Good Blood Pressure Control Research Articles

Blood pressure control and its associated factors among hypertensive patients in federal teaching hospital, ido- ekiti, Southwest Nigeria

Background: Hypertension is a modifiable risk factor for cardiovascular disease, stroke and renal disease worldwide. Despite improvement in treatment modality and therapeutic intervention, with proven benefits in reducing the burden of uncontrolled hypertension, majority of peoples’ blood pressure still remain uncontrolled. Aim: To assess the patterns of blood pressure control and its associated factors among hypertensive patients on follow-up. Setting: This study was done at the general out-patient department of Federal Teaching Hospital, Ido- Ekiti, Southwest Nigeria, which is a referral centre for private and government owned - health facility in the state and its environs. Methods: Hospital-based cross sectional study was conducted from June 4 – August 31, 2019. Systematic random sampling method was used to select the 320 participants. Semi-structured interviewer- administered questionnaire was used to seek information on participants’ socio-demographic characteristics, lifestyle changes and level of adherence to antihypertensive medication. Blood pressure was measured and recorded. Data was analyzed using SPSS 20. Multivariate logistic regression analysis was used to identify the factors associated with poor blood pressure control. Results: Mean age of the participants was 63.9± 11.5 years. 56.6% had their blood pressure controlled within the recommended limits. In multivariate analysis, civil servant (OR =45.160, 95% CI: 6.143 – 332.000) and adherence to medication (OR=15.35, 95% CI: 6.303 – 37.391) were the independent associated factors with good blood pressure control while old age (OR= 0.894, 95% CI: 0.837- 0.955) and diabetes (OR= 0.072, 95% CI: 0.016-.0,318) were independent associated factors with poor blood pressure control. Conclusions: Old age and diabetes are the predictors of poorly controlled blood pressure and therefore, clinicians and other stakeholders should provide close attention and targeted blood pressure control among this set of patients.

Role of family support and self-care practices in blood pressure control in individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala.

Background: Despite the availability of effective drugs, blood pressure (BP) control rate is sub-optimal in individuals with hypertension in low- and middle-income countries (LMICs). The role of self-care in the management of BP is less studied in LMIC settings. Methods: We conducted a community-based, cross-sectional study in individuals with hypertension in Kollam district, Kerala. A multistage cluster sampling method was used for the selection of study participants. We measured self-care by using an adapted Hypertension Self-Care Activity Level Effects (H-SCALE) scale. Descriptive statistics were used to summarise the data and logistic regression analysis was conducted to identify factors associated with BP control. Results: In total, 690 individuals with hypertension (women=60%) and a mean age of 57±8 years participated in the study. More than half (54%) of the participants were adherent to anti-hypertensive medications. However, the adherence rate was much lower for the dietary approach to stop hypertension (DASH) diet (12.8%), recommended level of physical activity (24%) and weight management (11.4%). Overall BP control was achieved in two of five individuals (38.4%, 95% CI: 34.7-42.0%). Among self-care activities, adherence to medications (AOR: 1.8, 95% CI: 1.3-2.5), DASH diet (AOR: 1.5, 95% CI: 1.0-2.4), and non-smoking status (AOR: 3.3, 95% CI: 1.7-6.4) were associated with control of BP. Additionally, good family support to self-care (AOR: 1.9, 95% CI: 1.1-3.1) was associated with better control of BP. Conclusion: In individuals with hypertension, the BP control rate is achieved in two of five individuals. Adoption of self-care activities are sub-optimal. Both family support and adherence to self-care activities are associated with BP control. Family based interventions to improve adherence to self-care activities could have a significant public health impact in achieving better population-level BP control rates in Kerala, India.

Suboptimal Blood Pressure Control, Associated Factors, and Choice of Antihypertensive Drugs among Type 2 Diabetic Patients at KCMC, Tanzania.

