Hypertensive Outpatients Research Articles

DRUG COST OF OUTPATIENT TREATMENT FOR HYPERTENSION AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: Hypertension is a common disease in the world as well as in Vietnam, a great threat to human health. With the number of people suffering from hypertension constantly increasing, the cost of treatment for this chronic disease is a dilemma that not only affects patients directly, but also a burden to society. The study was conducted to contribute to the analysis of the current outpatient drug costs for hypertensive patients. Materials and method: Conducted restropective study. Data was collected outpatient drug payment information for hypertensive patients in 2018. There were 1805 outpatient treatment sessions from 1-6/2018 included in the analysis. Results: The average drug cost of an outpatient treatment course for hypertension is 339,088 ± 257,021 VND. Imported drugs accounted for 80.69% of the total cost and 90.48% of the outpatient treatment course. The cost of antihypertensive drugs accounted for 38.21% of the total drug cost, and the drugs with the highest cost were brand-name drugs. Conclusion: The average drug cost of the treatment course of hypertensive patients with complications/comorbidities was significantly higher than that of patients with hypertension alone. Imported drugs and brand-name drugs account for a large proportion of drug costs for hypertensive outpatients. Key words: drug cost, hypertension, outpatient, Hue University of Medicine and Pharmacy Hospital.

Cost consequences analysis of hypertensive outpatients: a study in a private hospital in Yogyakarta special province

Background: Hypertension is a chronic disease that requires long-term treatment and has an impact on the cost of treatment. The costs will be greater given the loss of productivity, family burden, and social life impacted by hypertension based on patient’s perspective. Objective: The purpose of the study was to determine the costs and clinical outcome of antihypertensive therapy from the patient's perspective and to identify the discrepancies between the costs and the INA-CBGs (Indonesia Case Based Groups) tariff. Methods: The research was an observational study with a cross-sectional design. The targeted population was outpatients who had received antihypertensive therapy for at least 1 month at a private hospital in Yogyakarta. The costs included direct medical costs, direct non-medical costs, and indirect costs, while the clinical outcomes were patient’s blood pressure. The descriptive analysis was carried out to describe the characteristics of the research subjects, the clinical outcome, and the cost. Analysis of the discrepancies between the costs and the INA-CBGs tariff used the Mann-Whitney test and One-Sample t-test. Results: The results showed that the average direct medical costs, direct non-medical costs, and indirect costs from the patient’s perspective were IDR359,408.00, IDR24,617.00, and IDR 40,583.00, respectively. There was a significant difference between the real costs and the rate of INA-CBGs based on the results of statistical tests, while the cost discrepancy was IDR5,287,045.00. Conclusion: The direct non-medical costs and indirect costs of hypertensive outpatients were less than the direct medical costs. A significant difference occurred between the real costs and INA CBG’s tariff. Keywords: hypertension, cost consequences, pharmacoeconomics, patient’s perspective

Hypertension Control and Guideline-Recommended Target Blood Pressure Goal Achievement at an Early Stage of Hypertension in the UAE

(1) Background: The present study aimed to assess the changes in blood pressure (BP) within the first 6 months of treatment initiation in a newly treated hypertensive cohort and to identify the factors that are associated with achieving the target BP recommended by the American (ACC/AHA, 2017), European (ESC/ESH, 2018), United Kingdom (NICE, 2019), and International Society of Hypertension (ISH, 2020) guidelines. (2) Methods: We analyzed 5308 incident hypertensive outpatients across Abu Dhabi, United Arab Emirates (UAE), in 2017; each patient was followed up for 6 months. Hypertension was defined as a BP of 130/80 mmHg according to the ACC/AHA guidelines and 140/90 mmHg according to the ESC/ESH, NICE, and ISH guidelines. Multiple logistic regression was used to identify factors associated with achieving the guideline-recommended BP targets. (3) Results: At baseline, the mean BP was 133.9 ± 72.9 mmHg and 132.7 ± 72.5 mmHg at 6 months. The guideline-recommended BP targets were 39.5%, 43%, 65.6%, and 40.8%, according to the ACC/AHA, ESC/ESH, NICE, and ISH guidelines, respectively. A BMI of <25 kg/m2 was associated with better BP control according to the ACC/AHA (odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.07–1.49), ESC/ESH (OR = 1.27; 95% CI = 1.08–1.50), and ISH guidelines (OR = 1.22; 95% CI = 1.03–1.44). Hypertension treated in secondary care settings was more likely to achieve the BP targets recommended by the ACC/AHA (1.31 times), ESC/ESH (1.32 times), NICE (1.41 times), and ISH (1.34 times) guidelines. (4) Conclusions: BP goal achievement was suboptimal. BP control efforts should prioritize improving cardiometabolic goals and lifestyle modifications.

