Guidelines For Treatment Of Hypertension Research Articles

Re-evaluating cardiovascular risk in systolic-dominant, diastolic-dominant and parallelly-elevated hypertension: insights from northeast rural cardiovascular health study

BackgroundHypertension is a major risk factor for cardiovascular disease (CVD), with a high prevalence in rural northeastern China. This study assesses the cardiovascular risk associated with different blood pressure patterns: systolic dominant, diastolic dominant, and parallel elevation.MethodsWe analyzed data from the Northeast Rural Cardiovascular Health Study (NCRCHS), which included 8,189 participants aged 35 and above. Baseline surveys from 2012 to 2013 and follow-ups in 2015 and 2018 provided a median follow-up of 4.66 years. Participants were categorized into ten subgroups based on systolic and diastolic blood pressure elevations. Kaplan-Meier curves and Cox regression models were used to examine CVD incidence and cardiovascular risk across these groups.ResultsThe incidence of CVD varied significantly among hypertension categories. Patients with grade 1 hypertension had no significant increase in cardiovascular risk at nearly 5 years. Notably, parallel elevations in systolic and diastolic pressures posed the highest cardiovascular risk, while a predominant rise in diastolic pressure alone did not significantly increase risk. This highlights the importance of analyzing blood pressure comprehensively for cardiovascular risk stratification and suggests rethinking treatment strategies for diastolic dominant hypertension.ConclusionsOur findings call for a nuanced approach to cardiovascular risk assessment in hypertension, taking into account distinct patterns of systolic and diastolic blood pressure. The study supports personalized treatment interventions and reinforces current hypertension treatment guidelines. We advocate for prioritizing non-pharmacological management in grade 1 hypertension and further clinical evaluation of treatment thresholds for diastolic dominant hypertension.

Drugs for hypertension.

American College of Cardiology/American Heart Association (ACC/AHA) guidelines for treatment of hypertension were last published in 2018.1 Treatment of hypertensive urgencies and emergencies is not discussed here.

LARGE DIVERGENCES IN TARGET GROUPS OF ESH 2023 BP-LOWERING STRATEGIES IN OLDEST-OLD PATIENTS ACCORDING TO THEIR FUNCTIONAL AND/OR FRAILTY STATUS

Objective: Treatment individualization is part of good clinical practice. Part of it is medication de-escalation in older adults with limited life expectancy or advanced frailty syndrome. The 2023 ESH guidelines for treatment of hypertension, for the first time made provision for tailored medication use based on functionality and age of the patient. We aimed to assess whether the 2023 ESH Guidelines strategy for antihypertensive treatment individualization aligns with the widely adopted treatment strategy based solely on frailty status. Design and method: We used data from a cross-sectional, nationwide survey of health determinants in non-institutionalized older persons in Poland that was conducted from 2018 to 2019 (PolSenior2). For the current analysis, we extracted data for hypertensive persons aged 80 years and older. Based on Fried criteria we categorized participants into fit, pre-frail, and frail. The Mini-Mental State Examination was used to screen for cognitive impairment, and the basic Activities of Daily Living for functional screening. We also checked the classification-assignment based on the ESH 2023 functional categorization (fit, slowed but autonomous for most activities, severely dependent) that is proposed for assessment of eligibility to tailored antihypertensive treatment. We then checked the concordance between the classifications. Results: The mean (SD) age of 1458 participants (52% women) was 86.0 (4.7). According to Fried’s definition, 47.9% were pre-frail and 46.4% frail, respectively. Based on the ESH 2023 approach, 10.3% of participants were classified as severely dependent who required treatment individualization and prioritization (91.3% of them frail) and 66.3% as fit who should be treated as usual (59.2% of them pre-frail and 33.1% frail, according to Fried’s frailty criteria). We found the correlation between the two classifications to be low (Spearman’s r=0.39, p<0.05) with the kappa coefficient of 0.11 (p<0.05). Conclusions: In the community-dwelling hypertensives, aged 80+ years, who are candidates for individualized antihypertensive therapy, there was discrepancy between frailty status and the ESH 2023 functional criteria for antihypertensive treatment individualization. A thoughtful approach should be taken to standardize the methodological concepts and fine-tune them according to specific clinical needs.

