Hypertension Education Program Research Articles

HYPERTENSION AS A SILENT KILLER DISEASE: EDUCATION FOR AT-RISK COMMUNITIES IN PEKUWON VILLAGE

Hypertension is often called a silent killer disease because it does not give symptoms to the affected person. Bojonegoro Regency in East Java is one of the areas with a high rate of non-communicable diseases, reaching 385,465 people. Pekuwon Village in Bojonegoro Regency is one of many areas with high hypertension problems. An education program is needed to increase knowledge about hypertension as a disease that can come unexpectedly. The target of this education program is the people of Pekuwon Village aged 15-59 years. The hypertension education program was carried out during the Posbindu PTM activity in Pekuwon Village which was attended by 39 participants. The speaker of the education program was a village cadre who had been trained by the community service team of the Faculty of Public Health, Universitas Airlangga. The evaluation used pre-test before giving information and post-test after giving information. The results showed an increase in knowledge from 63.63% to 97.43%. These results meet the program's success indicators, namely a 30% increase in knowledge in the Pekuwon Village community.

Engaging an African American Church-based Community in Developing a Technology-focused Virtual Reality Hypertension Program

Abstract: Background: African Americans are disproportionately affected by cardiovascular disease and hypertension. To address this, we partnered with local church leaders in developing a virtual reality (VR) hypertension reduction program. Objectives: A community-based participatory research approach was adopted to develop a hypertension education program using VR, incorporating feedback from the African American church congregation members. Methods: Using a qualitative approach, a modified Delphi exercise, and member checking, the research team collaborated with congregation members who provided feedback and assisted in the development of the intervention. Lessons Learned: Incorporating feedback from church members significantly impacted the educational platform. Encouraged by the reverend, church members were engaged and participated in the 12-week program designed to reduce blood pressure. Novel approaches like VR may need more time to pilot to achieve desired results, particularly with vulnerable populations. Conclusions: This participatory research platform highlights the importance of incorporating external stakeholders throughout the research process in order to develop a meaningful health intervention using new technology that is tailored to the church members.

The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a "No-Code" Mobile App Builder: Development and Usability Study.

Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive-driven M-PAC mHealth programs aimed at hypertension prevention. We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the "no-code" app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process.

PS-BPC07-9: BLOOD PRESSURE LOWERING EFFICACY OF THE HYPERTENSION EDUCATION PROGRAM OF THE GERMAN SOCIETY OF HYPERTENSION AND PREVENTION

Objective: In 2013 the German Society of Hypertension and Prevention initiated a hypertension education program (HEP) - Mein Blutdruck - OK! (https://www.hochdruckliga.de/hypertonie-schulung-fuer-patienten.html). The objective of this study was to evaluate the blood pressure lowering efficacy of the HEP. Design and method: The HEP consists of 5 modules (blood pressure regulation, non-pharmacological treatment 1 and 2, pharmacological treatment, adherence) of group (4–6 patients) teaching, held by trained physicians and medical staff who underwent a specially designed train the trainer program. Each module consisted of 90 minutes training and patients underwent all 5 modules within 4 weeks. The validation study was performed in 8 hypertension outpatient clinics. Patients with mild (stage 1) hypertension, treated or untreated were included, and pharmacologic antihypertensive treatment was not altered during 6 months. The clinics were randomized to HEP or standard care. Blood pressure was monitored at baseline and after 6 months by standardized office measurements, home measurements (automatic oscillometric device, patients training) and 24 h ABPM. Primary endpoint was an at least 5 mmHg greater reduction of systolic office blood pressure by HEP compared to usual care. Results: 4 hypertension outpatient clinics were randomized to HEP, including 35 patients, 4 hypertension outpatient clinics were randomized to usual care, including 53 patients in the study. ABPM data were available in only 71 out of 88 patients. Data are presented in tables 1 and 2. Conclusion: The HEP resulted in significantly greater reductions of office and home blood pressure values as compared to usual care. The primary endpoint was met. Changes in ABPM daytime means did not differ significantly between groups, possibly due to insufficient available data. These results were obtained in patients with mild hypertension, either treated or untreated, and may differ in patients with severe or resistant hypertension.

