Hypertension Medication Research Articles

Impact of health information exchange access on medication management recommendations in a community-based pharmacy setting

BackgroundCommunity-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a health information exchange (HIE) on pharmacist recommendations during a medication management encounter. ObjectiveThe objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE. Practice descriptionMoose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE. Practice innovationThis cohort study reviewed data over 4 months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel used the HIE to acquire laboratory test results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication or disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow-up with the patient or provider was determined, if needed, and documented. Evaluation methodsCollected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results. ResultsThirty-four encounters were included. Most participants had diabetes (n = 21, 62%) and hypertension (n = 31, 91%). Nearly one-third of encounters (n = 11, 32%) resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n = 4, 36%), diabetes medication changes (n = 3, 27%), and statin initiations/escalations (n = 4, 36%). Four recommendations (36%) were accepted, with 1 requiring modifications from the provider; 3 recommendations (27%) were declined; and 3 recommendations (27%) were unanswered. ConclusionAccess to progress notes and laboratory values using an HIE enhanced the pharmacist’s ability to provide enhanced patient care recommendations during medication management consultations.

IJCM_195A: Prevalence of Drug Adherence Among Hypertensive Patients attending Primary Health Centre - A Cross sectional Study

Background: There is an increase in prevalence of hypertension 31.5% in urban and 26.2% in rural dwellers of Tamil Nadu (ICMR-INDIAB study). Adherence to hypertension medication is very important for improving the quality of life and preventing complications. In this study we aim to estimate the drug adherence among hypertensive patients using Morisky Medication Adherence Scale. Objectives: To estimate the prevalence of drug adherence and its influencing factors among hypertensive patients in Rural Health Training Centre areas of Madras Medical College. Methodology: 180 Hypertensive patients attending Non-Communicable Disease clinic from two rural health centres 90 patients from each Padiyanallur PHC and Medavakkam PHC were recruited for the study. In this study we have used The Morisky Scale MMAS-4 to address medication adherence. Results: Study results showed that 32.62% of hypertensive patients had high adherence to antihypertensive medications,53.48% patients had medium adherence whereas 13.9% patients had low adherence. Adherence to drug is higher among females (36.9%) than males (29.1%). Patients with low to medium adherence to antihypertensive drugs are having more than 10% risk of developing cardiovascular disease (OR – 3.6, 95% CI – 1.86 to 6.75) than their counterpart. Patients with good knowledge (42%) had high adherence than people with poor knowledge (24.2%) Conclusion: The study reported only 32.62% were found to be adherent to antihypertensive medications. To ensure high level of control among hypertensive sustained and focussed interventions should be implemented at all levels of health care.

Arabic translation and cultural adaptation of Hill-Bone compliance to high blood pressure therapy scale

BackgroundAdherence to prescription medications is vital to the success of any treatment plan, especially for chronic health conditions, such as hypertension (HTN). Although there are different scales used in assessing adherence to prescription medications, most if not all, of those scales are not available in Arabic. The absence of essential assessment tools makes the appraisal of adherence to prescription medications very difficult for native Arabic speakers. Therefore, this study aimed to translate and validate the Hill-Bone Compliance to High Blood Pressure Therapy (CHBPT) scale, which is commonly used to assess adherence to antihypertensive medications, among a sample of Arabic-speaking patients with HTN. MethodsThis was a single-center cross-sectional study that took place at a university-affiliated hospital. It interviewed adult (≥18 years) patients with HTN who were visiting the primary care clinics between January and November 2020. Non-Arabic speakers, those under 18 years of age, individuals without a diagnosis of HTN, and patients without any previously filled prescription medications for HTN within the past three months were excluded. The forward–backward translation method was used after receiving permission from the originators of the questionnaire to translate their scale to Arabic. Test-retest and Cronbach alpha methods were used to assess the reliability. Principal component analysis with varimax rotation was used to examine the construct validity. ResultsOne hundred and forty-one patients consented and participated in the study. Most of the patients were ≥ 50 years old (75 %), male (72 %), and had another chronic health condition besides HTN (99 %). The translated scale had good internal consistency (Cronbach alpha = 0.83) and reliability (intraclass correlation coefficient of 0.9). The Kaiser-Meyer-Oklin was 0.82 indicating adequate sampling to conduct factor analysis; hence, three factors (e.g., subscales) were extracted similar to the original scale. The mean scores for appointment keeping, medication taking, and reducing sodium intake subscales, as well as for the overall scale were 5.62 ± 1.39, 33.94 ± 3.87, 9.73 ± 2.1, and 49.29 ± 5.21, respectively. ConclusionThe translated version of the Hill-Bone CHBPT scale has both good reliability and validity and will hopefully help healthcare providers assess and monitor HTN patients’ adherence to their antihypertensive medication regimens. Multicenter studies should be conducted to verify the validity and reliability of the translated questionnaire among different Arabic-speaking patient populations with HTN.

