Hypertensive Patients Research Articles

P014 APPLICATION OF AI IN HYPERTENSION MANAGEMENT: A REVIEW

Background and Objective: The integration of artificial intelligence (AI) in healthcare has revolutionized the management of various diseases, including hypertension. This review explores the potential of AI applications in improving hypertension diagnosis, treatment, and patient outcomes. Methods: A comprehensive literature review was conducted using databases such as PubMed, Scopus, and IEEE Xplore. Studies published between 2010 and 2023 were included, focusing on AI models used for hypertension management, such as machine learning algorithms and predictive analytics. Results: AI has demonstrated significant accuracy in predicting hypertension risk factors, optimizing treatment plans, and monitoring patient adherence. Machine learning models, such as neural networks and decision trees, have shown up to 95% accuracy in early hypertension detection. Furthermore, AI-driven personalized treatment plans have resulted in improved patient outcomes and reduced healthcare costs. Conclusions: AI holds tremendous potential in transforming hypertension management by enhancing diagnostic precision and personalizing treatment strategies. Future research should focus on integrating AI with electronic health records and developing real-time monitoring systems to further improve patient care.

O51 EXPLORING GENETIC BASIS OF RESISTANT HYPERTENSION IN EUROPEAN AND AFRICAN POPULATIONS

Background: Approximately 15% of hypertensive (HTN) patients experience resistant hypertension (RHTN) despite the use of ≥ 3 antihypertensive agents (diuretic and blockers of calcium channels and the renin-angiotensin system) at maximum tolerated doses. Intriguingly, genetic variation and alterations in gene content may contribute to RHTN developing. Aim: To comprehend the genetic determinants of RHTN across diverse ethnicities, this study has compared the gene content and presence of single nucleotide variants (SNVs) in RHTN versus controlled-HTN and normotensive participants within European (EU) and South African (SA) populations. Methods: Blood-isolated DNA was collected from 6 participants from EU and 15 from SA. Patients were categorized into 3 groups: RHTN (SA; n=5 and EU; n=6), controlled-HTN (n=5), and normotensive (n=5). DNA was used for Whole Exome Sequencing (WES) analysis. Library preparation and exome capture were done using the MGIEasy Universal DNA library prep and exome capture v5 probe set. Mapping was done using GATK, and the variant calling and annotation were performed using with the SIFT tool and R software. Results: PCA analysis and minimum spanning network showed significant genetic diversity between EU and SA populations. WES identified 16 common genes, with 207 and 220 genes associated to RHTN in EU and SA, respectively. These genes were involved in cardiac electrical conduction (K+/Ca++ channels) and lipid storage (HDL deficiency). In addition, SNV within pharmacogenes in SA (CYP2D6, CYP3A5, APOE) and EU (ADD1) cohorts alongside genes linked to disease susceptibility (RyR1 and PPP1CA) were also identified. RyR1 and PPP1CA are both implicated in HTN development through their roles in calcium signaling and vascular smooth muscle cell function. Noteworthy, two SNVs, rs121918006 and rs61732908, within RyR1 were previously linked to HTN. Conclusions: The large genetic differences observed between EU and SA subjects highlight the diverse genetic landscape surrounding RHTN. Notably, specific genes and their related SNV that associated to cardiac calcium channels and lipid storage could show potential targets for personalized therapeutic intervention. Scientific Session 15: Exploring Novel Therapeutic Approaches to Kidney Disease

O47 THE ROLE OF IL-33 AND ST2 IN THE MODULATION OF TARGET ORGAN DAMAGE IN ANGIOTENSIN II-DEPENDENT HYPERTENSION

Introduction: Hypertension is associated with a chronic inflammatory state and aberrant immune system activity. Interleukin-33/suppression of tumorigenicity 2 (IL-33/ST2) signalling axis is important in the modulation of atherosclerosis and cardiovascular fibrosis. We aimed to evaluate the modulation of IL-33 and ST2 in hypertensive mouse models and patients. Methods and Results: Hypertension was induced by a 14-day infusion of Ang-II (490ng/min/kg) in 12-week-old WT C57BL/6, ST2KO, IL33KO mice. IL-33 and ST2 mRNA and protein were evaluated using qPCR and Western blot in WT mice. Ang II-infusion significantly increased IL-33 and ST2 protein expression in target organs related to hypertension, particularly the aorta (1.0±0.1 vs 2.8±0.2, p<0.0001, and 0.963±0.068 vs 2.094±0.231, p=0.002, respectively). Further, mRNA expression of IL-33 and ST2 was elevated in hypertensive aortas when compared with control (1.0±0.053 vs 1.76±0.271, p=0.0185 and 1.0±0.039 vs 1.978±0.221, p=0.0039, respectively). IHC from WT mice illustrated the localisation of IL-33 and ST2 in Ang-II aortas in ECs and SMCs. Further in human hypertensive mammary arteries, the localisation was. In-vivo, IL33KO and ST2KO mice showed no altered BP at baseline or after 14 days of Ang-II compared to WT littermates. ST2KO Ang-II mice showed protection against endothelial dysfunction compared to WT Ang-II mice through isometric tension studies (p=0.0317). Additionally, Ang-II-induced IL33KO and ST2KO mice worsen cardiac fibrosis compared to WT littermates (p=0.0005,p<0.0001, respectively). Conclusion: Both IL-33 and its receptor, ST2 are increased in the vascular and perivascular tissues in hypertension. Additionally, the IL-33/ST2 axis has a role in regulating cardiac fibrosis.

