High Blood Pressure Measurements Research Articles

Pediatric High Blood Pressure Recognition Associated With Electronic Decision Support: A Cohort Analysis.

Pediatric high blood pressure (BP) predicts future cardiovascular disease events. High BP is improperly measured, underrecognized, and undermanaged especially in disadvantaged populations. In a large, diverse, academic pediatric practice, we detail the associations of a comprehensive initiative with high BP provider recognition. A comprehensive BP initiative was promulgated including (1) retraining providers and staff on BP management; (2) deploying equipment at 55+ sites; and (3) electronic decision support tool alerting staff and clinicians and suggesting management. During the 14-month preintervention and 14-month postintervention periods, data on BP and patient characteristics were collected. The outcome was incident BP recognition defined as any of the following: BP-specific International Classification of Diseases, Tenth Revision, diagnosis; problem list entry; specialty referral; diagnostic testing; repeat visit; or antihypertensives. Dichotomized as underpre versus at or over 13 years of age, analyses utilized interrupted time series and multivariable-adjusted logistic regression. From preintervention (children, n=105 674; adolescents, n=54 365) to postintervention (children, n=87 917; adolescents, n=56 470), the proportion measured with high BP declined in children and adolescents (30% versus 14% and 30% versus 15%, respectively, each P<0.001). Post-intervention, high BP provider recognition was 58% higher in children (4.6%-7.3%) and 43% higher in adolescents (7.9% versus 11.3%; P<0.001 for both). The improvement was not different in disadvantaged race, ethnicity, or zip codes. A comprehensive BP initiative was associated with more appropriate high BP measurement and recognition including in disadvantaged populations. Future work may address the low overall and nonsustained recognition and consideration of electronic decision support for pediatric BP management and mitigating disparities.

Prevalence of high blood pressure in periodontal patients: A pilot study.

Arterial hypertension and periodontal diseases are pathologies with a high prevalence worldwide. Recent evidence suggests a possible causal relationship between them. Patients with moderate or severe periodontitis tend to have higher blood pressure measurements and a 30% to 70% higher likelihood of developing hypertension. The aim of this cross-sectional pilot study was to ascertain the prevalence of high blood pressure in patients with periodontitis. The study included 40 patients diagnosed with periodontitis who required non-surgical periodontal treatment. Demographic, periodontal and clinical characteristics, including blood pressure measurements, were registered. Fifteen percent of the patients were classified as hypertensive (n = 6), 67.5% as high-normal (n = 27) and 17.5% as normotensive (n = 7). Recent studies have estimated that the prevalence of highnormal blood pressure in the general population ranges between 30% and 50%. These findings suggest that patients with periodontal disease are more likely to have elevated blood pressure than patients with healthy periodontal tissues. High-normal blood pressure is associated with a 3 times higher likelihood of developing hypertension, so early detection and prevention are crucial public health strategies. Despite the limitations of this pilot study, it highlights the role of dentists in the prevention, diagnosis and blood pressure control to improve health and cardiovascular risk of patients with periodontitis.

