Blood Pressure Goals Research Articles

A Review of Olmesartan-based Therapy in Targeting Effective Blood Pressure Control and Achieving Blood Pressure Goals.

For >3 decades now, angiotensin receptor blockers (ARB) have been used in the management of hypertension (HTN) and HTN-related cardiovascular (CV) diseases. Olmesartan medoxomil (OLM) is an angiotensin II type 1 (AT1) receptor antagonist (or blocker) that binds tightly to the AT1 receptor with long-lasting efficacy over the 24-hour period and safety demonstrated in several trials. It is well tolerated and effective in reducing blood pressure (BP) in mono and combination therapy with thiazide diuretics or calcium channel blockers across a wide range of patient subgroups. The effectiveness and safety of OLM-based combination therapies have good and tolerable profiles with high adherence in the fixed single-pill formulation. Consistent antihypertensive efficacy and good tolerability when used as monotherapy or as a combined therapy make OLM a valuable treatment option for adults with HTN. In this review, we discuss the important clinical implications of OLM as an optimal choice as monotherapy and combination therapy in managing patients with HTN.

Biosocial predictors and blood pressure goal attainment among postmenopausal women with hypertension.

In postmenopausal states, women may not maintain blood pressure (BP) in the same way as men, even though most women follow their treatment plans and prescriptions more consistently than men. Biological and lifestyle factors influence the progression of hypertension in postmenopausal women (PMW). This study aimed to determine biosocial predictors associated with achieving the target BP in PMW with hypertension. A prospective observational study was conducted in the General Medicine Department at Karuna Medical College Hospital, Kerala, India. The definition of BP goal attainment was established based on the guidelines outlined by the VIII Joint National Committee 2014 (JNC VIII). Multivariate logistic regression analysis was used to analyse biosocial predictors, such as educational status, employment status, body mass index (BMI), number of children, age at menarche, age at menopause, and number of co-morbidities, associated with BP goal achievement. Of the patients, 56.4% achieved their BP goals on monotherapy and 59.7% achieved it on combination therapy. Level of education [odds ratio (OR) = 1.275, 95% confidence interval (CI): 0.234-7.172], employment status (OR = 0.853, 95% CI: 0.400-1.819), age at menopause (OR = 1.106, 95% CI: 0.881-1.149), number of children (OR = 1.152, 95% CI: 0.771-1.720), BMI (OR = 0.998, 95% CI: 0.929-1.071), and number of co-morbidities (OR = 0.068, 95% CI: 0.088-1.093) did not show a significant relationship, and age at menarche (OR = 1.577, 95% CI: 1.031-2.412) showed a significant association with BP goal attainment among hypertensive postmenopausal women. Half of the hypertensive postmenopausal women did not achieve their BP goals. Interventions are required to expand screening coverage and, under the direction of medical professionals, there should be plans to improve hypertension control and increase awareness of the condition.

Blood volume phenotypes and patient sex in resistant hypertension.

The relationship of blood volume (BV) to systemic blood pressure (BP) is not well defined in resistant hypertension (RH). The goal of this study was to examine the extent to which systemic BP stratified by patient sex would impact BV phenotypes. A retrospective analysis of clinical and quantitative BV data was undertaken in a cohort of ambulatory patients with a history of controlled and uncontrolled RH. We analyzed 253 unique BVs with 54% of patients above goal BP of <150 mmHg. BV phenotypes were highly variable but no correlation of systolic BP to absolute BV or percentage deviation from normal volume was identified in either sex. Males demonstrated overall larger absolute BVs with higher prevalence of large plasma volume (PV) expansion; females were overall more hypovolemic by total BV but with a higher frequency of normal PV than males. Females trended towards more RBC mass deficit (true anemia) (49% vs. 38%. P = 0.084) while more males demonstrated RBC mass excess (erythrocythemia) (21% vs. 11%, P = 0.029). Importantly, a significant portion (52%) of patients with true anemia identified by BVA would go undetected by hemoglobin measurement alone. BV phenotypes are highly diverse in patients with RH. However, absolute BV or variability in BV phenotypes even when stratified by patient sex did not demonstrate an association with systemic BP. BV phenotyping provides a key to optimizing clinical management by identifying RBC mass profiles particularly distinguishing true anemia, dilutional anemia, and erythrocythemia and the contribution of PV expansion. Findings support the clinical utility of BV phenotyping in RH.