P035 SOCIAL DETERMINANTS OF HEALTH AND CONTROL OF HYPERTENSION

Background and Objectives: Recent national blood pressure (BP) survey data of adults in Canada and United States show a troubling decline in the control of hypertension, particularly in women, the elderly and those with low income, less education and under-using health services. Social determinants of health (SDH) can be important barriers to controlling hypertension. Studies assessing associations of BP control and SDH have focused on one or a few domains. Objectives of this study are to screen treated hypertensive patients for a wide range of SDH, test for correlations and assess the effects of high-quality treatment on SDH and BP control relationship. Method: We created and applied a screening tool to gather personal information on 14 SDH from consecutive consenting eligible patients attending a complex hypertension care clinic. Logistic regression was used to assess association of each SDH domain with BP control. Results: Of 90 patients enrolled, 88 completed the 6-month study. At baseline, mean age (standard deviation) was 64 (14) years, 64% male, 69% white, 25% experiencing financial hardship, mean BMI 30.4 kg/m2 (5.9), mean automated office BP 138/78 (23/14), mean number of co-morbid conditions 4.2 (2.0) and 55% had treatment-resistant hypertension. From baseline to exit, BP fell to 127/73 (17/12), p<0.001, mean number of antihypertensive drug classes increased from 3.06 (1.43) to 3.23 (1.30), p=0.049 but BMI remained unchanged. There were no associations between uncontrolled hypertension and any of the 14 SDOH domains at baseline. However, at exit financial status was associated with uncontrolled hypertension on univariate analysis (p=0.022) and on multivariate analysis. Stress (p=0.063) and optimism status (p=0.085] showed a similar trend. These analyzes indicated better BP control among those with poorer financial status, higher stress levels or more pessimistic outlook. Conclusion: None of the SDOH were associated with uncontrolled hypertension at baseline. However good medical care and follow-up appeared to have improved BP control, noticeably in those experiencing financial hardship. Explanation of findings requires further study.

Abstract 50: The Comparison of Office Blood Pressure with Morning Home Blood Pressure: Self-Automated Measurement

Background: Morning hypertension is associated with poor cardiovascular outcomes. However, office blood pressure (OBP) remains a gold standard in hypertension monitoring and management. Unfortunately, the accuracy in OBP measurement is problematic. Objectives: This study aimed to determine whether routine or unattended OBP could accurately represent home blood pressure (HBP) in patients with hypertension. Methods: We conducted a single-center, cross-sectional study. Hypertensive patients aged between 18 and 80 years, capable of performing self-automated blood pressure measurement, were included in the study. Three self-automated methods of blood pressure measurement were performed: Routine OBP, unattended OBP, and HBP. All participants were instructed to rest for at least 5 minutes prior to measuring blood pressure, and HBP was recorded twice daily, in the morning and at night, for a week after the enrolled visit without antihypertensive medication adjustment. Results: Overall 190 consecutive patients were enrolled, with a mean age of 65.2 ±7.5 years old. Half of the patients had coronary artery disease or type 2 diabetes as comorbidities. Routine OBP was significantly higher than unattended OBP and HBP. Interestingly, Systolic values of unattended OBP were similar to those of morning HBP (mean difference -0.6 ±16.0 mmHg, p=0.641) with moderate correlation (r=0.516, p<0.001). Although diastolic values of unattended OBP were lower than those of morning HBP (mean difference -3.3 ±9.0 mmHg, p<0.001), the values were moderately correlated (r=0.581, p<0.001). Bland-Alman plots between unattended OBP and morning HBP were shown in Figure 1. Both systolic and diastolic values of unattended OBP and average HBP were significantly different (mean difference -3.5 ±14.9 mmHg, p=0.002, and 1.6 ±8.6 mmHg, p=0.013, respectively). Conclusion: Unattended OBP method could effectively represent morning HBP, thus advocating to use in clinical practice.

