Outpatient Hypertension Clinic Research Articles

The Association Between Obesity and Visit-to-Visit Variability in Systolic Blood Pressure: A Prospective Study

Abstract With the prevalence of obesity and all accompanying health risks, both prevention and health education, as well as identifying predictors for the development of obesity-related diseases are primary. The pathophysiological relationship between obesity and visit-to-visit variability in systolic blood pressure (SBPV) has not been completely resolved. To investigate the association between obesity and SBPV in hypertensive patients. The prospective study comprised three visits was performed at the hypertension outpatient clinic during the follow up period of 22-months between March 2014 and January 2016. This study included 300 randomly selected hypertensive patients (average 67.76±9.84 years), who were divided in groups of obese/non-obese examinees. SBPV was defined as the standard deviation (SD) from three values of SBP. The values of SBP and SBP-SD were significantly higher in the group of obese hypertensive patients than in the group of non-obese patients (127.06±8.30 vs. 120.37±7.75; 11.29±5.67 vs. 7.37±3.94 mmHg; p<0.01). The highest SBPV was recorded in the 4th quartile in obese patients (43.13±7.50 mmHg). SBPV was strongly correlated with BMI and Waist cirumferences (WC) (ρo=0.425, ρo=0.356, p<0.01). During 22-months follow up there was a significant decrease of SBPV for 8.2 mmHg, BP for 31/5 mmHg, BMI for 3.8 kg/m2, WC for 10 cm and body weight for 8.24 kg. During 22-months follow-up, reduction of body weight was associated with reduction of blood pressure variability in hypertensive patients. Persistently decrease both body weight and long term visit-to-visit variability may explain lower cardiovascular risk in obese-related disease.

Impact of ambulatory SBP and overweight on executive function performance in children and adolescents.

Neurocognitive impairment has recently emerged as a hypertensive target organ damage in children and adolescents. In the present study, we aimed to examine the effect of hypertension and overweight on executive function performance in youth. The study population included 116 consecutive children and adolescents referred to our outpatient hypertension clinic who underwent ambulatory blood pressure monitoring (ABPM) and assessment of executive function by Behavior Rating Inventory of Executive Function (BRIEF). Children and adolescents with hypertension presented higher T scores in shift sub-scale of Behavior Regulation Index (BRI) compared with normotensives. Participants with hypertension in the ABPM also presented higher T scores in subscales of metacognition (metacognition index). Night-time SBP correlated with BRI (r = 0.21, P < 0.05) and metacognition index (r = 0.19, P < 0.05) composite scales. BMI z score also correlated with BRI (r = 0.28, P < 0.005) and metacognition index (r = 0.22, P < 0.05) scales. The associations of night-time SBP with monitor and plan/organize subscales of metacognition index remained significant after adjustment for BMI z score and socioeconomical status. However, the associations of BMI z score with monitor scale was found to be mediated by night-time SBP. In ROC curve analysis, only night-time SBP could predict impaired performance in monitor and plan/organize scales (AUC 0.68 and 0.70, respectively). Night-time SBP may predict a poor performance in domains of executive function in youth. Although overweight/obese status was negatively associated with executive performance, mediation analysis showed that not obesity per se, but BP exerted negative impact on executive performance.

Pheochromocytoma and Paraganglioma: From Epidemiology to Clinical Findings.