Abstract WMP78: Mobile Stroke Units Enable Hyperacute Interventions for Intracerebral Hemorrhage

Introduction: Mobile stroke units (MSUs) are an evolving means to expedited acute stroke management. Recent landmark trials BEST-MSU and B_PROUD have proven that MSUs facilitate quicker thrombolysis times and improved functional outcomes at 90 days when compared to conventional emergency medical services (EMS) for acute ischemic stroke patients. Despite the growing body of literature surrounding MSUs and acute ischemic stroke, literature describing the intracerebral hemorrhage experience in MSUs has been lacking. Methods: Retrospective analysis of consecutive patients with acute intracerebral hemorrhage triaged by MSU or EMS from January 2018 to December 2022 was performed at two tertiary institutions. In the EMS cohort, only patients seen between 8 am to 8 pm, corresponding to the operating hours of the MSU, were included. Goal blood pressure was defined as systolic blood pressure &lt;160. Chi-squared test for categorical variables and t-test for continuous variables were used for statistical analysis. Results: A total of 146 MSU patients were compared to 221 EMS patients. Both cohorts had similar baseline demographics. Median initial blood pressure in the MSU was 190/99, which dropped to a median blood pressure of 157/80 upon arrival to the hospital. Initial systolic blood pressure in the hospital was significantly higher for EMS compared to MSU patients (166 vs 157, p=0.011). The majority (77%) of MSU patients received anti-hypertensive medications while in the MSU. Times from door to CT completion (14 vs 33 min, p=0.000), anticoagulation reversal (99 vs 139 min, p=0.013), anti-hypertensive medication administration (21 vs 45 min, p=0.020), and goal blood pressure (35 vs 51 min, p=0.000) were significantly faster in the MSU cohort. Conclusions: MSUs provide faster medical treatment for patients with acute intracerebral hemorrhage. The target blood pressure goal was met much quicker in the MSU. Faster time metrics convey a hypothetical benefit towards improved patient outcomes.

Abstract 137: Post-Stroke Blood Pressure Control and Follow Up Care in Real-World Setting

Introduction: Within 5 years of a stroke, approximately 25% of patients will have a recurrent event. Blood pressure (BP) reduction can reduce this risk; every 10 mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite this benefit, 50% of patients with hypertension remain uncontrolled after a stroke. Reasons for poor control may be related to poor post-stroke follow up care. We aim to quantify post-stroke BP control and follow up in a large health system. Methods: We performed a retrospective analysis of patients with stroke admitted to Yale New Haven Health System (YNHHS) between 2013-2021. YNHHS has 5 hospitals and a large outpatient network. Eligible patients included those who received primary care within YNHHS, were discharged alive, and not on dialysis. We analyzed patient features, time to outpatient encounter, and vital signs. The primary outcome was uncontrolled BP (&gt;140/90) obtained during the office visit closest to and before 6 months from the date of discharge. Results: During the study period 12,561 patients were admitted with stroke to YNHHS. After exclusions, the final cohort was 2,867 patients. Among these patients, 48 % were male, 65% non-Hispanic White, 22% non-Hispanic Black, 9% Hispanic, and 4% other. Mean (standard deviation) age was 68 (12) years. Approximately 25% of patients had uncontrolled BP. When the updated ACC/AHA (2017) BP goal (&lt;130/80) was applied, the amount of patient with uncontrolled BP increased to 52%. After 6 months, 318 (11%) had no visit with a medical provider, 250 (9%) patients had 1 follow up visit, and 2,299 (80%) patients had &gt;2 follow up visits. The median (interquartile range [IQR]) number of days to first visit with a PCP or neurologist was 30 (10-97) days and 45 (27-99) days, respectively. The median (IQR) number of visits with either a PCP or neurologist was 0 (0-2). Conclusion: Among patients with recent stroke, more than half do not achieve BP control per current guidelines. The majority of patients do not engage with a PCP or neurologist within 6 months following a stroke, even though they have an established provider within the system. Gaps in follow up represents a notable opportunity for improving post-stroke care.

