more significant decrease in BP than control arm adults. We also expect that HTN knowledge and youth self-efficacy will be higher for the intervention arm. Implementation data collected will allow for improvements to future renditions of the intervention. DISCUSSION/SIGNIFICANCE: Bringing health education home while simultaneously empowering youth is an innovative technology-driven model for improving BP for patients with uncontrolled HTN who may lack access to care. Outcomes of this project will result in a scalable and easily adoptable model to reach an otherwise difficult to reach adult population.

Pilot Results of a Digital Hypertension Self-management Program Among Adults With Excess Body Weight: Single-Arm Nonrandomized Trial.

BackgroundHome-measured blood pressure (HMBP) in combination with comprehensive medication support and lifestyle change are the mainstays of evidence-based hypertension (HTN) management. To date, the precise components needed for effective HTN self-management programs have yet to be defined, and access to multicomponent targeted support for HTN management that include telemonitoring remain inaccessible and costly.ObjectiveThe aim of this pilot study was to evaluate the impact of a digital HTN self-management program on blood pressure (BP) control among adults with excess body weight.MethodsA single-arm, nonrandomized trial was performed to evaluate a digital HTN self-management program that combines comprehensive lifestyle counseling with HTN education, guided HMBP, support for taking medications, and led by either a registered nurse or certified diabetes care and education specialist. A sample of 151 participants were recruited using a web-based research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in systolic BP from baseline to 3 months, and secondary outcomes included change in diastolic BP and medication adherence.ResultsParticipants’ mean age was 44.0 (SD 9.3) years and mean BP was 139/85 mm Hg. At follow-up, systolic and diastolic BP decreased by 7 mm Hg (P<.001, 95% CI –9.3 to –4.7) and 4.7 mm Hg (P<.001, 95% CI –6.3 to –3.2), respectively. Participants who started with baseline BP at goal remained at goal. For participants with stage 1 HTN, systolic and diastolic BP decreased by 3.6 mm Hg (P=.09, 95% CI –7.8 to 0.6) and 2.5 mm Hg (P=.03, 95% CI –4.9 to –0.3). Systolic and diastolic BP decreased by 10.3 mm Hg (P<.001, 95% CI –13.4 to –7.1) and 6.5 mm Hg (P<.001, 95% CI –8.6 to –4.4), respectively, for participants with stage 2 HTN. Medication adherence significantly improved (P=.02).ConclusionsThis pilot study provides initial evidence that a digital HTN self-management program improves BP and medication adherence.

Public's Knowledge of Hypertension and its Associated Factors: A Cross-Sectional Study

Background:Hypertension is a significant challenge for healthcare systems globally. It is estimated to cause 7.5 million deaths worldwide annually. Knowledge of hypertension plays a crucial role in behavioral changes required to prevent and manage the condition. This study aimed to assess the public's knowledge of hypertension’s risk factors, symptoms, complications, and treatment.Methods:This cross-sectional, descriptive, and exploratory study included a convenience sample of 723 Jordanian adults. The Hypertension Knowledge Test was used to measure the participants' knowledge of hypertension’s risk factors, symptoms, complications, and treatment.Results:The participants' mean score of total hypertension knowledge was 11.5 ±3.82 (52.2%), with 85.9% (n=621) having inadequate knowledge. Their mean scores for hypertension’s risk factors, symptoms, complications, and treatment were 7.45 ±2.35 (62.1%), 2.29 ±1.21 (45.8%), 1.38 ± 0.943 (46%), and 0.391 ± 0.603 (19.6%), respectively. Four factors were found to be significant predictors of participants' knowledge, such as age (p=0.002), education level (p&lt;0.001), family history (p&lt;0.001), and receiving hypertension-related information (p&lt;0.001).Conclusion:The participants had inadequate knowledge regarding hypertension’s complications, risk factors, symptoms, and treatment. Public health education programs that focus on hypertension knowledge are required. Nurses and other healthcare providers should take the initiative in hypertension education. Strategic planning and designing of hypertension programs are required to fit the needs of the Jordanian public to enhance their knowledge of hypertension and related preventive and control measures.

Burden of hypertension in Ghana - Analysis of awareness and screening campaign in the Ashanti Region of Ghana.