Pheochromocytomas (PCC) and paragangliomas (PGL) are rare neuroendocrine tumors. Pheochromocytomas arise from chromaffin cells in the adrenal medulla, and PGLs arise from chromaffin cells in the ganglia of the autonomic nervous system. Paragangliomas originate from sympathetic or parasympathetic ganglia in the abdomen, thorax, and pelvis. The majority of PCC and sympathetic PGL are endocrine active tumors causing clinical symptoms by secreting excess catecholamines (norepinephrine, epinephrine, dopamine) and their metabolites. The incidence of PCC and PGL ranges between 2 and 8 per million, with a prevalence between 1:2500 and 1:6500. It peaks between the 3rd and 5th decades of life, and approximately 20% of cases are pediatric patients. The prevalence among patients with hypertension in outpatient clinic ranges between 0.1-0.6% in adults and between 2-4.5% in the pediatric age group. 10-49% of these tumors is detected incidentally in imaging techniques performed for other reasons. However, 4-8% of adrenal incidentalomas are PCCs. Of these neuroendocrine tumors, 80-85% are PCCs and 15-20% are PGLs.Up to 40% of patients with PCC and PGL has disease-specific germline mutations and the situation is hereditary. Of 60% of the remaining sporadic patients, at least 1/3 has a somatic mutation in predisposing genes. 8% of the sporadic cases, 20-75% of the hereditary cases, 5% of the bilateral, adrenal cases, and 33% of the extra-adrenal cases at first presentation are metastatic. Although PCCs and PGLs have scoring systems for histological evaluation of the primary tumor, it is not possible to diagnose whether the tumor is malignant since there is no histological system approved for the biological aggressiveness of this tumor group. Metastasis is defined as the presence of chromaffin tissue in non-chromaffin organs, such as lymph nodes, liver, lungs and bone. Although most of the PCC and PGL are benign, the metastatic disease may develop in 15-17%. Metastatic disease is reported between 2-25% in PCCs and 2.4-60% in PGLs. The TNM staging system of the American Joint Committee on Cancer (AJCC) was developed to predict the prognosis, based on the specific anatomical features of the primary tumor and the occurrence of metastasis.

Prevalence of sleep apnea in patients with first diagnosis of hypertension

The risk of obstructive sleep apnea (OSA) is significantly increased in patients with hypertension. In addition, OSA appears to be an independent cardiovascular risk factor. So far, sleep apnea screening is only recommended for patients with refractory hypertension and history of OSA. Therefore, OSA often remains undiagnosed in hypertensive patients. The underlying prevalence data are mainly from outpatient hypertension clinics. Data on the prevalence of OSA in patients with hypertension in primary care are not yet available. Due to the cardiovascular risk, some experts recommend screening for OSA when high blood pressure is diagnosed. The study presented here describes for the first time the prevalence of OSA in GP patients immediately after the initial diagnosis of hypertension. 6 family practices participated in the study between December 2012 and April 2014. Cardiorespiratory polygraphy was performed on all patients diagnosed with hypertension during this period using a 24-hour blood pressure monitor (ABPM). A sleep physician evaluated the polygraphy data online. 50 patients were recruited, 6 patients did not meet the inclusion criteria. Thus, the data of 44 patients (19 women) were analyzed. An obstructive sleep apnea was diagnosed in 34% (n = 15) of the patients. 16% (n = 7) had a mild OSA, 16% (n = 7) a moderate OSA and 2% (n = 1) a severe OSA. In a relevant proportion of patients with newly diagnosed hypertension, an undiagnosed OSA was found. In order to estimate the possible effects of sleep apnea screening on hypertension patients, representative studies in the primary medical field are required.

Addressing the problem of inaccuracy of measured 24-hour urine collections due to incomplete collection.

The 24-hour urine collection is widely considered the gold standard for assessing 24-hour excretion of various analytes. Yet, studies show that >30% of collections are incomplete and hence understate the true 24-hour excretion. We previously validated an equation for estimating an individual's 24-hour creatinine excretion, based on weight, sex, race, and age. The present study examines whether routinely correcting measured 24-hour excretion of an analyte using the ratio of estimated to measured 24-hour urine creatinine mitigates the misleadingly low values that result from undercollection. Ninety-nine participants, recruited from an outpatient hypertension clinic, submitted a 24-hour urine collection for measurement of creatinine and sodium excretion. The urine collections were dichotomized into complete (n=63) and incomplete (n=36) collections based on previously described criteria for expected 24-hour creatinine excretion. To adjust for possible incompleteness of collections, the measured 24-hour values were then corrected by multiplying them by the ratio of estimated to measured 24-hour urine creatinine. The mean 24-hour creatinine excretion was 1682mg/d among complete collectors. Among incomplete collectors, the mean was 1211mg/d before and 1695mg/d after, adjustment. Similarly, mean 24-hour sodium excretion was 156mEq/d among complete collectors, whereas among incomplete collectors it was 121mEq/d before and 171mEq/d after, adjustment. Undercollection of 24-hour urines is a common problem and results in misleadingly low values for excretion of analytes being measured. Routine adjustment of 24-hour urine values using estimated values for 24-hour creatinine excretion can greatly mitigate artifactually low 24-hour excretion results.

