Hypertension Specialist Research Articles

Antihypertensive and comorbid medication patterns in patients referred to a specialist hypertension service: implications for work up and subsequent management

Antihypertensive and comorbid medication patterns in patients referred to a specialist hypertension service: implications for work up and subsequent management

Abstract P398: The effects of care by hypertension specialists on cardiovascular outcome, blood pressure control and cost-effectiveness among uncontrolled hypertensive patients

Background: Studies suggested that physician specialty had an impact on patient outcomes of cardiovascular disease. However, the effects of care by hypertension specialists on clinical outcomes and financial burden among uncontrolled hypertensive patients are unknown. Objective: This study was to assess the effects of care by hypertension specialists on risk of cardiovascular outcomes, blood pressure (BP) control, and cost-effectiveness among patients with uncontrolled hypertension. Methods: A retrospective cohort study of patients aged 45-79 years who were admitted for uncontrolled hypertension was conducted. We assessed the relationship between care by hypertension specialists and major adverse cardiovascular events (MACE), BP control, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) by the Cox regression, the generalized estimating equations (GEE) model, and the Markov model, respectively. Results: A total of 10680 patients with uncontrolled hypertension were followed up for a median of 4.0 years. Among the 5646 (52.9%) patients received care by hypertension specialists and had fewer MACE than the non-specialists group (21.5 vs 39.7 per 1000-person-year; hazard ratio 0.67; 95% CI: 0.57 to 0.79) according to multiple Cox regression after stabilized inverse probability of treatment weighting. At 4 years, the odds ratio between the hypertension specialist group and the non-specialist group was 0.83 (95% CI: 0.79 to 0.86). Odds ratios with declining trend were observed at 1, 2, and 3 years. Over a lifetime horizon, the ICERs of the hypertension specialists group was USD 6295.37 per QALY gained compared with the non-specialists group. Conclusions: This study provided some evidence that care by hypertension specialists was associated with reduced risk of MACE and improved BP control in patients with uncontrolled hypertension, and was cost-effective.

Renal Denervation for the Treatment of Hypertension: A Scientific Statement From the American Heart Association.

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the widespread availability of both pharmacological and lifestyle therapeutic options, blood pressure control rates across the globe are worsening. In fact, only 23% of individuals with high blood pressure in the United States achieve treatment goals. In 2023, the US Food and Drug Administration approved renal denervation, a catheter-based procedure that ablates the renal sympathetic nerves, as an adjunctive treatment for patients in whom lifestyle modifications and antihypertensive medications do not adequately control blood pressure. This approval followed the publication of multiple randomized clinical studies using rigorous trial designs, all incorporating renal angiogram as the sham control. Most but not all of the new generation of trials reached their primary end point, demonstrating modest efficacy of renal denervation in lowering blood pressure across a spectrum of hypertension, from mild to truly resistant. Individual patient responses vary, and further research is needed to identify those who may benefit most. The initial safety profile appears favorable, and multiple ongoing studies are assessing longer-term efficacy and safety. Multidisciplinary teams that include hypertension specialists and adequately trained proceduralists are crucial to ensure that referrals are made appropriately with full consideration of the potential risks and benefits. Incorporating patient preferences and engaging in shared decision-making conversations will help patients make the best decisions given their individual circumstances. Although further research is clearly needed, renal denervation presents a novel treatment strategy for patients with uncontrolled blood pressure.

2023 Philippine Working Group Consensus Statement on Renal Denervation Therapy for the Management of Hypertension

BACKGROUND: Hypertension is the most common risk factor for cardiovascular disease in the Philippines. Despite the availability of antihypertensive medications that are effective, safe, and tolerated by Filipino patients, the numbers of uncontrolled hypertensives are still increasing. Several factors play in the poor control of blood pressure, particularly resistant hypertension and hyperactive sympathetic nervous system. Renal denervation therapy is a novel device that has been shown to lower blood pressure in patients with resistant and difficult-to-treat hypertension and is deemed safe in clinical trials. A Philippine Working Group composed of specialists in cardiology, hypertension, vascular surgery, and clinical epidemiology has come up with consensus statements in identifying patients who will benefit from the procedure. Locally, there is a need to have hypertension centers treating uncontrolled and resistant hypertension and offer renal denervation therapy to appropriate Filipino patients. KEYWORDS: blood pressure, difficult-to-treat hypertension, renal denervation therapy, resistant hypertension