AGTR1 A1166C gene polymorphism is associated with the effectiveness of valsartan monotherapy in Chinese patients with essential hypertension: A retrospective analysis

Objective: To investigate whether angiotensin II type 1 receptor (AGTR1 A1166C) gene polymorphism was associated with the effectiveness of valsartan monotherapy in Chinese patients with essential hypertension. Methods: This retrospective analysis included 198 patients (⩾18 years of age) who received valsartan monotherapy (80 mg/day) for newly developed essential hypertension at the authors’ center between January 1, 2020 and December 31, 2023. Genotyping for AGTR1 A1166C gene polymorphism was done by polymerase chain reaction (PCR)-melting curve analysis of genomic DNA from peripheral blood samples. A dominant genetic model for AGTR1 A1166C (AA genotype versus AC + CC genotype) was used. Multivariate regression analysis of baseline variables and AGTR1 polymorphism was conducted to identify predictors of target blood pressure attainment (<140/90 mmHg) at the 4-week follow-up. Results: The median age of the 198 patients was (53.7±13.5) years, and 58% were men. Genotyping assays showed that 164 patients had the AA genotype, and 34 patients were of the AC/CC genotype, including 30 with the AC genotype and 4 with the CC genotype. Allele distribution was consistent with Hardy Weinberg equilibrium. 109 Patients (55.1%) attained the blood pressure target. Multivariate analysis showed that smoking (versus no smoking, HR 0.314, 95% CI 0.159-0.619, P=0.001) and AGTR1 A1166C AA genotype (versus AC/CC, HR 2.927, 95% CI 1.296-6.611, P=0.023) were significant and independent predictors of target attainment. 25 Patients (73.5%) with AGTR1 A1166C AC/CC genotype attained the target versus 51.2% (51/164) of patients with AGTR1 A1166C AA genotype (P=0.017). Patients with AGTR1 A1166C AC/CC genotype had a significantly greater reduction in systolic blood pressure [(33.1±10.8) mmHg versus (29.2±11.7) mmHg in AA carriers; P=0.029)]. Conclusions: Hypertensive patients carrying one or two C alleles of the AGTR1 A1166C gene were more responsive to valsartan treatment.

P042 EFFECTIVENESS OF STRUCTURED TELEMONITORING BLOOD PRESSURE IN PRIMARY CARE: UNCONTROLLED HYPERTENSE COHORTS

Introduction: E-health has emerged as a pivotal resource in healthcare delivery due to its widespread coverage, ease, and acceptance, particularly for chronic diseases. We aim to establish the effectiveness of structured telemonitoring in managing blood pressure among patients with uncontrolled essential arterial hypertension. Methods: An analytical observational retrospective cohort study of uncontrolled hypertensive patients aged ≥ 18 was conducted, with follow-ups at 150 and 240 days. Patients in the telemonitoring cohort were provided with validated digital blood pressure monitors, underwent remote monitoring, and received weekly feedback for 30 days from a multidisciplinary team. Conversely, the non-telemonitoring cohort received usual care consisting of attendance to in-person medical consultations as part of our institution's cardiovascular-risk-prevention program. Results: 350 patients were included, with median ages of 55 and 66 years in the telemonitoring and non-telemonitoring cohorts, respectively. Over the 240-day follow-up, the telemonitoring group achieved a significant reduction in systolic (-20.99 mmHg; 95% CI 14.99- 27.50; p 0.000) and diastolic blood pressure (- 14.99 mmHg; 95% CI 10.00- 18.99; p 0.000) compared to usual care, which demonstrated reductions of 19.99 mmHg (95% CI 16.49- 22.50; p 0.000) in systolic blood pressure and 6.50 mmHg, (95% CI 4.50- 9.00; p 0.000) in diastolic blood pressure. Conclusion: Telemonitoring is an effective strategy for patients with uncontrolled arterial hypertension, leading to earlier and significant blood pressure reductions.

P037 IMPROVING WELLBEING AND MENTAL HEALTH IN HYPERTENSIVE PATIENTS: A PILOT STUDY ON NATURE IMMERSION THERAPY

Background and Objective: Nature immersion therapy, also known as “Vitamin N,” has demonstrated a significant impact on enhancing well-being and mental health indicators. This pilot study aims to investigate the effects of Vitamin N treatment on the well-being, mental health, and affect scores of hypertensive patients undergoing medical treatment. Methods: A convenience sample of stable hypertensive individuals participated in a standardized 3-hour nature immersion session. Participants completed pre- and post-treatment assessments using the World Health Organization-Five Well-Being Index (WHO-5), Positive and Negative Affect Schedule (PANAS), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Paired samples analysis, including the Wilcoxon signed-rank test, was employed to assess changes in scores, along with effect size calculations. Results: The study comprised 18 participants, including 12 females (64.67%) and 6 males (33.33%), with 6 having a history of diabetes. Following conscious nature immersion therapy, a significant improvement was observed in the scores of the well-being scale, WHO-5, WEMWBS, and PANAS positive affect scale (p < 0.05). Conclusions: Conscious immersion therapy in nature yielded notable improvements in well-being assessment scales and increased positive affect scores (PANAS), suggesting potential benefits for enhancing well-being in patients with arterial hypertension.

