Good Blood Pressure Control Research Articles

Asociación entre conocimiento de hipertensión arterial y adherencia al tratamiento en pacientes hipertensos del Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú. 2015

Introducción. Conocer sobre hipertensión arterial podría favorecer la adherencia al tratamiento para un mejor control de la presión arterial.Objetivo. Evaluar si existe asociación entre conocimientos sobre hipertensión y adherencia al tratamiento en pacientes hipertensos del Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú.Materiales y métodos. Se realizó un estudio transversal analítico. El muestreo por conveniencia incluyó 340 pacientes hipertensos de consultorios de cardiología en el periodo mayo-agosto de 2015. La variable principal de exposición fue grado de conocimiento sobre hipertensión medida con el cuestionario de conocimientos sobre la hipertensión (CSH) y la variable respuesta fue grado de adherencia al tratamiento medida con el cuestionario Martin-Bayarre-Grau (MBG). Se utilizó regresión de Poisson para calcular razones de prevalencias (RP) con intervalos de confianza del 95% y valor de p<0.05 para establecer significancia estadística.Resultados. Se encontró asociación entre bajo conocimiento de hipertensión y adherencia parcial al tratamiento (RP=1.4; IC95%: 1.2-1.8), tener más de 10 años de hipertensión (RP=0.7; IC95%: 0.6-0.9), no haber recibido información sobre hipertensión (RP=1.4; IC95%: 1.2-1.7) y tiempo de consulta mayor a 15 minutos (RP=0.5; IC95%: 0.3-0.7).Conclusión. Los pacientes con bajo conocimiento de hipertensión tienen más probabilidad de tener adherencia parcial al tratamiento.

IS IT POSSIBLE TO IMPROVE THE ADHERENCE TO TREATMENT OF HYPERTENSION AND DYSLIPIDEMIA IN PATIENTS WITHOUT CLINICAL MANIFESTATIONS OF ATHEROSCLEROSIS?

The search for effective ways to improve adherence to medication in patients with hypertension at high risk is critical in reducing morbidity and mortality from cardiovascular diseases. Aim. To assess the possibility of improving adherence to therapy in high-risk hypertensive patients with dyslipidemia by means of electronic version of the SCORE scale in primary care. Material and methods. 300 hypertensive patients with dyslipidemia aged 40 to 65 years without clinical manifestations of atherosclerosis visiting primary care doctor (departmental clinic of Moscow) were examined. The study included only patients (n=150) with high cardiovascular risk and target organ damages (microalbuminuria, left ventricular hypertrophy, subclinical carotid atherosclerosis). The patients were randomized into two groups – main (n=76) and control (n=74). All patients were prescribed antihypertensive and lipid-lowering therapy, recommendations for a healthy lifestyle. In the main group, the positive dynamics of risk was demonstrated with the electronic version of the SCORE scale in the case of achieving target levels of blood pressure (BP) and total cholesterol, smoking cessation and weight loss. No such demonstration was done in the reference group. The duration of study was 12 months. In the groups, evaluation of the achievements of target BP values and lipid variables, risk factors correction, dynamics of SCORE risk and adherence to therapy was done. Adherence to treatment was assessed by Morisky-Green scale. Results. By the end of the study, the average Morisky-Green score in the main group was 2.14 vs 1.27 in the control group (p<0.001). In the main group, adherence to antihypertensive therapy persisted for 8.8 months, to statin therapy – 6.74 months; the same characteristics in the control group were 5.73 and 3.6 months, respectively (p<0.001). Achievement of target levels of BP and total cholesterol in the main group amounted to 55.3% and 35.5% of patients, respectively, in the control group – 18.9% and 10.8%, respectively (p<0.001). The SCORE risk value was significantly lower in the main group than this in control group (4.09 vs 5.25, respectively). Conclusion. Demonstration of electronic version of SCORE scale for high-risk hypertensive patients with dyslipidemia allows increasing the patient's adherence to treatment. This leads to the increase in the effectiveness of therapy, better control of BP and lipid parameters, correction of other modifiable risk factors and as a result to reducing overall cardiovascular risk.