SAT529 An Uncommon Case Report Of A Paraaortic Paraganglioma

Abstract Disclosure: E. Askar: None. J.R. Fredrick: None. S. Anantha: None. K.G. Reddy: None. Background: Extraadrenal pheochromocytomas, also known as paragangliomas are uncommon neuroendocrine tumors that develop from sympathetic ganglia chromaffin cells. These tumors rarely cause hypertension, in less than 0.2% of patients. Although pheochromocytomas are known to be secreting catecholamines, paragangliomas are less likely to be functional. Here we report a rare case of Catecholamine secreting Paraganglioma presenting with hypertension. Clinical Case: A 28 -year-old female with past medical history of Goldenhar syndrome presented to our outpatient institution complaining of headache, palpitations and high blood pressure measurements at home with systolic blood pressure ranging between 160-200 mm Hg for a few months prior to presentation. Her only medication was propranolol for hypertension. At presentation, blood pressure was 126/72 mm Hg, heart rate was 76 beats per minute. Physical examination revealed no significant findings. Abdominal exam did not reveal any palpable masses. The patient denied any history of substance, tobacco, or alcohol abuse. No family history was found for any similar masses or hypertension. Laboratory findings were significant for elevated normetanephrines at 785 pg/mL (18 to 111) with normal metanephrines level. CT abdomen was significant for 2.5 cm enhancing left paraaortic mass separate from kidneys and adrenal glands. The patient was started on doxazosin and propranolol was switched to atenolol. After her blood pressure was adequately controlled with the alpha and beta blockade, she was referred to a tertiary facility for excision of the mass. Robotic excision of the mass was performed successfully without any significant blood pressure variations noted intraoperatively. The diagnosis of a well differentiated extraadrenal pheochromocytoma was confirmed by pathology, and the patient was referred for outpatient genetic testing and endocrinology follow up. Conclusion: This is an extremely rare case of paraganglioma given its presentation and location of the mass. The previously reported paragangliomas usually present as ER visits with severe sympathetic symptoms but it is uncommon to present as an outpatient for secondary hypertension workup. In the literature, we have found case reports of catecholamine secreting paragangliomas which guided the management of this uncommon case as mentioned above. Clinicians must be aware of this rare presentation of paraganglioma in order to properly diagnose and manage the condition.

Abstract P327: “The More Data, The Better”: Patient Experiences With Blood Pressure Measurement For Hypertension Diagnosis

Background: Out-of-office blood pressure (BP) measurement is recommended when making new hypertension diagnoses. However, in current practice, hypertension is primarily diagnosed using clinic BP measurements. Objective: To understand patient attitudes about the accuracy and patient-centeredness of different BP measurement and hypertension diagnostic methods. Design: Qualitative study within a randomized controlled diagnostic study comparing the accuracy and acceptability of clinic BP, home BP monitoring (HBPM), and kiosk BP (in a waiting room or pharmacy) for diagnosing hypertension among patients in an integrated delivery system. All participants also completed 24-hour ambulatory blood pressure monitoring regimen (ABPM). Participants: Qualitative interview participants (aged 31-76 years) were recruited from the main study with a goal of balancing by study arms, measurement result (high vs normal ABPM), hypertension diagnosis status at 6 months, gender, and age. Approach: We conducted semi-structured interviews at two time points—shortly after completion of diagnostic testing and 6 months later—to explore attitudes and behaviors related to the different BP measurement diagnostic methods. Key results: Interview participants (n=35) found HBPM to be comfortable, convenient, and low burden, and believed it produced accurate results. Participants reported higher confidence in high BP measurements from HBPM or ABPM compared to measurement in clinics. Clinic measurements were reported as less convenient than HBPM. Participants overall did not favor kiosks due to concerns about accuracy and privacy. ABPM was described by participants as the most accurate method, partly due to repeated measurements over the 24-hour period in real-world contexts, but many found it uncomfortable and disruptive. Participants also noted that methods that involved repeated measures such as HBPM and ABPM were especially influential in making their own personal decision as to whether or not they had hypertension. Conclusions: Our findings suggest that strategies to enhance HBPM implementation for hypertension diagnosis in primary care may improve diagnosis and patient understanding of hypertension.

Chronic unpredictable stress changes left ventricular geometry and activation of the inflammasome