Comparison of the Efficacy and Tolerability of Candesartan Cilexetil between Hypertension patients of Muna and Tolaki Ethnicity

There are differences in the efficacy of a drug between ethnicities. Hypertension Treatment Guidelines of JNC 8 recommend not using angiotensin receptor blockers (ARBs) and ACE inhibitors in the black population for first-line therapy. The Tolaki and Muna ethnicities are two indigenous ethnic groups of the Southeast Sulawesi Province of Indonesia. The very different physical characteristics between these two ethnic groups raise the possibility that there are differences in the body's response to antihypertensive ARBs, including candesartan. The study aimed to compare the efficacy and tolerability of candesartan cilexetil monotherapy for one month in hypertensive patients of the Tolaki and Muna ethnicities. Assessment of therapy efficacy includes the proportion of patients achieving the therapeutic target according to JNC 8 and the reduction of blood pressure. Tolerability is assessed based on side effects and adverse drug reactions (ADR) reported by patients. Patients who met the criteria for this study were those who had recently been diagnosed with essential hypertension or hypertension with type 2 diabetes mellitus, were taking candesartan cilexetil (8 mg orally once a day), and had blood pressure values after one month of treatment. Sixty-eight Tolaki ethnic patients and 51 Muna ethnic patients who met the inclusion criteria were included in this study. The results showed that the decrease in systolic and diastolic blood pressure was greater in the Tolaki than those in the Muna ethnicity. The median value of the systolic decrease was -33 ((-10)–(-60)) mmHg for the Tolaki ethnic group and -10 (0–(-20)) mmHg for the Muna ethnic group. The median value of diastolic decline for the Tolaki and Muna ethnicities was -10 (0–(-37)) mmHg and -5 (5–(-20)) mmHg, respectively. The MAP value of the Tolaki ethnic group is 93.30 (80–110), and that of the Muna ethnic group is 110 (96.69–130). The achievement of the target of reducing blood pressure was also significantly higher for the Tolaki than the Muna ethnicities. Complaints felt by some people in both ethnic groups were dizziness, headaches, and feeling weak. Six people in the Muna ethnic group with diabetes mellitus with type 2 experienced hyperkalemia. There was a significant difference in the efficacy of candesartan for one month between Muna and Tolaki ethnic hypertension patients. There was no difference in tolerability between the two ethnic groups.

Abstract P326: Patient Predictors of Antihypertensive Medications Prescription Classes Revealed by the All of Us Research Project (AOURP) Registry

Hypertension (HTN) treatment guidelines recommend five general classes (ACEi, ARB, CCB, diuretics, beta-blockers) of medications with minimal guidance regarding specific classes for different types of patients. Understanding heterogeneity in HTN treatment and demographic and clinical traits of individuals receiving different medication classes may provide insights into outcome disparities and enable the development of more tailored treatment recommendations. Using EHR data from the national All of Us Research Project (AOURP) registry, we examined patient predictors of first-line HTN medication class usage. From the AOURP we selected: 1) patients aged 18+ and diagnosed with new-onset HTN between 2010 and 2021 which is determined by having no HTN medication prescription prior to diagnosis date; 2) patients not pregnant within a year before and after the HTN diagnosis. We restricted our analyses to individuals receiving routine care within the EHR database as defined by having at least one in-person visit in the year prior to the first HTN diagnosis and prescribed with a single class of HTN medications within a year of their HTN diagnosis. We performed multivariate regression analysis on the outcome of whether a certain class of first-line medication was prescribed another class. Our covariates include age, sex, race/ethnicity, comorbidities (diabetes, CVD, CKD), and household income. All reported odds ratios below have a p-value of less than 0.05. Among 5,521 AOURP participants, ACEi was the most prescribed class (29%), followed by CCB (23%), Diuretic (22%), Beta-blocker (17%), and ARB (9%). We found ACEi were more likely to prescribed for females (OR: 0.74) while diuretics were less likely to be prescribed for males (OR: 1.45). We found CCB (OR: 2.73) and diuretics (OR: 1.54) were more likely to be prescribed for Blacks than their White counterparts. We also found that ACEi (OR: 2.75) were more likely prescribed for diabetics. In terms of household income, we found that ARB (OR: 1.67) were prescribed more frequently for those in higher income brackets (<$25,000 vs $100,000+) compared to other classes of medication. This corresponds to the fact that ARB are relatively newer and more expensive class of HTN medications. Our findings show that although there are levels of clinical equipoise in terms of prescribed medication classes among the general population, evidence-based guidance on personalized antihypertension treatments may be needed.