O88 REDUCTION IN SYSTOLIC BLOOD PRESSURE FOLLOWING DIETARY FIBRE INTERVENTION IS DEPENDENT ON BASELINE GUT MICROBIOTA COMPOSITION

Background/Objective: Dietary interventions high in fibre have been shown to lower blood pressure (BP). This effect is via the gut microbiota, via fermentation of fibre and production of metabolites called short-chain fatty acids (SCFAs). Not all patients respond to dietary fibre interventions for unclear reasons. We aimed to determine if we can identify fibre-responders based on their gut microbiota and production of SCFAs. Methods: We performed a phase II cross-over placebo-controlled randomised clinical trial in untreated hypertensive patients. Twenty treatment-naive participants with hypertension received 40 g per day of fermentable fibre delivered as acetylated and butyrylated high amylose maize starch (HAMSAB) or the placebo for 3 weeks. Blood pressure was monitored at baseline and endpoint by ambulatory BP monitoring, with those experiencing a reduction of ≥2 mmHg in systolic BP classified as responders. The microbiota was determined by sequencing the V4-V5 region of the 16S rRNA gene in baseline stool samples. The relationship between baseline gut microbiota and response to dietary intervention was assessed with the MaAsLin2 package. Plasma SCFAs levels were quantified by mass spectrometry. Results: We observed a placebo-subtracted mean 24-hour systolic BP of –6.1 mmHg (p=0.03, reported in Jama et al., 2023 Nature Cardiovascular Research), with 14 (70%) individuals classified as responders and 6 (30%) as non-responders. Genera significantly enriched in responders included Dialister (β=1.29, q=1.921x10-134), Coprococcus (β=1.26, q=3.282x10-121), Bifidobacterium (β=1.67, q=1.11x10-81), Ruminococcus (β=0.161, q=1.11x10-8), and Roseburia (β=0.82, q=4.275x10-2). Responders also produced higher levels of the SCFAs butyrate (mean±SEM, non-responders 4.95±2.4 vs responders 51.15±14.7, p=0.0096), but no difference in other SCFAs. Conclusions: Participants who experienced a decrease in systolic BP following a dietary fibre intervention had increased bacterial genera known to contain species that produce SCFAs (Bifidobacterium, Roseburia, Ruminococcus) at baseline, and were able to produce more butyrate. These data suggest that baseline microbiota composition contributes to the response to dietary fibre intervention trials in people with hypertension, likely via increased capacity to produce butyrate.

O62 DEGREE OF HYPERTENSION CONTROL IN ABORIGINAL AND NON-ABORIGINE POPULATIONS OF A CITY IN NORTHERN ARGENTINE

High blood pressure is a widely prevalent pathology in the province of Formosa, 52% according to the latest Argentine national survey 2019, so we do not have current data, it was decided to carry out a survey that evaluates blood pressure, arterial stiffness and peripheral resistance. To evaluate how these variables are presented in 2 populations of our city, one of the general population and the other of an indigenous ethnic group of the province called Toba that lives in a neighborhood of this city. Materials and methods: data collection was carried out on patients in 3 institutions, all of which were public, with a prior diagnosis of the disease made by a health professional, in the Central Hospital of Formosa, the interdistrict hospital Evita, and the center of primary care in the Nam Qom neighborhood of Formosa. during a period of 1 month The pressure was taken by validated blood pressure monitors as well as central aortic pressure and peripheral resistance. by a Tel O Graph brand team. The data were analyzed Statistix 10.0. Results: 80 patients, 20 from the ethnic group and 20 from the general population, 62% women, age was 52 years in the general hospital (hg) and 54 in the health center (cs), systolic blood pressure was 129 1/2 and 82 1/2 diastolic, in cs 121 and 83. The central aortic velocity was 7.76 on average and the peripheral resistance 18.62 in the hc - in the cs 6.54 and 18.6. smoking habit, 45 and 25% respectively. The control was 87% in the BP in the hc and 75% in the cs population. Conclusions: Differences were found: a lower prevalence of uncontrolled hypertension than in the general population and in terms of VOP and peripheral resistance we were able to find a difference in favor of the CS population, and also in the degree of control of hypertensive patients in the same trend.