Hypertension Medication and Medicare Beneficiaries: Prescription Drug Coverage Satisfaction and Medication Non-Adherence among Older Adults.

Hypertension is so prevalent and requires strict adherence to medications to prevent further disease or death, but there is no study examining factors related to prescription drug non-adherence among 65 years old and older. This study aims to assess the likelihood of medication nonadherence among patients based on factors such as age, race, and socioeconomic status, with the goal of identifying strategies to enhance medication adherence and mitigate associated health risks. Using the 2020 Medicare Current Beneficiary Survey Public Use File to represent nationwide Medicare beneficiaries (unweighted n = 3917, weighted n = 27,134,782), medication non-adherence was related to multiple independent variables (i.e., age, sex, race/ethnicity, socioeconomic status, comorbidities, insurance coverage, and satisfaction with insurance). Cross-tabulations and Wald chi-square tests were used to determine how much each variable was related to non-adherence. Multivariate logistic regression was used to examine the association between medication non-adherence and factors such as prescription drug coverage satisfaction and cost-reducing behavior. Specific trends in medication non-adherence emerged among beneficiaries. Non-adherence was higher in older adults aged 65- to 74-year-olds and those with more chronic conditions (OR = 2.24; 95% CI = 1.74-2.89). If patients were dissatisfied with the medications on the insurance formulary or struggled to find a pharmacy that accepted their medication coverage, they had worse adherence (OR = 2.63; 95% CI = 1.80-3.84). Formulary and coverage must be expanded to improve adherence to antihypertensive medications in Medicare beneficiaries. Older adults aged 65 to 74 years may be less adherent to their medications because they do not see the seriousness of the disease and could benefit from further counseling. Patients with limited activities of daily living and more comorbidities may struggle with complex treatment regimens and should use adherence assistance tools.

Predicting the Intention to Adhere to Hypertensive Medication among Seniors: A Cross-Sectional Survey

Non-adherence to hypertension treatment is a wide problem, especially among senior citizens. Several approaches are needed to improve adherence, including identifying and prioritizing problems related to adherence. A formative study employing Theory of Planned Behavior (TPB) has revealed some salient beliefs underlying the intention to adhere to hypertension medication among seniors. To be the priority in a medication adherence strategy, the correlation of these beliefs on adherence needs to be further investigated. This study aims to determine which beliefs correlate most to the intention to hypertension medication adherence among seniors. A cross-sectional survey was conducted to seniors with hypertension in Yogyakarta and its surroundings. A questionnaire based on TPB was developed and utilized in this study. The questionnaire was distributed conveniently through two senior communities (offline) as well as Google Form link to some WhatsApp group of seniors (online) during September-October 2023. The data were analyzed using multiple linear regressions. Thirty-seven seniors completed the offline questionnaire, and 60 seniors completed the online questionnaire. The age of participants was 64.70 ± 7.123 years. Subjective norms and perceived behavioral control accounted significantly (p<0.001) for 59,3% of the variance in the adherence intention, but not attitude. Perceived behavioral control had the strongest correlation on intention. Participants’ beliefs of knowing how high their blood pressure was had the highest correlation to perceived behavioral control. Understanding which belief correlates most with intention to adherence provides insight to develop strategy to improve adherence among seniors.

