Hypertension In Population Research Articles

Quality of Life and Compliance Based On Hypertension Patient Characteristics At Krobokan Primary Health Center West Semarang District

Hypertension is the chronic diseases that is a health problem in Indonesia. According to the Basic Health Research 2018 the hypertension population in Indonesia is around 34.1% at the age of ≥18 years. Every year hypertension sufferers are increasing, around 29% of adults suffer from hypertension worldwide. Patients with hypertension require long therapy even for life which certainly makes patients continuously consume antihypertensive drugs which can ultimately affect patient compliance and quality of life. The purpose of the study was to determine description of quality of life and adherence based on hypertention patient at Krobokan Primary Health Center, West Semarang district. This study used a quantitative design with observational research and a cross-sectional approach conducted in the period March-May 2023. The instruments used were MMAS-8 and HRQOL SF-36 as many as 53 samples who met the inclusion criteria. The results showed that the highest respondent characteristics were female 36 (68%), age 56 - 65 years 26 (49%), high school 18 (34%), housewives 31 (58%), length of hypertension ≥ 2 years 27 (51%), one of hypertention drug taken 50 (94%), suffering from other illnesses 23 (43%) and moderate adherance 36 (68%). In the domains of energy, emotional role, physical role, physical function and general health had a low quality of life in most patients with moderate adherence

Exploring the Socio-economic Ramifications of Health Literacy and Medication Adherence on Hypertensive Patients

"This analysis examines the intricate interactions that exist link medication adherence, health literacy, and the socio-economic effects on individuals with hypertension. Hypertension, one of the most prevalent chronic conditions worldwide, requires in-depth understanding of the intricate relationships that exist between patients’ access to health information, adherence to prescribed treatment plans, and the broader socio-economic context. The appraisal reviews recent studies on the health literacy’s effect on hypertension patients’ adherence to medicine, with a focus on the contributions of social, institutional, and personal factors. It also examines the socio-economic consequences of low medication adherence and health literacy, emphasizing disparities in healthcare outcomes, increased medical costs, and worse life quality. This study looks at different methods to raise the level of health literacy and medication adherence in hypertensive populations, both individual and systemic. It emphasizes the significance of patient education programs, tailored communication strategies, and system innovations to address the unique challenges confronted by people with differing degrees of health knowledge. Furthermore, the study investigates the potential financial benefits of enhancing medication compliance and health literacy, illustrating how targeted interventions could reduce medical expenses, prevent problems, and foster a more robust community. It emphasizes the need for collaboration between lawmakers, communities, and medical professionals in order to enact workable policies and decrease the socio-economic toll that hypertension has. The intricate interactions between medication adherence, health literacy, and socio-economic determinants in relation to hypertension are highlighted in the analysis’s conclusion. By understanding and addressing these characteristics, healthcare stakeholders can develop targeted treatments to improve outcomes for patients with hypertension, advance health equity, and improve societal well-being."

The Global Burden of Resistant Hypertension and Potential Treatment Options.

Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains .140 mmHg or .90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.

CO36 Evaluating the Impact of State Level Masking Policies on Adherence over Time in Diabetic and Hypertensive Populations

CO36 Evaluating the Impact of State Level Masking Policies on Adherence over Time in Diabetic and Hypertensive Populations

Unravelling the Belgian cascade of hypertension care and its determinants: insights from a cross-sectional analysis

BackgroundHypertension is a major risk factor for cardiovascular disease and all-cause mortality worldwide. Despite the widespread availability of effective antihypertensives, blood pressure (BP) control rates remain suboptimal, even in high-income countries such as Belgium. In this study, we used a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management.MethodsUsing cross-sectional data from the 2018 Belgian Health Interview Survey and the Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40–79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression models were estimated to identify individual risk factors for being unlinked to hypertension care, untreated and not followed up appropriately.ResultsThe prevalence of hypertension based on self-reported and measured high BP was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% were diagnosed. Furthermore, 53.4% were linked to care, 49.8% were in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Among those diagnosed with hypertension, males, those of younger age, without comorbidities, and smokers, were more likely to be unlinked to care. Once in care, younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, among those treated for hypertension, females, those of younger age, and without comorbidities were more likely to receive no adequate follow-up.ConclusionOur results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are thus needed to improve the accurate and timely diagnosis of hypertension. Once diagnosed, the Belgian health system retains patients fairly well along the continuum of hypertension care, yet targeted health interventions to improve hypertension management for high-risk groups remain necessary, especially with regard to improving treatment rates.