Background Hypertension (HTN) can be present in up to two-thirds of patients living with diabetes mellitus (DM). It is a risk factor for the development of diabetes as well as complications like coronary artery disease (CAD), nephropathy, retinopathy, and neuropathy. Hypertension is treatable, and the degree to which it is controlled determines the risk of development of cardiovascular diseases and other complications in a given individual patient. Even though antihypertensive drugs are available and issued to hypertensive diabetic patients, the rate of control of HTN is often inadequate. The aim of this study was to assess the prevalence of suboptimal blood pressure (BP) control, its associated factors, and the choice of antihypertensive drugs among type 2 DM patients at Kilimanjaro Christian Medical Centre (KCMC). Methods A hospital-based cross-sectional study was conducted at the KCMC diabetes clinic from October 2018 to March 2019 among type 2 DM patients with HTN based on the inclusion criteria. Data were collected using structured questionnaires, and written informed consent was obtained. Suboptimal BP was defined as BP levels ≥ 140/90 mmHg according to the American Diabetes Association guideline published in 2018. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 25. Chi-square analysis was done to identify the independent predictors of BP control, and a p value of <0.05 was considered to be statistically significant. Results The data of 161 participants was analysed; the mean age was 63.9 ± 20.2 years, with the majority being females (67.1%). Despite all participants being on different classes of antihypertensives, 57.8% had suboptimal BP control. Among the participants with good BP control, 52.7% were on angiotensin-converting enzyme inhibitors (ACE-I). Poor diabetes control was observed in 50.1% participants as indicated by elevated glycated haemoglobin. Conclusion This study demonstrated that BP control in type 2 DM patients was suboptimal in more than half of the participants. The study showed that the use of ACE-I or angiotensin II receptor blockers (ARBs) in the majority of DM patients has a good impact in the control of blood pressure. The early initiation of ACE-I or ARBs among the diabetic patients will improve the optimal BP control.

Influence of guideline adherence and parameter control on the clinical outcomes in patients with diabetic nephropathy

IntroductionWe assessed the association between guideline adherence and outcomes of clinical parameter control and end-stage kidney disease (ESKD), and further studied the effect of parameter control on ESKD for Chinese...

COVID-19 and hypertension-evidence and practical management: Guidance from the HOPE Asia Network.

There are several risk factors for worse outcomes in patients with coronavirus 2019 disease (COVID‐19). Patients with hypertension appear to have a poor prognosis, but there is no direct evidence that hypertension increases the risk of new infection or adverse outcomes independent of age and other risk factors. There is also concern about use of renin‐angiotensin system (RAS) inhibitors due to a key role of angiotensin‐converting enzyme 2 receptors in the entry of the SARS‐CoV‐2 virus into cells. However, there is little evidence that use of RAS inhibitors increases the risk of SARS‐CoV‐2 virus infection or worsens the course of COVID‐19. Therefore, antihypertensive therapy with these agents should be continued. In addition to acute respiratory distress syndrome, patients with severe COVID‐19 can develop myocardial injury and cytokine storm, resulting in heart failure, arteriovenous thrombosis, and kidney injury. Troponin, N‐terminal pro‐B‐type natriuretic peptide, D‐dimer, and serum creatinine are biomarkers for these complications and can be used to monitor patients with COVID‐19 and for risk stratification. Other factors that need to be incorporated into patient management strategies during the pandemic include regular exercise to maintain good health status and monitoring of psychological well‐being. For the ongoing management of patients with hypertension, telemedicine‐based home blood pressure monitoring strategies can facilitate maintenance of good blood pressure control while social distancing is maintained. Overall, multidisciplinary management of COVID‐19 based on a rapidly growing body of evidence will help ensure the best possible outcomes for patients, including those with risk factors such as hypertension.

Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods.

Background: Acromegaly is a rare disease that requires modern treatment to decrease the risk of mortality, mainly from vascular diseases. Identifying acromegalic patients with increased cardiovascular risk is challenging. Speckle-tracking echocardiography (STE) is a modern, well-validated, and reproducible method of assessing left ventricular longitudinal deformation and providing a sensitive assessment of myocardial contractility. We hypothesized that STE may be useful in evaluating subclinical dysfunction of the left heart in acromegalic patients, especially when a left ventricle (LV) assessment is completed with STE of the left atrium (LA).Purpose: To assess the diagnostic value of speckle-tracking echocardiography in identifying the occurrence of LV and LA functional impairment in patients with acromegaly, in comparison to patients without this rare pituitary disease.Methods: Echocardiographic assessments of LV and LA function using the new STE method were performed in 60 subjects: 30 acromegalic (ACRO group) patients and a CONTROL group with 30 patients matched in terms of age, gender, systolic/diastolic pressure, and history of hypertension for at least 12 months.Results: The ACRO group, compared to the CONTROL group, presented: (1) higher left ventricular mass (left ventricular mass index: 132 vs. 108 g/m2, p < 0.001) and, in consequence, more frequent LV hypertrophy (80.0 vs. 53.3%; p = 0.028); (2) impaired LV systolic function measured by both left ventricular ejection fraction (LVEF) (63.4 vs. 66.9%, p < 0.001) and global longitudinal strain (GLS) (−18.1 vs. −19.4%, p = 0.023); (3) greater LA anteroposterior diameter (40.3 vs. 36.9 mm, p = 0.003) and indexed left atrial volume (37.9 vs. 27.6 ml/m2, p < 0.001); and (4) impaired echocardiographic strain parameters corresponding with LA function.Conclusions: Acromegaly, even in young patients with good blood pressure control, may be associated with left ventricular hypertrophy and subclinical impairment of the left ventricular and left atrial mechanical function, which may be identified by speckle-tracking echocardiography. Further research in this area is necessary to clarify the prognostic value of these phenomena.