Correlation Between the Number of Drugs Prescribed and Potentially Inappropriate Medication (PIMS) Based on Beers Criteria in Geriatric Hypertension Outpatients at Dr. Soedomo Hospital in Trenggalek

Background: Geriatric patients are elderly people who have various diseases and or problems as a result of diminished organ, psychological, social, economic, and environmental functioning and who require integrated health treatments from a multidisciplinary team. Uncontrolled hypertension can lead to complications such as stroke, CHD, and kidney failure. The more incidence of complications, causing the geriatrics to get more drugs (polypharmacy). Polypharmacy is one of the risk factors for the occurrence of Potentially Inappropriate Medication (PIMs) that often occurs in geriatric patients. The 2019 Beers Criteria is one of the clear criteria that can be used to determine the prevalence of PIMs in geriatric individuals. Objectives: The objective of this study was to see if there was a correlation between the number of drugs administered to hypertensive geriatric outpatients at Dr. Soedomo General Hospital in Trenggalek and the incidence of PIMs. This study employed an observational study with an analytical approach and retrospective. This study included a sample of 85 prescriptions for outpatient geriatric hypertension outpatient at Dr. Soedomo General Hospital in the period October - December 2020 taken using the purposive sampling technique. Data were analyzed using the C contingency coefficient correlation test. Results: 67,1% of prescriptions contained ≥ 5 kinds of drugs and 32,9% of prescriptions contained &lt; 5 kinds of drugs. Based on the incidence of PIMs, there were 97.6% of prescriptions for PIMs and 2.4% of prescriptions without PIMs. The C contingency coefficient correlation test shows the correlation coefficient (r) of 0.216 with a positive direction and p-value = 0.041. Conclusions: The number of drugs has a significant correlation and can cause the incidence of PIMs in geriatric patients with weak correlation strength. Collaboration between pharmacists and doctors is needed to provide the best therapy to patients, to maximize the role of pharmacists in monitoring drug use in geriatric patients at Dr. Soedomo Hospital in Trenggalek.

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study

BackgroundThe evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania.MethodologyA hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student’s T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance.ResultsA total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4–5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2–2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1–2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0–2.7, p = 0.04) to have independent association with cognitive impairment.ConclusionThis present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.

BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital outpatients: a cross-sectional, non-inferiority study

ObjectiveThis non-inferiority study aimed to determine the burden of obesity in a hospital outpatient setting of a developing country, using three commonly employed metrics as predictors of hypertension (HTN).DesignA cross-sectional...

PENGARUH KEBIASAAN MEROKOK DAN POLA MAKAN PASIEN TERHADAP KEJADIAN HIPERTENSI PADA PASIEN RAWAT JALAN DI POLIKLINIK RUMAH SAKIT PATAR ASIH LUBUK PAKAM TAHUN 2021

Hypertension or high blood pressure, sometimes also called arterial hypertension, is a chronic medical condition where the blood pressure in the arteries increases. The purpose of this study was to determine the effect of smoking habits and patient diet on the incidence of hypertension in outpatients at the hospital polyclinic Patar Asih Lubuk Pakam in 2020. The research method used a quantitative research design with a quasi experimental type. This research is a pre-experimental design using pre-test and final test. (the one group, pretest and post test design). The results obtained based on the analysis of the Paired T-test obtained p-value = 0.000 &lt;a = 0.05, so the research hypothesis is accepted, so it can be concluded that there is an effect of smoking on the incidence of hypertension in outpatients at Patar Hospital. Asih Year 2020. Conclusion: Smoking habits before the incidence of hypertension, namely "not done" as many as 9 people (30.0%), smoking habits after the incidence of hypertension namely "not done" as many as 22 people (73.3%). Suggestion: It is hoped that this research can add input for further researchers to add research variables.