Background: Psychosocial stress, particularly chronic unpredictable stress (CUS) has been identified as a risk factor for cardiovascular disease, but the effects of CUS on left ventricle (LV) function, geometry and systemic hemodynamics remains unclear. Moreover, whether and to what degree CUS activates intracellular formation of the inflammasome, including the NOD-LRR pyrin containing protein 3 (NLRP3) remains unknown. Accordingly, the central hypothesis of this project was that in a murine model of CUS, shifts in LV geometry and systemic hemodynamics would occur and be associated with the induction of NLRP3. Methods and Results: Mice (C57BL/6, 10wks of age, equal sex, n=16) were subjected to CUS for 4 weeks which entailed daily random stressors including tilted cage, wet bedding, and overnight light. Referent age and sex matched non CUS mice served as controls (n=16). LV function was assessed by high fidelity ultrasound and blood pressure measurements by tail cuff for both referent control and CUS mice. The changes in ambient heart rate (HR), LV end-systolic volume (LVEDV), and systolic blood pressure (SBP) were expressed as a function of referent control. All results are reported as mean ± SEM. While LV ejection fraction was equivalent between CUS and control groups (70 ± 3 vs. 67 ± 3%, respectively, p=0.48), HR trended higher (4.5 ± 3.1%, p=0.08), LVEDV was lower (-11 ± 5%, p=0.03) and SBP was elevated (12.1 ± 4.9%, p=0.04) - all indicative of heightened sympathetic tone. LV myocardial NLRP3 (rtPCR) was increased (1.47 ± 0.22 fold change, p=0.04) with CUS as was IL-1β (1.43 ± 0.20 fold change, p=0.05), a downstream cytokine activated by NLRP3. Conclusion: CUS, in and of itself, shifts LV geometry, causes mild hypertension and induction of the myocardial inflammasome- all of which would exacerbate/contribute to cardiovascular disease. This work was supported in part by National Institutes of Health grant R01HL130972-01A1 (F.G.S.), R01HL5949 (F.G.S.), RO1DK132948 (C.W. &amp; F.P.), R01 MH129798 (SKW) and P20GM109091 (F.H.) as well as a Merit Award from the Veterans Health Administration, BX000168-10A1 (F.G.S.), BX005320 (F.G.S.), BX002604 (M.J.R.), and VISN7 RDA (F.H.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Self-Measured Blood Pressure and Target Organ Damage in Newly Detected Hypertension in South Gujarat, India

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pressure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in individuals with untreated hyper-tension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) us-ing ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Resi-dential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Systolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dismissed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

Blood pressure monitoring techniques in the natural state of multi-scenes: A review.

Blood pressure is one of the basic physiological parameters of human physiology. Frequent and repeated measurement of blood pressure along with recording of environmental or other physiological parameters when measuring blood pressure may reveal important cardiovascular risk factors that can predict occurrence of cardiovascular events. Currently, wearable non-invasive blood pressure measurement technology has attracted much research attention. Several different technical routes have been proposed to solve the challenge between portability or continuity of measurement methods and medical level accuracy of measurement results. The accuracy of blood pressure measurement technology based on auscultation and oscillography has been clinically verified, while majority of other technical routes are being explored at laboratory or multi-center clinical demonstration stage. Normally, Blood pressure measurement based on oscillographic method outside the hospital can only be measured at intervals. There is a need to develop techniques for frequent and high-precision blood pressure measurement under natural conditions outside the hospital. In this paper, we discussed the current status of blood pressure measurement technology and development trends of blood pressure measurement technology in different scenarios. We focuses on the key technical challenges and the latest advances in the study of miniaturization devices based on oscillographic method at wrist and PTT related method at finger positions as well as technology processes. This study is of great significance to the application of high frequency blood pressure measurement technology.

Association between preeclampsia and HIV: a case-control study in urban South Africa