PS-P03-5: QUALITATIVE INSIGHTS INTO THE BARRIERS TOWARDS BLOOD PRESSURE SCREENING, TREATMENT ADHERENCE AND LIFESTYLE MODIFICATIONS IN SINGAPORE

In Singapore, despite numerous blood pressure (BP) campaigns, hypertension prevalence amongst adults has increased to 35%, exceeding the global rate of 31.1%. In light of the worrying trend, this research aims to examine major barriers faced by Singapore residents in their management of BP health. Through a novel reverse socialisation program, the study reached out to at-risk family members through their children and employed an in-depth qualitative lens to gain meaningful insights into the barriers faced at various stages of BP management care. An intergenerational hypertension education program was launched among Singapore grade 5 students. Students were educated about hypertension and taught how to utilize a BP monitor. They then shared their knowledge and measured their family members BP at home. Family members found with borderline or high BP were invited for an interview and had their BP measurements validated by a medical professional. In-depth semi-structured interviews were conducted with 15 adults who were identified to have borderline hypertension or hypertension. Transcripts were analysed using the constant comparative approach, an analytic strategy based on grounded theory. The study identified varying personal, psychosocial, and/or external barriers faced at three different stages of BP management care - regular screening, medical adherence and lifestyle modifications (Table 1). Firstly, a major barrier towards regular BP screening was low perceived need to seek medical care due to a lack of physiological symptoms, suggesting that many respondents perceived themselves as being less susceptible to hypertension. Secondly, barriers towards medical adherence were especially a concern for diagnosed hypertensives. A dominant factor was a lack of self-efficacy in following-up with the required care, such as fear of failing doctors expectations in follow-up appointments, lack of time and inability to comply with prescribed sudden changes to dietary and exercise habits Thirdly, the inability to comply with recommended lifestyle modifications was nuanced by various factors related to ones identity such as age, job, familial obligations and culture. The in-depth qualitative perspectives revealed a complex web of barriers to BP screening, adherence and lifestyle modifications. These have important implications for future health intervention designs. Particularly, health education and communication to at-risk communities require tailored interventions to overcome the varied personal, psychosocial, and external gaps at different stages of hypertension management care. For instance, threat-framed messages could be more effective in tackling the barrier of low perceived susceptibility to hypertension, while coping-framed interventions may be better suited for improving self-efficacy for treatment adherence.

Strategies for improving the treatment and control of hypertension in Japan.

Despite the significant advancements in the diagnosis and treatment of hypertension, the burden of hypertension remains a major global health care concern. In Japan, estimates show that more than two-thirds of the population have uncontrolled hypertension, regardless of whether they were taking antihypertensive medication. To improve hypertension management, hypertension guidelines have been developed and updated regularly by hypertension societies across various countries and regions. The Japanese Society of Hypertension (JSH) updated the Guidelines for the Management of Hypertension in 2019 (JSH 2019). The JSH 2019 aims to establish a standard management strategy for hypertension and provide evidence to all health care providers. One of its updated main features is its proposal for multidisciplinary team-based care (TBC) involving physicians, pharmacists, nurses, dietitians, and other health care providers. The TBC will help initiate and intensify the management of hypertension, as well as combat clinical inertia, which is expected to contribute to uncontrolled blood pressure and subsequent development of cardiovascular diseases. This is consistent with the recommendations from recent major guidelines on hypertension management. Moreover, to reduce the evidence-practice gap in hypertension management, it is essential to disseminate the essence of the guidelines and provide hypertension education programs for all health care providers and patients. This review summarizes the points of the JSH 2019-based strategy for improving hypertension management and discusses guidelines for its implementation into actual clinical practice.