American College of Cardiology and American Heart Association Blood Pressure Categories: A Systematic Review of the Relationship With Adverse Pregnancy Outcomes in the First Half of Pregnancy

(Am J Obstet Gynecol. 2023;228(4):418–429.e34) Many risk factors contribute to adverse outcomes in pregnancy related to elevated blood pressure. High blood pressure or hypertension, has also been shown to be connected to poor outcomes outside of pregnancy, and clinical guidelines have recently changed to reflect stage 1 and stage 2 hypertension rather than a global definition of hypertension. Guidelines for defining hypertension in pregnancy, however, have not changed with general practice guidelines. There is substantial evidence linking hypertension with pregnancy complications such as pre-eclampsia and eclampsia, but there has been no movement to adjust guidelines for hypertension diagnosis or treatment in pregnancy. This systematic review aimed to evaluate whether there is evidence to support the changing of practice guidelines and the definition of hypertension in pregnancy to the American College of Cardiology (ACC) and American Heart Association (AHA) recommendations to help identify individuals at risk of developing pre-eclampsia or other pregnancy complications.

Evaluation of treatment information quality on hypertension and diabetes on WeChat and TikTok: A cross-sectional content analysis.

Objective: This study aimed to assess the quality of the information in WeChat and TikTok videos related to hypertension and diabetes treatment. Methods: A sample of 120 Chinese videos was collected based on specific inclusion and exclusion criteria. The quality was evaluated using DISCERN, JAMA and the latest edition of Chinese guidelines for hypertension and diabetes prevention and treatment, and two observers independently scored each video using the three assessment tools. Results: Among all 120 videos, only 10 scored above 38 points in DISCERN, with 45 videos rated as "very poor". None of the video met all JAMA criteria simultaneously, and there were gaps in accuracy and completeness compared to the two guidelines. Furthermore, there was no significant correlation between information quality and the number of likes and comments. Conclusion: The current quality of information on the treatment of hypertension and diabetes on WeChat and TikTok was unsatisfactory. Consequently, the government should strengthen oversight of information quality, and social media platforms should actively review health-related content to prevent inaccurate information dissemination. Individuals should enhance their digital and health literacy.

Medical Measures in Hypertensives Considered Resistant.

Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.

Abstract 14319: Riociguat in Pulmonary Arterial Hypertension: Application of the 4-strata COMPERA 2.0 Risk Assessment Tool in the PATENT Studies

Background: The 2022 ESC/ERS treatment guidelines for pulmonary arterial hypertension (PAH) recommend using a four-strata risk assessment strategy at follow-up. COMPERA 2.0 is a refined four-strata risk assessment tool that subdivides patients at intermediate risk of mortality at 1 year into intermediate-low and intermediate-high risk groups for a more granular approach to risk prediction. Aim: This post-hoc analysis applied COMPERA 2.0 to the PATENT studies of riociguat in patients with PAH. Methods: COMPERA 2.0 was applied to patients who were pretreated with PAH therapy at PATENT-1 entry. Patients with missing data for COMPERA 2.0 variables were excluded. In PATENT-1, risk strata were assessed at baseline and Week 12; and 6-minute walking distance (6MWD) at Week 12 was analyzed by risk strata at baseline. All pretreated patients entering the PATENT-2 open-label extension were included in Kaplan-Meier analyses to assess association of risk strata at PATENT-1 baseline and Week 12 with clinical worsening and survival. Results: At PATENT-1 baseline (riociguat 2.5 mg n=102, placebo n=49), more patients were at intermediate-low risk than intermediate-high risk (Figure 1). At PATENT-1 Week 12, a higher proportion of patients were at low risk with riociguat vs placebo (Figure 1). At PATENT-1 Week 12, the following mean [SD] changes in 6MWD were seen in patients at intermediate-low risk (riociguat 24 m [57 m], placebo 10 m [60 m]) and intermediate-high risk (riociguat 34 m [56 m], placebo –2 m [70 m]) by COMPERA 2.0 at baseline. COMPERA 2.0 assessed at PATENT-1 baseline and Week 12 was able to discriminate between risk strata for clinical worsening and survival in PATENT-2 (n=167, log-rank tests: p≤0.001 for all analyses). Conclusion: This analysis confirmed the risk-reduction benefits of riociguat in patients with PAH and validated the utility of COMPERA 2.0 in the long-term risk assessment of patients from a clinical trial population.