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

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

Abstract P179: Association Between Serum Metabolites and Carotid Atherosclerosis Among Japanese Men

Background: Complex metabolic pathways may exist for atherosclerosis. We examined metabolomic signatures that reflect mechanistic pathways associated with carotid atherosclerosis in apparently healthy men. Methods: A cross-sectional study was conducted in 675 Japanese men (46-83 years) from the SESSA Study (2010-2014). A total of 468 serum metabolites were quantified by liquid chromatography mass spectrometry. The mean intima-media thickness (IMT) and total number of plaques from carotid arteries were measured using B-mode ultrasound. All metabolites were standardized prior to the analysis. We used partial least square regression and variable importance projection (VIP) method to extract the principal metabolites most associated with the mean IMT and total number of plaques. We used a multivariable linear model for the log-mean IMT and a multivariable Poisson model for the total number of plaques to assess the association between individual extracted serum metabolites and carotid measures. Each metabolite multivariable model adjusted for age, body mass index, smoking and drinking status, medications for hypertension, diabetes and dyslipidemia, and systolic blood pressure, high- and low-density lipoprotein cholesterols and hemoglobin A1c. We used false discovery rate adjusted p-values to control for multiple testing. Results: The average mean IMT and total number of plaques were 0.80 mm (SD: 0.16) and 2.06 (range: 0-14), respectively. There were 191 metabolites with a VIP value of one or higher for mean IMT. None of these metabolites was significantly associated with the log-mean IMT. On the other hand, there were 209 metabolites with a VIP value of one or higher for the total number of plaques. Among them, SulfoHexCer(d18:2/24:0(OH)) and SulfoHexCer(d18:2/16:0(OH)) had an inverse association with the total number of plaques (Figure 1). Conclusion: We identified distinct metabolites associated with the total number of plaques. The results suggest an important role of sphingolipids in carotid plaque formation.

Abstract P309: Health-Harming Legal Needs Are Associated With Blood Pressure, Quality of Life, and Utilization

Background: Health-harming legal needs (HHLNs) significantly contribute to stress and have been linked to chronic disease burden in low-income populations. Medical-legal partnerships (MLPs) target HHLNs by embedding legal services within clinics. The impact of HHLNs on chronic disease, quality of life, and utilization is uncertain. This study sought to determine whether presence of and the number of HHLNs is associated with high blood pressure, worse quality of life, and higher healthcare utilization rates. Method: This is a cross-sectional study of a MLP program involving a federally qualified health center and non-profit legal services organization. The evaluation included all individuals, 18 years old and above, who received care at the clinic and were screened for HHLNs. All patients were offered HHLN screening (23-items) between March 2021 and December 2022. Blood pressure status was measured by two approaches: 1) the presence of hypertension diagnostic codes or anti-hypertensive medication, 2) the most recent mean arterial pressure (MAP). Quality of life was assessed using the number of unhealthy physical or mental days in a month. Participants reported the number of urgent care, emergency department (ED), and hospital visits over the prior 12 months. Using an available case analysis approach and logistic regression, we assessed the association between the total number and individual HHLNs and the presence of hypertension diagnoses or medications. For MAP, unhealthy days, and utilization, we used linear and negative binomial regression models. Results: Four hundred seventy-five participants completed surveys. Nearly half (198; 41.7%) reported at least one HHLN. There were no differences in HHLN reported across demographic groups. The number of HHLNs was associated with having a diagnosis of or medication for hypertension (OR=1.08, p=0.049) but was not associated with MAP (coeff=0.098, p=0.596). The number of HHLNs was similarly associated with more unhealthy physical (coeff=0.150, p=0.015) and mental days (coeff=0.157, p=0.002). More HHLNs were also associated with higher urgent care (coeff=0.252, p<0.001) and ED utilization (coeff=0.181, p=0.014) but not hospitalizations (coeff=0.099, p=0.150). Hypertension was found to be associated with individual HHLN: income issues, losing health insurance, immigration applications, food insecurity and housing instability (all p<0.05) over other needs. Several more HHLNs were associated with physical and mentally healthy days in past month (all p<0.05). Multiple relationships persisted after controlling for demographics. Conclusions: The number of HHLNs and several specific legal needs are associated with hypertension, higher unhealthy physical and mental days, and higher urgent care and emergency department utilization. In future studies, we will study the longitudinal outcomes of HHLNs that are addressed by the MLP.