Intraoperative Hypertensive Crisis in a Patient with Normotensive Primary Aldosteronism. Lessons from a Clinical Case

Primary hyperaldosteronism is the most frequent cause of secondary hypertension. However, it can also be found in apparently normotensive patients, often associated with recurrent hypokalemia and isolated hypertensive episodes.&#x0D; We hereby present the case of a normotensive 50-year-old female patient with a surgical left kidney mass; however, after anaesthetic induction, surgery was aborted due to a severe hypertensive crisis. She was referred to our Hypertension Outpatient Clinic to rule out pheochromocytoma/ paraganglioma. The anamnesis revealed unexplained episodes of hypokalemia. Ambulatory blood pressure monitoring showed normal mean values of blood pressure and heart rate, with an isolated hypertensive peak. Plasma glucose, ions, creatinine, lipids, metanephrines and chromogranin A were normal, but plasma aldosterone was clearly elevated with suppressed plasma renin activity and high aldosterone/renin activity ratio. Primary aldosteronism was confirmed by the captopril test. Abdominal CT was compatible with left adrenal hyperplasia. Treatment with low-dose spironolactone was well tolerated and resulted in normal blood pressure, normokalemia and unsuppressed plasma renin activity. The patient underwent successful laparoscopic removal of a renal oncocytoma. &#x0D; We conclude that normotensive primary aldosteronism is not harmless; it can be associated with severe hypokalemia, anxiety, depression, hypertensive crisis and cardiovascular damage. Patients can also develop resistant hypertension. Adequate treatment can decisively improve the survival and quality of life of the patients with primary aldosteronism, but a correct diagnosis is needed first. Therefore, it must be considered as a diagnostic possibility in normotensive patients with unexplained hypokalemia or isolated hypertensive episodes.

DIAGNOSTIC ACCURACY OF A NOVEL CUFFLESS BLOOD PRESSURE MONITOR FOR ATRIAL FIBRILLATION SCREENING IN THE ELDERLY

Objective: Screening for atrial fibrillation (AF) during routine automated blood pressure (BP) monitoring in asymptomatic elderly subjects is an attractive tool. This study validated a novel cuffless BP monitor (Freescan, Maisense) for AF detection during BP measurement in elderly subjects versus reference continuous electrocardiography (ECG). Design and method: Subjects recruited from a hypertension outpatient clinic were instructed to self-measure their BP in the clinic setting using the Freescan cuffless BP monitor (up to 15 attempts until 5 valid BP readings were obtained), with simultaneous ECG monitoring using a Holter device. Data from the device were transferred via Bluetooth to an online data management system, where for each BP measurement an ‘AF’ indication was displayed in case of detected AF and ‘Arrhythmia’ in other arrhythmias. Results: 1,223 Freescan BP measurements with simultaneous automated AF detection were obtained from 132 subjects. Readings reported by the device as ‘unstable’ (uncertainty of displayed rhythm result: 31%) and those reporting error (19%) were discarded. Thus, data of 108 subjects who had 5 valid Freescan BP measurements were analyzed (age 73.9 ± 7.3 years, males 65%, treated for hypertension 85%, AF in ECG 19%). In reading-to-reading analysis (N = 540 valid Freescan readings) the sensitivity, specificity and accuracy of the Freescan device in detecting AF were 70%, 99% and 94%, respectively. In subjects’ analysis (N = 108) and by considering AF diagnosis if > = 3 of 5 Freescan readings indicated AF, the sensitivity, specificity and accuracy of Freescan in detecting AF were 76%, 100%, and 95%, respectively. When the indication ‘Arrhythmia’ was regarded as AF indication, in reading-to-reading analysis the sensitivity, specificity, and accuracy were 95%, 91%, and 92%, respectively, while when using the >=3 of 5 readings for AF diagnosis rule the sensitivity, specificity and accuracy were 100%, 92% and 94%, respectively. Conclusions: The Freescan device appears to have satisfactory diagnostic accuracy for AF screening during routine self-measurement of BP in the elderly, particularly when >=3 of 5 valid readings are considered for diagnosis.