Capacity of Clinical Officers to Care for Patients with Hypertension and Type 2 Diabetes Mellitus in Rural Healthcare Facilities in Kisumu County, Kenya

This study aimed to investigate the ability of clinical staff in a rural Kenyan health facility to manage patients with hypertension and type 2 diabetes mellitus. The study involved 146 clinicians from 56 medical facilities who were interviewed using semi-structured questionnaires, simulations, and observational instruments. Descriptive analysis was performed using SPSS version 24. Results showed that lack of knowledge of risk factors for HTN& T2DMHTN & T2DM, inability to perform a complete physical examination, inability to identify first-line medications for either hypertension or type 2 diabetes mellitus, unavailability of assigned patient follow-up clinic day/staff/room, and lack of treatment guidelines for hypertension and diabetes were associated with an inability to manage such patients. However, concurrent prescription of anti-hypertension medication along with advice on lifestyle modification strategies was associated with an ability to do so (OR 0.079; 95% CI0.016-0.934; P=P = 0.002). The study recommends that clinical staff receive education on the risk factors, physical examination, and first-line medications for managing hypertension and type 2 diabetes mellitus. Additionally, the study highlights the importance of having scheduled clinic days, assigned staff, dedicated rooms, and protocols and guidelines to improve the management of these conditions

Assessment of availability, readiness, and challenges for scaling-up hypertension management services at primary healthcare facilities, Central Highland region, Vietnam, 2020

IntroductionVietnam aims for 95% of commune health stations (CHSs) to have functional hypertension management programs by 2025. However, limited resources may impede the Central Highland region health system from achieving this goal. We assessed the availability and readiness of hypertension management services at CHSs in the Central Highland region and identified challenges to facilitate evidence-based planning.MethodsWe used a mixed-methods cross-sectional design to assess hypertension management services using WHO’s service availability and readiness assessment (SARA) tools in all 579 CHSs in the region, combined with twenty in-depth interviews of hypertension program focal points at communal, district, and provincial levels in all four provinces. We descriptively analyzed quantitative data and thematically analyzed qualitative data.ResultsHypertension management services were available at 65% of CHSs, and the readiness of the services was 62%. The urban areas had higher availability and readiness indices in most domains (basic amenities, basic equipment, and essential medicines) compared to rural areas, except for staff and training. The qualitative results showed a lack of trained staff and ambiguity in national hypertension treatment guidelines, insufficient essential medicines supply mechanism, and low priority and funding limitations for the hypertension program.ConclusionThe overall availability and readiness for hypertension diagnosis and management service at CHSs in the Central Highland region were low, reflecting inadequate capacity of the primary healthcare facilities. Some measures to strengthen hypertension programs in the region might include increased financial support, ensuring a sufficient supply of basic medicines, and providing more specific treatment guidelines.