Эффективность амбулаторного лечения артериальной гипертензии через призму качества жизни и гемодинамический фенотип пациентов

Актуальность. Эффективность амбулаторного лечения артериальной гипертензии (АГ) как совокупный результат — достижение целевого уровня артериального давления (АДцел) и приемлемый уровень качества жизни (КЖ) пациентов, а также влияние на него гемодинамического фенотипа, определяемого оригинальным методом количественного анализа связей параметров артериального давления (КАСПАД), не исследованы, что явилось целью данной работы. Материалы и методы. Обследованы 175 амбулаторных пациентов с АГ, средний возраст 60,0 (52,0–70,0) года, получавших длительную (3–12 лет) стандартную терапию антигипертензивными препаратами из основных групп лекарственных средств (ЛС). Оценивалось КЖ по русскоязычной версии опросника RAND-36; для определения гемодинамического фенотипа по КАСПАД использованы индивидуальные ряды величин АД (не менее 25), полученные при ежедневных домашних измерениях за 2–4 недели; проведен статистический анализ клинических и демографических признаков, их связей с КЖ и фенотипами. Результаты. Значимое ухудшение КЖ (физический компонент и общий уровень) отмечено с увеличением возраста, степени и кардиоваскулярного риска АГ, особенно при наличии хронических форм ишемической болезни сердца. КЖ у пациентов, не достигших АДцел, значимо ниже по большинству параметров, чем у достигших его лиц. Увеличение количества принимаемых ЛС сопряжено со снижением КЖ у лиц, достигших АДцел. Пациенты с гемодинамическим фенотипом D, независимо от фармакологической группы принимаемых ЛС и их количества, значимо реже достигают АДцел по сравнению с лицами с фенотипом H, а также имеют более низкое КЖ, еще более снижающееся при интенсификации медикаментозной терапии. Ингибиторы ангиотензинпревращающего фермента (ИАПФ) и блокаторы кальциевых каналов (БКК) были эффективны для достижения АДцел, в основном у пациентов с фенотипом H, но негативно влияли на КЖ: ИАПФ — при фенотипе H, БКК — при D. Бета-адреноблокаторы и диуретики существенно не влияли на КЖ. Предложена статистическая модель прогноза низкого общего уровня КЖ у пациентов с достигнутым АДцел на основе 5 клинико-демографических факторов. Выводы. Эффективность лечения АГ целесообразно оценивать по совокупности достижения АДцел и общего уровня КЖ не менее 60 баллов (по RAND-36). При назначении лечения следует учитывать гемодинамический фенотип: медикаментозную терапию всех пациентов с фенотипом D, а также лиц с фенотипом H при низком КЖ и недостигнутом АДцел необходимо дополнять комплексной реабилитацией с использованием немедикаментозных методов.

Are hypertensive patients with history of coronary artery disease at risk for silent lower extremity artery disease?

We aimed to investigate the association between hypertension and asymptomatic lower extremity artery disease (LEAD) in outpatients with known history of coronary artery disease (CAD). Patients with known history of CAD who have been undergone coronary angiography and have significant coronary artery stenosis (more than 60%) were included. LEAD was defined as ankle-brachial index (ABI)<0.9 in either leg. The risk of LEAD in hypertensive group was analyzed using chi-square test, and correlation between blood pressure (BP) and ABI was analyzed using Pearson correlation test in SPSS v.25. One hundred and four patients were included. 82.7% of patients were male. Mean age was 57.05±7.97. The prevalence of hypertension was 35.6%, and the prevalence of LEAD was 16.3%. A higher proportion of LEAD was found in hypertensive (18.9%) compared to non-hypertensive (14.9%), although not statistically significant (OR: 1.33; 95% CI: 0.46 to 3.85; p=0.598). There was an association between ABI and systolic BP (p=0.016), but not with diastolic BP (p=0.102). Our study showed that the prevalence of LEAD in hypertension, especially in the CAD population, is relatively high. There was no association between hypertension and LEAD, but a higher prevalence of LEAD was found in hypertensive patients. Nevertheless, LEAD screening is still recommended in hypertensive patients, especially in the CAD population, given the fact that outcomes of health and mortality are worse for those with concomitants of these diseases.