Translation and Validation of the Indonesian Version of the Hypertension Self-care Profile

BACKGROUND: High blood pressure self-care profile (HBP-SCP) is one of the instruments that needed to evaluate education program among hypertension patients. AIM: The purpose of the study was to translate and validate HBP-SCP into Indonesian version. METHODS: This study involved translation, content validation, and psychometric testing. The first instrument was conducted forward and backward translation by experts. Seven expert reviewed the contents for consistency, clarity, difficulty, representativeness, and suitability for inclusion. Finally, instrument was tested for reliability and validity on 40 hypertensive patients using Cronbach’s alpha and Pearson’s moment product. RESULTS: The final Indonesian version of HBP-SCP included behavior, motivation, and self-efficacy that each consists of 20 items questions were valid and reliable with positive expert review ratings (content validity index 0.964), internal consistency reliability coefficient ranged from 0.911 to 0.955. Items questionnaire of Indonesian version of HBP-SCP had strong correlation and significant validity (p ≤ 0.05). CONCLUSION: Indonesian version of HBP-SCP is a valid and reliable instrument to assess behavior, motivation, and self-efficacy among hypertension patients and evaluate group based hypertension education programs in Indonesia.

Раціональна антигіпертензивна терапія пацієнтів старших вікових груп

Стаття присвячена питанню ведення осіб старших вікових груп з артеріальною гіпертензією з наголосом на фармакологічне лікування. Для обґрунтування вибору антигіпертензивного препарату на підставі принципів доказової медицини наведено результати рандомізованих контрольованих клінічних досліджень із залученням хворих похилого і старечого віку з артеріальною гіпертензією. Згідно з проведеними систематичними оглядами та метааналізами в порівняльному аспекті представлено ефекти різних класів антигіпертензивних препаратів щодо впливу на серцево-судинні події при лікуванні цієї категорії пацієнтів. Рекомендації стосовно раціональної фармакотерапії артеріальної гіпертензії з урахуванням вікових особливостей хворих надано з варіантних позицій відповідно до настанов провідних експертів та міжнародних організацій – Європейського товариства кардіологів, Європейського товариства фахівців з гіпертензії, Американського товариства фахівців з гіпертензії, робочої групи Європейського товариства фахівців з гіпертензії та Товариства геріатричної медицини Європейського Союзу з ведення артеріальної гіпертензії в пацієнтів старечого віку, Канадського освітнього проєкту з гіпертензії, Американської колегії терапевтів і Академії сімейних лікарів, Національного інституту охорони здоров’я та вдосконалення медичної допомоги Великої Британії. Узагальнено тактику лікування пацієнтів похилого і старечого віку з артеріальною гіпертензією.

Patient perceptions of a student‐led remote hypertension education program

AbstractIntroductionThe COVID‐19 pandemic has drastically changed healthcare, promoting a shift to remote services. Managing long‐term therapy conditions, like hypertension, became increasingly difficult due to limited access to care. During these unprecedented times, two community pharmacies collaborated with a school of pharmacy to develop a new remote program to encourage patient centered disease state management.ObjectivesThe primary objective was to describe patient perceptions of participating in a student‐led, remote hypertension education program. The secondary objective was to gain insight on perceptions of the program's impact on current lifestyle.MethodsSecond‐ and third‐year pharmacy students worked with faculty preceptors to develop and remotely deliver an 8‐week curriculum. During each call, students educated on a topic and set S.M.A.R.T. (Specific, Measurable, Achievable, Realistic, and Timely) goals. After completing the program, participants were interviewed regarding their experience.This study was a qualitative design using semi‐structured interviews. Participants in the program were interviewed by trained investigators. All interviews were recorded, transcribed, and thematically coded to address study outcomes.ResultsA total of 12 participant interviews were conducted with all participants 50 years of age or older and a majority having a diagnosis of hypertension for greater than 20 years. From the interviews, six dominant themes were identified. Themes were: (a) students were knowledgeable, professional, and engaged; (b) participants felt comfortable communicating with the students and developed a positive relationship; (c) participants expressed having a positive impact on the students' education; (d) the program was organized; (e) participants reported positive lifestyle changes or reinforced habits that they plan to continue, and (f) the remote nature of the program was convenient, but face‐to‐face interaction was missed.ConclusionParticipants had an overwhelmingly positive experience completing the program. Utilizing students for development and implementation allowed the pharmacies to offer an additional clinical service and was a factor that impacted patient engagement and participation.

