Hypertension Specialist Research Articles

Digital health technology and hypertension management: a qualitative analysis of patient and specialist provider preferences on data tracking

Aim: Digital health for hypertension management holds potential for improving the quality of care but requires long-term patient engagement to track health data. We explored patient and hypertension specialist perceptions of clinical utility for data tracking including standardized patient-reported outcome measures (PROMs), home blood pressure (BP) measurement, and other health metrics. Methods: Participants reviewed general health status, patient satisfaction, and hypertension-specific PROMs. Semi-structured focus groups (n = 15) with nine patients with hypertension and six hypertension specialists were audio-recorded and thematically analyzed. Results: Key themes identified from patients included: (1) comfort and appreciation of home BP monitoring but only during important periods of hypertension care; (2) preference for tracking new symptoms and medication side effects; (3) patients perceived tracking other health measures including general PROMs, diet and exercise as less relevant to their care; and (4) visually represented BP trends evaluating associations with changes in other health parameters were perceived as useful. Key themes identified by hypertension specialists included: (1) concerns about patient digital literacy; (2) utilizing visual representations of long-term BP data trends for patient empowerment; and (3) unclear relevance of tracking medication adverse effects, PROMs, and other non-BP health metrics. Conclusion: Patients and hypertension specialists had similar perspectives for most aspects of data monitoring but differed in preference for a few aspects that were germane to patients, including monitoring medication adverse effects and symptoms. Including views on data tracking from both patients and providers are essential for designing digital tools to optimize hypertension management.

Is the KDIGO Systolic Blood Pressure Target

Meticulous management of hypertension is important in chronic kidney disease (CKD) to reduce the risk of cardiovascular disease, mortality, and progression of CKD. The recently published Kidney Disease Improving Global Outcomes (KDIGO) guideline on blood pressure (BP) management in CKD stresses the importance of standardized BP measurement and strict control of BP. This is a useful document that will help to improve the management of hypertension in CKD globally. However, the recommendation of systolic BP target of <120 mm Hg by KDIGO is controversial. It is based on weak evidence derived mainly from a single randomized controlled trial and its CKD subgroup analysis. Here, we review the current evidence surrounding BP target in CKD. We argue that the target recommended by KDIGO is not generalizable to the majority of people with CKD. Standardized BP measurements are challenging to implement outside specialist hypertension and research clinics, and the target of <120 mm Hg BP systolic cannot be extrapolated to routine clinic BP measurements. If applied to routine BP measurement, this target will expose the multimorbid and frail CKD patients to the risk of adverse events including falls and fractures. Furthermore, it will not be achievable in the majority of CKD patients. The target recommended by KDIGO is an outlier among contemporary major international hypertension guidelines and is likely to perplex clinicians. We believe the KDIGO-recommended target systolic BP <120 mm Hg for CKD is inappropriate in the majority of CKD patients and it may even be harmful for patients managed in routine clinical practice.

Hypertension healthcare professional beliefs and behaviour regarding patient medication adherence: a survey conducted among European Society of Hypertension Centres of Excellence

Purpose Little is known on the beliefs, perceptions and practices of hypertension specialists in addressing non-adherence to therapy. Therefore, a survey was undertaken amongst healthcare professionals (HCPs) managing hypertension in the European Society of Hypertension (ESH) Centres of Excellence. Materials and methods Cross-sectional data were obtained between December 2020 and April 2021 using an online anonymous structured questionnaire including 26 questions/136 items, that was sent to all ESH Excellence centres. Results Overall 67 from 187 centres (37.3%) responded and 200 HCPs from 30 countries answered the questionnaire. Participants (60% men) were mainly physicians (91%) and nurses (8%) from University hospitals (77%). Among physicians, 83% had >10 years professional experience. Average time dedicated to discuss medications was 1-5 min in 48% and 6-10 min in 29% of cases. Interviews with patients about adherence were the most frequently used assessment method. Chemical detection of medications in urine was available in 36% of centres. One third of physicians involved their patients regularly in treatment decisions. The most frequent methods to improve adherence included simplification of medication therapy, more frequent visits, and home blood pressure monitoring. Conclusions The level of implementation of tools to detect and improve adherence in hypertension management by HCPs in ESH excellence centres is low. Structured educational activities focussing on adherence management and access to the newest objective measures to detect non-adherence might improve these deficits.

Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial.

BackgroundThe burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience.ObjectiveThis study examined the efficacy and safety of telemedicine for the management of hypertension in Japan.MethodsPatients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network–attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting.ResultsInitial screening was completed by 99 patients, 54% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; P=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3% vs 70.0%; P=.01), and significant adverse events were not observed.ConclusionsWe present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation.Trial RegistrationUMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Consensus of experts from the Russian Medical Society of Arterial Hypertension. Arterial hypertension and erectile dysfunction

Sexual health is an essential part of overall health, and an active and healthy sex life is an important aspect of a good quality of life. Cardiovascular diseases and sexual health disorders have common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity and smoking) and common pathogenesis (endothelial dysfunction, inflammation and atherosclerosis). All this led to speculations about the pathophysiology and treatment options for sexual dysfunctions. The use of phosphodiesterase type 5 inhibitors has revolutionized the treatment of erectile dysfunction (ED) in men. This article focuses on ED and its relationship with hypertension. This document was created by experts from the Russian Medical Society of Arterial Hypertension with the participation of a member of the European Society of Hypertension Working Group on Sexual Dysfunction and Arterial Hypertension. In recent years, the expert group was very active in educating hypertension specialists and related specialties physicians about ED via numerous lectures at national and international congresses. It has been noted that ED precedes the development of coronary heart disease. The artery diameter hypothesis has been proposed as a possible explanation for this observation. Clinical manifestations of atherosclerotic lesions and/or endothelial dysfunction of the penile arteries may precede those in larger arteries. Patients with hypertension who receive antihypertensive drugs are more likely to suffer from sexual dysfunctions compared to untreated patients. The occurrence of ED appears to be related to the undesirable effects of antihypertensive drugs on the penile tissues. There is information about various effects of antihypertensive drugs on erectile function.

Influence of hypertension and other risk factors on the onset of sublingual varices

BackgroundSublingual varices (SV) are dilatations of tortuous veins that increased with age. Previous studies showed that this pathology could be correlated to some risk factors such as hypertension, age, gender and diabetes mellitus. In this study we evaluated, on a large number of subjects, the relationship between SV and different grades of hypertension as well as some risk factors extending the analysis to new risk factors such as dyslipidemia, obesity and antihypertensive therapy, modelling a possible dependence of SV on all these factors.MethodsIn the study 1008 subjects, 284 with and 724 without SV, were examined. The blood pressure was measured in office condition and, to exclude subjects with white coat syndrome or masked hypertension, also using a 24 h Holter pressure monitor. Hypertensive subjects were divided in resistant, drugs controlled (compensated) and patients with prior unknown hypertension (new diagnosed) groups. The presence or absence of SV as well as of the risk factors was assessed clinically. We tested the influence of age on the presence of SV by using the chi-square test and the relation between each risk factor and SV by the Cochran–Mantel–Haenszel test. Finally, we carried out a multivariate regression tree analysis in order to predict the presence of SV.ResultsWe confirmed the influence of age on SV and found a significant relationship between SV and both the compensated and resistant hypertension grades. We highlighted a relationship between SV and dyslipidemia in subjects with new diagnosed hypertension, and between SV and smoking in subjects with compensated hypertension grade. The regression tree showed a classification accuracy of about 75% using as variables hypertension grades, age and antihypertensive treatment.ConclusionsWe confirmed the SV dependence on age, resistant hypertension and smoking, highlighting a new association with dyslipidemia in new diagnosed hypertensive subjects and new relations depending on the hypertension grades. Thus, the SV inspection could be used to suggest a lipidologist as well as a hypertension specialist visit for a pharmacological and pressure check particularly in subjects presenting SV and dyslipidemia. However, further parameters are to be considered to improve the sensitivity of the prognostic tree model.