Urine N-acetyl-Ser-Asp-Lys-Pro measurement as a versatile biomarker to assess adherence to angiotensin-converting enzyme inhibitors.

Poor adherence to treatment is a major health issue in hypertension. The large number of drugs to be detected limits the implementation of chemical adherence testing by liquid chromatography/mass spectrometry (LC-MS/MS). AcSDKP, a peptide accumulating in the presence of angiotensin-converting-enzyme inhibitor (ACEI) treatment, has been validated as a proven marker of adherence by enzyme-linked immunosorbent assay. Our aim was to validate urine measurements of AcSDKP compared with active metabolites of various ACEI, measured simultaneously by LC-MS/MS. We first studied the time-dependent relationships between urinary perindoprilat and AcSDKP in a pharmacokinetic/pharmacodynamic study in healthy volunteers. We then compared the sensitivity and specificity of urinary AcSDKP vs. three ACEI active metabolites (enalaprilat, perindoprilat, ramiprilat) taken as reference to detect nonadherence in spot urine samples from a prospective cohort of hypertensive outpatients. The urinary excretion profiles of AcSDKP and perindoprilat were similar, exhibited a significant correlation, and showed excellent agreement in healthy volunteers. In patients, we found a similar agreement between AcSDKP and the three ACEI metabolites urinary concentrations. The sensitivity and specificity for adherence assessment of urine AcSDKP was 92.2 and 100%, respectively. We observed a difference in the evaluation of good adherence between ACEI metabolites (85.7%) and AcSDKP (79.0%) because of discrepancies in samples where AcSDKP reached undetectability quicker than ACEI metabolites. This characteristic of AcSDKP is of particular interest and could better reflect the true adherence status of patients. Overall, spot urine AcSDKP measurement by LC-MS/MS is a reliable marker of the intake of ACEI treatment and could substitute ACEI metabolites detection.

POLA PENGGUNAAN OBAT ANTIHIPERTENSI PADA PASIEN HIPERTENSI

Hypertension is an increase in systolic blood pressure of at least 140 mmHg or a diastolic pressure of at least 90 mmHg. This study aimed to determine the use of drugs in outpatient hypertension patients at the PuskesmasTilamuta. The design employed in this study wa a non-analytic descriptive analysis method by calculating the percentage of the amount of 3T, namely the right indication, the right drug, and the right dose in a non-experimental manner with a cross sectional design (cross-sectional) and retrospective data collection. Data were collected through mecical records of outpatient hypertension patiens in the area from January 2020 to Desember 2020. Then, the research subjects who met the inclusion criteria were 92 patients. The results showed that the calcium channel bloker (Amlodipine) class antihypertensives were mostly used at 53%. Based on the results of the study, it was found that some patients were not given anthypertensive drugs with inappropriate drug percentage (23%), incorrect indications (23%), inapporiate dosage (23%). Therefore, it is concluded that some patients do not comply with the accuracy of the indication, drugs, and the accuracy of dosage, so it is necessary to monitor the administration of antihypertensive drugs.

Salt and potassium intake evaluated with spot urine and brief questionnaires in combination with blood pressure control status in hypertensive outpatients in a real-world setting.