Structured hypertension education program for people with type 2 diabetes, the SHED study

ObjectivesThere is enough evidence that patient education and lifestyle modification has shown benefits in diabetes care, however the evidence is less for improving care of hypertension. Our study is the first in the UK to assess the impact of a structured hypertension education program in subjects with type 2 diabetes.Design: Prospective randomised controlled study.Setting and Intervention: From a diabetes clinic in a district and general hospital in UK 132 participants were equally randomised into intervention group and control group. Intervention included a once weekly education session for 4 weeks together with home blood pressure monitoring and dose changes in antihypertensives. Base line data was recorded with follow up after 3 and 6 months. ResultsMore participants achieved target BP in the intervention group versus control. This difference appeared early at the 3rd months (48.8% versus 20.4% respectively, p = 0.007) and remained at the 6th month (58.1% versus 20.4% respectively, p < 0.001). The change in number of pills was significantly lower in the intervention group. The mean increase in antihypertensive pills was 0.22 ± 0.48 (13 ± 30% increase) in the intervention group versus 0.62 ± 0.68 (41 ± 60% increase) in the routine group (p = 0.014), denoting less need to escalate treatment. ConclusionWe demonstrated that our structured education program has led to a significantly higher percentage of participants achieving the BP target, early after intervention, together with a significant reduction in the number of antihypertensive pills.

A Comprehensive Quality Assurance Platform in Canada for National Point-of-Care Chronic Kidney Disease Screening: The Kidney Check Program

A Comprehensive Quality Assurance Platform in Canada for National Point-of-Care Chronic Kidney Disease Screening: The Kidney Check Program

Development of the Health Awareness and Behaviour Tool (HABiT): reliability and suitability for a Canadian older adult population

BackgroundDetermining the effectiveness of community-based health promotion and disease prevention programs requires an appropriate data collection tool. This study aimed to develop a comprehensive health questionnaire for older adults, called the HABiT, and evaluate its reliability, content validity, and face validity in assessing individual health-related items (e.g., health status, healthcare utilization) and five specific scales: knowledge, current health behaviors (risk factors), health-related quality of life (HRQoL), perceived risk and understanding, and self-efficacy.MethodsIterative survey development and evaluation of its psychometric properties in a convenience sample of 28 older adults (≥ 55 years old), half from a low-income population. Following item generation, the questionnaire was assessed for content validity (expert panel), face validity (participant feedback), internal consistency of each scale (Cronbach’s alpha), and test-retest reliability for each item and scale (Pearson’s r and phi correlations, as appropriate).ResultsQuestions were drawn from 15 sources, but primarily three surveys: Canadian Community Health Survey, Canadian Diabetes Risk Questionnaire (CANRISK), and a survey by the Canadian Hypertension Education Program. Expert consensus was attained for item inclusion and representation of the desired constructs. Participants completing the questionnaire deemed the questions to be clear and appropriate. Test-retest reliability for many individual items was moderate-to-high, with some exceptions for items that can reasonably change in a short period (e.g., perceived day-to-day stress). Of the five potential scales evaluated, two had acceptable internal consistency (Cronbach’s alpha ≥ 0.60) and a subset of one scale also had acceptable internal consistency. Test-retest reliability was high (correlation ≥ 0.80) for all scales and sub-scales.ConclusionsThe HABiT is a reliable and suitable comprehensive tool with content and face validity that can be used to evaluate health promotion and chronic disease prevention programs in older adults, including low-income older adults. Some noted limitations are discussed. Data collected using this tool also provides a diabetes risk score, health literacy score, and quality-adjusted life years (QALYs) for economic analysis.