P121 ROLE OF AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN THE EVALUATION OF PATIENTS WITH SUSPECTED SLEEP APNEA

Background and Objective: Obstructive sleep apnea (OSA) often coexists with hypertension. Ambulatory blood pressure monitoring (ABPM) is essential for detecting significant blood pressure fluctuations, especially during nighttime. This study seeks to assess the role of ABPM in identifying OSA. Methods: We analyzed a database of patients with suspected OSA using the STOP-BANG questionnaire at a cardiology center from July 2020 to April 2024. Anthropometric characteristics, blood pressure behavior through ABPM, and sleep patterns via polysomnography were evaluated. The influence of risk predictors on OSA development was assessed using multinomial logistic regression. Results: The study included 38 men (50.6%) and 37 women (49.3%); 48 hypertensive patients (64%) and 27 without hypertension (27%). The average STOP-BANG score was 3.8. Of these, 92% had some degree of OSA. The mean age was 60±13.2 years. Neck circumference (NC) and total apnea-hypopnea index were 37.5 cm and 19.7 events/hour, respectively, with a predominance of REM OSA. Only NC and nocturnal diastolic pressure were significant variables. For the development of moderate OSA, NC showed significant relative risk ratios (RRR) (p=0.045). Severe OSA development was influenced by mean nocturnal diastolic blood pressure (MNDAP) and NC, with significant RRRs (p=0.007 and p=0.041, respectively). This means that for each mmHg increase in nocturnal diastolic pressure, the risk of severe OSA increases by 1.3 times compared to healthy patients, predominantly during REM sleep. Conversely, increased daytime diastolic pressure decreases this risk by 25%. Conclusions: An increase in mean nocturnal diastolic pressure measured by ABPM is a significant predictor of severe OSA development. This underscores ABPM's importance in evaluating patients with suspected OSA. While the STOP-BANG questionnaire is useful for initial OSA suspicion, it has limitations in identifying the most severe cases, necessitating tools like ABPM for more accurate assessment. The use of ABPM improves accuracy in detecting severe OSA and enhances understanding of hypertension phenotypes’ pathophysiology. Table 1. Obstructive Sleep Apnea (OSA) Severity Classification and Its Correlation with Mean Nocturnal Diastolic Blood Pressure (MNDAP), Mean Daytime Diastolic Blood Pressure (MDDAP), and Neck Circumference (NC)

P043 PREACH IMPLEMENTATION PROJECT A SOCIO-ECOLOGICAL FRAMEWORK FOR HYPERTENSION IN PAKISTAN

Background: Worldwide hypertension prevalence is projected to reach 1.56 billion by 2025, affecting 29% of the global population according to the WHO1. It contributes to 7.5 million deaths, 3.7% of total disability-adjusted life years (DALYs) and is responsible for causing stroke in 54% of hypertensives2,3. Pakistan has a prevalence of 43% hypertension with merely 12.5% of controlled hypertensives4,5. There is a pressing need for a national level intervention through uniform clinical approaches for optimum hypertension prevention, treatment and control6, 7. Through PREACH project, we prioritize primary care physicians as first-line responders and are training them on standardized hypertension guidelines to alleviate the burden from tertiary care hospitals. To detect new onset hypertension the project also incorporates early surveillance and community level screenings. Objectives: • To build capacity of practitioners on standardized guidelines endorsed by health ministry, PCS (Pakistan Cardiac Society) & PHL (Pakistan Hypertension League) • To raise community awareness, to screen and develop self-referral pathways to specialty care • To develop a robust national hypertension registry • To include hypertension in essential primary healthcare packages Methodology: Hypertension guidelines are developed. Accredited national certified workforce of more than 14,000 general practitioners (GPs) will be built through guidelines trainings via train the trainer model. Impact assessment studies will be done to assess training effectiveness and implementation at clinics. Community mobilization and awareness campaigns will be run to identify and direct self-referral pathway to an accredited GP. Development of national hypertension registry as a centralized system for data collection to report actual disease burden. Ministry of health will be advocated to prioritize hypertension management via multi-sectoral collaboration i.e. medical societies, academic, non-profit and private-sector for incorporations into annual development programs. Results \Conclusion: We aim to create an impact in the lives of 4.3 million beneficiaries (anti-hypertensive naïve hypertensive patients of Pakistan) by increasing self-referral of hypertensive cases to specialists through PREACH implementation project at all healthcare service delivery levels.

Delay Discounting and BMI in Hypertensives: Serial Mediations of Self-Efficacy, Physical Activity and Sedentary Behavior.