Comparison between magnesium sulfate (50 mg/kg) and lignocaine (2 mg/kg) for attenuation of intubation response in hypertensive patients

Aims and Objective: The aim and objective of this study was to compare between magnesium sulfate and lignocaine for attenuation of intubation response in hypertensive patients. Materials and Methods: This prospective, randomized, double-blinded study was conducted in an operating room of Jawaharlal Nehru Medical College Institute, in which 60 adult American Society of Anesthesiologists 1 and 2 controlled hypertensive patients undergoing elective surgery under general anesthesia and requiring endotracheal intubation were selected. Patients were randomized into two groups: Group I with thirty patients who received MgSO4 50 mg/kg half an hour before induction of anesthesia and Group II with thirty patients who received lignocaine 2 mg/kg intravenous bolus. Laryngoscopy and intubation were performed to see response in both the groups. Heart rate (HR) and blood pressure (BP) were recorded before, during, and after endotracheal intubation for 10 min. Results: The changes in the HR and mean arterial pressure (MAP) were compared, and the results showed that Group I patients had minimal response to any changes after intubation while Group II patients showed changes in HR and MAP toward baseline after laryngoscopy and endotracheal intubation. Discussion: Magnesium sulfate developed hypotension at various points, though it is associated with good control of adrenergic response during intubation, while lignocaine developed rate pressure changes which were not so good, also showing cardiac instability. Conclusion: Magnesium sulfate 50 mg/kg has a better control of BP during intubation in hypertensive patients with some incidence of hypotension when compared with lignocaine 2 mg/kg.

Diabetic Kidney Disease: A New Concept for an Old Problem

Diabetes Mellitus (DM) is a growing worldwide epidemic. It was estimated that more than 366 million people would be affected. DM has spread its presence over the world due to lifestyle changes, increasing obesity and ethnicities, among others. Diabetic nephropathy (DN) is one of the most important DM complications. A changing concept has been introduced from the classical DN to diabetic chronic kidney disease (DCKD), taking into account that histological kidney lesions may vary from the nodular or diffuse glomerulosclerosis to tubulointerstitial and/or vascular lesions. Recent data showed how primary and secondary prevention were the key to reduce cardiovascular episodes and improve life expectancy in diabetic patients. A stabilization in the rate of end stage kidney disease has been observed in some countries, probably due to the increased awareness by primary care physicians about the prognostic importance of chronic kidney disease (CKD), better control of blood pressure and glycaemia and the implementation of protocols and clinical practice recommendations about the detection, prevention and treatment of CKD in a coordinated and multidisciplinary management of the DM patient. And also the new hypoglycemic agents, - DDP4 inhibitors, GLP1R agonists, SLGT2 inhibitors-, can facilitate the management of DM and its complications in the patients with renal function impairment. Early detection of DM and DCKD is crucial to reduce morbidity, mortality and the social and economic impact of DM burden in this population.

A Profile of Renal Function in Northern Cameroonians with Essential Hypertension

Background/Aim: The two-way cause and effect relationship existing between high blood pressure and kidney dysfunction is currently a well-documented phenomenon with patients in either category being almost equally predisposed to the other pathology. Our goal was to assess the renal function capacity of hypertensive patients in our setting. Methods: This cross-sectional descriptive study involved the determination of blood pressure levels and the collection of blood and urine samples for the measurement of renal function markers. Hypertensive patients who came for medical follow-up constituted the study participants, and were enrolled consecutively into the study from February to May 2015. Data analysis was performed using the SPSS 20.0 software, and significant differences were determined at p < 0.05. Results: The prevalence of elevated creatinine and urea levels were 35 and 27%. Eighty percent of the participants had a decreased glomerular filtration rate (≤90 mL/min/1.73 m³), with at least 36% recording less than 60 mL/min/1.73 m³. Proteinuria and glucosuria were recorded in 15% and 8% of the participants, respectively. The mean diastolic pressure was observed to be significantly higher in participants with proteinuria (p = 0.016), and participants' weight directly correlated with systolic blood pressure (p = 0.015). Furthermore, the mean estimated glomerular filtration rate was relatively lower in participants >60 years compared to those <60 years (p < 0.001). Conclusion: Renal function is often perturbed in hypertensive patients, and good blood pressure control may reduce the progression of renal impairment. Thus, a systematic evaluation of renal function in addition to blood pressure control in hypertensive patients is indispensable towards effectively reducing the occurrence of renal events and preventing end-stage renal disease.