Relationships of Selected Factors, Health Literacy and Clinical Outcomes in Community Dwellers with Hypertension

OBJECTIVE:This study was undertaken to examine the relationship among selected factors, health literacy and clinical outcomes among community dwellers with hypertension.MATERIALS AND METHODS:The samples of 360 persons with hypertension aged 20 years old and over were selected using proportional stratified random sampling with simple random sampling from 6 sub-district Health Promoting Hospitals in Muang District, Prachinburi Province. The instrument was used to screen subjects who were 60 years old and older with The Short Portable Mental Status Questionnaire (SPMSQ). Health literacy was used for hypertension questionnaires and record clinical outcomes to elicit data regarding blood pressure levels, body mass index, and waist circumference. The data were analyzed using descriptive statistics and inferential statistics including chi-square test.RESULTS:The findings revealed that most participants had inadequate overall health literacy (53.1%), inadequate health literacy on functional, interactive and critical health literacy subscale (47.8%, 60.3%, 40.0% respectively) and that there was a significant correlation between selected factors and overall health literacy with statistical significance (p &lt; 0.01) were age, educational background, income, community roles, and severity of illness whereas gender, having co-morbidity and duration of living with hypertension was not associated. In addition, there was a significant correlation between health literacy level and clinical outcomes with systolic blood pressure with statistical significance (p &lt; 0.05) whereas diastolic blood pressure, Body mass index (BM) and waist circumference was not associated.CONCLUSION:This study suggested that healthcare teams should provide health information and hypertension education programs focusing on target populations, particularly to persons with inadequate health literacy including the elderly, those with low education and of low income. They should communicate effectively and make health information accessible and in a language that is easy-to-understand to promote proper decision-making and lead to good clinical outcomes.

Assessing the quality of guidelines for primary aldosteronism: which guidelines are worth applying in diverse settings?

To review the validity and applicability of clinical guidelines on the management of primary aldosteronism and to list their discrepancies to allow health-care providers and guideline developers to make informed decisions. Primary aldosteronism management guidelines, including specialist, subgroup, general guidelines written in English, were obtained from electronic databases. Appraisers independently extracted the data, and used the Appraisal Guidelines Research and Evaluation II (AGREE-II) tool and the Institute of Medicine (IOM) criteria to independently evaluate the methodological quality of the guidelines. Then, the appraisers used the Guideline Implementability Appraisal (GLIA) tool to assess the implementation of the guidelines that complied with AGREE-II and IOM. In addition, we further compared the discrepancies in the primary aldosteronism management recommendations. We have identified 12 guidelines published between 2006 and 2016. Only the Endocrine Society and the Canadian Hypertension Education Program guidelines of them were of good methodological quality according the AGREE-II and IOM instrument, but with still much room for improvement. Neither of these two was rated as easily implementable according to the GLIA tool. Discrepant recommendations were identified at all management steps (screening, confirmation, classification, treatment and follow-up). The guidelines quality was mostly poor, and the higher quality guidelines also needed improvement prior to their implementation. Meanwhile, significant differences existed in the recommendation for the same clinical problem. Therefore, future guideline development should be performed in strict accordance with the AGREE-II, IOM and GLIA criteria to improve the diagnosis and treatment of primary aldosteronism.

Étude PASTIS : pression artérielle sans intervention de soignant. Évaluation d’une mesure de la pression artérielle automatisée en cabinet

ObjectiveThe evaluation of automated office blood pressure (AOBP) measurement compared to 24-hour ambulatory BP monitoring (ABPM), Home BP measurement and manual BP. Patients and methodologyA total of 123 hypertensive patients were included. Overall, 68 completed the 4 measurement: Manual BP in the office (Omron 705 CP 3 measurements), ABPM (Spacelab of 96 measurement/per 24hours), Home BP (18 measurement during 3 days), AOBP using the SPRINT methodology: lying patient, isolated with an automatic measurement (Dinamap) every minutes during 8minutes (average of the last 3 measurement). Twenty-two out of 123 patients (26%) did not complete the Home BP measurement. ResultsThe average of AOBP measurement using SPRINT is 132±12/69±9mmHg, of ABPM 134±13/79±9, of Home BP: 135±13/70±13 and of manual BP: 138±13/72±11mmHg The Bland & Altman method highlight that the AOBP, the ABPM and home BP measurement are 3 substitutable methods. The confidence interval is smaller between the ABPM and the AOBP than with the home BP. ConclusionThe automated office blood pressure, as the Home BP measurement, can be considered a reliable substitute for the ABPM, when the later is not accessible, and when a repeated therapeutic evaluation is needed, or when the home BP measurement is not done. These results encourage us to use it more frequently as the Canadian Hypertension Education Program recommend it.