Risk of hypertension in patients with CLL/SLL who participated in ALPINE: A post hoc analysis.

e19016 Background: Bruton tyrosine kinase (BTK) inhibitors are an important therapeutic option for patients with CLL/SLL. The first-generation BTK inhibitor, ibrutinib (ibru), is associated with an increased risk of hypertension. Zanubrutinib (zanu) is a next-generation BTK inhibitor designed to maximize BTK occupancy and minimize toxicity with fewer off-target effects. This analysis evaluated the risk of developing hypertension based on initiation of antihypertensives (anti-HTN) in ALPINE (NCT03734016). Methods: Anti-HTN use in the zanu (n=324) and ibru (n=324) treatment arms was assessed. The definition of anti-HTN was based on Standardized Drug Grouping; concomitant anti-HTN were adjudicated by an independent hypertension specialist blinded to BTK inhibitor assignment. Time to initiating new anti-HTN and time to adding a new class of anti-HTN were assessed using the Kaplan-Meier method. Comparisons of time-to-onset endpoints were analyzed based on the log-rank test. Results: At baseline, patient characteristics were generally balanced between zanu and ibru arms (median age, 66.7 vs 67.1 y; male, 65.1% vs 71.4%; history of hypertension, 50.9% vs 50.0%; type 2 diabetes mellitus, 10.1% vs 8.9%). Among patients not on anti-HTN at baseline, 20.7% (n=35/169) of zanu- and 28.7% (n=51/178) of ibru-treated patients initiated anti-HTN during the study. Among all patients, fewer patients in the zanu arm initiated new anti-HTN (28.4% [n=92/324] vs 32.4% [n=105/324]) and the anti-HTN were initiated later (hazard ratio [HR], 0.77; P-value=.071). Additionally, statistically fewer patients in the zanu arm compared with the ibru arm started anti-HTN in a new class (24.1% [n=78/324] vs 29.3% [n=95/324]) and the anti-HTN were started later (HR, 0.72; P-value=.034). The event rates for initiation of new anti-HTN or a new class of anti-HTN were consistently lower in the zanu vs ibru arm at each timepoint (Table). Conclusions: In ALPINE, initiation of new anti-HTN or a new class of anti-HTN occurred less frequently in the zanu arm vs the ibru arm in patients with CLL/SLL. Adoption of anti-HTN occurred sooner with ibru than zanu. These findings should be considered when initiating BTK inhibitor therapy in patients with CLL/SLL who have an elevated cardiovascular risk. Clinical trial information: NCT03734016 . [Table: see text]

Prevalence, Clustering, and Current Management of Cardiovascular Risk Factors Upon First Referral to Hypertension Specialists: the APPROACH Study.

Several observational studies have been conducted to assess the prevalence of cardiovascular risk factors in hypertensive patients; however, none has yet investigated prevalence, clustering, and current management of cardiovascular risk factors upon first referral to hypertension specialists, which is the aim of the present study. Consecutive adult outpatients with essential/secondary hypertension were included at the time of their first referral to hypertension specialists at 13 Italian centers in the period April 2022-2023 if they had at least one additional major cardiovascular risk factor among LDL-hypercholesterolemia, type 2 diabetes, and cigarette smoking. Prevalence, degree of control, and current management strategies of cardiovascular risk factors were assessed. A total of 255 individuals were included, 40.2% women and 98.4% Caucasian. Mean age was 60.3±13.3years and mean blood pressure [BP] was 140.3±17.9/84.8±12.3mmHg). Most participants were smokers (55.3%), had a sedentary lifestyle (75.7%), suffered from overweight/obesity (51%) or high LDL-cholesterol (41.6%), had never adopted strategies to lose weight (55.7%), and were not on a low-salt diet (57.4%). Only a minority of patients reported receiving specialist counseling, and 27.9% had never received recommendations to correct unhealthy lifestyle habits. Nearly 90% of individuals with an estimated high/very high cardiovascular risk profile did not achieve recommended LDL-cholesterol targets. In patients with hypertension, both pharmacological and lifestyle therapeutic advice are yet to improve before referral to hypertension specialists. This should be considered in the primary care setting in order to optimize cardiovascular risk management strategies.

Thirty-five years of the European Society of Hypertension: from past to future.

The European Society of Hypertension (ESH) was established 35 years ago. Since then, it promoted and coordinated a number of activities which include educational projects, epidemiological surveys and research investigations whose main focus includes different clinical and therapeutic aspects of the hypertensive disease. This article, which is based on data presented during the Presidential lecture held during the 33rd ESH Meeting in Berlin, will provide an overview of the main organization and structure of the ESH. Emphasis will be given to the relevance of the different society bodies, with a particular focus on the educational and research activities, such as the 15 working groups and the more than 120 excellence centers located in European and extra-European countries. Other main activities of the Society refer to the ESH Hypertension Specialist Program, the ESH Summer School, the ESH Young Fellow Program and the Annual Scientific Meeting of the Society. A special emphasis will be given to the central role of the Society in the organization of the various research projects and in the development and dissemination of the ESH Guideline document on hypertension diagnosis and treatment. Finally, the future perspectives of the ESH in the context of the European scientific framework will be highlighted.

SPONTANEOUS, INDEPENDENT, SINGLE-CENTER RDN REGISTRY OF A RESISTANT HYPERTENSION MULTIDISCIPLINARY TEAM

Objective: Uncontrolled resistant hypertension (URH) is defined as Systolic Blood Pressure above 140mmHg despite at least 3 maximally tolerated doses of antihypertensive drugs including a diuretic. Renal sympathetic denervation (RDN) has proved efficacy in the sponsored SPYRAL and RADIANCE studies. However, little evidence is available from independent studies. Furthermore, patients with glomerular filtrate rate <45ml/min have been systematically excluded. This study aims to evaluate the safety and the efficacy of catheter-based radiofrequency RDN in patients with URH, including those with renal impairment. Design and method: Consecutive unselected patients with URH undergoing RDN were enrolled, assessed in a multidisciplinary team involving cardiologist, nephrologist and hypertension specialists, that excluded secondary forms. Efficacy was defined as change of office (OBP) and ambulatory blood pressure monitoring (ABPM) after RDN, safety as the absence of device-related major complication (BARC classification), end-stage renal disease, stroke, acute myocardial infarction and any cause of death within 1 month. 107 patients underwent RDN from 2012 to December 2023. The population had multiple comorbidities: 45% were smokers, 43% diabetic, 35% had peripheral artery disease, 30% coronary artery disease, 57% CKD. The average number of antihypertensive medications was 4.83±1.2 Baseline ABPM and OBP were 151.18±20,97/87,88±14,39mmHg and 155,92±24/85,25±15,5 mmHg, respectively Results: . At 12-month a significant reduction of systolic OBP and ABPM, respectively by -17.51±3.70 mmHg (P=0.001) and -7.03±3.37 mmHg (P=0.04) was noticed. BP reduction at 12-month follow-up was observed also among eGFR <45 ml/min, with a reduction by -18.73±7.14mmHg (P=0.02) in systolic OBP and by -17.81±7.49 (P=0.03) in ABPM. The therapeutic burden was slightly reduced baseline to 4 (3-5) at follow-up (p<0.01). No major complications were observed and renal function was stable up to 12 months, compared to baseline (1.87±2.37 vs. 2.44±3.56; -0.57±0.32; p=0.08). Conclusions: RDN on top of medical therapy is safe and feasible in patients with URH, even in a high-risk CKD population with multiple comorbidities. A significant reduction of SBP also in this subgroup up to 12 months was reported without undesired effects. Furthermore, our experience underlines the central role of multidisciplinary team evaluation for the appropriate management of URH.

Specialist hypertension clinics: an essential pathway but under-resourced.

Specialist hypertension clinics: an essential pathway but under-resourced.

Physical activity, obesity and risk of atherosclerotic cardiovascular diseases among patients with hypertension and diabetes attending a teaching hospital in Edo State, Nigeria.

Preventing Atherosclerotic Cardiovascular Diseases (ASCVD) can best be achieved by promoting a healthy lifestyle through improvements in diet, physical activity, and avoidance of tobacco use and exposure to second-hand smoke. The study aimed to determine the association between physical activity as well as obesity and the risk of atherosclerotic cardiovascular diseases among patients with hypertension and diabetes attending Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. The research was a descriptive, cross-sectional study of 394 systematically selected consenting patients with hypertension and diabetes presenting to a teaching hospital in Irrua, Edo State, Nigeria. The Cardiovascular risk assessment was determined using the Framingham 10year Risk of General Cardiovascular Disease. Anthropometric assessment, blood pressure and blood glucose were determined. Data was collected with a semi-structured questionnaire and analysed with Stata version 16. Chi square and logistic regression was used to test for association and significance level was set at p = 0.05. The study included 394 participants with a mean age of 54±15.47years. Respondents were mostly females (55.3%), physically inactive (70.3%), overweight (42.4%) and had a high risk (41.8%) of developing CVD in 10 years using Framingham categorisation. There was a significant association between physical activity (P<0.01; OR 2.45; CI: 1.53-3.92), obesity (P<0.01; OR 2.52; CI: 1.64-3.86) and risk of developing CVD. The study found a statistically significant relationship between physical inactivity, obesity, and the risk of atherosclerotic cardiovascular diseases. Increasing physical activity levels need to be a top priority at all levels of healthcare as well as the general population.

Validation of self-reported hypertension in young adults in the US-based Growing Up Today Study (GUTS).

Self-reporting is often used in large epidemiologic research to identify hypertensive participants, but its validity in young adults has not been sufficiently assessed. We aimed to validate self-reported hypertension diagnosis from questionnaires by using medical records among a sample of young adults aged 22-39 years in the Growing Up Today Study (GUTS), during a time of transition in national hypertension definitions. A sample of 1,000 GUTS participants were asked for permission to access their medical records, to confirm their self-reported hypertension status on questionnaires from 2010 to 2019. Paired self-reported and medical record information was available for 318 participants. Medical records were reviewed by a clinical hypertension specialist. We evaluated agreement, kappa statistic, sensitivity and specificity of self-reporting. We assessed the correlations between blood pressure measurements self-reported on the 2019 questionnaire and those from medical records and compared the measurements using paired t-tests. The selected sample was generally representative of the full GUTS cohort. Agreement, kappa coefficient, sensitivity and specificity of self-reported hypertension were 85.5%, 0.72, 100%, and 75.3%. Although the absolute differences in blood pressure measurements between self-report and medical records were small (e.g., the average difference in typical recent blood pressures was 3.5/1.2 mm Hg), these measures were only moderately correlated. Validity of self-reported hypertension was high in GUTS, ensuring use as an endpoint in future studies with confidence. We demonstrated that young adults likely without formal medical training are able to report hypertension status with reasonable accuracy.

A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic.

A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group. A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample. The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension. There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.

Prediction of adverse outcome by ophthalmic artery Doppler and angiogenic markers in pregnancies with new onset hypertension

ObjectivesTo compare the ophthalmic artery Doppler peak systolic velocity ratio (OA PSV-ratio) and soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF ratio) in predicting adverse maternal and perinatal outcomes in women presenting with new onset hypertension. Study designProspective cohort study in a specialist hypertension clinic, within a tertiary referral centre. Main outcome measuresComparison between the OA PSV-ratio and sFlt-1/PlGF ratio in predicting delivery within one week from presentation and adverse maternal and perinatal outcomes e.g. severe hypertension, neonatal unit admission, small for gestational age. ResultsWomen who delivered within one week, compared to those who did not, had a higher OA PSV-ratio (0.82 vs 0.71, p < 0.01) and sFlt-1/PlGF ratio (93.3 vs 40.5, p = 0.08). Independent predictors of the OA PSV-ratio included mean arterial pressure and maternal weight and predictors of the sFlt-1/PlGF ratio included diastolic blood pressure and use of antihypertensive medications. Prediction of adverse outcomes with both ratios were similar and only modest e.g. AUROC for predicting delivery within one week for OA PSV-ratio was 0.57 (95% CI 0.47–0.67) and for sFlt-1/PlGF ratio was 0.61 (95% CI 0.52–0.70) (p = 0.53). ConclusionsIn women presenting with new onset hypertension, the OA PSV-ratio and sFlt-1/PlGF ratio have similar and modest performance in predicting adverse outcomes.

Characterizing Hypertension Specialist Care in Canada: A National Survey

BackgroundThe hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists. MethodsAdult hypertension specialists across Canada were surveyed to describe hypertension centres and specialist practice in Canada, including the following: the patient population managed by hypertension specialists; details on how care is provided; practice pattern variations; and differences in access to specialized hypertension resources across the country. ResultsThe survey response rate was 73.5% from 25 hypertension centres. Most respondents were nephrologists and general internal medicine specialists. Hypertension centres saw between 50 and 2500 patients yearly. A mean of 17% (± 15%) of patients were referred from the emergency department and a mean of 52% (± 24%) were referred from primary care. Most centres had access to specialized testing (adrenal vein sampling, level 1 sleep studies, autonomic testing) and advanced therapies for resistant hypertension (renal denervation). Considerable heterogeneity was present in the target blood pressure in young people with low cardiovascular risk and in the diagnostic algorithms for investigating secondary causes of hypertension. ConclusionsThese results summarize the current state of hypertension specialist care and highlight opportunities for further collaboration among hypertension specialists, including standardization of the approach to specialist care for patients with hypertension.

Артериальная гипертензия среди детей и подростков как прогностический фактор риска. Проблемы диагностики

An analysis of modern studies has shown that arterial hypertension, detected in childhood, is one of the main risk factors for both cardiovascular diseases and the progression of renal failure in subsequent age periods, which indicates the importance of early diagnosis, treatment and prevention of this condition among children and children. teenagers. The increase in the prevalence of hypertension among children and the associated health risks actualize the issues of the level, methods, techniques and frequency of blood pressure screening, differentiation of primary and secondary hypertension for successful treatment and control of the disease, as well as the development of methods for analyzing multiple factors for accurate diagnosis and prediction of spread. arterial hypertension. Of greatest research interest are the issues of accurate measurement of blood pressure during routine medical examinations of children, including invasive or noninvasive methods for measuring blood pressure in newborns, the availability of proven equipment and specialists in pediatric hypertension, and the interpretation of blood pressure measurements.

Achievement rate of target blood pressure in patients with hypertension treated by hypertension specialists and non-specialists in a real-world setting.

Hypertension remains a major global healthcare issue. Considering that most Japanese patients with hypertension are managed by general practitioners, hypertension specialists should be involved in actual clinical practice. We investigated the blood pressure (BP), guidelines recommended for achievement rate of the target BP, and clinical variables of patients with hypertension treated by hypertension specialists and those treated by non-specialists in a real-world setting. Factors associated with the target BP achievement in this population were also investigated. Outpatients with hypertension from 12 medical facilities in Okinawa Prefecture were enrolled (n = 1469 [specialist group, 794; non-specialist group, 675]; mean age, 64.2 years; females, 45.8%). For all patients, BP and rate of the target BP achievement were 129.0 ± 15.5/74.6 ± 10.6 mmHg, and 51.8%, respectively. BP and the rate of target of BP achievement were 128.0 ± 15.1/73.4 ± 10.4 mmHg and 56.7% in the specialist group, and they were 130.1 ± 15.9/76.0 ± 10.8 mmHg and 46.1% in the non-specialist group. The urinary salt excretion and obesity rates were comparable between the specialist and non-specialist groups. Multivariable logistic analyses indicated that hypertension specialists and good medication adherence were positive factors, whereas obesity, chronic kidney disease, diabetes mellitus, and urinary salt excretion were inverse factors associated with target BP achievement in this population. Initiatives for salt reduction, medication adherence, and proper obesity management are crucial to improving BP management in patients with hypertension. Hypertension specialists are expected to play an essential role in them. For all patients, the target blood pressure (BP) achievement rate were 51.8%. Hypertension specialists and good medication adherence were positive factors in achieving target BP; conversely, obesity, diabetes mellitus, chronic kidney disease, and high urinary salt excretion were inverse factors in achieving target BP among patients with hypertension.

Retrospective Audit of Patient Characteristics and Outcomes Following Review in a Specialist Hypertension Clinic

Retrospective Audit of Patient Characteristics and Outcomes Following Review in a Specialist Hypertension Clinic

Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study.

Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient's condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ≥80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by -13/-5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control.

Clinical Profile and Management Approach of Patients Diagnosed with Resistant Hypertension in the Philippine General Hospital

INTRODUCTION: Resistant hypertension is blood pressure (BP) that remains above target despite treatment with maximum doses of three antihypertensive drugs, which may include a diuretic. The prevalence of resistant hypertension is unknown, and there are no local studies in the Philippines concerning this condition. METHODS: A retrospective descriptive cohort study was conducted in the Hypertension Clinic of the Section of Hypertension of the Philippine General Hospital. A total of 51 patients were diagnosed with resistant hypertension, and charts were reviewed and analyzed. RESULTS: Majority of the patients were female (31 [60.8%]), with a mean age of 56.3 years. All of them presented with symptoms; the most common presenting symptoms were headache, exertional dyspnea, nape pain, dizziness, and easy fatigability. Of the 51 patients, 45% also had diabetes mellitus, 11.8% had dyslipidemia, and 7.8% had a previous history of preeclampsia. Approximately 35% of these patients were smokers. The average BP before referral to the section was 167/94 mm Hg. By this time, most patients will either be on a four-drug regimen (42.1%) or a three-drug regimen (36.8%). The median number of visits in the Hypertension Clinic before control of BP was three follow-ups, with the average BP being 119/71 mm Hg. The regimens of the patients with controlled BP are three-drug combination (36.4%), four-drug combination (36.4%), and five-drug combination (27.3%). CONCLUSION: Early referral to a hypertension specialist may benefit a patient with resistant hypertension, decreasing the number of follow-up visits to control a patient’s BP. Patients with resistant hypertension may require four- to five-drug regimens, which may be needed to adequately control a patient’s BP. KEYWORDS: drug combination, elevated blood pressure, hypertension, resistant hypertension

EVALUATION IN REAL LIFE OF ‘SUIVI-HTA’, A FREE APPLICATION FOR HOME BLOOD PRESSURE MONITORING

Objective: Home Blood Pressure Monitoring (HBPM) is key to improve blood pressure control. To help hypertensive patients adopt HBPM and doctors use the results in their practice, the French ‘Fondation de Recherche en Hypertension Artérielle’ has developed the Suivi-HTA application, available since September 2020. We therefore aimed at carrying out a first real-life evaluation of the utilization of this application among hypertension specialists and their patients. Design and method: The survey was carried out in France between October 2020 and March 2021 in 8 hospitals and 2 private practices based on a standardized questionnaire assessing the acceptability and effective use of the application, as well as the doctor's opinion on patient satisfaction. Results: The survey included 135 hypertensive patients, 38% were women, 57% were over 55 years old. Only 27% regularly performed HBPM. If the application was offered, it was well accepted (women 65%, men 80%) with a more important rejection rate in hypertensives over 55 years old (26% vs. 3%, p&lt;0.0003) and with more comorbidities (31% vs. 7%, p = 0.0005). Rejection was mainly related to digital technology (no smartphone or tablet, lack of knowledge on downloading or using applications). Among the 113 patients who agreed to test the application, 98 (87%) effectively performed HBPM, 77 (67%) did so using Suivi-HTA, of which 60 (53%) generated and transmitted a HBPM report. According to the doctor's opinion, 88% patients who have used Suivi-HTA will be future users of the application. Patient satisfaction with the application was assessed as “good” for 93% patients. Conclusions: This national survey shows that the Suivi-HTA application has a good rate of acceptance and effective use among hypertensives. It also generates a very positive opinion in the medical community. However, age and presence of comorbidities were risk factors for reduced acceptance, in connection with the difficulties to digital accessibility. It would therefore be interesting, while globally promoting the use of HBPM in hypertensive patients, to develop specific strategies targeting patients with more comorbidities and/or at higher cardiovascular risk.