P1806OUTCOMES OF PEDIATRIC RENOVASCULAR HYPERTENSON: A SINGLE-CENTER EXPERIENCE

Abstract Background and Aims Renovascular disease is rare but important treatable cause of secondary hypertension in children. We aimed to evaluate the clinical presentations and long-term outcomes of pediatric patients with renovascular hypertension (RVH). Method We retrospectively reviewed medical records of patients with renovascular disease at our center between 1994 and 2019. Clinical courses including status of hypertension control with preservation of renal function during follow up were evaluated. Results 20 patients were diagnosed with RVH. 50 % (n = 10) were male, and median age at diagnosis was 10.1 (range 1.3 – 17.2) years, and median follow up period was 8.7 (range 0.1 – 24.6) years. 50 % (n = 10) presented with incidently detected high blood pressure (8 patients without symptoms, one with headache, and the other one with proteinuria), 25 % (n = 5) first admitted due to heart failure symptoms, and the rest (25 %, n = 5) presented with neurologic symptoms including seizure or paraplegia. Majority had no underlying disease except for 3 patients with Moyamoya disease. 80 % (n = 16) had unilateral renovascular stenosis. All patients showed elevated basal random renin activity (median 20.0, range 2.5 – 62.1 ng/ml/hr), and 45 % (n = 9) patients showed elevated basal random aldosterone level (median 822, range 266 – 2440 pg/ml). All patients needed antihypertensive medications for blood pressure control; 35 % (n = 7) of patients gained good control of blood pressure only with antihypertensive agents including angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), 40 % (n = 8) of patients who underwent percutaneous transluminal angioplasty all still needed antihypertensive agents including ACEI for blood pressure control. 20 % (n = 4) of the patients initially showed profoundly low relative function of involved kidney on diuretic scan, leading to nephrectomy. Three of these patients with nephrectomy successfully discontinued all antihypertensive agent gaining good control of blood pressure. The remaining one patient showed progressive deterioration of relative function on the involved side of kidney during 13 years, ended up with nephrectomy, but couldn’t discontinue ACEI. Glomerular filtration rate (GFR) was within normal range for all patients at diagnosis. For patients without nephrectomy, mean relative function of the involved kidney on diuretic scan was 33.5 ± 11.4 % at diagnosis. There was no significant change or deterioration of relative renal function during a mean follow up period of 10 ± 8 (median 11.5, range 0 – 19.5) years, although they all used ACEI/ARB. All patients including patients with nephrectomy showed normal GFR with a mean of 114.1 ± 19.5 ml/min/1.73 m2 at the last follow up. Conclusion Antihypertensive medications including ACEI and ARB were safely used with no further deterioration of the renal function of the involved side with or without angioplasty. Pediatric RVH is well managed with preserved renal function in long-term follow up.

P0929LOW PROTEIN DIET, BLOOD PRESSURE CONTROL AND NATRIURESIS IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE AND HEAVY PROTEINURIA