Blood Pressure Control Among Hypertensive Patients in University of Gondar Hospital, Northwest Ethiopia: A Cross Sectional Study

Hypertension is a common health problem worldwide. It doubles risk of stroke, myocardial infarction, chronic kidney diseases and peripheral arterial disease. Good control of hypertension is important to decrease these complications. For Good control, life style modification (low salt diet, exercise, weight reduction and cessation of smoking) and Different antihypertensive medications are used. The medicines have to be taken adherently and one has to be consistent in life style modifications. Here the blood pressure control status of hypertensive patients on treatment was assessed. Cross sectional study was conducted collecting data using a pretested questionnaire among all hypertensive patients on treatment at the cardiovascular follow up clinic of University of Gondar Hospital from March 1, 2016 to October 30, 2106. A consecutive of 310 hypertensive patients on pharmacologic therapy for at least 6 months were included. Good blood pressure control was defined as BP &lt; 150/90 for those aged 60 years or above and &lt;140/90 if younger than 60 years. Data was entered and analyzed by using SPSS version 20. Results are depicted descriptively using tables and graphs. Logistic regression was used to evaluate associations.A total of 310 participants (118 males & 192 females) were evaluated. Poor blood pressure control was observed in 115 (37%) of the study participants. Presence of diabetes mellitus (OR: 3.6; CI (1.46-8.8)) and poor adherence to antihypertensive drugs (OR: 6.6; CI (1.5-28.5)) were associated with poor BP control. However duration of hypertension, type or number of antihypertensive medications used were not associated with BP control. Patient older than 60years had good BP control. More than one third of patients have poor BP control. Poor blood pressure control was associated with poor adherence to antihypertensive medications & the presence of diabetes. However, elderly people (≥ 60years) were found to be associated with good BP control.

Knowledge of Hypertension and Compliance with Therapy Among Hypertensive Patients in the Bamenda Health District of Cameroon: A Cross-sectional Study.

IntroductionThe prevalence of hypertension has continued to increase and is now a great burden for health care providers. Obtaining information on the factors affecting compliance to antihypertensive drugs is thus important. The aim of this study was to assess knowledge of hypertension and to determine factors affecting the compliance of hypertensive patients to their antihypertensive drugs.MethodsThis was a cross-sectional study involving 221 hypertensive patients in the Bamenda Health District. Validated questionnaires were used. From December 2014 to March 2015, knowledge of hypertension was assessed using a 15-item scale, while compliance was assessed using the 8-item Morisky Medication Adherence Scale. Statistical analysis was performed using SPSS version 20.Results14.0%, 53.4%, and 32.6% of participants had adequate, average, and poor knowledge of hypertension, respectively. The antihypertensive compliance rate was 43.9%. Independent predictors of noncompliance were forgetfulness (OR = 0.011, 95% CI = 0.002–0.063), lack of motivation due to the incurable nature of the disease (OR = 0.068, 95% CI = 0.017–0.274), and lack of symptoms of the disease (OR = 0.019, 95% CI = 0.02–0.23). There was a significant association between compliance and blood pressure control (p < 0.001).ConclusionKnowledge of hypertension was poor. Compliance rate to treatment was low. Some medication-related, patient attitude, and health care provider factors affected compliance. Knowledge positively affected compliance, and good compliance was associated with good blood pressure control. Emphasis should be placed on patient education and reminders to patients to take their drugs.

Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial

Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions. Baseline hemodynamics (cardiac output, heart rate, systolic blood pressure) were recorded in the left lateral tilt position before fluid preload, and recorded every minute after spinal anesthesia until delivery. Umbilical cord blood gases were analyzed within 5 minutes of delivery. Good systolic blood pressure control was attained in both groups with minimal periods of hypotension (SBP <80% of bSBP) or hypertension (SBP >120% of bSBP). Cardiac output and heart rate increased over time with ephedrine, but decreased with phenylephrine. The maximum increase in CO from the baseline was 12%, in the ephedrine group, and this occurred 20 minutes after spinal injection. Cardiac output fell by more than 17% in the phenylephrine group, maximal at 10 minutes following spinal injection. Despite good systolic blood pressure control and increased cardiac output with ephedrine, administration of ephedrine was associated with significantly more fetal acidosis [Median (Interquartile range, IQR) UApH - phenylephrine = 7.33 (7.31-7.34) and ephedrine = 7.22 (7.16-7.27), P < .05].

Stroke and Falls-Clash of the Two Titans in Geriatrics.

Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population.

Use of an Innovative Technology Enabled Care Service (Tecs) “Florence” To Empower Patients and Enhance Adherence to Treatments in Diabetes

Summary: In Sandwell and West Birmingham Hospitals NHS Trust, diabetes prevalence is high with a large ethnic minority population. Social deprivation is significant and compliance is a major stumbling block in the achievement of diabetes and Blood Pressure (BP) targets. Our aims were to improve adherence to BP treatment via engaging patients in their own health through text reminders and regular encouragement, and determine the clinical and cost effectiveness of this simple, yet unique method of virtual clinic consultation through FLORENCE (Flo). Since April 2014 • 100 patients have enrolled for BP monitoring. • 26 for blood glucose and insulin reminder. Results • Medications have been adjusted (added new agent or increased dose) in 27/100 (27%). • 46/100 (46%) patients have been discharged with good BP control preventing 107 outpatient appointments (saving £11,663 vs. £2,329 Flo associated costs). • Total savings £9,334. • High patient satisfaction. • Improved utilization of manpower resources and healthcare professional time – thus clinically and cost effective model of care delivery recognizing the importance of supporting patients outside of face-to-face care to improve outcomes. Flo’s use continues to grow in our Trust. This simple Telehealth technology can be easily replicated in any NHS Trust or CCG, as has been shown within our own Trust.

Use of an Innovative Technology Enabled Care Service (Tecs) “Florence” To Empower Patients and Enhance Adherence to Treatments in Diabetes

Summary: In Sandwell and West Birmingham Hospitals NHS Trust, diabetes prevalence is high with a large ethnic minority population. Social deprivation is significant and compliance is a major stumbling block in the achievement of diabetes and Blood Pressure (BP) targets. Our aims were to improve adherence to BP treatment via engaging patients in their own health through text reminders and regular encouragement, and determine the clinical and cost effectiveness of this simple, yet unique method of virtual clinic consultation through FLORENCE (Flo). Since April 2014 • 100 patients have enrolled for BP monitoring. • 26 for blood glucose and insulin reminder. Results • Medications have been adjusted (added new agent or increased dose) in 27/100 (27%). • 46/100 (46%) patients have been discharged with good BP control preventing 107 outpatient appointments (saving £11,663 vs. £2,329 Flo associated costs). • Total savings £9,334. • High patient satisfaction. • Improved utilization of manpower resources and healthcare professional time – thus clinically and cost effective model of care delivery recognizing the importance of supporting patients outside of face-to-face care to improve outcomes. Flo’s use continues to grow in our Trust. This simple Telehealth technology can be easily replicated in any NHS Trust or CCG, as has been shown within our own Trust.

Blood Pressure Control: A Marathon or a Sprint?