UNATTENDED VERSUS ATTENDED AUTOMATED OFFICE BLOOD PRESSURE USING THE SAME DEVICE AND PROTOCOL

Objective: Office blood pressure measurements taken using automated devices (AOBP) are being increasingly used in clinical practice. This study compared unattended versus attended AOBP when the same device and measurement protocol is used. Design and method: Untreated or treated subjects attending an outpatient hypertension clinic were subjected to unattended and attended AOBP measurements (randomized order; 2 separate visits on 2 consecutive days; triplicate sitting measurements after 5-min rest; Microlife WatchBP Office professional oscillometric device) and 24-hour ambulatory blood pressure (ABP) monitoring (Microlife WatchBP O3). Results: 113 subjects were analyzed (mean age 60.9 ± 13.4 years, 54% males, 60% treated hypertensives; 25% smokers; 11% diabetics; 7% with cardiovascular disease). Unattended systolic AOBP was slightly lower than attended AOBP, with no difference in diastolic AOBP (unattended AOBP 128 ± 16.2/78.4 ± 11.8 mmHg, systolic/diastolic, mean difference −2.2 ± 10.8/−0.5 ± 8.3 mmHg, p = 0.04/NS). The attended-unattended systolic AOBP difference was correlated with attended systolic AOBP (r = 0.41, p < 0.01) but not with age. Subjects with attended systolic AOBP > = 140 mmHg had higher attended minus unattended systolic AOBP difference compared to those with lower systolic AOBP (7.4 ± 10.8 vs. −0.1 ± 10.1 mmHg respectively, p < 0.01). The attended-unattended AOBP was similar in treated hypertensives and untreated subjects (3.2 ± 11.7 vs. 1.2 ± 9.2 mmHg, p = NS), or in men and women (3.2 ± 11.4 vs. 0.8 ± 10.1 mmHg, p = NS). Daytime ABP did not differ from unattended and attended AOBP (difference 0.5 ± 12.3/−0.6 ± 9.1 mmHg, systolic/diastolic vs. unattended and −1.7 ± 14.2/−1.1 ± 8.9 mmHg vs attended AOBP, p = NS for all). Conclusions: These data suggest that when standardized triplicate AOBP measurements are obtained, there is no difference between unattended and attended measurements provided that the same device and measurement protocol is used. However, at office BP levels >140/90 mmHg attended AOBP may be higher than unattended measurements.

Sex differences in antihypertensive drug use and blood pressure control

BackgroundHypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are...

Clinical presentation and management of primary aldosteronism in late childhood and adolescence: Experience in an outpatient hypertension clinic

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Characterization of essential hypertension vs secondary hypertension in late childhood and adolescence: Experience in an outpatient hypertension clinic

Characterization of essential hypertension vs secondary hypertension in late childhood and adolescence: Experience in an outpatient hypertension clinic

Arterial stiffness and chronic stress: role of gender – Rigidità arteriosa e stress cronico: ruolo del genere

AimEvaluate whether exposure to chronic stress is associated with early vascular aging in hypertensive patients and possible gender differences in this relationship.MethodsPatients where recruited in a Hypertension outpatient clinic during a visit for the evaluation of subclinical organ damage. Aortic stiffness was measured as carotid-femoral pulse wave velocity (PWV) by applanation tonometry; common carotid intima-media thickness (IMT) and distensibility were evaluated by automated analysis of carotid ultrasound clips. Chronic stress was assessed using three different standardized scales: Perceived Stress Score 4 (PSS4), Depression Anxiety Stress Scale (DASS) and Chronic Stress Burden (CSB).ResultsData from 125 patients (age 56.7 ± 12.5years) were analyzed. No significant differences were found between men and women in terms of PWV [8.90 (1.9) vs 8.55 (1.8) m/s, p = 0.14], carotid distensibility (22.34 ± 8.79 vs 21.17±8.74 kPa−1, p = 0.545) and IMT (0.74 ± 0.12 vs 0.70 ± 0.13 mm, p = 0.132). Women presented significantly higher scores of PSS4 (7(3) vs 5(3), p = 0.007) and CSB (1.42 ± 1.24 vs 0.59 ± 0.85, p = 0.004). In the linear multiple regression analysis, CBS was correlated with PWV in the general population (beta = 0.37, p = 0.050) being responsible for 4% of the variance of PWV, without significant gender differences. Among the components of CBS, difficulties in relationships with someone close to the participant were associated with increased PWV only in women (p = 0.01). In a multiple regression model, this variable tended to be an independent predictor of PWV (beta = 0.37, p = 0.057), responsible for 7% of the PWV variance.ConclusionsIn hypertensive patients, chronic stress burden is associated with greater arterial stiffness; in particular, stress related to difficulties in relationships seems to be associated with greater vascular stiffness only in women.