Abstract 42: Metabolite Risk Scores of Lifestyle Measures Improve Incident Hypertension Prediction

Introduction: Metabolites capture the metabolic environment associated with exposures. Objective: To develop and assess the usefulness of metabolite risk scores (MRSs) as biomarkers representing exposure measures. Methods: We used two separate sets of individuals sampled from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Both sets of individuals had metabolite data measures on the Metabolon HD4 platform. We applied the least absolute selection and shrinkage operator (LASSO) to develop MRSs for current smoking, physical activity, Mediterranean diet, and anxiety in set 1 (n=2,178), cross-sectionally, and evaluated them for replication in set 2 individuals (n=4,002). We defined hypertension as SBP140, DBP90, or hypertension medication use, and estimated MRS associations with incident hypertension longitudinally (6 years after the baseline exam, on average) in set 2 individuals free of hypertension at baseline (426 cases and 1,556 controls). The association models were adjusted for age, sex, and BMI. We compared the estimated association with those of self-reported phenotypes. Results: All MRSs were developed in set 1 individuals have replicated associations in set 2 individuals. The figure provides the estimated association of MRSs for diet, smoking, physical activity, and anxiety with incident hypertension and compares them to the associations of self-reported Mediterranean diet, anxiety measured using the Spielberger trait anxiety scale, pack-years of smoking, and self-reported physical activity in MET-min/day. All associations are per 1 SD increase in the exposure measure. The figure shows that the MRS associations are often stronger than those of the self-reported measure. Conclusions: MRSs have the potential to serve as accurate biomarkers of self-reported exposures.

Abstract P540: Sleep Duration, Rapid Eye Movement Sleep, and Subclinical Myocardial Damage

Introduction: Sleep is strongly linked to clinical cardiovascular disease and was added in 2022 to the AHA’s Life’s Essential 8. Optimizing sleep duration and quality may reduce the risk of cardiovascular disease. Few studies have examined self-reported sleep duration and percent time in rapid eye movement (REM) sleep measured by single night in-home polysomnography with high sensitivity cardiac troponin T (hs-troponin T), a biomarker of subclinical cardiovascular disease. Methods: We conducted a cross-sectional study of adults without a history of cardiovascular disease who participated in both the Atherosclerosis Risk in Communities (ARIC) Study and the Sleep Heart Health Study (SHHS) in 1995-1998. We used linear regression with sleep duration and percentage time of REM sleep modeled as predictors with restricted cubic splines and examined associations with the outcome, hs-troponin T. We adjusted for age, sex, body mass index, waist-to-hip ratio, alcohol intake, smoking status, systolic blood pressure, hypertension medication use, diabetes, HDL- and LDL-cholesterol, and cholesterol-lowering medication use. Results: Among 1,587 participants (mean age 63, 54% female), the mean sleep duration was 7.3 hours, and mean % REM time was 20.7. Sleep duration was not associated with hs-troponin T ( Figure, Panel A ). However, percentage REM sleep was negatively associated with hs-troponin T, but with a threshold effect; there was a negative linear association of hs-troponin T with % REM sleep but only at values <15% ( Figure, Panel B ). Conclusion: While self-reported sleep duration was not associated with TnT levels, there was evidence that low % REM sleep, a specific neurophysiological sleep state, was associated with subclinical cardiovascular disease. These findings suggest that multiple sleep dimensions should be considered in efforts to optimize cardiovascular health.