This symposium discussed several recent initiatives used around the world to improve the management of hypertensive patients and achieve better blood pressure (BP) control. The key objectives of the symposium were to review the current position with regards to BP control in Europe, to discuss the initiatives used in Italy, France, and Canada to improve hypertension management and their outcomes, and to assess how single-pill fixed-dose combinations of antihypertensive drugs have improved adherence. Some of the key barriers to BP control were discussed and measures to overcome these presented, so that further improvements in hypertension management can be achieved going forward. Prof Anthony Heagerty opened the meeting by discussing the key causes of suboptimal BP control and the results of the SPRINT study. Prof Massimo Volpe presented the initiative to achieve 70% BP control and assessed its success to date in Italy. Prof Jean-Jacques Mourad discussed the results of the PAssAGE 2014 study and French League Against Hypertension Survey (FLAHS) in 2015, following the initiative to achieve 70% BP control in France by the end of 2015. Prof Raj Padwal presented the Canadian hypertension Education Program (CHEP) and the improvements in the management of hypertensive patients in Canada. Finally, Dr Julian Segura bought the meeting to a close by discussing how fixed-dose combinations have improved adherence in clinical practice.

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial.

PurposeUrapidil is putatively effective for patients with hypertension and acute heart failure, although randomized controlled trials thereon are lacking. We investigated the efficacy and safety of intravenous urapidil relative to that of nitroglycerin in older patients with hypertension and heart failure in a randomized controlled trial.Materials and MethodsPatients (>60 y) with hypertension and heart failure were randomly assigned to receive intravenous urapidil (n=89) or nitroglycerin (n=91) for 7 days. Hemodynamic parameters, cardiac function, and safety outcomes were compared.ResultsPatients in the urapidil group had significantly lower mean systolic blood pressure (110.1±6.5 mm Hg) than those given nitroglycerin (126.4±8.1 mm Hg, p=0.022), without changes in heart rate. Urapidil was associated with improved cardiac function as reflected by lower N terminal-pro B type natriuretic peptide after 7 days (3311.4±546.1 ng/mL vs. 4879.1±325.7 ng/mL, p=0.027) and improved left ventricular ejection fraction (62.2±3.4% vs. 51.0±2.4%, p=0.032). Patients given urapidil had fewer associated adverse events, specifically headache (p=0.025) and tachycardia (p=0.004). The one-month rehospitalization and all-cause mortality rates were similar.ConclusionIntravenous administration of urapidil, compared with nitroglycerin, was associated with better control of blood pressure and preserved cardiac function, as well as fewer adverse events, for elderly patients with hypertension and acute heart failure.

Assessment of Human Tribbles Homolog 3 Genetic Variation (rs2295490) Effects on Type 2 Diabetes Patients with Glucose Control and Blood Pressure Lowering Treatment

Effects of human tribbles homolog 3 (TRIB3) genetic variation (c.251 A>G, Gln84Arg, rs2295490) on the clinical outcomes of vascular events has not been evaluated in patients with type 2 diabetes after blood pressure lowering and glucose controlling treatment. We did an analysis of a 2×2 factorial (glucose control axis and blood pressure lowering axis) randomized controlled clinical trial at 61 centers in China, with a follow-up period of 5years. The major vascular endpoints were the composites of death from cardio-cerebral vascular diseases, non-fatal stroke and myocardial infraction, new or worsening renal and diabetic eye disease. A total of 1884 participants were included in our research with a 4.8years median follow-up. For glucose lowering axis, patients with TRIB3 (rs2295490) AA (n=609) genotype exhibited significantly reduced risk of major vascular events compared with AG+GG (n=335) genotype carriers (Hazard ratio 0.72, 95% CI 0.55–0.94, p=0.016), Paradoxically, the risk of vascular events were significantly increased in patients with AA (n=621) compared to AG+GG (n=319) genotype for intensive glucose control (Hazard ratio 1.46, 95% CI, 1.06–2.17, 35 p=0.018). For blood pressure lowering axis, marginally significant difference was found between TRIB3 variant and coronary events. Our findings suggest that good glucose and blood pressure control exhibited greater benefits on vascular outcomes in patients with TRIB3 (rs2295490) G allele.