A4370 Assessment of Adherence to Antihypertensive Drugs Using Urine Analysis in a Tertiary Care Hospital

Objectives: Non-adherence to medications is a common issue across patients with hypertension. Non-adherence to medications has serious consequences in patient's health and in the cost of health services. The aim of the study was to assess adherence to antihypertensive drugs using urine analysis in patients attending adult outpatient clinic at Sultan Qaboos University Hospital (SQUH). Methods: This is a cross sectional study conducted in specialized lipid and Hypertension outpatient clinics at SQUH. The inclusion criteria to participate in the study were hypertensive patients aged above 18 years and taking at least one antihypertensive drug. 162 hypertensive patients agreed to participate in the study and provided sufficient urine samples for analysis. Further data was collected such as concomitant diseases; blood pressure and medications. Results: The mean (SD) age of participants was 55 (13) year and 43% of participants were females. The prevalence of directly measured nonadherence by urine drug detection was 27%. Compared with adherent patients, those who did not adhere to their treatment (n = 43) had a higher number of antihypertensive pills and drugs (3.2 vs 2.5, P = 0.002) put there was no significant difference in the total number of pills. After adjustment for age, SBP and DBP were higher in nonadherent than adherent group (SBP: 151 ± 19 vs 144 ± 18 respectively, P = 0.026; and DBP: 84 ± 11 vs 78 ± 9 respectively, P < 0.001). Conclusion: Our finding indicates a suboptimal adherence to antihypertensive drugs in patients attending the outpatient clinics of a university hospital. However, it is better than the adherence rate reported in other studies.

A11166 Analysis for antihypertensive drug patterns and blood pressure control in hypertension outpatient clinic

A11166 Analysis for antihypertensive drug patterns and blood pressure control in hypertension outpatient clinic

Development and Validation of a Questionnaire to Measure Patient’s Experiences of Health Care in Pulmonary Arterial Hypertension Outpatient Clinics

Measuring the patients' experience of care at an outpatient clinic can provide feedback about the quality of health care and if needed, can be support for quality improvements. To date, there is no patient reported experience measurement (PREM) developed targeting patients at the pulmonary arterial hypertension (PAH) outpatient clinics. Therefore, the aim was to develop and evaluate the psychometric properties of a PREM scale to be used for patients at PAH-outpatient clinics. The development and psychometric evaluation of the PREM for patients at PAH outpatient clinics followed two stages: (I) development of the PAH Clinic PREM (PAHC-PREM) scale based on interviews with patients; and (II) psychometric evaluation of the PAHC-PREM scale including data quality, factor structure (construct validity), criterion validity and internal consistency. A sample of 156 patients at PAH outpatient clinics completed the PAHC-PREM scale (median age 69 years, 57% women). Unidimensionality of the PAHC-PREM scale was supported by parallel analysis. A single factor explained 67% of the variance. Inter-item and item-total correlations were satisfactory (0.46-0.88 and 0.64-0.91, respectively). Internal consistency reliability with ordinal coefficient alpha was good (0.93). The PAHC-PREM scale was demonstrated to have good psychometric properties and is now ready to be used to measure quality of health care experience from patients at PAH-outpatient clinics.

THE IMPACT OF DIURETICS ON ERECTILE FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Erectile dysfunction is frequently encountered in hypertensive patients. Along with blood pressure elevation, antihypertensive drugs have been implicated in the pathogenesis of erectile dysfunction. Although the effects of diuretics on erectile function seem detrimental, contradictory findings are available in the literature. We therefore aimed to evaluate the impact of diuretic therapy on erectile function in hypertensive patients without erectile dysfunction. Design and method: Consecutive male hypertensive patients between 30 and 70 years of age attending our Hypertension Outpatient Clinic who initiated diuretic therapy participated in the study. Erectile function was evaluated at baseline and three months after diuretic initiation. Erectile function was assessed using the International Index of Erectile Function, a validated 15-item questionnaire. Results: Overall, 247 male hypertensive patients participated in the study. Diuretic monotherapy was initiated in 56 participants, while diuretics were added to prior therapy in the rest 191 participants. From the latter group, 122 were on monotherapy with angiotensin receptor blockers and 69 were on dual therapy with angiotensin receptor blockers plus calcium antagonists. Erectile dysfunction appeared in 8/56 participants (14.2%) on diuretic monotherapy, in 27/122 participants (22.1%) on dual therapy with diuretics added to ARBs, and in 14/69 participants (20.3%) on triple therapy (diuretics on top of prior ARBs plus calcium antagonists administration). Conclusions: Diuretic-induced erectile dysfunction is common among patients with arterial hypertension. Further studies are needed to verify our findings, enlighten the mediating mechanisms, and clarify the management of such patients.