Reducing salt and increasing potassium intake are recommended lifestyle modifications for patients with hypertension. The estimated 24-h urinary salt excretion value from spot urine using Tanaka's formula and the salt check-sheet scores, questionnaire-based scores of salt intake, are practical indices of daily salt intake. However, few studies have evaluated salt intake with these methods in hypertensive outpatients. We examined salt and potassium intake with the spot urine method and the salt check-sheet scores of hypertensive outpatients in a multi-facility, real-world setting and examined whether the salt or potassium intake evaluated with these methods related to inadequate blood pressure control. Hypertensive outpatients from 12 medical facilities in the Okinawa prefecture were enrolled from November 2011 to April 2014 (n = 1559, mean age 63.9 years, 46% women). The mean blood pressure, urinary salt excretion value, urinary potassium excretion value, and total score on the salt check-sheet were 129/75 mmHg, 8.7 g/day, 1.6 g/day, and 10.4 points, respectively. The urinary salt excretion value and total score on the salt check-sheet but not urinary potassium excretion value were associated with inadequate blood pressure control (≥140/90 mmHg). Higher body mass index, estimated glomerular filtration rate, urinary potassium excretion value, total score on the salt check-sheet, and presence of inadequate blood pressure control were associated with high urinary salt excretion (≥10.2 g/day). In conclusion, hypertensive outpatients with high urinary salt excretion values estimated using Tanaka's formula or with high scores on the salt check sheet may be candidates for more intensive salt reduction guidance.

Comparison of Brachial Blood Pressure and Central Blood Pressure in Attended, Unattended, and Unattended Standing Situations.

Central systolic blood pressure (cSBP) is an independent predictor of future cardiovascular disease. Unattended brachial SBP (bSBP) can eliminate the white-coat effect. However, unattended cSBP and unattended standing cSBP have never been reported. We aimed to compare bSBP and cSBP in attended, unattended, and unattended standing situations. We also aimed to compare the white-coat effect and unattended orthostatic BP change between bSBP and cSBP. Altogether, 104 hypertensive outpatients were included (mean age: 66.0 ± 9.8 years, 41.3% male, mean body mass index: 25.0 ± 4.5). Attended bSBP/cSBP values were 127.3 ± 15.7/119.2 ± 15.0, unattended bSBP/cSBP values were 122.7 ± 15.3/114.4 ± 15.1, and unattended standing bSBP/cSBP values were 123.6 ± 15.7/114.1 ± 14.8 mmHg (correlation coefficients/coefficients of determination between bSBP and cSBP: 0.971/0.943, 0.970/0.941, and 0.964/0.929, respectively; all p < 0.001). No significant difference was observed in the white-coat effect between bSBP and cSBP (4.6 ± 5.8 vs. 4.8 ± 5.7 mmHg). Although there was no significant difference between unattended sitting SBP and unattended standing SBP in terms of both bSBP and cSBP, a numerically small but significant difference was observed in the unattended orthostatic BP change between bSBP and cSBP (0.9 ± 8.0 vs. -0.3 ± 9.0 mmHg, p = 0.002). In conclusion, significant and strong correlations were observed between bSBP and cSBP in attended, unattended, and unattended standing BP measurements. The white-coat effect on bSBP was equivalent to that on cSBP. There was a numerically small but significant difference in the unattended orthostatic BP change between bSBP and cSBP.

The Effect of Health Education by Using Leaflet Media to Increase the Knowledge of Hypertension Patients in Outpatients At South Tapanuli District Hospital

Hypertension or high blood pressure is a chronic condition characterized by increased pressure on the walls of arteries. The results of the Basic Health Research (Riskesdas) 2018 showed that the prevalence of hypertension increased compared to Riskesdas 2013, which rose from 25.8% to 34.1%. The purpose of this study was to determine the effect of health education by using leaflet media to increase the knowledge of hypertension patients in outpatients at South Tapanuli District Hospital. The research method used was Quasy Experiment with One group pre-post test design in one group design. The sample in this study amounted to 31 people. The data obtained were processed using the Wilcoxon Sign Rank Test. The results showed that there was an influence of health education on increasing knowledge of patients with hypertension in outpatients in South Tapanuli District Hospital,where before being given health education, respondents had 7 knowledge worth 9 people(29,0%), and after being given health education respondents had 10 knowledge totaling 10 people (32,3%). Based on the Wilcoxon statistical test results obtained p-value = 0,000 &lt;0.005. Suggestions of this research can be used as a new source in increasing the knowledge of hypertension sufferers, and further researchers can use the slide show method or lecture method.