Our study aimed to examine the association between delay discounting (DD) and body mass index (BMI) in individuals with hypertension. Additionally, we sought to explore and compare the potential mediating effects of self-efficacy, physical activity and sedentary behavior in this association. A cross-sectional survey was conducted in two cities in the Jiangsu province of China, specifically Nanjing and Yangzhou, from March to June 2023. A total of 972 hypertensive patients completed the questionnaire (M age = 64.7 years, SD age = 8.2 years, 54.2% female). Participants engaged in a money choice experiment on computers, provided their height and weight, and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and General Self-Efficacy Scale (GSES). The experimental program was generated using the programming software E-Prime version 2.0. Multiple hierarchical regression analysis was conducted to identify potential covariates. Two serial mediation models were conducted using PROCESS macro 4.1 in SPSS 27.0. Physical activity and sedentary behavior were designated as M2 to investigate and contrast their respective mediating effects in the association between delay discounting and body mass index. Self-efficacy, physical activity, and sedentary behavior served as mediators in the relationship between delay discounting and BMI. Self-efficacy accounted for 14.9% and 14.3% of the total effect in Models 1 and 2, respectively, while physical activity and sedentary behavior each accounted for 14.9% and 9.5% of the total effect, respectively. The serial mediation effects of self-efficacy and physical activity, as well as self-efficacy and sedentary behavior, were significant (B = 0.01, 95% CI [0.01, 0.02]; B = 0.01, 95% CI [0.002, 0.01]), collectively contributing 2.1% and 2.4% of the total effect. Sedentary behavior played a smaller mediating role compared to physical activity in this association. The results indicated that self-efficacy, physical activity and sedentary behavior could act as mediators in the association between delay discounting and BMI, thus potentially mitigating the risk of obesity in hypertensive individuals.

P228 THE PORTRAIT OF THE HYPERTENSIVE PATIENT: THE REALITY OF A NORTHERN PORTUGUESE SUBPOPULATION IN THE CONTEXT OF PRIMARY CARE

Background and Objectives: Hypertension is a chronic disease, and is one of the main cardiovascular risk factors. Knowing the local reality, regarding the comorbidities of the hypertensive population, profile of pharmacological therapy and level of blood pressure control are fundamental for the design of management and treatment strategies for hypertensive disease. In Portugal, hypertension has a estimated prevalence of 26,78% and the overwhelming majority of patients are assisted in primary care, where the health professionals have software tools such as BI-CSP, which uses Microsoft's Power-BI platform, allowing the retrieval of data about different variables. The aim of this study is to characterize a subpopulation studied at the Fânzeres Primary Care Center regarding demographic data, morbidity, blood pressure control and antihypertensive medication. Methods: This is an observational and cross-sectional descriptive study with an analytic component. The population consists of patients diagnosed with hypertension (N=3474). The retrieval of data was carried out using the MIMUF and BI-CSP. Results: In the population from which the 3474 hypertensive patients were selected, hypertension has a prevalence of 26%. The most common cardiovascular comorbidities were dyslipidemia (50%), Obesity (30%) and Diabetes (33%). 63% of patients had a systolic blood pressure (SBP) of <140mmHg and 28% had a SBP <130mmHg on the last measurement. Regarding the antihypertensives prescribed on a 4 month period, molecules that act on the renin-angiotensin axis are the main class used corresponding to 583K DDD (defined daily dose), followed by thiazides (300K DDD) and calcium channel blockers (250K DDD). Conclusions: There is still suboptimal control of hypertension in the population studied, which implies the adoption of more effective treatment strategies. It is important not only to involve adapting pharmacological treatment to the most recent guidelines, but also promote healthy lifestyles, control comorbidities and improve the follow-up of these patients. A multidisciplinary approach, using face-to-face and remote methods to strengthen contact with the healthcare team, can help to achieve these goals.

Therapeutical Approach to Arterial Hypertension - Current State of the Art.

Arterial hypertension (AH) is recognized as the most common illness within the group of cardiovascular diseases and the most massive chronic non-infectious disease in the world. The number of hypertensive patients worldwide has reached 1.28 billion, contributing to an increase in cardiovascular diseases and premature death globally. The high prevalence of hypertension emphasizes the importance of effectively treating this condition. Elevated blood pressure often leads to lethal complications (heart failure, stroke, renal disorders, etc.) if left untreated. Considering an increase in AH prevalence in the future, a successful therapeutical approach to this disease and its complications is essential. The goal of AH treatment is to maintain normotensive blood pressure through various approaches, including lifestyle changes, a well-balanced diet, increased physical activity, psychoeducation, and, when necessary, pharmacotherapy. The evolving pharmacotherapeutic landscape reflects the progress made in our understanding of hypertension and emphasizes the need for continuous innovation to meet the challenges posed by this prevalent global health concern. The journey toward more effective and tailored treatments for hypertension is ongoing, and the introduction of new medications plays a pivotal role in shaping the future of antihypertensive pharmacotherapy.