FEMALE SEXUAL DYSFUNCTION WITH DIURETICS IN WOMEN WITH ARTERIAL HYPERTENSION

Objective: Sexual dysfunction is more prevalent in female than in male hypertensive patients. Although the pathophysiology of female sexual dysfunction is more complex than the male one, antihypertensive drugs seem to contribute to female sexual dysfunction. The role of diuretics in female sexual dysfunction remains largely unclarified. We therefore aimed to evaluate the impact of diuretic therapy on female sexual function in hypertensive women free of sexual dysfunction. Design and method: Consecutive female hypertensive patients between 30 and 70 years of age attending our Hypertension Outpatient Clinic who initiated diuretic therapy participated in the study. Female sexual function was evaluated at baseline and three months after diuretic initiation. Female sexual function was assessed using the Female Sexual Function Index, a validated 19-item questionnaire. Results: In total, 218 female hypertensive patients participated in the study. Diuretics were introduced either as monotherapy in patients not taking antihypertensive drugs (58 patients) or as part of combination therapy in patients already taking angiotensin receptor blockers (103 patients) or angiotensin receptor blockers plus calcium antagonists (57 patients). Female sexual dysfunction occurred in 6/58 (10.3%) participants on diuretic monotherapy, in 18/103 (17.4%) participants on dual therapy (ARBs and diuretic addition), and in 9/57 (15.8%) participants on triple therapy (prior ARBs+calcium antagonists and diuretic addition). Conclusions: Initiation of diuretic therapy is associated with incident female sexual dysfunction in 10–20% of women with arterial hypertension. Further studies are needed to verify our findings, enlighten the mediating mechanisms, and clarify the management of such patients.

THE PREVALENCE OF RESISTANT AND UNDERCONTROLLED HYPERTENSION AMONG PATIENTS OF A HYPERTENSION OUTPATIENT CLINIC IN SZEGED

Objective: In Hungary, between 2005–2009 around 57% of hypertensive patients did not reach the goal blood pressure (BP). Design and method: In one of the Hypertension Outpatient Clinics of the 1st Department of Medicine Nephrology-Hypertension Center in Szeged 310 patients’ data were analyzed. Means of two measurements were calculated. The goal SBP was 140/ mm Hg. Means ± SD are reported. Results: The mean age of hypertensive patients was 61.4 ± 14.3 years. The mean duration of HT was 14.2 ± 12.0 years. Among these 310 HT patients 115 (37%) were men (age 58.2 ± 15.6 years) and 195 (63%) women (age 63.4 ± 13.1 years). BP of 186/310 (60%) patients were in goal range (SBP 124 ± 9 mm Hg) and 124/310 (40%) were not (SBP 155 ± 17 mm Hg). Among the 310 patients 45 (15%) had only DM as additional risk factor, type-1 and type-2 together. Twenty-one (17%) of 124 HT patients with undercontrolled BP had diabetes mellitus (DM) (BP 149 ± 15/89 ± 8 mm Hg). By the definition of RHT alltogether 234/310 (76%) patients had RHT (BP 158 ± 17/97 ± 8 mm Hg) in this population. But 257/310 (83%) patients were taking 3 or more antihypertensive drugs, and their SBP was 136 ± 20 mm Hg. The difference (n = 23) between 257 and 234 were the patients with 3 drugs but reaching the goal SBP. With combinations of 4 or more drugs 111 of the 234 (47%) RHT patients had BP < 140/90 mm Hg and 63 (27%) of patients with 4 or more drugs them didn’t reach the goal BP. Among the multiple drug combinations, 83/310 (27%) patients were taking 3 antihypertensive drugs, 65/310 (21%) 4 drugs, 48/310 (15%) 5 drugs, 34/310 (11%) 6 drugs, 20/310 (6%) 7 drugs and 7/310 (2%) 8 drugs. Fifteen patients were on monotherapy, their BP were 124 ± 12/79 ± 9 mm Hg, and only 1 of them was undercontrolled (BP 154/100 mm Hg). All the patients taking 2 drugs were in goal range. Conclusions: A fourfold combination of antihypertensive agents was the most frequent in this population. The most frequent drug classes were the ACEIs and/or ARBs, the DHP-CCBs and the thiazide diuretics.