The Effect of Health Education by Using Leaflet Media to Increase the Knowledge of Hypertension Patients in Outpatients At South Tapanuli District Hospital

Hypertension or high blood pressure is a chronic condition characterized by increased pressure on the walls of arteries. The results of the Basic Health Research (Riskesdas) 2018 showed that the prevalence of hypertension increased compared to Riskesdas 2013, which rose from 25.8% to 34.1%. The purpose of this study was to determine the effect of health education by using leaflet media to increase the knowledge of hypertension patients in outpatients at South Tapanuli District Hospital. The research method used was Quasy Experiment with One group pre-post test design in one group design. The sample in this study amounted to 31 people. The data obtained were processed using the Wilcoxon Sign Rank Test. The results showed that there was an influence of health education on increasing knowledge of patients with hypertension in outpatients in South Tapanuli District Hospital,where before being given health education, respondents had 7 knowledge worth 9 people(29,0%), and after being given health education respondents had 10 knowledge totaling 10 people (32,3%). Based on the Wilcoxon statistical test results obtained p-value = 0,000 <0.005. Suggestions of this research can be used as a new source in increasing the knowledge of hypertension sufferers, and further researchers can use the slide show method or lecture method.

: REASONABLENESS IN PRESCRIPTION FOR TREATMENT OF HYPERTENSION OUTPATIENT

Objective: To evaluate the reasonableness of prescription for treatment of hypertension outpatients at the examination department of Hau Nghia Regional General Hospital - Long An. Objects and methods: Cross-sectional, retrospective, non-intervention descriptive studies on 180 patients who came to examine and treat hypertension at the examination department, stored on the software of the Hau Nghia Regional General Hospital - Long An. Results: All cases of patients using angiotensin inhibitors, diuretics, calcium channel blockers, AT1 receptor inhibitors were used at the correct dose and the correct number of times a day. In the case of mandatory indications, all patients with comorbidities had a reasonable indication of 100%, only patients with myocardial infarction and diabetes had reasonable indications of 94.74% and 94.12% respectively. The majority of treatment regimens were correctly applied on the specific patient. The rational use rate of prescription regimen was 95.51%, 2-drug regimen was 95.45% and that of 3-drug regimen reached 100%. There were no violations of contraindications in the use of therapeutic regimens. Conclusion: The use of hypertension drugs all had reasonable indications, achieving a high rate, there was no violation of contraindications in the use of treatment regimens.

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study.

The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.

Blood Pressure Control and Associations with Social Support among Hypertensive Outpatients in a Developing Country.

Relationships between social support characteristics with blood pressure control and recommended behaviors in Vietnamese hypertensive patients have not been investigated. This study is aimed at examining the role of social support characteristics in hypertension control and behaviors. Patients with hypertension (n = 220) in Hanoi, Vietnam, were recruited into a cross-sectional study. Both functional and structural characteristics of social support and network were examined. Results showed that increasing total network size was related to 52% higher odds of uncontrolled hypertension (adjusted OR = 1.52, 95%CI = 1.22 − 1.89). Higher network sizes on the provision of information support related to advice, emotional support related to decisions, and practical support related to sickness were associated with lower odds of uncontrolled hypertension. Every additional 1% of the percentage of network members having hypertension decreased 2% the odds of uncontrolled hypertension (adjusted OR = 0.98, 95%CI = 0.96 − 1.00). A 1% additional network members who were living in the same household was associated with a decrease of 0.08 point of behavioral adherence score (coef. = −0.08; 95%CI = −0.12 − 0.03). Meanwhile, a 1% increase of network members who were friends on the provision of practical support related to sickness and jobs was related to an increase of 0.10 point and 0.19 point of behavioral adherence score (coef. = 0.10; 95%CI = 0.04 − 0.17 and coef. = 0.19; 95%CI = 0.06 − 0.32, respectively). The current study suggested that further interventions to improve hypertension management should address the potential effects of social network characteristics.