Abstract WP196: Blood Pressure After Endovascular Therapy: A Systematic Review and Metanalysis of Randomized Control Trials

Background and Objectives: There are limited data evaluating the optimum blood pressure (BP) goal post mechanical thrombectomy (MT) and its effect on outcomes of patients with large vessel occlusions (LVO). The objective of this study was to compare the efficacy and safety of intensive versus less intensive blood pressure control after reperfusion with MT via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We searched the PubMed, and Embase to obtain articles related to blood pressure control post MT through September, 2023. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. Effect sizes were computed as odd ratio (OR) with random-effect or fixed-effect models. Results: Four Randomized Clinical Trials (RCTs) with 1566 patients (762 randomized into intensive blood pressure control vs. 806 randomized into loess intensive blood pressure control) were included. The RCT analysis showed that the likehood of functional independence was less in the more intensive treatment group compared with the less intensive treatment group functional independence (mRS 0-2: OR 0.66, 95% CI 0.54-0.89, P &lt; 0.001). There was no significant increasing the risk of symptomatic intracranial hemorrhage (sICH: OR 1.14, 95% CI: 0.77-1.69, P = 0.51), or mortality ( mortality 1.22, 95% CI: 0.90-1.66, P =0.19). Conclusion: This systematic review and meta-analysis indicate that in patients who achieved successful MT for acute ischemic stroke with LVO, intensive BP control was associated with lower likehood of functional independence at 3 months without significant difference in sICH or mortality risk. Results of upcoming RCTs may provide further insight.

Abstract TMP63: Blood Pressure (BP) Protocol Violations in IV Tenecteplase Treated Ischemic Stroke Patients is Associated With Early Neurologic Deterioration and Symptomatic Intracranial Hemorrhage

Background: The American Heart Association guidelines recommend BP goal of &lt;180/105 mmHg for the first 24 hours in acute ischemic stroke (AIS) patients treated with IV Alteplase and now adopted for IV Tenecteplase (TNK). Studies suggest increased hemorrhage risk in patients with BP ≥170 mmHg and greater BP variability. Methods: We performed a retrospective study with data from the Get with The Guidelines database and electronic medical record of all adult AIS patients treated with TNK at a Comprehensive Stroke Center from 6/2021 to 6/2023. All BP readings from ED arrival to 24 hours post TNK were queried. We analyzed the temporal trends of BP characteristics and their association with early neurological deterioration (END) and symptomatic intracranial hemorrhage (sICH). The BP characteristics included mean and standard deviation of systolic (SBP) and diastolic (DBP) measurements, intra-patient BP variability and frequency of excessive BP (SBP &gt; 180 mmHg and DBP &gt; 105 mmHg) at each time point. Results: There were 132 TNK treated patients: mean age 68 ± 15 years, 54% male, 73% Caucasian, median admission NIHSS 9, IQR 4-15, 42 (32%) underwent mechanical thrombectomy, 72 (54.5%) treated with IV antihypertensive(s). Of these, 6 (4.5%) developed END and another 6 (4.5%) sICH. Of the 5901 BP measurements, 217 (3.7%) and 99 (1.7%) exceeded systolic of &gt;180 mmHg and diastolic of &gt;105 mmHg respectively. All END and sICH patients had excessive BP within 4 hours post TNK (Figure 1) and during this time there was a strong association of END with excessive SBP (14% vs 4.8%; p=0.05) and DBP (14% vs 1.2%; p &lt; 0.001). sICH had a similar but weaker association: excessive SBP (7.7% vs 4.9%; p=0.3) and excessive DBP (3.8% vs 1.4%; p=0.2). Conclusion: Our findings suggest that excessive BPs within 4 hours of TNK may be associated with patients developing END and sICH. Further exploration of moderate BP parameters deserve further study post thrombolysis, like the BEST II study in post thrombectomy patients.

What is the optimum target blood pressure goal for pregnant persons with chronic hypertension?

What is the optimum target blood pressure goal for pregnant persons with chronic hypertension?