BACKGROUNDPreeclampsia is a considerable cause of maternal and infant morbidity and mortality. Although its etiology is unknown, preeclampsia has been described as a state of exaggerated maternal inflammatory response. Therefore, it has been hypothesized that preeclampsia would occur less commonly in states of immune deficiency.OBJECTIVEThis study aimed to compare the prevalence of treated and untreated HIV infections among preeclamptic cases and controls, determine infant outcomes, and evaluate the association between HIV and preeclampsia after adjusting for known predictor variables, including maternal age, gravidity, body mass index, and smoking.STUDY DESIGNThis case-control study investigated the association between preeclampsia and HIV infection using secondary data from an unrelated study. We defined preeclamptic cases as pregnant women who were normotensive until 20 weeks of gestation and thereafter had at least 1 high blood pressure measurement either before or at delivery and proteinuria, defined as protein excretion of ≥300 mg within 24 hours or >2 protein on dipstick urinalysis. The prevalence of HIV infection was compared between cases and controls. Multivariate logistic regression analysis was used to assess the association between preeclampsia and potential confounding variables and reported using odds ratios and 95% confidence intervals.RESULTSThere were 571 cases with preeclampsia and 596 normotensive controls included in this study. The median age was 27 years for cases and 26 years for controls (P=.008). Most participants (69%) had ≥2 previous pregnancies with no difference between the cases and controls (P=.176). Overall, 43% of the participants were obese, with a mean body mass index of 29 (interquartile range, 24.5–34.2), with higher proportions of women who were overweight and obese in the group with preeclampsia (P=.031). The prevalence of HIV was significantly lower in cases than in controls (24% vs 30%, respectively; P=.014). Compared with 16% of infants born preterm to normotensive controls, 48% of infants were born preterm born to women with preeclampsia (P<.001). Compared with 14% of infants born with low birthweight to normotensive controls, 53% of infants were born with low birthweight to women with preeclampsia (P<.0001). Untreated HIV infection was negatively associated with preeclampsia (unadjusted odds ratio, 0.330; 95% confidence interval, 0.197–0.552; P<.0001), whereas factors associated with preeclampsia were advanced maternal age (odds ratio, 1.673; 95% confidence interval, 1.209–2.316; P=.002) and obesity (odds ratio, 1.611; 95% confidence interval, 1.023–2.537; P=.040). After adjusting for maternal age, gravidity, smoking, and body mass index in the multivariate regression, only obesity remained significantly associated with preeclampsia (adjusted odds ratio, 1.624; 95% confidence interval, 1.024–2.575; P=.039).CONCLUSIONBefore the large-scale rollout of antiretroviral therapy in a setting with a high burden of HIV and preeclampsia, untreated HIV infection was found to have a protective effect against preeclampsia. The protective effect against preeclampsia was not apparent for HIV infection treated with antiretroviral therapy.

GWAS of longitudinal trajectories at biobank scale

Biobanks linked to massive, longitudinal electronic health record (EHR) data make numerous new genetic research questions feasible. One among these is the study of biomarker trajectories. For example, high blood pressure measurements over visits strongly predict stroke onset, and consistently high fasting glucose and Hb1Ac levels define diabetes. Recent research reveals that not only the mean level of biomarker trajectories but also their fluctuations, or within-subject (WS) variability, are risk factors for many diseases. Glycemic variation, for instance, is recently considered an important clinical metric in diabetes management. It is crucial to identify the genetic factors that shift the mean or alter the WS variability of a biomarker trajectory. Compared to traditional cross-sectional studies, trajectory analysis utilizes more data points and captures a complete picture of the impact of time-varying factors, including medication history and lifestyle. Currently, there are no efficient tools for genome-wide association studies (GWASs) of biomarker trajectories at the biobank scale, even for just mean effects. We propose TrajGWAS, a linear mixed effect model-based method for testing genetic effects that shift the mean or alter the WS variability of a biomarker trajectory. It is scalable to biobank data with 100,000 to 1,000,000 individuals and many longitudinal measurements and robust to distributional assumptions. Simulation studies corroborate that TrajGWAS controls the type I error rate and is powerful. Analysis of eleven biomarkers measured longitudinally and extracted from UK Biobank primary care data for more than 150,000 participants with 1,800,000 observations reveals loci that significantly alter the mean or WS variability.

Prevalence of Diabetes and Hypertension Among King Abdulaziz University Employees: Data From First Aid and Cardiopulmonary Resuscitation Training Program.