Abstract Background and Aims Recent data suggest the possibility to optimize blood pressure control by low protein diet (LPD) in patients with diabetic kidney disease (DKD). We aimed to assess the effects of a low protein diet (LPD) supplemented with keto-analogues on urinary sodium excretion and blood pressure control. Method Prospective, uni-center study with a total duration of 15 months.The study was conducted in a tertiary Nephrology Clinic and included a total of 92 diabetic patients with advanced CKD (eGFR &amp;lt; 30 mL/min) and heavy proteinuria (&amp;gt; 3 g/g creatininuria). Intervention consisted in a LPD (0.6 g/kg-day) supplemented with keto-analogues of essential amino acids with nutritional counselling and adjustment of antihypertensive therapy. The primary efficacy parameter was proteinuria during intervention as compared to pre-enrolment. Blood pressure (BP), urinary sodium excretion, eGFR and blood glucose control were secondary end-points. Results Mean arterial pressure (MAP) decreased from baseline (Bs) to end of study (EOS) with -11 (-17 to -7) mmHg despite a reduction with 22% of patients needing antihypertensive medication. Independent predictors of a lower than median MAP (90mmHg) were a lower protein intake (HR 0.00 (0.00; 0.04; p=0.002), treatment with furosemide (HR 1.06 [1.06; 3.85]; p=0.03) but not with angiotensin-aldosterone system inhibitors (RAASi) [HR 0.17 (0.17; 0.90); p=0.03)] and was not influenced by natriuresis. Natriuresis decreased from 130 (121-135) to 80 (71-86) mmol/day (p&amp;lt;0.0001). A lower than median natriuresis (100mmol/day) was directly related to proteinuria [HR 0.0003 (0.00; 0.004); p=&amp;lt;0.0001], eGFR [HR 0.0001 (0.00; 0.14); p=0.01] and to diuretic therapy [0.21 (0.05; 0.83); p=0.03] but not to protein intake. Cardiovascular events were observed in 20% of patients and their occurrence was related to a lower MAP [0.97 (0.95; 0.99}; p=0.001]. No renal adverse were noted and the diet was nutritionally safe. Conclusion A low protein diet supplemented with ketoanalogues of essential amino acids on top of anti-hypertensive therapy (mostly loop diuretics) allows for a good control of blood pressure, unrelated to natriuresis in heavy proteinuric patients with advanced DKD.

Managing Cardiovascular Risk Factors without Medications: What is the Evidence?

In this era of potent medications and interventional cardiovascular (CV) procedures, the importance of beginning with and including Therapeutic Lifestyle Changes (TLC) is frequently forgotten. A major goal of this review article is to show and emphasize that modification of CV risk with nonmedication approaches makes an essential contribution to CV risk reduction. Available information on TLC and modifiable CV risk factors was reviewed and assessed. Modifiable major CV risk factors include diabetes mellitus, hypertension, hyperlipidemia, tobacco abuse, obesity, stress, and a sedentary lifestyle. Age as a major CV risk factor is, of course, not susceptible to modification. A contribution to the control of CV risk factors can occur without the start of medications and there is proof of benefit for beginning with a non-pharmacological approach. TLC can benefit all of the major modifiable CV risk factors and there is good evidence for the additional benefit of supervised and group TLC. TLC includes physical activity, diet, and smoking cessation. Evidence for the benefits of TLC in reducing CV disease events is well established. However, medications must be added in those patients with higher CV risk to obtain maximum cholesterol reduction (lower is better for the low-density lipoprotein cholesterol) and good blood pressure control. The benefit of TLC is frequently forgotten in this era of potent medications and invasive procedures. The benefits of diet and physical activity are emphasized with supporting data. Many motivated patients can prolong their lives significantly by dedication to TLC. Therapeutic Lifestyle Change (TLC) especially encompasses increased physical activity, a healthy diet, and smoking cessation. There is extensive proof for the benefit of TLC in contributing to cardiovascular (CV) disease prevention. CV diseases have strong metabolic and inflammatory components, both of which can be improved by TLC.

OR34-04 Efficiency of Adrenal Venous Sampling in the Treatment Choice of Primary Aldosteronism (AVSTAT Study)