Abstract WP124: Dual Energy Head CT Immediately Following Mechanical Thrombectomy Rarely Leads to Changes in Clinical Management

Introduction: No guidelines exist regarding imaging after mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Dual Energy Head CT (DECT) can differentiate between contrast staining and intracranial hemorrhage (ICH). We obtained routine DECT for AIS patients immediately following MT. We aimed to understand the impact of DECT on clinical management. Methods: We conducted a single-center retrospective study of AIS patients who underwent MT and immediate post-procedure DECT between March 2021 and February 2023. Patients were grouped by whether or not DECT results changed management, compared to our standard post-thrombectomy protocol and as documented in clinical notes. Continuous variables were compared using Wilcoxon Rank-Sum tests, and categorical variables were compared using Chi-square tests. Results: Of 173 patients who met inclusion criteria, 13 (7.5%) had documented changes in management following DECT. Management changes included delayed anti-thrombotic administration, lowered systolic blood pressure goals, and serial imaging. There were no statistically significant differences in age, gender, initial NIHSS, ischemic core size pre-MT, or treated vessel between patients with and without a change in management. Patients with management changes were more likely to have had procedural complications, contrast staining, any ICH, and symptomatic ICH (Table). While 34 patients had ICH on DECT, this only led to a documented change in management for 11 (32.4%) patients. Conclusion: Routine DECT immediately after MT rarely changed clinical management. Immediate DECT may be reserved for patients with intraprocedural complications or those with clinical suspicion of ICH.

Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016-2020.

Postoperative hypertension frequently occurs after surgery for congenital heart disease. Given safety concerns when using calcium channel blockers in infants along with the cost and side-effect profile of nitroprusside, we retrospectively assessed our experience of using nicardipine and nitroprusside for postoperative blood pressure control in infants who underwent surgery for congenital heart disease. We also investigated the cost difference between the medications. This study was a single-center retrospective, pre-post chart review of patients who had surgery for congenital heart disease between 2016 and 2020. The primary aim was a noninferiority comparison of achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent. Secondary comparisons included achievement of blood pressure goal at 2 hours after medication initiation, Vasoactive-Inotropic Score (VIS), and blood transfusion, crystalloid volume, and calcium needs. Academic quaternary-care center. Infants under 1 year old who required treatment for hypertension with nitroprusside ( n = 71) or nicardipine ( n = 52) within 24 hours of surgery for congenital heart disease. None. We failed to identify any difference in proportion of patients that achieved blood pressure control at 1-hour after medication initiation (nitroprusside 52% vs. nicardipine 54%; p = 0.86), with nicardipine noninferior to nitroprusside within a 15% margin. Of patients who did not achieve control at 1-hour post-medication initiation, receiving nicardipine was associated with blood pressure control at 2 hours post-medication initiation (79% vs. 38%; p = 0.003). We also failed to identify an association between antihypertensive types and mean VIS scores, blood transfusion volumes, crystalloid volumes, and quantities of calcium administered. Index cost of using nitroprusside was 16 times higher than using nicardipine, primarily due to difference in wholesale cost. In our experience of achieving blood pressure control in infants after surgery for congenital heart disease (2016-2020), antihypertensive treatment with nicardipine was noninferior to nitroprusside. Furthermore, nicardipine use was significantly less expensive than nitroprusside. Our contemporary practice is therefore to use nicardipine in preference to nitroprusside.

Abstract NS3: Nurse Led Interventions Improve the Timeliness of Blood Pressure Reduction in Patients Presenting With Acute Nontraumatic Intracerebral Hemorrhage

Introduction: The 2022 AHA/ASA Guidelines for Intracerebral Hemorrhage (ICH) recommend initiating treatment and lowering blood pressure (BP) within 2 hours of ICH onset and reaching the target systolic BP of 130-150mmHg within one hour of treatment initiation. This study evaluates the effectiveness of nursing education at a Comprehensive Stroke Center (CSC) on improving the timeliness of BP medication administration and BP reduction in ICH patients. Methods: Emergency Department (ED) code stroke patients with a diagnosis of ICH were included in the analysis from 6/2022-12/2022 (pre-intervention) and 1/2023-6/2023 (post-intervention). Guideline based education regarding the importance of timely medication administration was provided in nursing huddles. Nurse to patient ratios were changed to 1:1 until goal BP achieved. BP medications were also placed in the CT scanner pyxis for immediate access. Baseline demographics, NIHSS, ICH score, and door to blood pressure reduction related time metrics were collected. Data were analyzed using R package. Results: 34 patients were analyzed, 12 (35%) pre and 22 (65%) post-intervention. Patient demographics and characteristics were not different between both groups (Table 1). Time from first BP medication order to BP in range improved: 62(46.7-80) vs 43(33-52.3) mins p=0.02. In addition, the time from door to Systolic BP 130-150mmHg improved 81 (68.5-91.3) vs 56 (37.38-73.5) mins p=0.02 (Table 2). Conclusion: Guideline based education is effective in promoting nursing-led interventions to achieve timely BP reduction of ICH patients to the target goal of 130-150 mmHg.