Abstract P436: Pre-Diabetes With and Without Cardiac Dysfunction and the Risk of Heart Failure in Older Adults

Background: Whether pre-diabetes (pre-DM) is independently associated with the risk of heart failure (HF) in the elderly remains inconclusive. Objective: To examine the prevalence of cardiac dysfunction in pre-DM and the prognostic differences of HF in pre-DM with and without cardiac dysfunction in a diverse elderly population. Methods: We included HF-free individuals with euglycemia (n=770) or pre-DM (n=2157) who underwent echocardiography at the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 (baseline). A composite cardiac dysfunction measure included ≥2 echocardiographic abnormalities (Left ventricular hypertrophy [LV mass index ≥115 g/m 2 in men or≥95 g/m 2 in women], left atrial enlargement [LA volume index ≥34 mL/m 2 ], diastolic dysfunction [E/e’ >13, E/A>2, or E-wave deceleration time >240 ms], and systolic dysfunction [ejection fraction<45%]) and high NT pro-BNP (>125 pg/mL in obese or >100 in non-obese). Our outcome was a new diagnosis of definite or probable acute decompensated HF. We assessed the prevalence of the composite cardiac dysfunction in pre-DM (fasting glucose 100-125 mg/dL or HbA1c 5.7-6.4%) and the association between pre-DM and incident HF with and without cardiac dysfunction at baseline adjusting for age, sex, race, center, education, smoking, BMI, systolic blood pressure, total cholesterol, hypertensive medication, lipid-lowering medication, and eGFR (CKD-EPI) in the Cox regression models. Results: 9.5% of elderly individuals with pre-DM had cardiac dysfunction. In a median follow-up of 7 years, compared to euglycemia without cardiac abnormalities, we found a significant risk of HF in pre-DM with cardiac dysfunction (HR 2.6, 95% CI 1.6-4.5) but not in pre-DM without cardiac dysfunction (0.8, 0.5-1.2). The finding was consistent in sex and race groups and sensitivity analyses excluding those with a history of hypertension or obesity. Conclusion: Pre-DM is associated with an increased risk of HF in elderly people, but the risk was only significant among those with cardiac dysfunction.

Abstract 44: Soluble CD14 and Risk of Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: Black adults in the U.S. experience a greater burden of systemic inflammation and cognitive impairment and dementia compared with White adults. Increasing evidence suggests peripheral inflammation is a risk factor for cognitive decline, however few longitudinal studies have investigated these relationships. CD14 is a pattern recognition receptor expressed by monocytes and macrophages that promotes inflammation. Concentrations of the soluble form of CD14 (sCD14) vary by race, and higher sCD14 was associated with incident coronary heart disease (CHD) and stroke in Black but not White participants in the REGARDS cohort study. We hypothesized higher sCD14 would also be more strongly associated with incident cognitive impairment (ICI) in Black compared to White adults. Methods: We performed a nested case-control study of ICI in the REGARDS study, a biracial cohort of 30,239 American adults ≥45 years old. Cases were 495 participants without cognitive impairment or stroke at baseline who developed ICI during a median 3.5 years of follow-up based on abnormal scores on ≥2 of 3 cognitive tests. 587 controls were selected from a cohort random sample and free of cognitive impairment or stroke at baseline. Logistic regression models estimated odds ratios (OR) of ICI by concentration of sCD14 measured from stored baseline serum samples. We tested for a sCD14-by-race interaction a priori. Results: The sCD14-by-race interaction term was statistically significant in each model (p-interaction <0.05). In analyses stratified by race, adjusting for demographic factors (age, sex, and region), a 1-SD increment sCD14 was associated with a 40% higher odds of ICI among Black adults (OR: 1.40; 95% CI: 1.07, 1.95) with no association among White adults (OR: 1.08; 95% CI: 0.90, 1.28). In models adjusted for cognitive and vascular risk factors (income, education, systolic blood pressure, hypertension medication use, dyslipidemia, BMI, history of heart disease, atrial fibrillation, diabetes, smoking, and alcohol use), the relationship was attenuated in Black participants (OR: 1.33; 95% CI: 0.96, 1.84) and remained null among White participants (OR: 0.99; 95% CI: 0.81, 1.22). Comparing those with sCD14 concentration >90th percentile to below, adjusted for risk factors, Black participants had a 2.47 (95% CI: 1.08, 5.67) higher odds of ICI with no association in White participants (OR: 0.91; 95% CI: 0.46, 1.80). Discussion: Higher sCD14 was associated with ICI risk in Black but not White adults, similar to prior observations for stroke. Results suggest that sCD14-associated inflammatory responses may be a risk factor for ICI among Black adults.