ObjectivesHypertension is a major risk factor for cardiovascular mortality globally and in Ghana. May Measurement Month (MMM) is a global awareness and screening campaign initiated by the International Society of Hypertension.MethodsParticipants were recruited by opportunist sampling in the Ashanti region of Ghana. The blood pressures of participants were measured three times and the mean of the last two readings was used for the analysis. Simple and multiple logistic regression was used to determine the predictors of hypertension.ResultsThe MMM 2018 awareness and screening campaign enrolled 5054 participants with a mean age of 39.4 ± 14.7 years. There were 2553 (50.6%) males, 987 (20.1%) of respondents had never checked their blood pressure and 676 (13.9%) had a prior history of hypertension. The prevalence of hypertension was 37.4%. We found that 589(66.8%) of 822 respondents with high blood pressure did not have a history of hypertension. Respondents with a known history of hypertension on medication were 442 (65.9%) and 219(68.0%) of 322 respondents on medication had uncontrolled hypertension. The predictors of high blood pressure in a multiple logistic regression were increasing age (OR = 1.05 CI 1.05–1.06, p < 0.001), history of alcohol intake (OR = 1.33 CI 1.04 −1.70, p = 0.02), overweight (OR = 1.4 CI 1.14–1.76, p = 0.001) and obesity (OR = 1.32, CI 1.01–1.74, p = 0.047).ConclusionThere is a high prevalence of hypertension in the Ashanti region in Ghana. Most participants with hypertension were not aware and the majority of those with hypertension on medications were uncontrolled. This calls for more education and screening of hypertension to decrease cardiovascular mortality.

Induction of labor versus expectant management of patients with gestational hypertension at term.

Objective: To compare maternal morbidity in planned induction of labour versus expectant management in women with gestational hypertension at term. Study Design: Randomized Clinical Trial. Setting: Department of Obstetrics and Gynecology, Bolan Medical Complex Hospital Quetta. Period: January 2017 to December 2017. Material &amp; Methods: 240 pregnant women with the diagnosis of gestational hypertension with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg without proteinuria were included. Patients were equally divided into two groups; group A (the intervention group) and group B (the expectant group). In group A, cervical ripening was stimulated with use of intravaginal prostaglandins. In group B, patients were monitored until the onset of spontaneous Labour. In both groups intervention was recommended in case of non-optimal FHR, the diastolic blood pressure ≥110mmHg or the systolic blood pressure ≥170 mmHg and eclampsia. Results: Out of 120 deliveries, 87 (72.5%) delivered by vaginal and 33 (27.5%) by caesarean section in group A. While in group B, out of 120 deliveries, 66 (55%) delivered by vaginal and 54 (45%) by caesarean section. The frequency of maternal outcome like mild preeclampsia present in 15% and 40% of women in group A and in group B respectively. Severe preeclampsia was noted 7.5% and 22.5% in group A and in group B respectively. Seizures were found in 2.5% of women in group A and 10% of women in group B. Conclusion: Complications like mild and severe preeclampsia and eclampsia could be prevented by induction of labour at term and also by widespread use of prenatal care education, prompt diagnosis and treatment of gestational hypertension.

코로나 팬데믹시대에 지역사회 기반의 YouTube 비대면 자가교육 프로그램 운영과 고혈압 환자의 만족도

Objectives: This study explored YouTube"s educational program developed for hypertensive patients in response to the COVID-19 pandemic at a community Hypertension and Diabetes Registration and Education Center and evaluated participant satisfaction. Methods: We conducted content analysis of hypertension-related videos uploaded on the YouTube channel “I Want to Know Blood Vessels!” and descriptive analysis of a cross-sectional study that evaluated the satisfaction of 213 hypertensive patients who watched these videos. Results: From April 2020 to November 2021, the center delivered a total of 25 videos related to hypertension. Most individual educational materials were viewed for seven to nine minutes, whereas the total screening time reached over 3 hours. Readers viewed lifestyle habit videos on exercise (up to 6,530 times) and nutrition (up to 1,400 times) more often than specialized videos on hypertension. Of the participants, 100% were satisfied with non-face-to-face self-management education, whereas 99.5% felt they received help from the contents. Conclusions: The improved accessibility of information and communication through YouTube’s educational strategy can enhance health education and promotion programs, while improving hypertensive patients’ health behavior. However, further research is needed to devise a more appropriate method for developing educational materials based on patient video inquiry patterns and preferences.

Postpartum Hypertension Education Improves Patient Hypertension Knowledge

Preeclampsia (PE) and eclampsia account for more than 19% of maternal mortality in Mississippi. Recent patient, provider, and advocacy focus groups have indicated a need for increased awareness and management of postpartum (PP) cardiovascular health among women with prior PE. The aim of this study is to examine the effect of hypertension (HTN) education on the awareness and knowledge of PP cardiovascular health.