Exploring CYP2D6 polymorphisms and angiotensin receptor blocker response in the Bai hypertensive population.

The CYP2D6 enzyme is crucial for the metabolism and disposition of a variety of drugs. This study was conducted to examine the relationship between CYP2D6 gene polymorphisms and the response to angiotensin receptor blocker (ARB)-based treatment in patients of Chinese Bai ethnicity with hypertension. Seventy-two hypertensive adults from the Chinese Bai ethnic group, exhibiting systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg, were recruited. Targeted regional sequencing was utilized to genotype single nucleotide polymorphisms in the CYP2D6 gene, aiming to assess their frequency and to evaluate their influence on the therapeutic efficacy of ARB medications. Our research identified nine significant CYP2D6 polymorphisms associated with the efficacy of ARB treatment in the Bai hypertensive cohort. Specifically, patients possessing certain mutant genotype at rs111564371 exhibited substantially greater reductions in SBP and DBP, with P -values of 0.021 and 0.016, respectively, compared to those carrying the wild genotype. Additionally, these mutant genotype at rs111564371 and rs112568578 were linked to approximately 20% higher overall efficacy rates and a 10% increased achievement rate relative to the wild genotype. Our research with the Bai hypertensive group shows that certain CYP2D6 polymorphisms significantly influence ARB treatment outcomes. Mutations at rs111564371 led to better blood pressure control ( P -values: 0.021 for SBP, 0.016 for DBP), improving ARB efficacy by appromixately 20% and increasing treatment goal achievement by 10% over the wild-type genotype. Our investigation into CYP2D6 polymorphisms within the Bai hypertensive cohort marks a substantial advancement towards personalized healthcare, underscoring the pivotal influence of genetic constitution on the effectiveness of ARB therapy.

Development and Validation of a Predictive Model for Early Identification of Cognitive Impairment Risk in Community-Based Hypertensive Patients.

Objective: To investigate the risk factors for the development of mild cognitive dysfunction in hypertensive patients in the community and to develop a risk prediction model. Method: The data used in this study were obtained from two sources: the China Health and Retirement Longitudinal Study (CHARLS) and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 1121 participants from CHARLS were randomly allocated into a training set and a validation set, following a 70:30 ratio. Meanwhile, an additional 4016 participants from CLHLS were employed for external validation of the model. The patients in this study were divided into two groups: those with mild cognitive impairment and those without. General information, employment status, pension, health insurance, and presence of depressive symptoms were compared between the two groups. LASSO regression analysis was employed to identify the most predictive variables for the model, utilizing 14-fold cross-validation. The risk prediction model for cognitive impairment in hypertensive populations was developed using generalized linear models. The model's discriminatory power was evaluated through the area under the receiver operating characteristic (ROC) curve and calibration curves. Results: In the modeling group, eight variables such as gender, age, residence, education, alcohol use, depression, employment status, and health insurance were ultimately selected from an initial pool of 21 potential predictors to construct the risk prediction model. The area under the curve (AUC) values for the training, internal, and external validation sets were 0.777, 0.785, and 0.782, respectively. All exceeded the threshold of 0.7, suggesting that the model effectively predicts the incidence of mild cognitive dysfunction in community-based hypertensive patients. A risk prediction model was developed using a generalized linear model in conjunction with Lasso regression. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve. Hosmer-Lemeshow test values yielded p = .346 and p = .626, both of which exceeded the 0.05 threshold. Calibration curves demonstrated a significant agreement between the nomogram model and observed outcomes, serving as an effective tool for evaluating the model's predictive performance. Discussion: The predictive model developed in this study serves as a promising and efficient tool for evaluating cognitive impairment in hypertensive patients, aiding community healthcare workers in identifying at-risk populations.