Clinical characteristics of Black patients with hypertensive urgency.

Hypertensive urgency is defined as a severely elevated systolic blood pressure (SBP) of ≥ 180mmHg and/or diastolic blood pressure (DBP) of ≥ 120mmHg, in the absence of end organ damage. It is known that there are racial differences in prevalence and severity of hypertension but there is a dearth of studies looking at hypertensive urgency in Black populations living in Europe. We sought to define the clinical characteristics of Black patients presenting with hypertensive urgency, in order to better define the risks and complications this growing population of patients faces. This was a single-centre retrospective cohort study of 63 consecutive Black and Afro-Caribbean patients attending a South London district general hospital outpatient hypertension clinic from April 2014 to June 2016. All patients had initially presented with hypertensive urgency to their GP, the Emergency Department, or the hospital's medical take. The cohort had a mean age of 52.7years and an even gender balance. Thirty-four patients had a pre-existing diagnosis of hypertension, with a 9-year median time since diagnosis. This was the first presentation of hypertension for the remaining 46%. Other comorbidities found were diabetes mellitus (10%), ischaemic heart disease (5%), hyperlipidaemia (5%), and cerebrovascular disease (2%). Patients who drank alcohol regularly were found to have significantly higher blood pressures than those who did not. Most patients presented with typical symptoms of uncontrolled hypertension, with headache (25%) and chest pain (16%) being most common. Features of end organ damage were also common, with 32 patients having hypertensive retinopathy, 16 patients having proteinuria and 14 patients found to have left ventricular hypertrophy on echocardiography. The large proportion of newly diagnosed hypertensive patients presenting with end organ signs of prolonged uncontrolled hypertension suggests that there are significant numbers of undiagnosed Black patients in the community, suggesting that we should more actively conduct test for hypertension and its complications when we encounter these patients, who constitute a growing part of the populations in Europe.

Medication use practices and inspection of returned pills during follow-up attendance at a tertiary care hypertension clinic in Nigeria

Background: Medication use practices in the treatment of hypertension (HTN) have been shown to determine outcomes. This study characterizes the profile of medication practices by hypertensive patients attending a tertiary health-care facility in Nigeria. Materials and Methods: This was a cross-sectional study in the outpatient HTN clinic of a tertiary hospital in southern Nigeria. Hypertensive patients seen during routine clinic visits were given the usual clinic instructions and requested to come with all medicines including herbal medications in their possession at their subsequent visits. A semi-structured observer-administered questionnaire was used to document all information sought and on medicines inspected. Data collected were analyzed and presented descriptively. Results: A total of 509 patients were recruited into the study (M:F ratio 1:2.2) aged 22–97 years. The mean(SD) number of all medicines used by the patients was 5.5 ± 2.While the mean(SD) number of antihypertensive medicines was 2.9 ± 1.3 with 75 patients (14.8%), 135 (26.6%), 144 (28.3%) and 154 (30.3%) on 1, 2, 3, and 4 or more antihypertensive medicines respectively. Calcium channel blocker was the most used antihypertensive medicine, 350 (68.8%). Of interest, was the use in 68 (13.4%) patients of unprescribed herbal medicines. A number of patients, i.e., 205 (40.2%) had discrepancy between their prescribed medicines and that presented to the clinic. This included the use of nonprescribed medicines, including analgesics (35%), vitamins (28.1%), nonsteroidal anti-inflammatory drugs (17.1%), and food supplements (6.8%). Conclusion: This study highlights the profile of antihypertensive medication use, revealing the significant use of nonprescribed medicines and factors likely to influence outcomes of therapy. It further underscores the importance of careful inspection during clinic attendance of all medication being taken by the patient.