BACKGROUND: Adrenal venous sampling (AVS) is strongly recommended for a subtype diagnosis of primary aldosteronism (PA) if adrenalectomy (ADX) is desired by the patient. Given various issues related to AVS such as technical demand, invasive nature, expensive cost and radiation exposure, AVS is expected to lead efficiently to the subtype diagnosis and ADX. Aim: Primary objective was to assess the performance of AVS to determine treatment of PA by investigating the ratio of unilateral disease and rate of ADX following AVS in patients with unilateral disease. Methods: Sixteen major referral centers in ENS@T (n=10) and Japan (n=6) participated in the study. Study period was from 2006 to 2018. Data on total number of PA patients, AVS (total number and number of successful procedures), number of patients with unilateral diseases, and number of patients that underwent ADX were collected by a questionnaire-based survey. In addition, reasons for not proceeding to ADX in patients with a unilateral diagnosis were investigated. The diagnosis of PA was based on the positive case detection and at least one positive result in confirmatory testing. Results: Total number of confirmed PA patients and conducted AVS showed a dramatic increase during the past decade (PA: 1061 pts/ 2006–2011 to 3718 pts/ 2012–2018; AVS: 720/ 2006–2011 to 2448/ 2012–2018). Success rate of AVS was improved from 79.0% (2006–2011) to 92.5% (2012–2018). Both rate of unilateral PA and ADX of successful procedures decreased from 42.7% (2006–2011) to 37.3% (2012–2018) and from 40.8% (2006–2011) to 34.9% (2012–2018), respectively. Of the patients with successful AVS, bilateral disease was diagnosed in 63.5% (1812/2854 pts). Of the unilateral PA patients, 11.9% (125/ 1054 pts) were not subjected to ADX. The rate of the patients not subjected to ADX was significantly higher in Japan than in ENS@T centers both in patients with successful AVS (75.8% vs. 53.4%) and with unilateral disease (19.9% vs. 8.6%). Clinical decision against ADX in unilateral disease was made by the physicians in 33.3%, the patients in 33.3%, and both in 33.3%. Medical factors for Dr.’s decision against ADX in unilateral disease included good blood pressure control, normokalemia, comorbidities (e.g. DM, CKD), non-lateralized CT findings (e.g. no tumor, contralateral tumor), and discordant results among different criteria of AVS.Conclusions: High prevalence of bilateral disease and change of treatment policy after implementation affected the efficiency of AVS as an essential diagnostic procedure prior to ADX. Development of non-invasive procedures to exclude bilateral PA and more strict indication of AVS are warranted.

How do ultrafine particles in urban air affect ambulatory blood pressure?

Air in urban areas is usually contaminated with particle matter. High concentrations lead to a rise in the risk of cardiovascular and respiratory diseases. Some studies have reported that ultrafine particles (UFP) play a greater role in cardiovascular diseases than other particle matter, particularly regarding hypertensive crises and DBP, although in the latter such effects were described concerning clinical blood pressure (BP). In this study, we evaluate the relationship between 24-h ambulatory BP monitoring (ABPM) and atmospheric UFP concentrations in Barcelona. An observational study of individual patients' temporal and geographical characteristics attended in Primary Care Centres and Hypertensive Units during 2009-2014 was performed. The participants were 521 hypertensive patients, mean age 56.8 years (SD 14.5), 52.4% were women. Mean BMI was 28.0 kg/m and the most prominent cardiovascular risk factors were diabetes (N = 66, 12.7%) and smoking (N = 79, 15.2%). We describe UFP effects at short-term and up to 1 week (from lag 0 to 7). For every 10 000 particle/cm UFP increase measured at an urban background site, a corresponding statistically significant increase of 2.7 mmHg [95% confidence interval = (0.5-4.8)] in 24-h DBP with ABPM for the following day was observed (lag 1). We have observed that a rise in UFP concentrations during the day prior to ABPM is significantly associated with an increase in 24 h and diurnal DBP. It has been increasingly demonstrated that UFP play a key role in cardiovascular risk factors and, as we have demonstrated, in good BP control.

COVID‐19: diabetes and death. A call to action

<scp>COVID</scp>‐19: diabetes and death. A call to action

Inflammation May be the Future of Cardiovascular Risk Reduction: Does Colchicine have a Current Indication?

Inflammation as a cardiovascular risk factor has attracted increasing attention . The current standard of care for decreasing the occurrence of cardiovascular events includes controlling risk factors such as hypertension and maximizing the lowering of low-density lipoprotein cholesterol (LDL-C). However, a recent study demonstrated decreased cardiovascular risk with the anti-inflammatory agent canakinumab and created more interest in decreasing cardiovascular risk by decreasing inflammation. Canakinumab is not yet approved and will undoubtedly be very expensive, so interest in an established medication such as colchicine, which is inexpensive to produce, is appropriate if evidence-based benefit is adequately confirmed. Colchicine has existing indications for gout and familial Mediterranean fever and for decreasing the incidence of postpericardiotomy syndrome. If an evidence-based benefit in decreasing cardiovascular risk can be demonstrated for colchicine, it will be of significant importance. Meta-analyses and observational studies have provided evidence to suggest that colchicine decreases cardiovascular risk because of its anti-inflammatory effects. However, randomized controlled trials (RCTs) are needed, and the recently published COLCOT (Colchicine Cardiovascular Outcomes Trial) showed definite benefit on cardiovascular outcomes in adults who had experienced a myocardial infarction within the previous 30days. Sufficient evidence now supports the use of colchicine for secondary prevention in patients at the highest cardiovascular risk who continue to have cardiovascular events despite good blood pressure control and maximum LDL-C reduction. Nevertheless, more RCTs will be necessary before widespread general use of colchicine in cardiovascular disease prevention can be recommended. The current acquisition cost issues with colchicine also need to be resolved.