O06 HYPERTENSION CONTROL AND COMORBIDITIES: INSIGHTS FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019

Background and Objective: Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data from MMM collected between 2017 and 2019 to evaluate hypertension control among adults aged 18 years and the frequency of comorbidities. Methods: Three sitting blood pressure (BP) readings, anthropometric measurements, and self-reported history of diabetes, myocardial infarction and stroke were collected. Missing BP readings were inputted using multiple imputation based on available BP measurements and sociodemographic variables. Hypertension was defined as an average systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. Hypertension treatment was defined as current medication use; control was defined as BP <140/90 mmHg. Results: Among 2,907,848 participants from 95 countries, 34.2% had hypertension, and 12.1% had a history of at least one other chronic condition. Specifically, 8.3% self-reported type 2 diabetes, 4.5% had experienced myocardial infarction, and 2.9% had a history of stroke. Some individuals had multiple comorbidities at the time of the screening: 6% had both myocardial infarction and type 2 diabetes, 8% had myocardial infarction and stroke, 2% had stroke and type 2 diabetes, and 8% had all three comorbidities. Among those with hypertension, 58.9% were on medication and 24.0% had at least one additional comorbidity, specifically, 15.8% reported type 2 diabetes, 8.8% had experienced myocardial infarction, and 5.5% had a history of stroke. Of those with hypertension on medication, 43.1% were controlled. Among treated individuals, hypertension control rates were higher in individuals with comorbidities (50% vs 30%). Conversely, individuals without comorbidities had poorer hypertension control. Conclusions: The data suggest a high prevalence of comorbidities within the screened population and among individuals diagnosed with hypertension. Additionally, individuals without comorbidities exhibited suboptimal hypertension management.

P045 HEALTH AND CARE STATUS OF HYPERTENSIVE PATIENTS IN PRIMARY CARE UNITS IN THE CONOCOTO-QUITO-ECUADOR DISTRICT: BASELINE OF THE HEARTS INITIATIVE - 2019

Background: Hypertension is a significant global public health problem due to the burden of disease and premature death it causes. Its control depends on the quality and timeliness of diagnosis, treatment, and patient follow-up. Studies show an increase in prevalence, poor control, and low coverage in the diagnosis, treatment, and follow-up of hypertensive patients. In response to this problem, since 2019 the Ministry of Health of Ecuador has implemented the HEARTS Initiative proposed by PAHO in primary health care units. This study is part of the baseline prior to its implementation. Objective: To identify the health and care status of hypertensive patients attending primary care units in the Conocoto district. Methodology: A descriptive retrospective study was conducted, reviewing the medical records of 681 patients who attended follow-up consultations in the 9 health units of the district. Results: The average age of the patients was 67.12 years (SD 14.2), with 72.1% being women and 96.7% of mixed ethnicity. The average annual number of consultations was 4.24; 40.4% of the patients were overweight and 41% obese. Of the patients who underwent laboratory tests, 45.1% had hypercholesterolemia, 48% had low HDL, and 10.9% had impaired renal function. An electrocardiogram was performed in 3.4% and a funduscopy in 1.7%. Most patients received counselling on lifestyle changes; 31.9% of the patients had uncontrolled hypertension; depending on the health unit this ranged from 11.3% to 52.3%. Conclusions: The lack of hypertension control is lower than reported in other studies, although many patients do not have the minimum necessary tests. Follow-up should be improved, not only of blood pressure control but also of the patient's clinical condition.

P145 EFFICACY AND SAFETY OF PERINDOPRIL/INDAPAMIDE/AMLODIPINE/BISOPROLOL SINGLE PILL COMBINATION IN PATIENTS WITH ESSENTIAL HYPERTENSION UNCONTROLLED ON TRIPLE THERAPY: AN INTERNATIONAL, RANDOMIZED, DOUBLE-BLIND, PHASE III TRIAL

Background and objectives: In hypertensive patients uncontrolled on triple therapy, guidelines recommend the addition of a fourth drug such as mineral corticoid receptor antagonists, or alternatively, a betablocker. They also support the use of SPCs at any step of the treatment to increase treatment adherence and BP control. Currently, no SPC of 4 drugs is available. This 4-month phase III trial aimed to demonstrate the superiority in BP reduction, ofperindopril/indapamide/amlodipine/bisoprolol (Per/Ind/Aml/Biso) SPC versus a free combination of Per/Ind/Aml in hypertensive patients uncontrolled on triple therapy at optimal doses. Methods: After a 2-month run-in period on the combination of Per/Ind/Aml at optimal doses (10/2.5/5 or 10/2.5/10 mg), patients with sustained uncontrolled essential hypertension with office SBP≥140mmHg and SBP at 24h-ambulatory blood pressure monitoring (ABPM)≥130mmHg received the quadruple SPC of Per/Ind/Aml/Biso (10/2.5/5/5 or 10/2.5/10/5 mg) or continued the same triple therapy for two additional months. Efficacy was assessed on office-SBP (primary endpoint), DBP, BP control, 24h-ABPM and home-BPM (HBPM). Results: 183 patients were randomized: 53.0% were men, mean age was 57.4±10.6 years, mean BMI was 28.2±2.6 kg/m2, and mean office SBP/DBP was 150.35±8.49/90.09±8.23mmHg. After two months, significantly greater decrease in office-SBP (-8.0mmHg, 95%CI [-11.9; -4.0]; p<0.0001) was observed in the quadruple SPC group (n=80) versus the triple therapy group (n=83). Greater decrease in the 24h-systolic ABPM was achieved with the quadruple SPC therapy (-7.5mmHg, 95%CI [-10.9;-4.1]; p<0.0001). Higher percentage of patients achieved 24h-ABPM and HBPM control in the SPC group 51.2% vs 20.7% (p<0.0001) and 60.7% vs 25.4%, (p<0.0001) respectively. After intentional 1-day SPC omission in patient volunteers (n=28), mean 24h-ABPM remained below the 130/80mmHg target, supporting the sustained efficacy of the SPC. Both treatments were well tolerated. Conclusion: The first quadruple SPC of Per/Ind/Aml/Biso demonstrated its superiority to the free combination of Per/Ind/Aml, offering a new alternative to treat effectively and safely patients with hypertension uncontrolled with a combination of Per/Ind/Aml at optimal doses.

P133 ALTERED P-WAVE DISPERSION IN NEWLY DIAGNOSED YOUNG HYPERTENSIVES

Background and objective: P wave dispersion (Pd) is a useful electrocardiographic marker for predicting the onset of atrial fibrillation. It has been little studied in recent hypertension. The aim was to determine the behavior of maximum P wave duration (Pmax) and Pd in young hypertensive patients with recent onset and its relationship with other variables. Methods: A cross-sectional, prospective, comparative study was performed in 60 young men (30 hypertensive and 30 non-hypertensive). P wave measurements were obtained with 12-lead electrocardiogram. Statistical analysis included applications of simple linear correlation, sample means were compared by Student's t-test. Results: There were no significant differences in the baseline characteristics of both groups. Pmax (78.67 ± 5.71 ms) and Pd (42.33 ± 6.26ms) were found to be significantly prolonged (p<0.001) in the hypertensive group compared to normotensive subjects (Pmax 61.00 ± 7.69 ms; Pd 25.00 ± 8.61 ms). Pd correlated significantly (r = 0.716; p<0.001) with systolic and diastolic blood pressure (r = 0.696; p<0.001). Conclusions: Pmax and Pd are found to be increased in young patients with recent-onset hypertension, and these values increase in direct proportion to blood pressure figures.

Abstract P348: Effects of Different Antihypertensive Regimens on Cognitive Function and Blood Pressure Changes in Elderly Hypertensive Patients: Network Meta-Analysis

Background: Elderly hypertensive patients with cognitive impairment not only exhibit reduced processing speed and executive function but also suffer significant deficits in memory and motor speed, adversely affecting their quality of life. This study employs a network meta-analysis to evaluate the effects of different antihypertensive regimens on cognitive function and blood pressure changes in elderly hypertensive patients. Methods: A comprehensive search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang and VIP databases for randomized controlled trials on different antihypertensive regimens for elderly hypertensive patients. Data analysis and graphing were performed using Review Manager 5.3 and Stata 16.0 software. Results: A total of 16 studies involving 11,694 elderly hypertensive patients and six antihypertensive regimens were included. The network meta-analysis results indicated that elderly hypertensive patients treated with angiotensin II receptor blockers (ARBs) had a greater change in cognitive function scores compared to those receiving usual care (standardized mean difference [SMD] = 0.46, 95% CI [0.23, 0.70]), angiotensin-converting enzyme inhibitors (ACEIs) (SMD = 0.33, 95% CI [0.06, 0.61]), beta-blockers (BBs) (SMD = 0.48, 95% CI [0.17, 0.78]), and diuretics (SMD = 0.32, 95% CI [0.01, 0.63]). Similarly, patients treated with calcium channel blockers (CCBs) showed greater changes in cognitive function scores compared to those receiving usual care (SMD = 0.37, 95% CI [0.04, 0.70]) and BBs (SMD = 0.38, 95% CI [0.02, 0.74]). The SUCRA rankings for changes in cognitive function scores among different antihypertensive regimens were ARB (93.6%), CCB (81.2%), diuretics (47.1%), ACEI (43.4%), usual care (17.9%), and BB (16.8%). Conclusion: The current evidence suggests that, compared to usual care, ACEIs, BBs, CCBs, and diuretics, ARBs might be the optimal regimen for improving cognitive function in elderly hypertensive patients.