Abstract P253: Lifetime Risk of Dementia by Midlife Vascular Risk Factor Burden: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Vascular risk factors play an important role in the development of dementia and death over the lifecourse. However, no absolute lifetime risk of dementia by individual and composite number of vascular risk factors have been reported. Methods: We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study. We examined the associations of vascular risk factors with incident dementia. Risk factors were measured at visit 2 (1990-1992) and included hypertension (SBP140mmHg, DBP90mmHg or medication use), diabetes status (self-reported physician diagnosis, medication use or HbA1C6.5%) and smoking status. Incident dementia was ascertained via active surveillance involving cognitive function assessments, informant reports, hospitalization codes and death records. We performed survival analysis using age as time scale and accounted for death without dementia as a competing event. We used age 60 as the origin and age on December 31 st , 2019, as the administrative censoring endpoint. Results: Among 13,161 participants, 45%, 40%, and 15% had 0, 1 and 2+ risk factors. There was a dose-dependent association between number of risk factors and the cumulative incidence of dementia (Figure A) and death (Figure C) . In competing risk models ( Figure B ), the cumulative incidence of dementia (95% CI) in persons with 0, 1 and 2+ risk factors by age 80 was 7.5% (6.6-8.5%), 10.3% (9.2-11.5%) and 13.7% (11.5-15.7%). By age 90, due to higher risk of mortality among those with vascular risk factors, the dementia risk (95% CI) for 0, 1 and 2+ risk factors were 34.8 (32.3-37.3%), 31.2% (29.0-33.2%) and 26.7% (23.9-29.6%). Conclusion: Preventing vascular risk factors in midlife may substantially reduce the age-specific risk of dementia. However, since fewer risk factors also lead to longer survival to oldest ages where dementia risk is very high, reducing lifetime risk of dementia beyond age 90 years will require additional preventative strategies. Figure: Cumulative incidence of dementia using Kaplan Meier estimator (A), using cumulative incidence function with competing risk of death (B), and cumulative incidence of death (C), according to the number of vascular risk factors in mid-life.

Abstract MP09: Population Level 24-Hour Urinary Sodium and Potassium Associations With Blood Pressure Differs by Sex: Findings From the New York City Heart Follow-Up Study 2010 and 2018

Introduction: Hypertension (HTN) is a leading cause of heart disease and stroke amongst New York City (NYC) residents, with notable sex-based disparities in prevalence and cardiovascular (CV) outcomes. While prior 24-hour urinary population-based studies in other populations have shown that the association between sodium and potassium and blood pressure (BP) is primarily driven by hypertensive adults, the studies did not adequately evaluate how these associations may differ by sex. Hypothesis: Our study examined whether the relationship between sodium, potassium, and the sodium/potassium ratio and BP varies significantly by sex assigned at birth, stratified by HTN status, in the NYC population. Methods: The Heart Follow-Up Study (HFUS) is a cross-sectional survey conducted in 2010 and 2018 among NYC residents ages 18 and older. Study data included BP measurements, sodium and potassium urinary analytes, and self-reported information about CV health. Analyses were based on 1,606 and 2,327 participants, respectively, and weighted to the NYC population. HTN was defined as per the National Health and Nutrition Survey criteria: systolic BP≥140, diastolic BP≥90, or current use of HTN medication. We applied t -tests to detect differences in mean age-adjusted electrolyte excretions between hypertensive and normotensive adults, stratified by sex. Furthermore, we used multivariable linear regression models, which included sex as an interaction term, to assess the association between sodium and potassium intake and BP at the two time points, and to evaluate potential effect modifications by sex. Results: In 2018, we observed no substantial difference between the mean age-adjusted 24-hour urinary excretion of sodium, potassium, and sodium/potassium ratio and HTN status among NYC males or females ( p >.05). From multivariable models, we observed a consistent positive association between sodium/potassium ratio and mean BP in normotensive males; the relationship was stronger in 2010 (2.060, 95% CI: 0.865-3.255) compared to 2018 (0.312, 95% CI: 0.101-0.523). However, this association was not evident in normotensive females at both time points. We did not observe a consistent association between sodium, potassium, and sodium/potassium ratio and BP within the HTN group in males or females at either time point. Conclusions: The association between sodium/potassium levels and BP differs by sex. This association was evident exclusively in normotensive males, although we noted that the magnitude of this association was smaller in 2018 than in 2010. This suggests that sodium/potassium excrement may be a stronger indicator for BP variations within this subgroup. Recognizing that sex-based variations exist, our results suggest conducting intra-sex analysis to better understand CV health disparities and develop tailored public health strategies that will reduce adverse CV outcomes.

Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama

Background: CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes. Methods: The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose>200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates. Results: In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p<0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control. Conclusion: There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.

Abstract P307: Differences in Cardiovascular Disease Burden, Screening, Education, and Care by Clinic Type in the 2022 Health Center Patient Survey (HRSA)

Background: Persons experiencing homelessness (PEH) have a 2-3-fold risk for cardiovascular disease (CVD) mortality. Evidence has repeatedly shown elevated chronic disease burden, reduced access to care, and lower utilization of medication to control CVD risk factors in this setting. Migrant communities also experience reduced access to care and the impacts from deferring care. There are targeted, federally-funded health clinics in place for both settings. However, these systems are frequently overwhelmed and limited by their scope of care to primary care. There is scarce evidence on differences between access, quality, and experiences of care delivered relative to other safety-net models. Method: The 2022 Health Center Patient Survey (HCPS) was collected on behalf of the Health Resources and Services Administration (HRSA). The HCPS is a nationally-representative, three-staged, sample-based survey collected via 1:1 interviews with clinic patients. The survey assessed sociodemographics, health conditions and behaviors, access to and utilization of care, and patients’ experiences with comprehensive services they received at HRSA-funded health centers, including: community health centers (CHC), healthcare for the homeless (HCH) clinics, migrant health centers (MHC), and public housing primary care (PHPC) clinics. A total of 103 unique awardees and 318 health center sites were recruited, and 4,414 patient interviews were completed. Investigators analyzed patient characteristics and multiple survey items related to AHA’s Essential 8 metrics for differences across clinic type. Results: MHC and HCH clinics had fewer elderly patients (~7%) than CHC and PHPC clinics (~17%). There were differences across sex, race, and ethnicity across all four clinic types. Cardiovascular disease history ranged from 4.9% (MHC) to 14.7% (HCH). Reported 7-day physical activity measures, average sleep below 7 hours per day, and Lifetime smoking (>100 cigarettes; OR=4.2, p<0.001) were all greatest among HCH patients. Fewer HCH and MHC patients reported ever having or recent lipid tests (both p<0.001). HCH patients were more likely to report hypertension (p=0.003), but less likely to report receiving nutrition advice (all p<0.05). MHC patients were less likely to be prescribed hypertension medication (p=0.044) and HCH patients were less likely to be taking medication even if it was prescribed (p<0.001). Adjustment for differences in age or CVD history were able to explain some observed differences, but increased the magnitude of other disparities. Conclusion: CVD burden differs across the various HRSA funding mechanisms for clinics, as do demographics and multiple metrics of health behaviors and biomarkers of cardiovascular health. Greater disease burden in HCH and MHC patients is likely compounded by increased risk factors and under performance in providing health education interventions.

P-selectin and C-reactive protein in relation to home blood pressure and coronary calcification: a SCAPIS substudy.

Soluble P-selectin (sP-selectin) and high-sensitivity C-reactive protein (hsCRP) have previously been associated with hypertension, but the relation with out-of-office blood pressure (BP) and coronary artery calcification score is unknown. We aimed to examine the relationship between sP-selectin, hsCRP and home BP, as well as coronary artery calcification score and carotid artery plaques. In the Swedish CArdioPulmonary bioImage Study (SCAPIS), 5057 randomly selected participants were evaluated with office and home BP using the semi-automatic Omron M10-IT device. For this cross-sectional study, participants with sP-selectin <4 standard deviations above mean and hsCRP <5 mg/l, representing low-grade inflammation, were included. Using generalized linear models, these inflammatory markers were evaluated in relation to BP classifications, as well as coronary artery calcification score and carotid artery plaques. Of participants, 4548 were included in the analyses. The median age was 57.2 (53.4-61.2) years, and 775 (17.0%) reported taking medication for hypertension. Participants in the highest quartile of sP-selectin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.40-1.98, P < 0.001] and hsCRP [OR 2.25, (95% CI 1.89-2.60), P < 0.001] were more likely to have sustained hypertension. Participants in the highest quartile of hsCRP were also more likely to have masked hypertension, OR (95% CI) 2.31 (1.72-3.10), P < 0.001 and carotid artery plaques, OR (95% CI) 1.21 (1.05-1.38), P = 0.007. Increased sP-selectin and hsCRP were independently associated with sustained hypertension. These findings indicate an association between hypertension and platelet activity, as expressed by sP-selectin.