SUN-449 PATIENT WITH FABRY DISEASE IN CHRONIC HEMODIALYSIS FOR 7 YEARS AND 9 YEARS OF ENZYME REPLACEMENT THERAPY (ERT) IN TOTAL

Fabry disease (FD) is a lysosomal storage disease of inheritance linked to the X chromosome caused by the deficiency of the enzyme alpha-galactosidase A. It is a multisystemic disease with mainly renal, cardiac and nervous system involvement. Before the advent of dialysis and transplantation, men commonly died of chronic renal failure in the fifth decade of life. In a 2006 study of more than 100 patients with FD, all patients who survived older than 56 years developed ESRD and no patient survived beyond 60 years. Case report of a 60-year-old FD patient treated with agalsidase beta for 9 years. At first consultation, he presented hypertension and moderate proteinuria that reached a nephrotic range. Nitrogen products rose gradually, proteinuria values decreased to a moderate range and were maintained over time. The renal biopsy reported zebra bodies in the cytoplasm of podocytes. Molecular diagnosis of FD was made, detecting mutation c.520 T>G in exon 3 of the GLA gene. He started ERT with agalsidase beta immediately. After more than one year of ERT, the patient began hemodialysis (HD) at age 52. He continued infusions of intradialysis ERT without complications. The patient evolved with severe hyperparathyroidism that required parathyroidectomy. In 2017, brown tumor was diagnosed in the right wrist region. Surgery was performed to remove it. Despite good control of blood pressure and ERT, the patient evolved with left ventricular hypertrophy. In 2018 he presented mild precordial pain and then syncope. Acute non-ST elevation myocardial infarction was diagnosed. Medical treatment was performed without the need for angioplasty. Then he presented no more cardiovascular complications. He was evaluated for cross-kidney transplantation, because he had a different blood group donor. But this did not prosper. The patient received ERT uninterruptedly from the beginning, during 2009 he received agalsidase alfa for a short period due to the shortage of agalsidase beta. He currently remains in HD. Medication: Bisoprolol, valsartan, acetylsalicylic acid. Calcium, calcitriol, sevelamer and paricalcitol. Vitamin B, folic acid, erythropoietin and iron. Renal biopsy: Podocyte cytoplasm shows the typical structure of glycosphingolipid deposits, arranged in onion-like or zebra-like-figures. Echo doppler: Hypertrophy of the LV with septal predominance. Fey estimated by Simpson: 62%. Fibrosis of the ring and mitral valve. Fibrosis of the aortic sigmoids, with preserved opening. Pericardial effusion of mild grade. Initially, 3-year survival of FD patients on dialysis in the US was significantly lower compared to non-diabetic controls: 63% vs. 74% (95% CI, 67 to 80%; P _ 0.03). A study recently showed a mortality rate of patients with FD in HD of 7.38 (95% [CI] 7.33–7.42) per 100 people per year, lower than the mortality of patients with nephroangiosclerosis or diabetes. Mutation c.520 T>G was described as a renal variant. Although then the patient evolved with hypertrophy of LV. This is a complication of both hypertension and FD and being able to determine the cause with accuracy is difficult. In Argentina, cross-donor transplantation was legislated recently. FD is a multisystemic disease leading to life-threatening complications. ERT can have a positive impact on patient survival despite the progression of the disease and noble organs affeted.