Possibilities of Using the National Electronic Data Syetstem in Assessing the Control of Arterial Hypertension at The Primary Health Care Level in the Kyrgyz Republic Using the Example of a Single Family Medicine Center.

To determine the capabilities of the National Electronic System for collecting quantitative data necessary to assess the quality of management and effectiveness of arterial hypertension (AH) control at the primary health care (PHC) level and to develop indicators and possibilities of their use for a standardized report on the quality of AH management and control at the PHC level in the Kyrgyz Republic. Data from electronic outpatient records were processed for all registered patients of a pilot family medicine center (FMC) that was selected randomly. The registered patient group consisted of 91,226 people older than 18 years, including 37,740 men and 53,486 women. The data obtained during contact with a patient was entered by the family doctor into the electronic outpatient record and automatically forwarded to the center that collected and aggregated the data. To monitor AH control, 11 indicators were developed and evaluated. The indicators were divided into 3 groups: indicators for identifying AH, indicators for the quality of AH patient management, and indicators for the effectiveness of AH control. In total, 26,206 patients (7,933 men and 18,273 women) visited the FMC during a year, and blood pressure (BP) was measured in 71.4% of them. In 2022, 5,072 patients (5.6% of the registered group) visited the FMC for AH, including 1,539 men and 3,533 women (4.1 and 6.6% of the registered patient group, respectively; p&lt;0.001). The proportion of patients with AH who, according to the clinical protocol, had their BP measured 2 times a year or more, was 81.4% and was slightly higher for women than for men (82.3% and 79.1%, respectively; p&lt;0.01). 38.7% of AH patients received antihypertensive drugs. Lipid-lowering therapy was prescribed to 23.5% of AH patients. The proportion of AH patients taking acetylsalicylic acid was higher, 36.3% for the whole group, including 34.1% for men and 37.2% for women (p&lt;0.05). The efficacy of AH treatment was 62.8%. Any monitoring system has limitations for the amount of useful data that can be obtained ensuring their proper quality. Taking this into account, two major indicators are suggested to use for evaluating the effectiveness of AH control at the PHC level: 1) the number of AH patients who have achieved the BP goal; 2) the number of AH patients who visited a medical institution (health care facility) during a calendar year relative to the number of registered patients (AH detectability).

Efficacy and safety of phospholipid nanoparticles (VBI-S) in reversing intractable hypotension in patients with septic shock: a multicentre, open-label, repeated measures, phase 2a clinical pilot trial