Relationship between serum apolipoprotein B and risk of all-cause and cardiovascular disease mortality in individuals with hypertension: a prospective cohort study

BackgroundDyslipidemia frequently coexists with hypertension in the population. Apolipoprotein B (ApoB) is increasingly considered a more potent predictor of cardiovascular disease (CVD). Abnormal levels of serum ApoB can potentially impact the mortality risk.MethodsThe prospective cohort study employed data from the National Health and Nutrition Examination Survey (NHANES), which was performed between 2005 and 2016, with follow-ups extended until December 2019. Serum ApoB concentrations were quantified using nephelometry. In line with the NHANES descriptions and recommendations, the reference ranges for ApoB concentrations are 55–140 and 55–125 mg/dL for men and women, respectively. Participants were categorized into low, normal, and high ApoB levels. The low and high groups were combined into the abnormal group. In this study, all-cause mortality (ACM) and CVD mortality (CVM) were the endpoints. Survey-weighted cox hazards models were used for evaluating the correlation between serum ApoB levels and ACM and CVM. A generalized additive model (GAM) was employed to examine the dose-dependent relationship between ApoB levels and mortality risk.ResultsAfter a median of 95 (interquartile range: 62–135) months of follow-up, 986 all-cause and 286 CVD deaths were recorded. The abnormal ApoB group exhibited a trend toward an elevated risk of ACM in relative to the normal group (HR 1.22, 95% CI: 0.96–1.53). The risk of CVM was elevated by 76% in the ApoB abnormal group (HR 1.76, 95% CI: 1.28–2.42). According to the GAM, there existed a nonlinear association between serum ApoB levels and ACM (P = 0.005) and CVM (P = 0.009).ConclusionsIn the US hypertensive population, serum Apo B levels were U-shaped and correlated with ACM and CVM risk, with the lowest risk at 100 mg/dL. Importantly, abnormal Apo B levels were related to an elevated risk of ACM and CVM. These risks were especially high at lower Apo B levels. The obtained findings emphasize the importance of maintaining appropriate Apo B levels to prevent adverse outcomes in hypertensive individuals.

Type 2 diabetes mellitus aggravates coronary atherosclerosis in hypertensive individuals based on coronary CT angiography: a retrospective propensity score-based study.

The effect of type 2 diabetes mellitus (T2DM) on coronary atherosclerosis detected on coronary computed tomography angiography (CCTA) in hypertensive patients has attracted increasing attention. This study investigated the relationships of T2DM with coronary artery plaque characteristics and semiquantitative CCTA scores in hypertensive patients. In this single-center study, 1,700 hypertensive patients, including 850 T2DM [HT(T2DM+)] and 850 non-T2DM [HT(T2DM-)] individuals, were retrospectively analyzed after propensity matching. Plaque type, extent, coronary stenosis, segment involvement score (SIS), segment stenosis score (SSS), and CT-based Leaman score (CT-LeSc) based on CCTA were assessed and compared between the two groups. HT(T2DM+) patients had more coronary segments with calcified plaque (2.08 ± 2.20 vs. 1.40 ± 1.91), mixed plaque (2.90 ± 2.87 vs. 2.50 ± 2.66), nonobstructive stenosis (4.23 ± 2.44 vs. 3.62 ± 2.42), and obstructive stenosis (1.22 ± 2.18 vs. 0.78 ± 1.51), a lower proportion of 1-vessel disease (15.3% vs. 25.5%), a higher proportion of 3-vessel disease (59.6% vs. 46.7%), and higher SIS (5.5 ± 3.1 vs. 4.4 ± 3.0), SSS (10.3 ± 8.5 vs. 7.7 ± 7.1), and CT-LeSc (9.4 ± 5.6 vs. 7.9 ± 5.2) than HT(T2DM-) patients (all P-values <0.05). Multivariable analysis revealed that T2DM was an independent risk factor for calcified plaque [odds ratio (OR) = 2.213], obstructive coronary artery disease (CAD) (OR = 1.271), multivessel disease (OR = 1.838), SIS > 4 (OR = 1.910), SSS > 6 (OR = 1.718), and CT-LeSc > 5 (OR = 1.584) in hypertension population (all P-values <0.05). T2DM was independently associated with the presence of calcified coronary artery plaque and increased the risk of obstructive CAD, multivessel disease, and CT-LeSc > 5 in hypertensive patients. More attention should be given to the assessment and management for coronary atherosclerosis in hypertensive patients with T2DM, as this population may have a higher risk of cardiovascular events.