Evaluation of Hypertension Patient Management During Family Medicine Trainee Education

Objective: Hypertension (HT) is a systemic disease manifested by high blood pressure and is a major health problem, common in the community and the cause of serious complications. Control of blood pressure levels is an essential step in reducing omit complications. The aim of the study is to evaluate the impact of face-to-face HT training on the HT knowledge and awareness of the family medicine resident doctors and to understand their needs.
 Materials and Methods: Our study was planned in a descriptive-cross-sectional research design. Just before and after the face-to-face training, participants were given a questionnaire developed by researchers based on two documents: the Turkish Hypertension Consensus Reports published in 2019, and the Hypertension Diagnosis and Treatment Guidelines published by the Turkish Endocrinology and Metabolism Society in 2022.
 Results: In our study, we observed the effect of face-to-face education on 15 sub-categories of HT as an intervention research model. In the post-training evaluation, 12 of the 15 sub-categories involved theoretical questions, and three were case-based evaluation questions. The goal was to answer 50% or more of the questions correctly, and it was observed that, after the training, in five of the fifteen sub-categories, this target was generally achieved.
 Conclusion: Face-to-face training is effective in increasing knowledge and awareness, and evaluation capacity, which are two important elements of HT administration in primary care. A detailed examination of 15 sub-categories related to HT revealed the categories that were better in terms of effect size. Our study also detailed the effects on sub-categories related to HT management (such as resistance to first-stage HT management), which reveal interesting and somewhat unexpected results.

Explaining the Decline in Coronary Heart Disease Mortality Rate Using IMPACT Model: Estimation of the Changes in Risk Factors and Treatment Uptake in Iran between 2007 and 2016.

Coronary heart disease (CHD) contributes significantly to mortality and morbidity in Iran. A model was fitted in this study to determine changes in risk factors and treatment uptake to CHD mortality rate reduction in Isfahan between 2007 and 2016. The IMPACT model was fitted to determine how much the decrease in CHD death can be explained by treatment uptake and significant risk factors included in the analyses for adults aged 35 to 84 years. Body mass index (BMI), diabetes, and smoking were considered as the CHD risk factors in the model. Medical and interventional treatments were studied in four different groups of patients. The primary data sources were obtained from the Persian registry of cardiovascular disease (PROVE), The Isfahan healthy heart program (IHHP), and the impact of self-care management and adopted Iranian guidelines for hypertension treatment on improving the control rate of hypertension (IMPROVE CARE) study, death registration system, and the Isfahan province Cemetery. The CHD mortality rate decreased by 14% between 2007 and 2016 in Iran for adults aged 35 to 84 years and prevented or delayed 212 CHD deaths in 2016. Treatment uptakes caused 99% postponed or prevented death. Treatment for heart failure in hospitals explained approximately half of the death prevented by treatment. Risk factors caused about 15% of excess death. It appears that the prevalence of CHD is increasing while the death rate is decreasing because of these observed changes. Risk factors worsened in 2016 and, without treatment, could lead to an increase in CHD mortality in Iran. Preventive policies should control the risk factor and contribute to the decrease in CHD death.

Prevalence of Hypertension and Its Association with Cardiovascular Risk Factors in College Students in Hunan, China.

Although the prevalence of hypertension has been well studied in middle age and elderly populations, few studies have systematically investigated the prevalence of hypertension and its association with cardiovascular and cerebrovascular risk factors in young populations. This study examined the prevalence of hypertension in college students and its correlation with cardiovascular and cerebrovascular risk factors, such as neck circumference and body mass index (BMI). This population-based study recruited a total of 1719 students (723 were junior, 502 were sophomore, and 494 were freshman), including 996 males (average age: 20.8 years) and 723 females (average age: 20.4 years). Hypertension was defined by the 2018 revised edition of the Chinese Guidelines for Prevention and Treatment of Hypertension. Blood and pulse pressure were measured using standard protocols. Circulating levels of lipids, glucose, glycosylated hemoglobin (GHb), leptin, and adiponectin were determined using standard methods. The Chi-squared (χ2) test was used for comparison of significant differences between groups. Linear and logistic regression analyses were used to explore risk factors that significantly influence hypertension. The prevalence of hypertension was 10.59% in the total cohort, and sophomores had a higher prevalence of hypertension than freshmen and juniors (χ2 = 19.372; P < 0.001). In addition, male students had a significantly higher prevalence of hypertension (10.24%) and abnormal pulse pressure (8.13%) than female students (1.4% and 0.83%) (χ2 = 327.424, P < 0.001 for high SBP and χ2 = 60.49, P < 0.001 for high DBP, respectively). Correlation analysis revealed that hypertension was significantly correlated with neck circumference and BMI (r = 0.509, P < 0.001; r = 0.474, P < 0.001), but not significantly correlated with the other parameters examined. The prevalence of hypertension in college students is closely correlated with two obesity indicators, neck circumference and BMI.

Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis

Background and objective Thiazide diuretics are first-line drugs for the treatment of hypertension, but hypertension treatment guidelines have systematically discouraged their use in patients with advanced chronic kidney disease (CKD). For the first time, a systematic review and random-effects meta-analysis were performed to assess the effectiveness of thiazides and thiazide-like diuretics to treat hypertension in patients with stages 3b, 4, and 5 CKD. Design, setting, participants, & measurements A systematic review and random-effects meta-analysis that included a literature search using the following databases were performed: MEDLINE through PubMed, Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) through the Cochrane Library, Embase, and ISI – Web of Science (all databases). Prospective studies that evaluated the effectiveness of thiazide and thiazide-like diuretics in individuals with a GFR < 45 mL/min/1.73 m2 were included. Results Five clinical trials, totaling 214 participants, were included, and the mean GFR ranged from 13.0 ± 5.9 mL/min/1.73 m2 to 26.8 ± 8.8 mL/min/1.73 m2. There was evidence of a reduction in mean blood pressure and in GFR, as well as in fractional sodium excretion and fractional chloride excretion. Conclusion Thiazide and thiazide-like diuretics seem to maintain their effectiveness in lowering blood pressure in patients with advanced chronic kidney disease. These findings should spur new prospective randomized trials and spark discussions, particularly about upcoming hypertension guidelines.

Remote physiologic monitoring for hypertension in primary care: a prospective pragmatic pilot study in electronic health records using propensity score matching.

Since 2019, the Centers for Medicare and Medicaid Services covers remote physiologic monitoring (RPM) for blood pressure (BP) per hypertension diagnosis and treatment guidelines. Here, we integrated Omron VitalSight RPM into the health system's electronic health record to transmit BP and pulse without manual entry, assessed feasibility, and used pragmatic prospective matched cohort studies to assess initial effects in (1) uncontrolled (last two office BP ≥140/90 mmHg) and (2) general (diagnosed hypertension or last office BP ≥140/90 mmHg) hypertension patient populations. Seventeen clinicians at two internal medicine practices were oriented. Eligible patients were aged 65-85 years had Medicare insurance with ≥1 office visit in the previous year. We prospectively identified matched controls (age, sex, BP, and number of office visits in previous year) from other primary care practices within the health system and estimated the association between RPM availability (clinic-level) and patient BP outcomes after 6 months. ClinicalTrials.gov: NCT04604925. Feasibility. Uptake was low at pilot clinics: 10 physicians prescribed RPM to 118 patients during the 6-month pilot. This included 7% (14/207) of the prespecified uncontrolled hypertension cohort and 3.3% (78/2356) of the general hypertension cohort. Surveyed clinicians (n = 4) reported changing their patients' medical treatment in response to RPM BPs, although they recommended having a dedicated RN or LPN to review BP readings. Effectiveness. At 6 months, BP control was greater at pilot practices than among matched controls (uncontrolled: 31.4% vs 22.8%; P = .007; general: 64.0% vs 59.7%; P < .001). Systolic BP at last office visit did not differ (mean [SD] 146.0 [15.7] vs 147.1 [15.6]; P = .48) in the uncontrolled population, and was lower in the general population (131.8 [15.7] vs 132.8 [15.9]; P = .04).The frequency of antihypertensive medication changes was similar in both groups (uncontrolled P = .986; general P = .218). Uptake notwithstanding, RPM may have improved BP control. A potential mechanism is increased physician awareness of and attention to uncontrolled hypertension. Barriers to RPM use among physicians require further study.