Commentary on “Computational Study of Anatomical Risk Factors in Idealized Models of Type B Aortic Dissection”

The management of patients with type B aortic dissection (TBAD) is complex. Patients are treated with urgent intervention in the presence of complications such as rupture, end-organ ischemia, and continuing pain despite good blood pressure control. Patients without these complications are currently treated medically until complications develop, but in some series mortality is as high as 50% at 5 years, with death occurring as a result of extension of the dissection and rupture.1,2

PP.13.19] MONOTHERAPY WITH RILMENIDINE PRODUCES AN EFFECTIVE BLOOD PRESSURE CONTROL AND IMPROVES ECHOCARDIOGRAPHIC VARIABLES IN YOUNG MILD TO MODERATE HYPERTENSIVES

Objective: Rilmenidine is a new centrally acting antihypertensive agent with selective agonist activity at imidazoline I1 receptors from the brain with less adverse effects than other centrally acting sympatholytic drugs. In previous studies, Rilmenidine proved effective antihypertensive efficacy regardless of the age of patients. It is especially effective in patients with sympathetic overstimulation. The aim of this study was to evaluate the antihypertensive efficacy of rilmenidine and its effects on left ventricular hypertrophy and diastolic function in young patients with mild to moderate hypertension. Design and method: We performed a prospective study, lasting 3 months, in which 42 patients younger than 55 years old, (medium age 47.9 ± 5.6years), received once a day 1 mg rilmenidine. Diastolic left ventricular function was assessed by the following Doppler parameters: early (E) and late (A) peak velocities, E/A ratio, isovolumic relaxation time (IVRT), and deceleration time of E velocity (DT). Left ventricular mass index (LVMI) and diastolic function were determined at baseline and after 3 months. Blood pressure and heart rate were monitored at baseline and every month. Patients were requested to subjectively estimate their state as excellent, good, satisfactory and unsatisfactory. Results: After 3 months of therapy, systolic BP was reduced from 157.9 ± 13.6 mmHg to 130.1 ± 11.4 mmHg (p < 0.005) and diastolic BP from 97.6 ± 6.8 mmHg to 82.6 ± 6.7 mmHg (p < 0.005). Heart rate was reduced from 86.4 ± 6.6 bpm to 71.2 ± 4.4 bpm. LVMI decreased from 131.5 ± 3.5 g/m2 to 113.4 ± 3.6 g/m2 (p < 0.001). E/A ratio increased from 0.86 ± 0.24 to 1.02 ± 0.14 (p < 0.002). IVRT decreased from 118 ± 11 ms to 98 ± 10 ms (p < 0.001) and DT decreased from 216 ± 21 ms to 187 ± 17 ms (p < 0.002). 83.3% from the patients were controlled after 3 months of therapy. Treatment was well tolerated. None of the hypertensives estimated his state as unsatisfactory. Conclusions: Rilmenidine can be regarded as an effective and safe therapeutic possibility in mild/moderate young hypertensives. Therapy with Rilmenidine proved a good control of blood pressure, rich the therapeutic target, and was accompanied by the regression of cardiac hypertrophy and improvement in left ventricular diastolic function.