Gender and race disparities in the prevalence of chronic kidney disease among individuals with hypertension in the United States, 2001-2016.

Chronic kidney disease (CKD) is a common complication among individuals with hypertension. We aimed to identify the prevalence of CKD and the sex and race disparities within the hypertensive population in the United States from 2001-2016. A total of 16,148 participants with hypertension were included, representing 561,909,480 individuals from the U.S. population between 2001 and 2016, as documented in the National Health and Nutrition Examination Survey. The prevalence of albuminuria and CKD stage were assessed using survey-weighted general linear regression analysis. Heterogeneity in the CKD stage among the hypertensive population, stratified by sex and race, was identified through survey-weighted logistic regression analysis. Overall, the prevalence of albuminuria remained stable (p for trend = 0.3196), and changes in the CKD stage were minimal (p for trend > 0.05) from 2001-2016. In the analysis of CKD stage heterogeneity by sex and race, the prevalence of CKD was higher among women than men and higher among individuals of other races combined than non-Hispanic Whites, but the differences were not statistically significant. The overall CKD stage within the hypertensive population plateaued between 2001 and 2016. Our findings highlight the importance of continuous monitoring and potential refinement of renoprotection strategies in individuals with hypertension to mitigate the persistent burden of CKD and address health disparities among different demographic groups.

PREVALENCE OF INSULIN RESISTANCE IN PREDIABETIC PATIENTS WITH HYPERTENSION

stage between normal people and patients with type 2 diabetes mellitus. The pathogenesis is mainly related to insulin resistance (IR). The relationship between IR and hypertension is a complex and multifactorial phenomenon. We examined the prevalence of IR in prediabetic patients with hypertension. Objectives: The present study aimed to determine the incidence of IR according to the HOMA2 model in the group of prediabetes with hypertension, compared with the group of prediabetes without hypertension. Subjects and Methods: The cross-sectional study described and collected data from 191 people with prediabetes from February 2023 to September 2023 at the Examination Department of Cho Ray Hospital. IR was determined by the HOMA2 calculator, using a threshold of 1.29 for IR. Prediabetes and hypertension were diagnosed according to ADA 2022 and ISH 2020 criteria, respectively. Results: The number of subjects selected to analyze the data was 179 patients, including 89 prediabetes patients without hypertension and 90 prediabetes patients with hypertension. The prevalence of IR in the overall prediabetes group was 56.9%. The prevalence of IR in the hypertensive group was 66.7%, higher than the non-hypertensive group at 47.2%, which was statistically significantly different. The values of the index in HOMA2 did not differ statistically significantly between non-hypertensive and hypertensive populations. Conclusions: The prevalence of IR in prediabetes patients with hypertension was 66.7%, greater than the prediabetes patients without hypertension of 47.2%, P = 0.013. Attention should be paid to good control of blood pressure in patients with prediabetes.

Tribal differences in hypertension and cholesterol profiles in Aceh, Indonesia.

One of the factors that contributes to coronary heart disease and stroke is high blood pressure, or hypertension. Hypertension is influenced by race and sex. The objective of this study was to assess the hypertensive population in Aceh by tribal community and to examine the relationship between cholesterol history and hypertension. This study used incidental sampling as a non-probability sampling method, in which 152 participants were evaluated for the profile of hypertension with a history of cholesterol. Blood pressure was measured using a blood pressure measuring device. HDL, LDL, triglyceride, and total cholesterol levels were measured using LIPID Pro. Data analysis was performed using the Kruskal-Wallis and Mann-Whitney tests with p<0.05. The study population (N=152) consisted of 81 males (53%) and 71 females (47%) across the ethnicities of Aceh (64:42%), Gayo (19:13%), Alas (33:22%), and Aneuk Jamee (36:24%). In the male group, hypertension was associated with total cholesterol (r=0.03; p=0.78), HDL (r=0.20; p=0.07), and LDL (r=0.21; p=0.07) levels, whereas in the female group, hypertension was primarily correlated with LDL levels (r=0.20; p=0.09). In general, hypertension in males and females in the four tribes in Aceh is associated with HDL, LDL, and total cholesterol levels.

The relationship between mean corpuscular hemoglobin concentration and mortality in hypertensive individuals: A population-based cohort study.