Unravelling the Enigma: A Study on Exploring the Idiopathic Surge in Serum Alkaline Phosphatase Level

A 73 year old Indian female with type O blood group came for routine checkup when it was discovered she had elevated levels of serum alkaline phosphatase (600 mg/dL). Other liver function tests were within normal limits. Abdominal imaging revealed grade I fatty liver but an extensive serological search for significant hepatobiliary disease was negative. She is currently under medication for diabetes and hypertension, association with raised enzyme level couldn't be interpreted due to paucity of testing.

Discontinuation of blood pressure–lowering, glucose–lowering, and lipid–lowering medications after bariatric surgery in patients with morbid obesity: a nationwide cohort study in South Korea

BackgroundLimited evidence exists on the patterns of medication use for hypertension, diabetes mellitus (DM), and dyslipidemia after bariatric surgery among Asian patients. ObjectivesTo investigate the patterns in the use of blood pressure–lowering, glucose-lowering, and lipid-lowering medications following BS in Korean patients with morbid obesity. SettingThis study is a retrospective cohort study using the Health Insurance Review and Assignment claims database of South Korea (from 2019 to 2021). MethodsWe included patients who underwent BS between 2019 and 2020 in South Korea. We evaluated the treatment patterns of blood pressure–lowering, glucose-lowering, and lipid-lowering medications at 3-month intervals for 1-year following BS, including medication use, individual medication classes, and the number of medications prescribed. Furthermore, we estimated remission rates for each disorder based on patient characteristics by defining patients who discontinued their medications for at least 2 consecutive quarters as remission. ResultsA total of 3810 patients were included in this study. For 1-year following BS, a marked decrease in the number of patients using blood pressure–lowering, glucose-lowering, and lipid-lowering medications was observed. The most remarkable decrease occurred in glucose-lowering medications, which decreased by approximately −75.1% compared with that at baseline. This tendency was consistently observed when analyzing both the number of medications prescribed and the specific medication classes. Regarding remission rates, patients who were female, younger, and received the biliopancreatic diversion-duodenal switch as their BS showed a relatively higher incidence of remission than other groups. ConclusionsBS was associated with a decrease in the use of medications for hypertension, diabetes mellitus (DM), and dyslipidemia.

Nanostructured dendrimer improves the solubility of carvedilol, furosemide and nimodipine

Essential hypertension has been treated for over 30 years using both diuretics and beta-blockers. When it comes to treating heart failure, there are three different generations of beta-blockers that are now in use. Carvedilol is a blocker from the third generation. Nimodipine is a common L-type calcium channel blocker. The hypertension medication furosemide is a loop diuretic. This class of medications' low solubility in water has emerged as a serious obstacle in the pharmaceutical industry's pursuit of better treatments. A novel class of polymers called dendrimers has recently gained a lot of interest due to its impressive solubility-enhancing characteristics. Results from hemolysis studies and cytotoxicity tests using the novel nanostructure dendrimer shown here demonstrate superior performance of synthetic dendritic macromolecules compared to commercially available PAMAM dendrimer. Dendrimers are used to enhance the solubility of nimodipine, furosemide, and carvedilol up to 38.08µg/ml, 70.999µg/ml and 147.065µg/ml respectively. The enhancement of dendrimer-mediated solubility is primarily determined by factors such as dendrimer concentration and generation size. Drugs containing dendrimers may be studied using Fourier-transform infrared spectroscopy. Based on the results of this investigation, nanostructured dendrimer technology may help with hydrophobic medication dispersion.