OS 18-04 HYPERTENSION AS A PREDICTOR OF PATTERN OF LV HYPERTROPHY AND GEOMETRIC REMODELING IN ELDERLY

Objective: Hypertension (HTN) inarguably causes remodeling of left ventricle (LV). However, the effect of awareness, treatment and control of hypertension on LV geometry has not been established. We sought to identify the relationship between the classification of LV geometry and awareness, treatment and control of hypertension in a large Thai elderly population. Design and Method: Participants with complete echocardiographic data were enrolled in 2012. Detailed hypertension data was retrieved from the survey in 1997, 2002, 2007 and 2012. Linear regression models adjusted for age, gender, diabetes, smoking status were used to analyze an association between awareness, percentage of controlled hypertension over 15 years and LV geometry. Results: Complete echocardiographic data was available in 1,021 participants. A mean age was 69 ± 5 years; 69.7% were male. Compared with no hypertension, hypertensive participants had higher LV septal thickness, posterior wall thickness, stroke volume index, relative wall thickness and LV mass per body surface area (BSA) (all p-value < 0.05). Adjusted for age, gender, diabetes and smoking status, LV mass was 87.7 ± 22.3 gm/m2 in non-hypertensives and steadily increased in unaware, controlled and uncontrolled hypertension (93.8 ± 23.9 gm/m2, 93.6 ± 22.8 gm/m2 and 98.7 ± 24.9 gm/m2 respectively, p for trend < 0.001). There was an inverse correlation between percentage of controlled hypertension over 15 years and LV mass. Among all hypertensives in 1997, participants who had the highest controlled HTN had the lowest LV mass 92.2 ± 22.6 gm/m2, followed by intermediate controlled HTN 95.6 ± 23.3 gm/m2 and poor controlled HTN 99.1 ± 23.6 gm/m2 (p for trend 0.003). Conclusions: Awareness, treatment and control of hypertension strongly relate to increased LV mass. Unaware hypertensives have similar LV mass as controlled hypertensives. Uncontrolled hypertensives have the highest LV mass. These results urge us to intensify hypertension screening and better control of blood pressure.

PP.24.01] SERIAL AMBULATORY BLOOD PRESSURE MONITORING, INTENSITY OF ANTIHYPERTENSIVE DRUG TREATMENT, AND PREGNANCY OUTCOMES IN WOMEN WITH HYPERTENSION FOUND EARLY DURING PREGNANCY

Objective: Few data are available on serial ambulatory blood pressure monitoring (ABPM) throughout pregnancy and antihypertensive drug treatment required for good blood pressure (BP) control in hypertensive pregnant women. Our aim was to evaluate BP control, antihypertensive drug treatment intensity, and pregnancy outcomes in patients with hypertension (HTN) found early during pregnancy. Design and method: We studied 49 consecutive pregnant patients (mean age 33.4 ± 4.8 years, BMI before pregnancy 24.5 ± 3.7 kg/m2) referred for office HTN found early during pregnancy (mostly before 5 weeks) who gave birth to 50 children (1 twin pregnancy) in 2011–2015. Gestational HTN was previously diagnosed in 39 women, and 9 women had a history of previous miscarriage or stillbirth, with multiple previous pregnancies lost in some patients. ABPM was repeated at 5–10–15–20–25–30–33–35–37 weeks of pregnancy. We calculated overall antihypertensive treatment intensity in standard daily drug doses per patient (standard doses: labetalol 200 mg, methyldopa 750 mg, metoprolol 50 mg, nifedipine 20 mg, verapamil 120 mg). Statistical analysis was performed using ANOVA. Results: All children were born alive (24 vaginal delivery, 26 cesarean section) and are well at follow-up. Gestational age was 38.0 ± 2.5 (range 29–40) weeks, and birth weight was 3215 ± 653 g (range 955–4200). Preeclampsia/eclampsia occurred in 10/3 patients. Four patients had normal BP values by ABPM throughout pregnancy and did not receive antihypertensive drugs. Most patients were treated with labetalol (100–600 mg) and methyldopa (500–2000 mg). Throughout pregnancy, BP remained well controlled (24 h mean SBP/DBP 120.3–126.0/75.3–77.1 mmHg), the number of treated patients increased from 25 at 5 weeks to 42 at 25–35 weeks, and the average number of daily antihypertensive drug doses in treated pts increased from 1.82 at 5 weeks to 2.98 at 37 weeks (p < 0.001).Conclusions: Serial ABPM-guided antihypertensive drug treatment started early during pregnancy was associated with favorable outcomes. The number of patients requiring treatment and the treatment intensity to maintain good BP control increased throughout the pregnancy. No physiological BP fall at the end of 1st trimester was observed. Our findings help estimate the expected treatment intensity required in pregnant patients with preexisting hypertension.