Hematology is an essential field for investigating the prognostic outcomes of cardiovascular diseases (CVDs). Recent research has suggested that mean corpuscular hemoglobin concentration (MCHC) is associated with a poor prognosis in several CVDs. There is no evidence of a correlation between MCHC and hypertension. Therefore, our study aimed to analyze the association of MCHC with all-cause and cardiovascular mortality in hypertensive patients. We used cohort data from U.S. adults who participated in the National Health and Nutrition Examination Survey from 1999-2014. COX regression was applied to analyze the relationship between MCHC and all-cause and cardiovascular mortality. In addition, three models were adjusted to reduce confounding factors. We reanalyzed the data after propensity score matching (PSM) to inspect the stability of the results. Stratified analysis was additionally adopted to investigate the results of each subgroup. Our research included 15,154 individuals. During a mean follow-up period of 129 months, 30.6% of the hypertensive population succumbed to mortality. Based on previous studies, we categorized patients with MCHC ≤33mg/dl as the hypochromia group and those with >33mg/dl as the non-hypochromia group. After PSM, the hypochromia group had higher all-cause mortality (adjusted hazard ratio [HR]:1.26, 95% confidence interval [95%CI]:1.11-1.43) and cardiovascular mortality (adjusted HR:1.42, 95%CI:1.12-1.80) than the non-hypochromia group. The results of the COX regression remain stable after matching. Stratified analyses before PSM revealed an interaction of anemia in the relationship between MCHC and mortality, whereas there was no significant interaction after matching. In hypertensive individuals, low MCHC was correlated with a poor prognosis. Further studies on MCHC are necessary to analyze the potential mechanisms of its poor prognosis in hypertensive populations.

PREVALENCE AND ASSOCIATED PROGNOSIS OF ELECTROCARDIOGRAPHIC FINDINGS IN HYPERTENSIVE PATIENTS. AN ANALYSIS OF A 5-YEAR FOLLOW-UP STUDY

Objective: Various electrocardiographic abnormalities may be identified in hypertensive patients, but their prognostic significance has not been sufficiently studied. We investigated the presence of diverse ECG findings in a hypertensive population and their predictive ability for cardiovascular disease. Design and method: We studied 1851 white Caucasian hypertensive patients (age 58±12years, 51% females) free of cardiovascular disease for a mean period of 5.3±3.4 years. At baseline, all patients underwent standard 12-lead electrocardiography. Left ventricular hypertrophy (LVH) criteria were assessed using both the Sokolow and the Cornel-Voltage formulas. An interventricular conduction delay (IVCD) was defined as a QRS &gt;110msec in the absence of a bundle branch block (BBB). QRS fragmentation was identified as notches in the QRS complex not related to BBB. The QTc interval was considered prolonged if &gt; 440ms in men and &gt;460ms in women. ST depression was defined as &gt;1 mm in depth. The outcome studied was the incidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke. Results: LVH criteria were fulfilled in 7% with the Sokolow formula and in 5.3% with Cornell Voltage criteria. A prolonged PR was evident in 6.3%. An IVCD, a left BBB and a right BBB were observed in 9%, 4.1% and 1% of the population respectively. QRS fragmentation was identified in 18% of the study population. An early transition zone was found in 30% of the population and a late transition zone in 19%. QTc was prolonged in 9.8% of cases. Prevalence of TWI was 3.8%, of which 39% was anterior TWI, 73% was lateral TWI and 11% was inferior TWI. Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that only prolonged QTc (HR: 1.86, 95% CI: 0.97-3.54, p=0.06) and presence of TWI (HR: 2.6, 95% CI: 1.1-5.9, p=0.025) were associated with the composite endpoint. In multivariate models controlling for standard confounders the association with TWI was overall sustained. Conclusions: Among hypertensive patients without cardiovascular disease, ECG abnormalities are frequent. A prolonged QTc and T wave inversion seem to exhibit prognostic significance for cardiovascular events.