PS-BPP02-8: BRIDGING THE GAPS IN HYPERTENSION CARE IN NIGERIA: END-LINE EVALUATION OF COMMUNITY ACTION AGAINST NON-COMMUNICABLE DISEASES (COMAAND) PROJECT

Title: Bridging the Gaps in Hypertension care in Nigeria: End-line Evaluation of COMmunity Action Against Non-communicable Diseases (COMAAND) Project Objective: Non-Communicable Diseases (NCDs) have become a global public health burden leading to at least 70% of deaths globally. Cardiovascular Diseases (CVDs) are the primary drivers of this epidemic, and hypertension is the leading determinant of CVD mortality. We implemented an innovative community-based strategy focused on early detection and timely management of hypertension in three communities in Anambra state, Nigeria entitled COMmunity Action Against Non-communicable Diseases (COMAAND). We conducted a baseline study to establish hypertension's prevalence, awareness, treatment, and control in implementing communities. In this study, we set out to assess the same metrics we evaluated at baseline, and also compared them with the findings at baseline to establish the impact made by the project. Design and Methods: We conducted a cross-sectional survey (at baseline and end-line) using an adapted version of the May Measurement Month (MMM) questionnaire. Blood pressure was measured following the 2018 ESC/ ESC Guideline for treatment of arterial hypertension, and anthropometry was taken in line with the Diet Anthropometry and Physical Activity (DAPA) measurement toolkits of the National institute for health research, Medical Research Council (MRC) the UK. Hypertension was defined as blood pressure (BP) &gt; = 140/90 mmHg, and/or self-reported treatment of hypertension with antihypertensive medication in the last 2 weeks. Awareness of hypertension was defined as a self-report of any previous diagnosis of hypertension by a healthcare professional. Treatment of hypertension was self-reported use of prescription medication for management of hypertension during the previous 2 weeks. Control of hypertension is a pharmacological treatment of hypertension associated with an average BP &lt; 140/90 mmHg Results: 360 participants were sampled across three participating communities, and are averagely 47 years old (there was no significant difference in the age of participants at end-line vs baseline. Body mass index and systolic BP reduced significantly at the end-line compared to baseline (23.8 kg/m2 vs 26.2 kg/m2, 130.1 mmHg vs 135.0 mmHg) respectively, as well as habits such as cigarette smoking and alcohol intake reduced at end-line compare to baseline (5.3% vs 26.6%, and 40.3% vs 62.1%) respectively. Hypertension prevalence reduced by 17.3%, Awareness increased by 36.8%, treatment increased by 111.1%, and control decreased by 18.6% at the end-line compared to baseline. Conclusion: COMAAND project has helped in bridging the gaps in hypertension care, especially in increasing awareness, and improving uptake of treatment.

JS-HR-4: PREECLAMPSIA UP TO DATE; WHAT WE SHOULD KNOW FOR MOTHER AND CHILD.

Preeclampsia (PE) is a systemic hypertensive disorder of pregnancy thought to arise from placental maladaptation and subsequent systemic inflammatory processes. PE is associated with significant maternal and fetal mortality with hypertensive disorder of pregnancy accounting for -14% of maternal deaths globally and also with increased maternal risks for chronic diseases in later life. In 2017, the American College of Cardiology/American Heart Association hypertension treatment guidelines identified hypertension as blood pressure (BP) 130/80 mmHg. The reference BP for hypertension during pregnancy as specified in international guidelines is still &gt; 140/90 mmHg. Also, recommended target BP level differs between these guidelines. A large number of studies have been examining the incidence of PE and fetal outcomes according to BP levels to figure out the optimal level for pregnant women. Given only termination of pregnancy has been proved to initiate the resolution of PE once it has developed, prevention of PE is a health care priority. However, the predictive value of BP and other clinical characteristics for PE is relatively low, and therefore, improved method for the prediction of PE and associated adverse outcomes is required. Past history of PE is now widely known to link with major chronic diseases such as hypertension, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease in later life. Since many cardiovascular risk factors are modifiable and related to lifestyle, all women with prior PE should be followed-up by physician even after resolution of PE (eg. hypertension, proteinuria). However, no long-term follow-up strategy for former-PE patient has yet been established. The 2019 Maternal Mortality update from the WHO report indicated the major contribution of PE and eclampsia to worldwide maternal deaths. Further investigation is needed to decrease PE related maternal and fetal deaths and also to reduce maternal risks for chronic diseases in later life. Participation of physicians is necessary to offer appropriate medical care to women with prior PE.