PP.11.14] PROGNOSTIC SIGNIFICANCE OF SLEEP APNEA SYNDROME ON FALSE LUMEN AORTIC EXPANSION IN POST ACUTE AORTIC SYNDROME

Objective: Good blood pressure control is essential in patients with acute aortic syndrome (AAS). It has been shown that the obstructive sleep apnoea syndrome (OSAS) is a risk factor for resistant arterial hypertension, and aortic dilatation. Here, we assessed benefit of systematic screening for SAS in post AAS.Design and method: We performed a prospective study of patients having undergone surgical treatment for AAS in our university medical centre between January 2010 and June 2014. The patients were screened for OSAS by a polygraphy record in a sleep clinic after the onset of AAS. The severity of OSAS was defined according to the apnoea hypopnoea index (AHI, per hour) and the oxygen desaturation index (ODI, per hour), using the following classes for both index: less than 5: no SAS; 6 to 15: mild SAS; 16 to 30; moderate SAS; upper than30: severe SAS. Blood pressure control was assessed by a 24 hour ambulatory blood pressure monitoring. Results: The population comprised 71 patients (males: 64.7%; median age: 57 [49–64], type A AAS: 49.3%; type B AAS: 50.7%). According to the AHI, 58 patients (81.7%) had OSAS and 31 (43.6%) had severe OSAS. The factors associated with the severity of OSAS were the body mass index (p = 0.0148 for the AHI and 0.009 for the ODI), abdominal perimeter (p = 0.0016 for the AHI and 0.0106 for the ODI). A prognostic analysis revealed a significant increase in the intrathoracic false lumen dilatation rate as a function of OSAS severity (p = 0.0008 for the AHI and p = 0.0284 for the ODI). The median rate of increase was 7.5 mm/year [5–10] in the AHI>30 group and 5.0 mm/year [0–8] in the ODI>30 group. There were no intergroup differences in blood pressure control according AHI category, but a diastolic blood pressure difference was noted for the ODI (p = 0.0008). Conclusions: Our results suggest that systematic screening for OSAS is of value in patients with AAS. The false lumen dilatation rate appears to be related to the severity of OSAS. It remains to be seen whether the treatment OSAS would modify the false lumen dilatation rate.

PS 17-72 ANTI-HYPERTENSIVE MEDICATION ADHERENCE IN A PRIMARY CARE CLINIC IN SOUTH-WESTERN NIGERIA

Objective: Factors preventing optimal blood pressure control exist at the patient, physician, and health system levels. This study aimed at identifying patient-related factors in the control of hypertension among adults with hypertension in a rural Primary Care clinic in South-West Nigeria. Design and method: This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication, accessing care at the Primary care clinic of Wesley Guild Hospital, Ilesa, Nigeria. Consenting patients who met the inclusion criteria were serially recruited and studied with a structured questionnaire. The Morisky medication adherence scale (MMAS-4) was incorporated into the questionnaire alongside socio-demographic information and hypertension history questions. Anthropometry, blood pressure, pulse and respiratory rates were also measured. Data was analyzed using the SPSS® version 16 software. Results: Of the 235 respondents, 46.0% were males and 54.0% were females. The mean age was 45.7 ± 17.1 years, with a diagnosis of hypertension for a mean duration of 4.2 ± 2.2 years. Nearly half of the respondents had good blood pressure control (42.6%), while 33.1% and 24.3%, respectively, had stage I and stage II hypertension according to the JNC VII criteria. Low medication adherence was found in 59.8 % of the respondents. This level of adherence was adduced to the following reasons: lack of funds to procure medications (44.0%), ‘faith healing’-Pronouncements by spiritual leaders (20.4%), use of herbal remedies (14.3%), forgetfulness (10.2%), wrongly perceived seriousness of the condition (4.7%) and side effects of medication (4.3%). Conclusions: Medication adherence was poor among the respondents. Given the patient-related reasons stated for this, concerted efforts needs to be intensified to adequately educate patients on the need to stay adherent. Also, the need for provision of quality generic medications at a reduced cost cannot be overemphasized. Abstract Type: Oral or Poster Abstract Submission No.: PN-2114