Since the 1990's attempts to favorably modulate nitric oxide (NO) have been unsuccessful. We hypothesized that because NO is lipophilic it would preferentially localize into intravascularly infused hydrophobic nanoparticles, thereby reducing its bioavailability and adverse effects without inhibiting its production. We aimed to determine the efficacy and safety of intravenous infusion of a fluid comprised of hydrophobic phospholipid nanoparticles (VBI-S) that reversibly absorb NO in the treatment of hypotension of patients in severe septic shock. This is a multicentre, open-label, repeated measures, phase 2a clinical pilot trial done at six hospital centers in the USA. Patients in severe septic shock were enrolled after intravenous fluid therapy had failed to raise mean arterial blood pressure (MAP) to at least the generally accepted level of 65mmHg, requiring the use of vasopressors. The primary endpoint of this study is the proportion of patients in whom MAP increased by at least 10mmHg. VBI-S was administered intravenously to patients as boluses of 100ml, 200ml, 400ml, and 800ml at 999ml/min until the blood pressure goal was reached after which the infusion was stopped, and the MAP was recorded. All patients who received any volume of VBI-S were included in the primary and safety analysis. The study is registered with ClinicalTrials.gov, NCT04257136. Between February 17, 2020 and January 3, 2023, 20 eligible patients were enrolled in the study. In all 20 (100%) patients, the goal of increasing MAP by at least 10mmHg using VBI-S was achieved (p=0.0087, effect size=0.654). Mean VBI-S volume required to meet the primary goal was 561.0±372.3ml. The goal of lowering vasopressor dose was also achieved (p=0.0017). Within 48h or less after VBI-S, there was a statistically significant improvement in oxygenation, serum creatinine, clotting variables, procalcitonin, lactic acid, and the sequential organ failure assessment (SOFA) score. At 24h and 48h following administration of VBI-S, 12/15 (80%) and 9/12 (75%) patients developed hyperlipidemia, respectively. No severe adverse events of VBI-S were observed, and there were no treatment-related deaths. These preliminary findings suggest the safety and efficacy of VBI-S in treating hypotension in patients with septic shock. However, a definitive mortality benefit cannot be demonstrated without a randomized controlled study. The Naval Medical Research Command-Naval Advanced Medical Development program via the Medical Technology Enterprise Consortium.

Association Between Self-Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial).

Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear. Cross-sectional analysis was performed of the 12-month visit of participants in the intensive arm of SPRINT (Systolic Blood Pressure Intervention Trial), which randomized adults to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic BP goals. TI was defined as no increase in antihypertensive regimen intensity score, which incorporates medication number and dose, when systolic BP is ≥120 mm Hg. Self-reported adherence was assessed using the 8-Item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (MMAS-8 score <6), medium (MMAS-8 score 6 to <8), and high (MMAS-8 score 8). Poisson regressions estimated prevalence ratios (PRs) and 95% CIs for TI associated with MMAS-8. Among 1009 intensive arm participants with systolic BP >120 mm Hg at the 12-month visit (mean age, 69.6 years; 35.2% female, 28.8% non-Hispanic Black), TI occurred in 50.8% of participants. Participants with low adherence (versus high) were younger and more likely to be non-Hispanic Black or smokers. The prevalence of TI among patients with low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (versus high) were associated with TI (PR, 1.11 [95% CI, 0.87-1.42]; PR, 1.08 [95% CI, 0.84-1.38], respectively). Although clinician uncertainty about adherence is often cited as a reason for why antihypertensive intensification is withheld when above BP goals, we observed no evidence of an association between self-reported adherence and TI.

Effectiveness of Hypertension Management Strategies in SPRINT-Eligible US Adults: ASimulation Study.

Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long-term impact of 4 hypertension management strategies in SPRINT-eligible US adults. The validated Blood Pressure Control-Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT-eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline-recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team-based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT-eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team-based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment-related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team-based care by 27 200. As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team-based care to usual care may be a pragmatic way to manage risk in this high-CVD-risk population.

Pharmacist-led rapid medication titration for hypertension management by telehealth: A quality improvement initiative.

Hypertension guidelines recommend team-based care for the treatment of high blood pressure (BP). Clinical pharmacists can help patients get to goal BP with rapid medication titration in conjunction with telehealth visits. We conducted a pharmacist-led home BP monitoring pilot program from June 2020 to September 2021. Forty-two patients with a SBP ≥140 despite using ≤2 antihypertensive medications were referred for pharmacist telehealth with expedited medication titration to achieve a BP goal <130/80. The mean enrollment SBP/DBP was 155.2 (SD, 15.8)/89.7 (SD, 11.5) mm Hg, and the mean completion SBP/DBP was 132.1 (SD, 10.9)/77.6 (SD, 10). The number of hypertension medications prescribed increased from 1.3 to 1.6 with no instances of falls or hypotension. At completion, 31% of patients had an automated office blood pressure (AOBP) with SBP <130mm Hg and DBP <80mm Hg. A pharmacist-led, home BP monitoring telehealth pilot program helped patients safely achieve BP goals.