SUN-224 PREGNANCY IN EGYPTIAN HEMODIALYSIS FEMALES: A RETROSPECTIVE MULTI-CENTER OBSERVATIONAL STUDY

Women of childbearing age on conventional hemodialysis (HD) had decreased fertility when compared with the general population, although it is not impossible. Furthermore, in women who conceived, maternal and fetal morbidity and mortality remained elevated. Only few publications addressed the status of pregnancy in HD females in Egypt. Thus, the aim of the current study was to assess the frequency and consequences of conception rate in Egyptian HD females. The study comprised 2 phases: Phase one investigated the frequency of conception in hemodialysis females in 291 HD units all over Egypt, while phase two studied the consequences of conception and factors affecting its fate in 22 HD units comprising 211 married females in their childbearing period. The 5-year conception rate was 5.2%, and was associated with higher dialysis blood flow rate, larger dialyzer size, longer session length, better control of blood pressure, as well as lower level of serum ferritin. Live birth frequency was 33.3% of conception; and compared to cases with abortion, it was statistically significantly associated with younger maternal age, and insignificantly associated with higher length of dialysis sessions and lower serum phosphorus level. During the third trimester, a dialysis duration of 24 hours/week resulted in better conception outcomes compared to respective dialysis duration of 20 hour/week, although the differences were statistically insignificant. The viable babies’ weights ranged between 0.9 – 3.5 kg with a mean of 2.1 kg. Compared to vaginal delivery, Caesarian sections were attended by better neonatal outcomes. The mean gestational age was 32.6 weeks with range of 24 to 36 and there was no pregnancy-related maternal mortality. Fertility is not uncommon and is largely safe in married Egyptian HD female. Better conception potentials and outcomes could be related to better dialysis adequacy, and proper control of phosphate.

Evaluation of drug therapy problems among outpatient hypertensive and type-2-diabetic patients at a Tertiary Hospital, South-West Nigeria

Background: Health-related burden and poor outcomes due to drug therapy problems (DTPs) is a major concern in healthcare delivery especially in resource-poor countries.Objective: To evaluate extent and types of DTPs as well as disease-specific clinical parameters in outpatient hypertensive and type-2-diabetic (T2D) patients attending a tertiary hospital in Nigeria.Materials and Methods: This entailed questionnaire-guided interaction with 205-adult hypertensive and 198-T2D patients who were purposively enrolled, followed by a retrospective review of their medical records from September - November 2018. Domains of DTP explored included drug and dose selection, drug form, treatment duration, patients’ adherence and drug interactions. Data were summarised using descriptive statistics, while categorical variables were evaluated with Chi-square test at p&lt;0.05 level of significance.Results: Overall, 840 DTPs were identified among participants. This comprised 422(50.2 %) DTPs among T2D (average = 2.13 DTPs per patient), and 418(49.8 %) DTPs in the hypertensive (average = 2.04 DTPs per patient). The order of occurrence of DTPs among T2D was non-adherence [intentional, 173 (41.0 %) and unintentional, 69 (16.4 %)]&gt;drug interactions, 155 (36.7 %)&gt;drug selection, 25 (5.9 %); while for hypertensive patients, the order was non-adherence [intentional, 156 (37.3 %); unintentional, 57 (13.6 %)]&gt;drug interactions, 157 (37.6 %)&gt;dose selection, 25 (6.0 %)&gt;drug selection, 23 (5.5 %). A total of 133(65.5 %) hypertensive patients had good blood pressure (≤140/90 mmHg) control, while the mean glycosilated haemoglobin was 7.5 (SD=2.6 %).Conclusion: Extent of DTPs among participants is high, with non-adherence and drug interactions constituting the highest DTPs burden. There is generally a need for prescribers and pharmacists in particular to be wary of potential or actual DTPs during patient encounters, as this may ensure better therapeutic outcomes.Keywords: Drug therapy problems, Hypertensive and type-2-diabetic patients, Outpatient, Nigeria

Posterior reversible encephalopathy syndrome due to autonomic dysreflexia in medullary infarction

The simultaneous occurrence of cervicocephalic arterial dissection and posterior reversible encephalopathy syndrome (PRES) is a rare entity. A healthy 33-year-old male with no known comorbidities had sudden onset pain in the neck, while he was doing strenuous physical labor. Over the next 2 days, he developed symptoms such as swaying to either side while walking, numbness on the left side of his body, painless progressive bilateral blurring of vision, and drooping of bilateral eyelids. On arrival at the emergency room, he was drowsy with a Glasgow Coma Score of 14 and complained of headache in addition to the preexisting symptoms. He also reported that his entire visual field was clouded and dark. On examination, he was detected to have a blood pressure of 220/120 mmHg with bilateral mild ptosis and nonreactive pupils. He had cortical blindness at the time of admission. He had significant gait and truncal ataxia but no other cerebellar signs. Motor system examination was unremarkable and plantars were flexor. No objective sensory deficit was demonstrable. Magnetic resonance imaging showed acute infarct in the vermis with vertebral artery dissection at V4 extending to the basilar artery. In addition, there were diffuse T2-hyperintensities in the bilateral occipital areas without restricted diffusion suggestive of posterior reversible encephalopathy syndrome [Figure 1]. He was admitted to the intensive care unit; the high blood pressure was treated aggressively with labetalol and hydralazine. Gradually, his vision improved over 48 h and back to normal acuity by 5 days. His magnetic resonance angiography with the neck vessels showed a dissection of the vertebral artery. His symptoms of medullary infarct persisted for a few weeks and then resolved completely. Young brainstem stroke with neck pain points to vertebral artery dissection. Concurrent worsening with autonomic fluctuation can be due to associated PRES and is to be considered as this situation is eminently treatable with good control of blood pressure at the earliest.