S-14-5: JSH GUIDELINE FOR THE MANAGEMENT OF HYPERTENSION 2019 (JSH2019) ∼ CONCEPT AND SUBSEQUENT CHALLENGES ∼

Hypertension Treatment Guidelines 2019 (JSH2019) is based on JSH2014 and complies with Minds’ clinical practice guideline creation manual, and adopts a policy of adding new evidence. For this reason, we have newly ‘ extracted clinical issues, raised them as clinical questions (CQ), conducted a comprehensive systematic review (SR), created a body of evidence, and made recommendations.’. Since conducting SR appropriately requires a huge amount of labor, we decided to form an SR team centered on young members of the Society and proceed with the work while receiving guidance from a support team of epidemiological experts. In particular, we hope that SR will lead to the development of young people who will lead the future, and we also aimed to submit the results of SR to Hypertens Res. In the end, we were able to create 17 CQs. Furthermore, in JSH2019, we calculated the absolute risk of CVD in Japanese people based on the JALS and Hisayama-town studies, and used it for risk stratification. Hypertension was defined as a blood pressure value of 140/90 mmHg or higher for which the efficacy of antihypertensive drugs has been proven in patients who are not at high risk. Evidence was also emphasized for blood pressure reduction goals. To the low-risk and the moderate-risk patients with elevated blood pressure, we recommended to achieve the target blood pressure control by modifying lifestyle habits without using antihypertensive drugs. We also asked patient groups to review the guidelines, aiming to reflect the values and wishes of patients. As we approach the third year since the publication of JSH2019, we would like to consider the remaining issues. There are still many patients whose blood pressure is not properly controlled, and many of whom are not aware that they have hypertension. Improvements in blood pressure control among the population are desired through countermeasures against clinical inertia and population tactics. This guideline was created with the aim of preventing CVD and improving patient prognosis, as described above. However, in a super-aging society, patients’ hopes are not necessarily to improve only the prognosis of life. There are many issues that need to be addressed in future guideline revisions, such as reconsidering recommendations for the elderly by appropriately understanding the ‘values and wishes of patients’ according to their age.

Assessing the Impact of Intensified Hypertension (HTN) Treatment Guidelines: A Single Center Experience.

Hypertension (HTN) is an independentrisk factor for heart disease, stroke, and premature death. In 2017 there was a shift in the definition of HTN by the American College of Cardiology (ACC), as well as the American Heart Association (ACC/AHA), resulting in lower blood pressure (BP) readings meeting criteria for diagnosis. Our study aimed to explore the impact the change had on a single cardiology practice's management of patients with HTN. We performed a retrospective chart review of a single cardiology practice. We separated the time into two categories: 12 months before and 12 months after the reclassification of HTN categories in November 2017. A paired t-test analysis was done comparing averaged blood pressures (BPs) in each of the two time periods, as well as the number of medications in each time period and several subgroup analyses. A total of 441 patients were included in the final analysis. Patients were prescribed an average of 2.61± 1.20 medications at baseline, and 2.74 ± 1.22 medications post-reclassification (p < 0.0001). There was an average of 0.82 ± 1.28 medication changes per patient. The overall average BP was 133.7 ± 14.1/76.4 ± 9.5 at baseline, and 131.3 ± 13.1/76.7 ± 7.7 after the recategorization [Δ -2.41 (95% CI 1.18-3.63)/0.269 (95% CI -0.29 to 0.459); p<0.0001 for systolic blood pressure (SBP), p=0.467 for diastolic blood pressure (DBP)]. The change in definition of HTN significantly impacted this single cardiology practice. There was astatistically significant increase in antihypertensive medications prescribed with an expected decrease in BP observed in this study.