DIAGNOSTIC VALUE OF SERUM IRISIN LEVELS IN HYPERTENSIVE PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA SYNDROME

Objective: To observe the diagnostic value of serum irisin level in patients with hypertension for severe obstructive sleep apnea syndrome. Design and method: A total of 156 hypertensive patients were selected from the Hypertension Center of the People 's Hospital of Xinjiang Uygur Autonomous Region from September 2019 to January 2020. Baseline data, PSG and ABPM were collected and serum irisin levels were measured. According to AHI, the patients were divided into severe OSAS group (n=79 cases) and non-severe OSAS group (n=77 cases). Results: Male patients in severe OSAS group were significantly more than those in non-severe OSAS group, and abdominal circumference and neck circumference in severe OSAS group were greater than those in non-severe OSAS group. Serum irisin concentration in severe OSAS patients was lower than that in non-severe OSAS group, and the difference was statistically significant(14.94 ng/ml vs 42.34 ng/ml, p &lt; 0.001). Serum irisin concentration was negatively correlated with AHI (r=-0.359, p &lt; 0.01). The critical value of serum irisin concentration was 38.07 mg/ml by ROC curve, the AUC is 0.761, the sensitivity was 86.07%, the specificity was 61.07%, the positive predictive value was 69.38%, and the negative predictive value was 81.03%. Conclusions: In hypertensive population, the serum irisin concentration of OSA patients was negatively correlated with the severity of OSAS. Serum irisin level can be used as a diagnostic index for severe OSAS patients.

ASSESSMENT OF HYPERTENSIVE PATIENTS’ COMPLEX METABOLIC STATUS IN THE NORTHEASTERN REGION OF HUNGARY USING DATA MINING METHODS

Objective: Previously, the metabolic status of Central and Eastern European hypertensive adult patients has not been thoroughly explored. Therefore, we aimed to identify the prevalence of hypertension and its associated metabolic abnormalities in a relatively large adult population using data mining methods. Design and method: We analyzed the data of adults who visited the University of Debrecen Clinical Center’s hospital (n = 937,249) by evaluating a period of 20 years (2001-2021). Results: We identified a total of 292,561 adults with hypertension (male/female: 45.4/54.6%), with a 31.2% calculated prevalence of hypertension in the whole study population and a higher prevalence in males (33%) compared to females (29.9%). We found an increasing prevalence in consecutive age groups both in males and females up to the age of 80. The ratio of males with hypertension was higher from 18 to 65 years of age. Markedly higher body mass index (BMI) values were found in hypertensive patients as compared to non-hypertensives (29.5±6.3 vs. 26.57±5.6 kg/m2, p&lt;0.001). A significantly higher triglyceride level was found in hypertensive adults compared to non-hypertensives (1.46 (1.06–2.07) vs. 1.19 (0.82–1.73 mmol/L, p&lt;0.001). We could not find significant differences in total cholesterol and LDL-C levels in the entire patient population (5.1±1.2 vs. 5.0±1.2 mmol/L and 3.1±0.99 vs. 3.1±1.0 mmol/L, respectively). Significantly higher serum glucose levels (5.8 (5.2–6.9) vs. 4.7 (4.6–5.8) mmol/L, p&lt;0.001) were found in subjects with hypertension. Significantly higher urea and creatinine levels were found in hypertensive patients compared to normotensives (5.78 (4.6–7.5) vs. 4.6 (3.7–5.7) mmol/L, p&lt;0.001 and 76 (64–92) vs. 69 (59–81) μmol/L, p&lt;0.001, respectively). Furthermore, we also assessed the rate of significant concomitant diseases in our hypertensive population. Conclusions: The results proved that data mining is an excellent yet not-too-widespread method used to define prevalence in large patient cohorts. This novel way of statistical analysis could be beneficial not only for regional clinical practice but nationwide strategies as well.