ObjectivesSaudi Arabia has a very high rate of chronic illnesses, especially hypertension (HTN) and diabetes. This study aimed to investigate the prevalence and control of diabetes and hypertension among employees at a university in Saudi Arabia, including the associated risk factors, and to evaluate the need for early screening among these individuals.MethodsThis retrospective study used data from the first aid training program. In total, there were 3964 employees who completed the program, and only 1000 employees were enrolled. The program was conducted at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Blood pressure (BP), random blood sugar, and body mass index (BMI) were measured in all employees. Descriptive data, including mean, standard deviation (SD), crosstab, chi-square, and linear regression, were analyzed. Categorical variables were described using frequencies and percentages.ResultsThe prevalence of hypertension and diabetes was 31% and 5%. There were 365 males and 635 females. Employees with risk factors such as gender, age, and body mass index had significant effects on having high blood pressure and random blood glucose measurements. Of the employees who reported being free from chronic diseases, 2.9% had abnormal random blood glucose readings (prediabetic and diabetic ranges), while 37.4% had abnormal blood pressure readings (prehypertensive and hypertensive ranges).ConclusionThe high prevalence of hypertension and diabetes reflects the crucial role of early screening in diabetes and hypertension protocols and raising awareness regarding protocol implementation in Saudi Arabia to improve quality of life (QoL) at the individual and community levels.

Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure

To assess pediatrician adherence to the 2017 American Academy of Pediatrics' clinical practice guideline for high blood pressure (BP). Pediatric primary care practices (n=59) participating in a quality improvement collaborative submitted data for patients with high BP measured between November 2018 and January 2019. Baseline data included patient demographics, BP, body mass index (BMI), and actions taken. Logistic regression was used to test associations between patient BP level and BMI with provider adherence to guidelines (BP measurement, counseling, follow-up, evaluation). A total of 2677 patient charts were entered for analysis. Only 2% of patients had all BP measurement steps completed correctly, with fewer undergoing 3-limb and ambulatory BP measurement. Overall, 46% of patients received appropriate weight, nutrition, and lifestyle counseling. Follow-up for high BP was recommended or scheduled in 10% of encounters, and scheduled at the appropriate interval in 5%. For patients presenting with their third high BP measurement, 10% had an appropriate diagnosis documented, 2% had appropriate screening laboratory tests conducted, and none had a renal ultrasound performed. BMI was independently associated with increased odds of counseling, but higher BP was associated with lower odds of counseling. Higher BP was independently associated with an increased likelihood of documentation of hypertension. In this multisite study, adherence to the 2017 American Academy of Pediatrics' guideline for high BP was low. Given the long-term health implications of high BP in childhood, it is important to improve primary care provider recognition and management. ClinicalTrials.gov: NCT03783650.

High Definition Oscillometric Blood Pressure Measurement in Apparently Healthy Dogs: A Clinical Study

High Definition Oscillometric Blood Pressure Measurement in Apparently Healthy Dogs: A Clinical Study

Improving the quality of blood pressure measurements in an outpatient diabetes clinic

Hypertension is an important modifiable risk factor for cardiovascular disease in patients with diabetes. Despite established guidelines, the percentage of patients meeting the target blood pressure (BP) of <140/90 mm...

PENGARUH PEMBERIAN PROMOSI KESEHATAN TERHADAP PENGETAHUAN IBU HAMIL TENTANG BAHAYA HIPERTENSI DI WILAYAH KERJA PUSKESMAS TANJUNG BATU KECAMATAN KUNDUR TAHUN 2018

Hypertension happens to be a high blood pressure measurement which is identified by systolic pressure of >140 mmHg and diastolic pressure of > 90 mmHg. The high blood pressure or also known as hypertension during pregnancy is tremendously risky for both mother and baby. This hypertension potentially causessome abnormalities such as inclined fetal growth, declining of consciousness, high-risk birth and thedecreasingof mother body defense.In fact, the incidence of hypertension in pregnant women specifically at the working area of Puskesmas Tanjungbatu is quite high which reached the number of 20 cases in 2017 and 22 cases in 2018. This research utilized Pre-test and Post-test design of Experiment group. The data were collected using a20-questions form of questionnaire to 62 respondents. The result shows the knowledge of pregnant women before health promotion on hypertension hazards is 1.1613, meanwhile after health promotion was given is 1.9677. From this finding, it is noted that there has been an escalation of 0.8064. And from the data test, p-value of 0.000 (p-value <0.05) is obtained, which means that there is a significant difference between average knowledge before and after the health promotion of the hypertension hazards to pregnant women in the Puskeskas Tanjungbatu in 2018.