Social Determinants of Health Attenuate the Relationship Between Race and Ethnicity and White Matter Hyperintensity Severity but not Microbleed Presence in Patients with Intracerebral Hemorrhage

The association between race and ethnicity and microvascular disease in patients with intracerebral hemorrhage (ICH) is unclear. We hypothesized that social determinants of health (SDOHs) mediate the relationship between race and ethnicity and severity of white matter hyperintensities (WMHs) and microbleeds in patients with ICH. We performed a retrospective observational cohort study of patients with ICH at two tertiary care hospitals between 2013 and 2020 who underwent magnetic resonance imaging of the brain. Magnetic resonance imaging scans were evaluated for the presence of microbleeds and WMH severity (defined by the Fazekas scale; moderate to severe WMH defined as Fazekas scores 3-6). We assessed for associations between sex, race and ethnicity, employment status, median household income, education level, insurance status, and imaging biomarkers of microvascular disease. A mediation analysis was used to investigate the influence of SDOHs on the associations between race and imaging features. We assessed the relationship of all variables with discharge outcomes. We identified 233 patients (mean age 62 [SD 16]; 48% female) with ICH. Of these, 19% were Black non-Hispanic, 32% had a high school education or less, 21% required an interpreter, 11% were unemployed, and 6% were uninsured. Moderate to severe WMH, identified in 114 (50%) patients, was associated with age, Black non-Hispanic race and ethnicity, highest level of education, insurance status, and history of hypertension, hyperlipidemia, or diabetes (p < 0.05). In the mediation analysis, the proportion of the association between Black non-Hispanic race and ethnicity and the Fazekas score that was mediated by highest level of education was 65%. Microbleeds, present in 130 (57%) patients, was associated with age, highest level of education, and history of diabetes or hypertension (p < 0.05). Age, highest level of education, insurance status, and employment status were associated with discharge modified Rankin Scale scores of 3-6, but race and ethnicity was not. The association between Black non-Hispanic race and ethnicity and moderate to severe WMH lost significance after we adjusted for highest level of education, suggesting that SDOHs may mediate the association between race and ethnicity and microvascular disease.

PENGUKURAN, SOSIALISASI GEJALA DAN PENANGANAN DINI HIPERTENSI PADA LANSIA DI KECAMATAN LEUWIGOONG KABUPATEN GARUT

Hypertension is better known by the public as a disease of high blood pressure. High blood pressure (High Blood Pressure / BP), diabetes mellitus and lipid abnormalities are the most common risk factors for cardiovascular disease. The implementation method used is blood pressure checks and counseling related to hypertension. The location of this health education is Lewigoong-Garut District, precisely in Kampung. Ciseureuh Village. Sindangsari. The target of this health education is the pre-elderly-elderly age range. The purpose of conducting health examinations and counseling on blood pressure in Leuwigoong District, Garut Regency are: Knowing the blood pressure in the community and the possibility of hypertension they are experiencing, Increasing public knowledge about the dangers and complications of hypertension, Providing knowledge of general and specific symptoms when blood pressure is above normal/ Hypertension, Providing knowledge about early treatment of Hypertension, Disseminating a healthy lifestyle to young and old age for the prevention of Hypertension. From this community service activity, it can be concluded that blood pressure checks are very useful for residents of Cisereuh Leuwigoong village. Examination that coincides with hypertension education to residents on a one by one basis is more effective when compared to the lecture method because the examiner and residents directly interact and communicate directly.

Organization of the therapeutic education process in hypertension at the level of primary health care

High blood pressure is a major public health problem, with indicators of morbidity and mortality being alarming. Therapeutic education in hypertension increases the level of awareness, blood pressure control and prevents complications. The aim of the study is to evaluate the process of organizing the therapeutic education of patients with hypertension at the level of primary health care in the Republic of Moldova. Study design: descriptive, transversal, by applying the questionnaire developed in the interest of the study. Study methods: statistical, synthetic, comparative, graphical. Th e study involved 371 respondents, of which 65% family physicians, 35% nurses. The majority of medical staff (98.1%) consider therapeutic education important, 87.3% recognized the definition of therapeutic education and its benefits: blood pressure control (90.6%); decrease in mortality caused by complications (81.7%); increasing treatment compliance (72.5%); disease awareness (65.5%). The surveyed medical staff demonstrated a disproportionate involvement in the 4 stages of the organization process: 42.3% are involved in the planning stage, 93.0% - implementation 29.1% - evaluation and 54.2% - organization. The process of organizing therapeutic education is incomplete, due to the lack or insufficiency of planning and evaluation of therapeutic education of patients with hypertension.

Explore the correlation between cerebral vessel characteristics with cognitive impairment among elder individuals: a community study from China