PREVALENCE AND PROGNOSTIC VALUE OF T-WAVE INVERSION IN HYPERTENSIVE PATIENTS: A 5-YEAR FOLLOW-UP STUDY

Objective: Data on prevalence and associated prognosis of repolarization abnormalities among hypertensive patients are limited. We investigated the presence and extent of ST-segment and T-wave changes in a hypertensive population and their predictive ability for cardiovascular disease. Design and method: We studied 1851 white Caucasian hypertensive patients (age 58±12years, 51% females) without a history of cardiovascular disease for a mean period of 5.3±3.4 years. At the baseline examination, all patients underwent standard 12-lead electrocardiography. T-wave inversion (TWI) was defined as T-wave deflection &gt; -0.1 mV in &gt; 2 contiguous leads, unless associated with bundle branch block. Anterior, lateral, or inferior TWI was defined as TWI in leads V2-V4 or V5, V6, I, AVL or II, aVF respectively. The depth in millimeters of TWI in each lead was recorded and the maximum depth per location was calculated. ST depression was defined as &gt;1 mm in depth in two or more contiguous leads. During follow-up, patients underwent clinic visits at least yearly for management of hypertension and risk factors. The outcome studied was the incidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke. Results: In the entire population, prevalence of TWI was 3.8%, of which 39% presented with anterior TWI, 73% with lateral TWI and 11% with inferior TWI. ST depression was observed in 3.6% of patients (anterior in 0.8%, inferior in 0.9% and lateral in 2.6%). Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that presence of TWI was associated with a significantly greater risk for cardiovascular events (HR: 2.6, 95% CI: 1.1-5.9, p=0.025). The association was stronger for lateral TWI (HR: 3.3, 95%: CI: 1.34-8.30, p=0.01) compared to other locations. In multivariate models controlling for standard confounders these associations were overall sustained. Depth of TWI and presence of ST depression were not associated with cardiovascular risk. Conclusions: Among hypertensive patients without cardiovascular disease, TWI is infrequent but significantly associated with future cardiovascular events. Lateral TWI carries the worse prognosis.

HYPERTENSION TREATMENT IN LOW-INCOME COUNTRIES BY POSTTRANSLATIONAL MODIFICATION OF ANGIOTENSIN II

Objective: Although hypertension is a worldwide health problem, treatment options in low-income countries are still limited, resulting in high mortality. Therefore, the availability of drugs that are affordable and accessible to patients in low-income countries is still an urgent need. Since angiotensin II is one of the essential vasoconstrictive peptides in the human organism, we analyzed the impact of its posttranslational modification to pyruvamide-Ang II by pyridoxal-5’-phosphate on blood pressure. Pyridoxal-5’-phosphate is a less expensive vitamin B6 derivative and therefore could be a novel, cost-effective drug for the treatment of hypertension. Design and method: The post-translational modification of angiotensin II to pyruvamide-angiotensin II by pyridoxal-5’-phosphate was investigated in vitro by mass spectrometry. Calcium ion influx into vascular smooth muscle cells treated with angiotensin II or pyruvamide-angiotensin II, respectively, was also investigated in vitro. In ex vivo experiments, the vasoconstrictive effect of angiotensin II and pyruvamide-angiotensin II, respectively, was analyzed by using the bioassay of the isolated perfused rat kidneys. Furthermore, angiotensin II and pyruvamide-angiotensin II were investigated in in vivo experiments. Both Wistar Kyoto rats and spontaneously hypertensive rats were treated with pyridoxal-5’-phosphate by using mini-osmotic pumps and the blood pressure was measured time-dependently. Results: Calcium ion influx in vascular smooth muscle cells after stimulation with pyruvamide-angiotensin II was significantly decreased compared to angiotensin II. Perfusion pressure of isolated perfused rat kidney increased less by pyruvamide-angiotensin II than by angiotensin II. The systolic and diastolic blood pressure of spontaneously hypertensive rats treated with pyridoxal-5’-phosphate decreased from 171/139 ± 5 mmHg to 129/98 ± 2 mmHg after three days. The blood pressure of Wistar Kyoto rats treated with angiotensin II increased to 167/133 ± 3 mmHg, while the blood pressure of Wistar Kyoto rats treated with angiotensin II and pyridoxal-5’-phosphate decreased to 129/99 ± 2 mmHg. Conclusions: Pyridoxal-5’-phosphate significantly decreased rat blood pressure and might be a cost-effective drug for hypertension treatment. Respectively, an increased pyridoxal-5’-phosphate intake recommendation in the form of vitamin B6 intake might have a decreasing effect on blood pressure in the hypertensive population.