Knowledge, attitude and practice of Iranian hypertensive patients regarding hypertension.

Introduction: This study aimed at evaluating knowledge and awareness of hypertension and the risk factors for hypertension among hypertensive patients. Methods: In this study, 110 hypertensive patients were enrolled and filled out two self-administered questionnaires. The first questionnaire was about the demographic characteristics and the second one was about the knowledge (n = 10), attitude (n = 9) and practice (n = 8). The internal consistency and the stability of the questionnaires were approved. The Mann-Whitney U test and Kruskal-Wallis and Spearman correlation coefficient were used for statistical analysis. Results: Seventy-three percent of participants know the normal range of hypertension. Most of the participants truly knew that stress (87.3%), obesity (70.9%) and aging (48.2%) are risk factors for hypertension. About 60% of participants knew the complications of uncontrolled hypertension. About 82.7% of participants believed that after adaptation of body to hypertension, there is no need to use antihypertensive drug. About 13.6% of participants measured their blood pressure daily and 11.8% of them measured it once a month. The educational level of participants was significantly associated with knowledge score (P = 0.01). There was a significant correlation between knowledge (P < 0.001) and attitude and also attitude and practice (P < 0.001) scores. Conclusion: These findings have important implications for developing proper and continuous self-management hypertension education programs in Iran which should mostly emphasize on the practical information about control and prevention programs.

일부 고혈압 전단계 성인의 고혈압 지식, 태도와 예방행위와의 관계

Objectives: The purpose of this study was to examine the relationships between hypertension knowledge, attitude, and preventive activities of 20-30 years prehypertension adults. Methods: The subjects for this study were 178 prehypertension adults in J city. The data were collected using the questionnaires for knowledge, attitude and preventive activities. The data analysis was done by descriptive statistics, independent t-test and multiple regression analysis. Results: The mean of hypertension knowledge was 10.99 out of 18, attitude was 4.28 out of 5, and prevention activities was 5.32 out of 7. The influencing factors for hypertension preventive activities were attitude, perceived health status, marrital status and gender which accounted for 82.6% of the total variance. Conclusions: Hypertension attitude was identified as a variable that affects hypertension preventive activities. For preventing hypertension, national campaign and health education program in each prehypertension early adults need to be built.

The role of occult hypertension in retinal vein occlusions and diabetic retinopathy

ObjectiveThe aim of the study was to investigate whether individuals who develop retinal vein occlusion (RVO) or sudden-onset activity in otherwise quiescent diabetic retinopathy (DR) and those who have normal blood pressure (BP) or controlled hypertension according to their family physician show evidence of occult hypertension on 24-hour BP monitoring. MethodsPatients with a new-onset RVO or DR that led to vitreous hemorrhage after a period of quiescence were identified. Informed consent was obtained, and patients were enrolled in the study if they met all of the inclusion criteria. Hypertension cut-offs were established in accordance with the Canadian Hypertension Education Program and the American Heart Association recommendations. All patients underwent a baseline BP measurement and 24-hour ambulatory BP monitoring. ResultsA total of 20 patients were enrolled in the study. Eleven (55%) were female (mean age 67.5 years). Seven patients (35%) had diabetes. Seventeen had retinal vein occlusions (85%), and 3 had sudden-onset activity in otherwise quiescent diabetic retinopathy (15%). Ten patients (50%) had no previous history of hypertension, and 10 (50%) had controlled hypertension on medications. Two patients (10%) failed to wear their BP cuff for the 24-hour duration and were excluded from the analysis. The average baseline systolic BP and diastolic BP were 133 and 78 mm Hg, respectively. Twelve patients (67%) tested positive for hypertension on their 24-hour recording, and 5 (42%) of these patients had no history of hypertension. One of 12 patients (8%) had a positive nighttime average only but a normal daytime average. Nine of the 12 patients (75%) who had a positive recording had a subsequent change made to their medications. ConclusionsUncontrolled hypertension is a known risk factor for the development of RVO and for vitreous hemorrhage in otherwise quiescent DR. Many of these patients may have occult hypertension that has not been detected by the currently usual standard. Twenty-four-hour ambulatory BP monitoring is a useful and potentially lifesaving clinical test, which can detect uncontrolled hypertension, especially nocturnal hypertension, in this cohort of patients. The results of this test have important treatment implications that can help prevent or minimize further systemic complications.