The Risk of Obstructive Sleep Apnea among Patients with Type 2 Diabetes Mellitus.

Context/Aims:Obstructive sleep apnea (OSA) and Type 2 diabetes mellitus share obesity as a common risk factor. The presence of OSA may contribute to increased morbidity and mortality of diabetes. Despite their close association, OSA is not routinely evaluated in diabetic patients. This study was conducted to determine the risk of OSA among Type 2 diabetes mellitus patients.Methods:Type 2 diabetic patients attending a tertiary hospital in Nigeria were evaluated for OSA risk using the Berlin Questionnaire. Other parameters measured included anthropometry and blood pressure (BP).Results:Three hundred and twenty-seven patients participated in this survey: 177 (54.1%) were female and 150 (45.9%) were male. The average age of the patients was 56.2 ± 9.3 years. Seventy-eight (44.8%) females were obese compared to 30 (20.0%) males,P < 0.001. Two hundred and one (61.5%) patients were previously known hypertensives with only 48 (23.9%; 95% confidence interval [CI]: 18.2–30.4) of them having good BP control. One hundred and sixty-two (49.5%, 95% CI; 44.0–55.1) patients had a high risk for OSA: 96 (54.2%; 95% CI: 44.6–61.7) females and 66 (44.0%; 95% CI: 35.9–52.3) males. The strongest predictor for a high risk of OSA was poorly controlled BP with an odds ratio of 2.6 (95% CI: 1.6–4.3).Conclusion:This study has demonstrated that there is a high risk of OSA among Type 2 diabetic patients and that OSA risk is significantly associated with poor BP control and obesity. We recommend that diabetic patients should be assessed for OSA risk as part of their routine evaluation.

Monotherapy versus combination therapy for the initial treatment of hypertension

Objectives: There is a significant gap among hypertensive patients who are being treated and those who actually achieve blood pressure (BP) control. The main objective of this article is to determine if there are any differences in clinical outcomes and BP control with a combination treatment as compared to monotherapy as the initial treatment of hypertension. It also focuses on to compare the efficacy and compliance of fixed-dose combination (FDC) as compared to monotherapy and conventional multi-pill combination therapy as the initial treatment of hypertension. Methods: A search of literature was done using PubMed and Google scholar to prepare a review on this topic. Results: The main evidence supporting the use of combination therapy is focused on the use of combinations of renin–angiotensin System (RAS) blocker with calcium channel blockers (CCBs) and with thiazide diuretics. Several randomized clinical trials have proven the efficacy of combination therapy to be superior to monotherapy as initial treatment for timely and adequate BP control. Conclusion: Several benefits of achieving good BP control have been proven by several studies including the Systolic Blood Pressure Intervention Trial study, but only a few guidelines internationally recommend combination antihypertensives as a routine first-line treatment in all hypertensive patients. It is reasonable to go for aggressive management of hypertension involving the use of FDC antihypertensives from two different classes of drugs to achieve the recommended goals of BP of

National Medical Research Center for Preventive Medicine, Moscow, Russia

Arterial hypertension is the leading cause of cardiovascular morbidity and mortality. According to Russian and international studies, prevalence of hypertension is approximately 40%. In the next years an increase in the number of patients can be expected. Hypertension is the main independent risk factor for coronary heart disease for all age groups. Modern antihypertensive drugs can provide good control of blood pressure and reduce the incidence of complications and mortality. By prescribing antihypertensive therapy, it is necessary to achieve the target level of blood pressure, for most patients ≤130/80 mm Hg. When prescribing combination therapy, preference should be given to fixed combinations. Approximately 10% of patients with hypertension have resistance to therapy. Such patients often need an extended diagnostic search to exclude pseudoresistance and secondary hypertension. One of the main causes of pseudoresistance is poor adherence to therapy. Patients with resistant hypertension have a higher risk of adverse outcomes compared with patients without this type of disease.