THE PRONOSTIC VALUE OF NOCTURNAL BLOOD PRESSURE IN UNTREATED ADULT HYPERTENSIVES FROM ALGERIAN POPULATION

Objective: The aim of our work is to study the prevalence of nocturnal blood pressure patterns in our Algerian population of untreated adult hypertensives and its impact on target organ damages. Design and method: We recruited 304 untreated adult hypertensives. All our patients underwent 24-hour ABPM, and the following target organe damages assessment: ACR (urinary albumin/creatinine), echocardiography, fundoscopy, and carotid ultrasound. Our patients were classified according to nocturnal blood pressure into two groups: nocturnal hypertensive (NH: BP&gt; or = 120/70) and nocturnal normotensive (NN: BP&lt;120/70). We carried a descriptive study of hypertension prototypes, followed by an analytic study in search of predictors of target organ damages (cardiac, renal and vascular). Results: The mean age was 46±12 years, with 82% males. The prevalence of patterns according to nocturnal blood pressure were: NH (n=250; 82.2%) vs NN (n=54; 17.3%). In the bivariate analysis, there was a significant difference between two groups for the following damages: cardiac (HN=52% vs NN=34.6; P=0.01), renal (HN=27.5% vs NN=12.8%; P=0.02) and vascular (HN=25% vs NN=2%; P&lt;0.001). On multivariate analysis, indexed LV mass was correlated with waist circumference (B=0.34, P=0.01) and diurnal systolic BP (SBP) (B=1.37; P&lt;0.001). ACR was correlated with glycemia (B=0.33; P=0.002) and nocturnal SBP (B=0.64; P=0.01). Intima-media thickness was correlated with age (B=0.009, P&lt;0.001) and nocturnal SBP (B=0.004, P&lt;0.001). On logistic regression, cardiac damage was correlated with age (OR=1.05; P=0.02), BMI (OR=1.21; P=0.02) and diurnal SBP (OR=1.08; P=0.003). Renal damage was correlated with glycated hemoglobin (OR=1.6; P=0.04). Vascular damage was correlated with age (OR=1.3; P&lt;0.001) and nocturnal diastolic BP (DBP) (OR=1.07; P=0.002). Conclusions: The nocturnal hypertension are prevalent in our population. nocturnal hypertension is a predictor of renal and vascular damages. In contrast, diurnal hypertension is a predictor of cardiac damage. These results confirm the literature data on the prognostic value of nocturnal blood pressure. We suggest an active screening for nocturnal hypertension by using ABPM in the hypertensive population with high cardiovascular risk.

Knowledge, attitudes, and practices (KAP) regarding intra-abdominal pressure monitoring among pediatric intensive care nurses: A cross-sectional study

ObjectivesThis study aimed to assess the knowledge, attitudes, and practices (KAP) and the training requirements of pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, in order to provide a reference for the development of relevant training programs and operational procedures in clinical practice. MethodsThis descriptive cross-sectional survey was conducted from April 2023 to June 2023. A convenience sample was created by recruiting 212 pediatric intensive care nurses in eight hospitals in Zhejiang Province. A self-developed IAP monitoring KAP assessment tool was used for evaluation, which included knowledge (14 items), attitude (6 items), and practice (8 items), three dimensions, 28 items. ResultsThe overall KAP score was 60.73 ± 8.35; the knowledge score was 7.84 ± 2.35, with a scoring rate of 56.0%; the attitude score was 25.16 ± 3.23, with a scoring rate of 83.9%; and the practice score was 28.44 ± 6.46, with a scoring rate of 69.3%. Nurses wh-o have received IAP monitoring training have higher KAP score, knowledge score and practice score than those who have not received it (P < 0.05). Nurses aged ≤ 30 showed better knowledge of IAP monitoring than those aged > 30 (P < 0.05). Among the participants, 55.7% of the nurses believed the current knowledge was insufficient to perform IAP measurement effectively. Difficulty in identifying the high-risk population of intra-abdominal hypertension (IAH) (64.6%), unfamiliarity with the operation process of IAP measurement (55.6%), and unreasonable nurse-patient ratio allocation (52.8%) were the main obstacles for nurses to monitor IAP. ConclusionsPediatric intensive care nurses have a positive attitude towards IAP monitoring, but the knowledge level and practical behavior still need to be strengthened. In particular, the knowledge of published consensus definitions, measurement techniques, and frequency for IAP monitoring is inadequate. It is necessary to implement tailored IAP monitoring training based on their training needs and potential obstacles to promote the standardization and scientificity of IAP monitoring.