BackgroundBrain Magnetic Resonance Imaging (MRI) examination of cerebral small vessel disease (CSVD) may help screen vascular cognitive impairment. A recently estimated CSVD score system was suggested to capture the overall CSVD burden. The study aimed to detect the association between systemic evaluation score of cerebral vascular imaging parameters with cognitive functions.MethodsThis was a cross-sectional study in community settings. From October 2017 to September 2018, elder (≧60) residents were recruited through on-site visit in 6 communities from Shanghai, China. The participants underwent brain MRI, carotid ultrasound, laboratory tests of blood and urine samples. Cognitive function was evaluated using Mini-Mental State Examination (MMSE). MRI score of CSVD was calculated according to the 2012 standard for the evaluation of statistical changes in imaging.ResultsTotal 171 subjects completed survey and examinations. There were 55 participants diagnosed with cognitive impairment, with a total percentage of 32.2%. Participants with and without cognitive impairment showed significant differences in age, BMI and education level. Cognitive impaired participant had more disease history/comorbidity of hypertension and chronic renal insufficiency, higher level of creatinine, as well as lower level of full blood count (FBC) and alanine aminotransferase (ALT). A significant difference was detected in CSVD score between participants with and without cognitive impairment. Results of linear regression analysis showed significant negative correlations between MMSE score and both left and right carotid artery peak systolic velocity (PSV), however the CSVD score was only borderline (P = 0.0566) positively correlated with MMSE. Multivariate linear correlation analysis including all collected risk factor data showed that left carotid artery PSV score was among the independent negative correlated factors of MMSE. Multivariate binary logistic analysis showed that age, education and history of hypertension were the only statistically associated factors of cognitive impairment.ConclusionsThe current study identified high prevalence of cognitive impairment in a Chinese community. In addition, correlations between cerebral vascular disease imaging status and cognitive functions were confirmed although the sample size limited the possibility of screening cognitive impairment with imaging technique.

Abstract 10718: Prevalence, Correlates and Associated Mortality of Undiagnosed Angina in People Without Established Cardiovascular Disease in Us Adults: From the National Health and Nutrition Examination Survey 2001-2018

Background: The prevalence, correlates and associated mortality of undiagnosed angina in persons without established cardiovascular disease in the USA has not been established. We set out to establish the prevalence and correlates as well as assess mortality outcomes. Methods and Results: Included in our study were National Health and Nutrition Examination Survey (NHANES) participants from 2001-2018, aged ≥40years and free of established cardiovascular disease. The diagnosis of angina was established using the Rose Angina Questionnaire. The prevalence of undiagnosed angina was 1.99% (95% confidence interval (CI) 1.79- 2.20), corresponding to 2.6 million (95% CI 2.3 - 2.9) persons. In multivariable analysis, female sex (aOR 1.75, 1.37-2.25), lower education attainment (aOR 1.59, 1.08-2.33), obesity (aOR 2.68, 1.19-2.37), ever smokers (aOR, 1.51, 1.17-1.94), low income(Poverty index ratio &lt;3) aOR 1.89, 1.44-2.47), and hypertension (aOR 1.48, 1.12-1.96) were independent correlates of undiagnosed angina. Only 3.8% of all participants with undiagnosed angina were concomitantly on beta blockers, aspirin and a statin. The death rate was 1.08 per 1,000 person months and 1.71 deaths per 1000 person months among those without angina and those with angina, respectively. Conclusion: The prevalence of undiagnosed angina among US adults ≥40years and older was 2%. Female sex, hypertension, obesity, low income, smoking and low education were associated with undiagnosed angina. Harboring undiagnosed angina was associated with higher risk of mortality.

Development and Psychometric Validation of the Hypertension Beliefs Assessment Tool Among Adult Population in Northwest Ethiopia.

BackgroundIn Ethiopia, the majority of hypertension cases remain undiagnosed, untreated, and uncontrolled. Beliefs about hypertension and its complications play an important role in hypertension management behaviors. Accurate assessment of individuals’ beliefs towards the disease is of paramount importance in the design of hypertension education. This study aimed to develop and validate a hypertension belief assessment tool based on the Health Belief Model for the general population among rural adults in northwest Ethiopia.MethodsThe study included item construction, face and content validation, factor analysis, and establishment of reliability and validity of the tool. A total of 308 rural adults participated in the study. Inter-item and item-to-total correlations were used to examine the items assessed with the same content on a scale. Principal component analysis with promax rotation was used to extract the factors. Internal consistency reliability was assessed using Cronbach’s alpha coefficient. Convergent and discriminant validity were assessed using average variance extraction and maximum shared variance.ResultsThe median age of the participants was 41 (IQR: 31–55) years. Of the participants, 175 (56.8%) were female and 287 (93.2%) were farmers. Kaiser-Meyer-Olkin test value of 0.84 and significant Bartlett’s test of sphericity (p=0.000) revealed that the data were suitable for exploratory factor analysis. The principal component analysis identified 6 factors, which explained 70.06% of the variation of the hypertension belief. Cronbach’s alpha was 0.85 for the entire scale, ranging from 0.74 to 0.92 for the sub-domains. The average variance extracted was above 0.5 for all factors, indicating convergent validity. The maximum shared variance between the two constructs was lower than the average variance extracted from each factor, indicating that discriminating validity had been established.ConclusionThe hypertension belief assessment tool was found to be valid and reliable, which can be used to measure the health beliefs on hypertension for the rural adult population.