The PCORnet Blood Pressure Control Laboratory: A Platform for Surveillance and Efficient Trials.

Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.

Screening for hypertension: an elevated office blood pressure measurement is valuable, adding an automated one is even better.

Previous studies have examined the relevance of hypertension (HTN) screening in walk-in clinics. So far, no valid algorithm has been proposed on how to integrate HTN screening in this context. The aim of our study was to assess, in a walk-in clinic setting, the HTN screening strategy for performing an automated office blood pressure (AOBP) measurement following an initially high office blood pressure (OBP) measurement. Included participants were adults with nonemergent medical conditions and an initial walk-in clinic OBP between systolic 140 and/or diastolic 90 mmHg and systolic 180 and/or diastolic 110 mmHg. AOBP was performed with patients unattended. The 24-h ambulatory blood pressure measurement (ABPM) was used as the diagnostic threshold. Fifty participants were included in the study. The overall HTN prevalence as confirmed by the 24-h ABPM was 46% [95% confidence interval (CI): 32.19-59.81]. After an elevated OBP, AOBP over diagnostic thresholds occurred in 32 patients and were confirmed by ABPM in 20 participants, leading to a 62.5% positive predictive value (95% CI: 51.5-72.3%). Measurements under the AOBP diagnostic threshold occurred in 18 patients and were confirmed by ABPM in 15 participants, leading to a negative predictive value of 83.3% (95% CI: 62.3-93.8%). In a walk-in clinic, an elevated OBP is a useful screening tool due its ability to recognize nearly one in two patients as actually hypertensive. Adding an AOBP makes it possible to specify what course of action to take. This ultimately results in better targeting of patients for an ABPM referral.

Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow-up and Population Blood Pressures.

Recognizing high blood pressure (BP) as the most prevalent cardiovascular risk factor in patients with rheumatic diseases and all adults, experts recommend clinic protocols to improve BP control. The aim of this study was to adapt and implement a specialty clinic protocol, "BP Connect," to improve timely primary care follow-up after high BP measurements in rheumatology clinics. We examined BP Connect in a 6-month preimplementation and postimplementation quasi-experimental design with 24-month follow-up in 3 academic rheumatology clinics. Medical assistants and nurses were trained to 1) check (re-measuring BPs ≥140/90 mm Hg), 2) advise (linking rheumatic and cardiovascular diseases), and 3) connect (timely [<4 weeks] primary care follow-up using protocoled electronic health record [EHR] orders). We used EHR data and multivariable logistic regression analysis to examine the primary outcome of timely primary care follow-up for patients with in-network primary care. Staff surveys were used to assess perceptions. Interrupted time series analysis was performed to examine sustainability and BP trends in the clinic populations. Across both 4,683 preimplementation and 689 postimplementation rheumatology visits by patients with high BP, 2,789 (57%) encounters were eligible for in-network primary care follow-up. Postimplementation, the odds of timely primary care BP measurement follow-up doubled (odds ratio 2.0, 95% confidence interval 1.4-2.9). Median time to follow-up decreased from 71 days to 38 days. Moreover, rheumatology visits by patients with high BP decreased from 17% to 8% over 24 months, suggesting significant population-level declines (P < 0.01). Implementing the BP Connect specialty clinic protocol in rheumatology clinics improved timely follow-up and demonstrated reduced population-level rates of high BP. These findings highlight a timely strategy to improve BP follow-up amid new guidelines and quality measures.