Evaluation of treatment effectiveness and 10-year cardiovascular disease risk level in hypertensive outpatients

Hypertension represents a substantial risk factor for the development of cardiovascular disease (CVD), stroke, and chronic kidney disease. CVD stands as the primary cause of global mortality. This study employed a prospective cross-sectional design spanning 4 weeks. Data were collected using a pro forma designed to capture patients’ sociodemographic and clinical information. Prescribers’ adherence to anti-hypertensive prescription guidelines, as per the JNC8 guideline, and patients’ attainment of target blood pressure (BP) goals were assessed. Framingham 10-year CVD risk score estimation was employed to estimate patients’ 10-year CVD risk levels. Among the patients, 51 (59.3%) had anti-hypertensive prescriptions that adhered to the JNC8 guidelines. However, a majority, 54 (62.8%), failed to achieve their JNC8 target BP goals, and 44 (51.2%) exhibited intermediate 10-year CVD risk levels. Furthermore, 71 (98.6%) of the patients did not receive the recommended statin and/or aspirin therapy, despite its necessity. An association was found between patients’ achievement of JNC8 target BP goals and their 10-year CVD risk levels. The majority of patients received anti-hypertensive prescriptions that aligned with JNC8 guidelines. Nonetheless, most of them did not attain their JNC8 target BP goals and exhibited intermediate to high 10-year CVD risk levels.

Software-driven chronic disease management: Algorithm design and implementation in a community-based blood pressure control pilot

Background: Optimal guideline-directed medical therapy is rarely attained in practice, resulting in inadequate control of diseases such as hypertension, with poorer results in under-resourced communities. Technology, including artificial intelligence-driven decision support and software-driven workflow transformation, can potentially improve disease outcomes at a reduced cost, although it must be integrated with a holistic approach. Methods: We describe the design of a software platform that enables rapid iterative remote management of &gt;20 conditions across cardiac-kidney-metabolic disease. The platform distributes work across a care team of providers and care navigators, automates decision-making, ordering, and documentation, supports rapid incorporation of new evidence, and launches pragmatic trials. We describe software used in a 500-person community-based blood pressure control implemented as a single-arm quality improvement program. The primary endpoint was the proportion of patients meeting the Healthcare Effectiveness Data and Information Set quality measure blood pressure goal (&lt;140/90) at 12 weeks. Results: A total of 1609 patients were screened, 945 (59%) were found to have uncontrolled hypertension, and 512 patients consented to join the program. The average age was 61 ± 11 years; 59% were female, and 99% self-identified as Black. Blood pressure distribution was: 10% Stage 1 (SBP 130–139 mmHg or DBP 80–89 mmHg), 69% Stage 2 (SBP 140–179 mmHg or DBP 90–119 mmHg), and 21% Stage 3 (SBP &gt;180 mmHg or DBP &gt;120 mmHg). Two hundred four patients (39%) proceeded to a provider encounter, and 160 of these (78%) completed the program. The Healthcare Effectiveness Data and Information Set blood pressure goal was achieved in &lt;12 weeks of enrollment for 141 participants (69% of those enrolled, 88% of those who completed the program). Conclusion: Software-driven remote blood pressure is feasible, although strategies to improve patient enrollment will be needed to achieve maximum impact. Future work will be required to compare outcomes to usual care and evaluate concurrent management of multiple cardiac-kidney-metabolic conditions.

KDIGO 2021 Blood Pressure Target Update and Chronic Kidney Disease Progression

In 2021, Kidney Disease: Improving Global Outcomes (KDIGO) published revised guidelines, including updated recommendations for the management of chronic renal disease and the control of blood pressure. The 2021 KDIGO Guidelines utilize current research and comprehensive scientific evidence to provide the most favorable blood pressure goals for those suffering from chronic kidney disease. The primary objective is to decelerate the advancement of renal impairment, mitigate problems linked to chronic kidney disease, and enhance the patient's quality of life. The 2021 KDIGO guidelines ground the blood pressure target recommendations for patients with chronic kidney disease (CKD) in a thorough evaluation of the extent of kidney damage, cardiovascular risk, and individual patient characteristics. The 2021 KDIGO guidelines recommend tailoring blood pressure control in patients with CKD to each individual rather than following a standardized method.

Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation.

It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached. In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients. From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol.