Effective Management Of Hypertension Research Articles

OPTIMIZATION OF COMPONENT VARIABLES BY STATISTICAL APPROACH FOR DESIGN OF CHRONOTHERAPEUTIC DOSAGE FORM FOR HYPERTENSION

Objective: Blood pressure (BP) pursues circadian rhythms projecting its highest values during early morning and lowest during night. The aim of the present investigation was to design a newer programmable chronotherapy based capsule system containing delayed release microspheres of losartan potassium for effective management of hypertension.
 Methods: First, the microspheres were prepared with Eudragit RS100 by optimization technique through the application of Design Expert® software. The optimized microsphere formulation was filled in a capsule shell, and these shells were coated with 10% w/v Eudragit L100:Eudragit S100 (in ratio 1:2), in isopropyl alcohol: water as solvent system, to provide the necessary delay in emptying of capsule content. The whole capsular system was evaluated by various characteristic formulation parameters. Validation of optimization model and statistical interpretation of results was done using analysis of variance.
 Results: The results indicated that the optimized triple coated capsule shells showed an extended release of drug from microspheres after a lag time of 4 h.
 Conclusion: Conclusively, the chronotherapeutic system of losartan potassium was successfully developed to be dosed at bedtime that could benefit from the known circadian rhythms of the disease to control the BP for once a day therapy

Sudden Natural Death in Owerri Imo State, a 10 Years (2003-2012) Retrospective Postmortem Study

Abstract: Sudden unexpected natural death (SUND) was uncommon in our environment; with the adoption of western life style and societal pressures this mode of death is becoming more common. Understanding the causes of sudden natural death is important for prevention and improving treatment outcomes. Aim: The aim of this study was to describe the demographic data, the immediate cause of death and associated risk factors in the sudden unexpected natural death (SUND) cases in Imo state. Methodology: The archived case notes, Post-mortem registers and reports in the data bases of Departments of Pathology and Medical records and Biostastics of Federal Medical Centre (FMC) Owerri were used as the sources of data for this study from January 2003 to December 2012. Full post-mortem examinations were performed by consultant pathologists in the department using laid down protocols. Results: The male to female ratio was 3.3:1 with mean age of 45.2 ± 17.0. The age range was 15 to 80 years. The peak age of incidence was in the 41-50 years age group. The leading causes of SUND were the cardiovascular system (CVS) 55.4%, followed by central nervous system (CNS) which made up 23.1%, gastrointestinal system (GIT) constituted 8.5%, the Respiratory system (4.2%), Vascular disorder (4.2%) and undetermined causes (6.4%). The associated risk factors included dietary factors 14 cases (29.8%), alcohol use 9 cases (19.15%), cigarette smoking (17.02%), Diabetes mellitus 6 cases (12.76%), family history 5 cases (10.64%), those without associated factors 3 cases (6.38%) and congenital anomalies 2 cases (4.25%). Conclusion: In Nigeria, with increased western lifestyle, changes in dietary habits and rise in socioeconomic status, cardiovascular diseases especially complications of hypertension has become the most important cause of sudden unexpected natural death in our society. This calls for immediate and effective management of hypertension through effective clinical and public health policy implementation.

Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on the Next Blood Pressure Guidelines in Asia.

To estimate the impact of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for high blood pressure (BP) on the next hypertension guidelines in Asia. The 2017 ACC/AHA guidelines for high BP in adults changed the diagnostic threshold and the management goal of BP from 140/90 to 130/80mmHg. Another characteristic of the new guideline is its focus on a practical approach for the effective management of hypertension by using home and ambulatory BP monitoring; this point is also recommended in the 2014 Japanese Society of Hypertension Guidelines for the Management of Hypertension. In Japan, the guidelines for hypertension management are currently under revision and will be released in the spring of 2019. The core concept of the 2019 Japanese Society of Hypertension Guidelines for the Management of Hypertension, i.e., early and tight BP control over 24h, will contribute to target-organ protection and cardiovascular disease prevention for Asians.

The effects of a self-management program based on the 5 A's model on self-efficacy among older men with hypertension

Background: Aging population is progressively increasing. Older adults suffer from the different chronic health conditions such as hypertension. Behavior change is a key strategy for effective hypertension management. Successful behavior change necessitates the adequate self-efficacy. Objectives: This study aimed to evaluate the effects of a self-management program based on the 5 A's model on self-efficacy among the older men with hypertension. Methods: This randomized controlled trial was conducted in 2016–2017 on older men with hypertension in Ramsar, Iran. In total, 60 eligible participants were randomly allocated to an intervention and a control group. The participants in the intervention group were offered a self-management program based on the 5 A's behavior change model. Data were collected using a demographic questionnaire, a hypertension assessment form, the Self-Efficacy for Managing Chronic Disease Scale, and the hypertension Self-Efficacy Scale. Self-efficacy scales were completed for participants both before and 12 weeks after the intervention onset. The paired- and independent-sample t, Wilcoxon signed-rank, Mann–Whitney U, and Chi-square tests were used in the data analysis. Results: The pretest mean scores of hypertension self-efficacy in the intervention and the control groups were, respectively, 48.62 ± 11.71 and 44.65 ± 15.4, which significantly increased to 79 ± 13.13 and 62.06 ± 15.38 at posttest (P

Decision-making experiences of patients with end-stage kidney disease (ESKD) regarding treatment in Ghana: a qualitative study

BackgroundThis is the first qualitative study to explore patient decision-making regarding end-stage kidney disease (ESKD) treatment in sub-Saharan Africa. The study addresses an important gap in the literature concerning choice and decision-making in an international context.MethodsThe study employed a qualitative research design, using grounded theory methodology. In-depth interviews were conducted with twenty-two adult patients with ESKD in 3 clinical settings in Ghana. Data analysis involved coding and a constant comparative approach to generate key themes. Ethical approval was gained from relevant ethics committees both in Ghana and the United Kingdom.ResultsFour main factors (personal, financial, healthcare system, and support network) were identified to influence patient decision-making regarding ESKD treatment in Ghana. Treatment was initiated for various reasons, including, initially, the urgent need to avoid premature death. Many approached their condition hoping for a cure and did not always understand the chronic nature of their condition. Financial and geographical inaccessibility of renal replacement therapy (RRT), as well as a relative lack of biomedical treatment choices, made decision making daunting for the individual with ESKD in Ghana. The subject of death or conservative management was not openly discussed. Rather patients did everything possible to seek alternative forms of treatment, including the simultaneous use of other non-RRT and traditional or faith-based healing approaches.ConclusionsWhilst similarities exist, this study illuminates stark cultural and contextual differences which make decision-making on ESKD treatment a daunting experience for the individual with ESKD in Ghana - as compared to those in high-income countries. The challenges associated with ESKD management in Ghana calls for meticulous efforts at primary prevention of the disease, including interventions directed at effective management of diabetes mellitus, hypertension and other chronic kidney disease (CKD) precursor conditions. Enhancing information provision would promote informed decision making, particularly within the initial stages of patient decision-making.

Abstract 17394: Hypertension in Adults: Quality Improvement Intervention Evaluation of a Self-Measured Blood Pressure Monitoring Program

Introduction: Hypertension (HTN) is an insidious condition that affects many Americans. This quality improvement initiative evaluated the effectiveness of HTN management through a Self-Measured Blood Pressure (SMBP) monitoring tool through Check.Change.Control® (CCC). Hypothesis: To implement CCC and evaluate the impact on blood pressure throughout rural primary care clinics and wellness clinics over a six month period. This initiative assessed barriers for patients to adhere to medication regimen and barriers for providers to engage in patients’ HTN management. Methods: This initiative used CCC data to evaluate blood pressure changes and trends. Survey monkey were used to assess and evaluate patients and providers barriers for HTN management. Results: The sample included 208 adults with diagnosis of HTN with medication regimen. Regular tool use resulted in 76% reporting BP equal or less than 140/90. Compliance with medication regimens improved to 79.23%. The overall mean reduction in systolic was -11.3 mm Hg and diastolic was –9.7 mm Hg. Barriers reported through surveys included forgetting to take medication (5%) and forgetting to pick up medication from the pharmacy (2%). Most survey respondents (89.97%) agreed that text message reminders helped them be compliant.Thirty-six percent of providers and clinical staff cited time as a limiting factor for enrolling patients; providers reported one third of patients (33%) cited lack of interest in the program as the barrier for enrollment. 87.67% of respondents asserted CCC was helpful in managing hypertensive patients and foresee continuing using the tool. Conclusions: This quality improvement initiative showed how the addition of CCC can aid improve compliance with medication regimens and blood pressure management. Technology empowered patients to better manage their HTN. High acceptance of the tool among providers, volunteers, and participants facilitated the connection between community, work, and healthcare organizations to improve HTN management. Future efforts should focus on creating and implementing initiatives to help reduce barriers for HTN management.

Local Delivery and Sustained-Release of Nitric Oxide Donor Loaded in Mesoporous Silica Particles for Efficient Treatment of Primary Open-Angle Glaucoma.

Nitric oxide (NO) donors are ideal drug candidates for reducing intraocular pressure in the treatment of glaucoma. However, poor cornea penetration, short duration of efficacy, and narrow therapeutic index of most NO donors obstruct their clinical applications in glaucoma treatment. This study reports a novel NO donor delivery system based on mesoporous silica nanoparticles that can readily overcome the above difficulties and deliver the NO-donating drug sodium nitroprusside to the target tissues (trabecular meshwork and Schlemm's canal). Mesoporous silica nanoparticles loaded with sodium nitroprusside can produce more exogenous NO and sustain higher NO concentration in animal eye models, which significantly extend the duration of intraocular pressure reduction from 3 to 48 h with only 1/40 of the dose of sodium nitroprusside solution. These findings open up the possibility of mesoporous silica nanoparticles loading sodium nitroprusside for effective management of ocular hypertension.

Responsive and Equitable Health Systems—Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines

IntroductionHypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the...

THE NEED OF BETTER ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION MANAGEMENT IN REDUCING STROKE INCIDENCE

Objective: Strokes are among the most common causes of morbidity and mortality, and in individuals who suffered stroke, subsequent long-term neurological deficit in a larger or smaller range is also an important factor. Arterial hypertension and atrial fibrillation are the most common influencing factors of strokes. Numerous clinical and epidemiological studies have confirmed that elevated systemic blood pressure values are among the major risk factors for both ischemic and hemorrhagic stroke, and the effect of arterial hypertension is complex. Aim of the study was to point out the need to improve the early identification, elimination and treatment of risk factors for stroke, according to the valid recommendations of the European Society of Hypertension and European Society of Cardiology. Design and method: Retrospectively, we analyzed a cohort of patients hospitalized for stroke during a three month period (July - September 2016) at the Ist Department of Neurology in Bratislava. The group consisted of 104 patients, from which ischemic stroke was diagnosed in 88 subjects (84.6 %) and hemorrhagic stroke in 16 subjects (15.4 %). The average age was 70.7 years. A history of previous stroke was in 18 (17.3 %) patients. Results: Among the most important risk factors in addition to age, we found that arterial hypertension as the most common risk factor occured in 96 subjects (92.3 %). Atrial fibrillation occured in 34 patients (32.7 %), but only 14 patients (41.2 %) were treated with anticoagulant therapy before hospitalization. Hemorrhagic stroke during anticoagulant therapy was only in 1 patient, but ischemic stroke in 13 patients. In this group of patients with anticoagulant therapy who have evolved ischemic stroke in spite of this treatment, we found that in 7 patients (53.8 %) the treatment was underdosed and therefore inneffective. Conclusions: Our results from real clinical practice points to the need to improve the effective management of arterial hypertension and atrial fibrillation, the most common influencing factors of stroke. It is necessary to improve the inadequate indication of anticoagulant treatment with consideration of the stroke risk calculation for atrial fibrillation (CHA2DS2-VASc Score) and bleeding risk calculator (HAS-BLED).

Quality of community basic medical service utilization in urban and suburban areas in Shanghai from 2009 to 2014.

Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction.

Colon specific polyelectrolyte complexation based formulations of losartan potassium for effective management of hypertension

Losartan Potassium is an angiotensin II receptor antagonist AIIRA with antihypertensive activity It is used in the management of hypertension and heart failure The main purpose of the study was to formulate and evaluate a colon specific polyelectrolyte complexation based formulations of Losartan Potassium LP The polyelectrolyte complexes were prepared by physical mixing of cationic Chitosan C in combination with anionic polyions like Xanthan gum X Sodium alginate SA The polyelectrolyte complex PEC blend were incorporated into Hydroxy propylmethylcellulose HPMC capsules and the capsule were coated with the solution of Eudragit S w v by dip coating method to safeguard the release of drug in the upper gastrointestinal tract The powder blends were evaluated for their additive properties FTIR spectroscopy of physical mixture of Drug and polymer exhibited no interaction with the drug as major peaks of the drug were found to be intact in the spectra The blend of all the batches were evaluated for parameters like angle of repose was found to be between Bulk density was found to be between gm cc and tapped density between gm cc Carr rsquo s Index was found to be in between Hausner rsquo s ratio ranged between All the formulations showed excellent blend properties Prepared coated capsules were evaluated for physical parameters like percent swelling index and vitro drug release Percent swelling index suggested that Eudragit S at w v concentration was found to have best percent swelling index accounting to highest value of after twelve hours of study Dissolution study suggested that the F formulation comprising Chitosan SA mg showed the highest drug release i e in hrs at pH phosphate buffer with regard to release kinetics the data were best fitted with the first order kinetics with super case II release kinetics From the data it was suggested that Chitosan Alginate based polyelectrolyte complex may constitute an excellent carrier for colonic drug delivery system CDDS

Unobtrusive Detection of Simulated Orthostatic Hypotension and Supine Hypertension Using Ballistocardiogram and Electrocardiogram of Healthy Adults.

Effective management of neurogenic orthostatic hypotension and supine hypertension (SH-OH) due autonomic failure requires a frequent and timely adjustment of medication throughout the day to maintain the blood pressure (BP) within the normal range, i.e., an accurate depiction of BP is a key prerequisite of effective management. One of the emerging technologies that provide one’s circadian and long-term physiological status with increased usability is unobtrusive zero-effort monitoring. In this paper, a zero-effort device, a floor tile, was used to develop an unobtrusive BP monitoring technique. Namely, RJ-interval, the time between the J-peak of a ballistocardiogram and the R-peak of an electrocardiogram, was used to develop a classifier that can detect changes in systolic BP (SBP) induced by the Valsalva maneuver on healthy adults (i.e., a simulated SH-OH). A t-test was used to show statistical differences between the mean RJ-intervals of decreased SBP, baseline, and increased SBP. Following the t-test, a classifier that detected a change in SBP was developed based on a naïve Bayes classifier (NBC). The t-test showed a clear statistical difference between the mean RJ-intervals of the increased SBP, baseline, and decreased SBP. The NBC-based classifier was able to detect increased SBP with 89.3% true positive rate (TPR), 100% true negative rate (TNR), and 94% accuracy and detect decreased SBP with 92.3% TPR, 100% TNR, and 95% accuracy. The analysis showed strong potential in using the developed classifier to assist monitoring of people with SH-OH; the algorithm may be used clinically to detect a long-term trend of symptoms of SH-OH.

In situ gel of Nifedipine: an approach for extended release with Zero order kinetics

Nifedipine was formulated as in situ gel forming tablet using natural and synthetic polymers in combination. The tablets were prepared with various drug polymer ratios of HPMC, Xanthum gum and Guar gum by direct compression method. The polymers has the potential in retarding drug release to its gelling nature and ability of entrapping the drug within the gel .The swelling property of these polymers helps to improve the dissolution rate of drug. The tablets were evaluated to thickness, weight variation,drug content, hardness, friability, in vitro swelling and in vitro release studies. Hardness of the tablets were ranged from 4.3 to 6.0 kg/cm2. All the formulations showed compliance with Pharmacopoeal standards. FT-IR study did not showed any possible interaction between Nifedipine and excepients. The percentage of release were from 38.12 to 76.95%. The dissolution studies indicated that formulation F4 was most successful of the study and it exhibited anomalous(non-fickian)diffusion mechanism Such a drug delivery system may provide a viable alternative for effective management of hypertension and other related disorders. With respect to the application in controlled release systems, the overall delivery rate from a polymeric specimen is expected to be a function of swelling and disintegration characteristics of a specimen, and therefore, the weight uptake can be considered a measure of the release only in the case of polymers with low water solubility and increased stability to hydrolysis.

Task shifting in the management of hypertension in Kinshasa, Democratic Republic of Congo: a cross-sectional study

BackgroundThe Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC.MethodsWe conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses.ResultsAlmost half the patients were female (53.1%), patients’ mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8–28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3–16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively).ConclusionUncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.

Hypertension is associated with worse cognitive function and hippocampal hypometabolism in Alzheimer's disease.

A growing body of evidence suggests that cardiovascular disease risk factors including hypertension may be linked to sporadic Alzheimer's disease (AD). It is well known that hypertension is associated with cerebrovascular disease and vascular dementia on the basis of vascular remodeling. However, the mechanisms linking hypertension and AD remain unclear. We studied 197 patients with AD (86 male; mean age ± SD: 75.8 ± 7.4 years) from the Alzheimer's Disease Neuroimaging Initiative database with (n = 97) and without (n = 100) hypertension. We explored associations between hypertension and clinical, plasma, cerebrospinal fluid and imaging markers of AD pathology in order to elucidate the underlying mechanisms that may link AD and hypertension. We found that patients with AD with hypertension had worse cognitive function (Alzheimer's disease Assessment Scale-cognitive subscale, P = 0.038) and higher neuropsychiatric symptom burden (Neuropsychiatric Inventory Questionnaire, P = 0.016) compared with those without hypertension. Patients with AD with hypertension showed reduced glucose hypometabolism in the right (P < 0.001) and left (P = 0.007) hippocampus. No differences were found in magnetic resonance imaging volumetric measurements, [18 F]florbetapir uptakes, plasma and cerebrospinal fluid between patients with AD with and without hypertension. Although hypertension is associated with worse cognitive function, behavioural symptoms and hippocampal glucose hypometabolism, it is not associated with evidence of increased amyloid or tau pathology. Effective management of hypertension may potentially have a therapeutic role in the alleviation of symptoms in AD.

Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore.

PurposeOut-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore.Materials and methodsA sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs.ResultsSixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31–60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring.ConclusionAlthough physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several important gaps in knowledge and clinical practice.

A cross-sectional study of the prevalence, awareness, treatment and control of hypertension in Shenzhen, China

ObjectivesAn understanding of the awareness, treatment and control of hypertension is helpful to guide decision-making regarding interventions to reduce the risk for diseases with hypertension as a key risk factor....

Abstract 221: Environmental Scan of Telemedicine Networks With Services for Hypertension Management, 2016

One of the barriers affecting continuity of hypertension care is access to health care, especially in low-income and rural areas. Telemedicine (TM) provides consultation and specialized treatment remotely, and reduces barriers of access to appropriate, high quality care. Common barriers include limited affordable transportation, job or other time constraints, and geographic isolation. TM use has increased, but there is limited information about the ease of finding TM networks and programs (TMNPs) by the general public. To address this gap, we conducted an environmental scan, during Sept.-Nov. 2016, assessing the ease of identifying existing TMNPs in the United States using simple internet searches (e.g., Google, Bing, Yahoo). First, we used the American Telemedicine Association’s 2015 Gap Analysis, Health Resources &amp; Services Administration (HRSA) funded programs and 2013 Maryland telemedicine matrix as our template. After identifying the TMNPs, we assessed TM services provided, especially for hypertension (HTN). After compiling a consensus list of TMNPs in the US, we categorized the TMNPs based on their website’s list of services. Of the 50 states and District of Columbia (DC), we found 36 networks and 17 programs. Of these 53 TMNPs, only 1.9% (n=1) indicated that they provide TM services specifically for the management of HTN. However, there were 18 (34.0%) TMNPs that listed cardiology services. The only TMNP specifically focused on hypertension control was in the southeast, an area with a high burden of HTN. This TMNP was called the “Smartphone Medication Adherence Stops Hypertension” (SMASH), and was funded by the National Institutes of Health. The program has reported 95% control among their patient population with HTN in rural areas, including Hispanic and black adults. Other related programs included those focused on heart failure (5.7% (n=3) and diabetes management 9.4% (n=5). This initial environmental scan found most programs presented limited information about their population of interest. For example, 86.7% (n=46) did not provide information about the number of patients, area(s) served and number of partners and providers on their websites. Our results suggest common methods of obtaining information about TMNPs lack important information on TM services for HTN patients, and/or challenges in identifying existing services for patients to access. Using data collected from this environmental scan, our group will develop an exhaustive collection of data on existing TMNPs’ services (including how to participate), working directly with HRSA’s Telemedicine Resource Centers. The information from our environmental scan may produce regional and county-level telemedicine mapping to inform not only patients and their healthcare providers, but also clinicians, researchers, program managers, and decision makers on existing TMNPs that remotely provide effective HTN management.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China: a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care.

Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40-60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m2]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.