Prevalence of cardiovascular disease risk factors, health behaviours and atrial fibrillation in a Nepalese post-seismic population: a cross-sectional screening during a humanitarian medical mission

Background and Aims: Nepal is a developing country with increasing rates of cardiovascular disease (CVD), and the recent 2015 earthquakes imposed critical social and epidemiological effects to the population. This study aims to assess the prevalence of CVD risk factors, social health behaviours and atrial fibrillation (AF) in a native population from a remote Nepalese village that was the epicentre of the May 2015 earthquake.Methods: Observational, cross-sectional study, addressing the population of dislodged inhabitants of Sindhupalchok. Data was collected during an opportunistic clinical screening in the midst of a humanitarian medical mission and consisted of demographic, anthropometric and medical data.Results: A total of 270 patients were assessed (41% in a temporary settlement with continuous organisational support and 59% in the remote village with less back-up). Among adults, 89% had low fruit consumption, 49% were overweight or had augmented waist circumference, 42% had smoking habits, 57% consumed alcohol regularly, 22% had high blood pressure measurements and 5% had abnormal glycaemic levels. An 11% prevalence of AF was found among the elderly.Conclusions: The studied population has a high prevalence of CVD risk factors, poor health behaviours and a significant prevalence of AF among the elderly representatives. International partnering and humanitarian work might be important tools to assess the population’s needs and implement corrective measures.

Beyond Resistant Hypertension.

Obstructive sleep apnea (OSA) is an independent cause of resistant hypertension (RH) but its association with refractory hypertension (RfH), a recently described form of severe hypertension, has not yet been investigated. This study seeks to analyze the association between the presence and severity of OSA/OSA syndrome with RfH and to compare it with a group of patients with OSA/OSA syndrome and RH. We conducted a multicenter, cross-sectional study of consecutive patients diagnosed with RH by means of 24-hour ambulatory blood pressure monitoring. Those patients with blood pressure levels ≥130/80 mm Hg, despite taking at least 5 antihypertensive drugs, were considered to have true RfH. All patients underwent a sleep study and completed a detailed clinical history related to OSA, current medication, and cardiovascular diseases. Overall, 229 patients were included (mean age, 58.3 years; 63% male), of whom 42 (18.3%) satisfied the criteria for RfH. Compared with those with RH, patients with RfH had a higher cardiovascular risk profile, higher blood pressure measurements, and a 2-fold greater risk of having both severe OSA (odds ratio, 2.1, with a prevalence of apnea-hypopnea index ≥15, 95.2% and apnea-hypopnea index ≥30, 64.3%) and OSA syndrome (apnea-hypopnea index ≥5+Epworth Sleepiness Scale >10; odds ratio, 1.9; 52.4% versus 37.3%; P=0.023), as well as higher OSA severity (apnea-hypopnea index, 41.8 versus 33.8 events/h; P=0.026). Patients with RfH had an even greater prevalence and severity of OSA and OSA syndrome than RH patients, highlighting the need to identify these patients to refer them to sleep units on a preferential basis.

Abstract P-465: IS THIS BLOOD PRESSURE REAL?? A PILOT STUDY FOR A COMMON DILEMMA AT THE BEDSIDE

Aims & Objectives: Blood pressure measurements are vital for monitoring critical patients. Non- invasive monitoring is usually performed via oscillatory method (OM). The aim of this study was to investigate the reliability of automated oscillometric blood pressure (BP) monitoring in the presence and absence of muscle spasms in patients with hypertensive values. Methods This was a prospective observational pilot study performed in a tertiary PICU between September 2017-December 2017. In case of high BP measurement via OM a second measurement was obtained by the bedside nurse. If the record was confirmed the second time, measurement was performed by a single operator (MD) using the auscultation method(AM). Demographic and relevant laboratory and clinical data (including concomitant muscle spasms) were recorded. Results Total of 100 measurements were performed in 6 patients during the study period. Female gender was in majority (66%). Demographic and pertinent data are shown in Table1. Measurements via OM vs AM are shown in Table 2. Correlation coefficient for SBP and DBP measurements was r=-0.01 (p=0.922) and r=0.33 (p=0.001) respectively. Muscle spasms were observed during 71% of the measurements. There was no correlation between 2 methods regarding SBP measurements with muscle spasms (r=0.12, p=0.313). Without muscle spasms a correlation existed between OM and AM (r=0.39, p=0.001).Conclusions Muscle contractions and increased tone may cause faulty BP measurements via standard OM in neuromuscular patients. Hypertensive measurements need to be confirmed via AM for validity for optimal approach. Confirmation may prevent medical anxiety and overtreatment.