ANALYSIS OF FACTORS RELATING TO DAY-TO-DAY HOME BLOOD PRESSURE VARIATION IN HYPERTENSIVE PATIENTS

Objective: In order to prevent cardiovascular events and organ injuries in hypertensive patients, strict blood pressure (BP) control over 24 hours is of primary importance. In addition to the BP level, it has been indicated that the variabilities of blood pressure during a day or between visits also influence the risk of cardiovascular disorders. This study aimed to delineate the factors relating to the variations of office and home BPs throughout a year in hypertensive outpatients under antihypertensive therapy. Design and method: The subjects enrolled in this study were 83 hypertensive out-patients who recorded home blood pressure measurements. Office BP and the home BP records within 7 days before each visit were collected for the analyses calculating the coefficient of variation (CV). In addition to the physical findings such as blood pressure and body mass index, laboratory data of blood and urine samples were collected. Results: The office BP value (131/77mmHg) was comparable to the morning home BP (130/76) and higher than the evening home BP (126/73), however, the CV values were comparable between the office and the morning and evening home BPs. Correlations of BP and CV were stronger between the morning and the evening home BPs than between the office and the home BPs. The CV of systolic office BP was greater in patients with diabetes mellitus than patients without diabetes (7.8 vs 6.1%). In patients with chronic kidney disease, the CVs of diastolic office BP and diastolic evening home BP were greater than patients without chronic kidney disease (8.0 vs 6.2% and 8.1 vs 6.7%, respectively). In addition, The CVs of diastolic morning and evening home BP were positively correlated with serum creatinine and negatively correlated with estimated glomerular filtration rate. Patients with cardiovascular diseases such as stroke and coronary artery disease showed greater CV of diastolic morning home BP than patients without cardiovascular diseases (8.2 vs 6.6%). Conclusions: These results suggest that the home BP exhibits different variability from the office BP and the BP variability is increased in high-risk hypertensive patients with diabetes mellitus, chronic kidney disease and cardiovascular diseases.

ASSESSMENT OF CENTRAL AORTIC BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION: RESULTS FROM A PAN-INDIA ASSESS CABP REGISTRY

Abstract Objective: Although central aortic blood pressure (CABP) has shown to be better predictor of cardiovascular events than brachial BP in randomized trials, the real-world clinical practice data are scarce. Our study aimed to assess brachial and CABP and illustrate the correlation between them in patients with hypertension. It also aimed to assess the therapeutic drug classes prescribed in hypertensive patients. Design and method: This was a single-visit, prospective, non-interventional, observational study of hypertensive outpatients. Data collection included clinical and demographic characteristics, brachial (sphygmomanometer) and CABP (Agedio B900 device (IEM, Stolberg, Germany) and antihypertensive treatment. Results: A total of 3989 patients were enrolled with the mean age of 56.6 ± 12.2 years. About 58.6% were male and 66.4% were obese. Mean systolic (SBP) and diastolic blood pressure (DBP) was 156 ± 15.2/ 95.6 ± 12.9 mm Hg. Mean arterial pressure was 119.4 ± 21.8 mm Hg and heart rate was 83.1 ± 14.6 bpm. The central blood pressure parameters were: central systolic blood pressure (CSBP), 139.8 ± 16.3 mm Hg; central diastolic blood pressure (CDBP), 96.1 ± 13.2 mm Hg; central pulse pressure (CPP), 43.4 ± 15.3 mm Hg; augmentation index (%), 29.1 ± 16.6; pulse wave velocity, 8.8 ± 3.8 m/s. A positive correlation was observed between SBP and CSBP (r = 0.6809, p &lt; 0.0001); DBP and CDBP (r = 0.7413, p &lt; 0.0001); and PP and CPP (r = 0.638, p &lt; 0.0001). About 83.1% patients were taking antihypertensive medications and 76.94% (n = 3163) patients were receiving monotherapy: ACE inhibitors, 6.96%, angiotensin receptor blockers, 30.92%, beta-Blockers, 12.6%, calcium channel blockers, 17.93%, diuretics, 8.54%, and alpha/central blockers, 0.17%. Combinations of two and three drugs were received by 21.6% and 1.46%, respectively Conclusions: Brachial BP was positively correlated to CABP in hypertensive patients. Majority of patients were receiving angiotensin receptor blockers as antihypertensive monotherapy.