한국형 DASH 교육 프로그램이 여성노인의 산화스트레스, 항산화능력과 호모시스테인 농도에 미치는 효과

Purpose: The purpose of this study was to investigate the effects of the Korean Dietary Approaches to Stop Hypertension (DASH) education program on oxidative stress, antioxidant capacity, and serum homocysteine (Hcy) level in elderly Korean women. Methods: This was a quasi-experimental study employing non-equivalent control group pretest-posttest design. The DASH group (n=27) underwent the DASH education program for 12 weeks, whereas the control group (n=21) was provided one education session. The survey was conducted before and after the intervention period. Results: In DASH group, monounsaturated fatty acid (MUFA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes significantly increased after the intervention as compared to prior to the intervention. No significant differences were found in the control group. After the intervention, thiobarbituric acid reactive substance (TBARS) and Hcy levels significantly decreased in the DASH group but not in the control group. Conclusion: The DASH education program was effective in reducing oxidative stress and Hcy levels in elderly Korean women. Key Words: Diet; Oxidative stress; Antioxidants; Homocysteine; Women Key Words: DASH 식이; ì‚°í™”ìŠ¤íŠ¸ë ˆìŠ¤; í•­ì‚°í™”ëŠ¥ë ¥; í˜¸ëª¨ì‹œìŠ¤í Œì¸; ì—¬ì„±ë ¸ì¸

OP.6A.04] HIGH PREVALENCE OF MASKED UNCONTROLLED HYPERTENSENSION AMONG TREATED PATIENTS FOLLOWED UNDER ROUTINE CANADIAN CLINICAL CARE

Objective: Masked hypertension (MH), defined as elevated ambulatory blood pressure (BP) among patients with seemingly well controlled office blood pressure measurements (OBPM), has been associated with high cardiovascular risk. Previous studies have reported a MH prevalence between 10% to 30%, mostly among untreated individuals. The main objective of this study was to describe the prevalence of MH in borderline controlled hypertensive patients treated with short-acting antihypertensives in Canadian routine clinical care. Furthermore, differences between OBPM and home BP measurements (HBPM) taken 24-hours after last medication dose were assessed in treated hypertensive patients with borderline and almost controlled BP. Design and method: Real-life, prospective Canadian study conducted in general practitioners’ offices. Enrolled patients had borderline (SBP 130–139 and/or DBP 80–89 mmHg) or almost controlled (SBP 140–149 and/or DBP 90–99 mmHg) BP based on OBPM and were treated with short-acting antihypertensives. Patients collected HBPMs for 7 consecutive days. MH was defined as HBPM SBP > = 135 and/or DBP > = 85 mmHg among borderline controlled patients. Results: 983 patients were included; 370 (37.6%) were borderline controlled and 613 (62.4%) were almost controlled. Mean (SD) age was 60.5 (11.0) years, 50.1% were male and 65.7% were Caucasian without any remarkable differences between groups. OBPM and HBPM values are summarized in Table 1. Among patients with borderline controlled OBPM hypertension, 187 (50.5%) had MH.Conclusions: A higher rate of MH than what was previously reported in the literature was observed in this study, which confirms previous studies suggesting that the use of short-acting antihypertensives may be a risk factor for MH, probably due to suboptimal coverage over 24 hours. These results support the latest Canadian Hypertension Education Program recommendations that OBPM alone is inadequate for BP control optimization.