A Compendium on Hypertension: New Advances and Future Impact.

A Compendium on Hypertension: New Advances and Future Impact.

DIFFERENT APPROACH FOR Management OF HYPERTENSION EMERGENCY AND URGENCY AMONG EMERGENCY PHYSICIANS AND OTHER SPECIALISTS IN THE ITALIAN REAL WORLD

Abstract Objective: To investigate differences for management and treatment of hypertension emergency (HE) (HU) and urgency among emergency physician and doctors working in other departments. Design and method: The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by E-mail invitation to the members of Italian Scientific societies in the field of Emergency Medicine and Hypertension. Results: 665 questionnaires were collected: 59.7% from emergency departments (EDs), 22% from Emergency and Urgency Medicine wards, 8.7% from Cardiology Units, 5.7% from Internal Medicines and 3.9% from Intensive care or Stroke units. Emergency physicians more frequently defined chest pain as possible presentation of HE than other physicians (91.2 % vs 85.8% p &lt; 0.05), while tinnitus and conjunctival hemorrhages were less frequently considered as possible presenting symptoms (35% vs 42.9%, p &lt; 0.05 for tinnitus; 38.5% vs 45.9% p = 0.05 for conjunctival hemorrhages). We did not observe any significant differences in most of laboratory and instrumental examinations, except for lung ultrasound that was most frequently performed by emergency physicians compared the other specialists (43.8% vs 32.1% p &lt; 0.005). They also investigated cocaine or amphetamine abuse more frequently than the others (98.5% vs 95.9% p &lt; 0.05). The therapeutic approach for blood pressure (BP) reduction showed some differences: a larger use of urapidil (67.8% vs 54.9% p = 0.003) and captopril (59.6% vs 39.2 % p = 0.002) and lower of furosemide (54.4% vs 66.8% p &lt; 0.05) was reported by ED physicians compared to other groups. Hospitalization was more frequently required in the presence of acute organ damage (45.3% vs 30% p &lt; 0.05) by emergency physicians than other specialists, on the opposite side they suggested less frequently hypertension specialist evaluation (63% vs 74% hypertension specialist advice in more than 50% of cases, p &lt; 0.05) and ambulatory BP monitoring (65% vs 79% p = 0.001) or home self BP monitoring (39.4% vs 56.1% in at least the 75% of cases, p = 0.003) than the other specialists. Conclusions: Management and treatment of HE and HU may be different according to doctor's specialty. Educational initiatives, should be done to standardized treatment protocols and to improve medical knowledge about this largely prevalent problem.

VIEWS AND PERSPECTIVES OF HYPERTENSION EXPERTS IN GREECE REGARDING THE EFFICACY AND SAFETY OR RENAL SYMPATHETIC DENERVATION

Objective: The role of renal sympathetic denervation (RSD) in the management of arterial hypertension remains controversial, given the initial enthusiasm by the first studies, the great disappointment by the first sham-controlled randomized study and the current promising finding in recent randomized trials. Therefore, an uncertainty exists about the beliefs of hypertension specialists regarding RSD. This analysis presents the opinions of hypertension experts in Greece regarding the efficacy and safety of RSD. Design and method: Chairpersons of ESH Hypertension Excellence Centers in Greece and their senior clinical research fellows, were invited to participate in a meeting aiming to discuss the current evidence on the clinical utility of RSD. Individual responses were recorded and qualitatively analyzed, in order to reach consensus about the safety and efficacy of RSD. Results: Twenty-five experts participated in the meeting (cardiologists 52%, internists 40%, nephrologists 8%). Participants agreed upon the favorable results of three recent clinical trials and supported the view that RSD is an effective method. 44% believe that further technological development of the denervation catheter is expected to improve the results of the technique. Importantly, 22% of the experts highlighted the additional benefits of the method in regressing target organ damage and in patients with increased activity of the sympathetic nervous system. However, 44% of the experts underlined the lack of reliable predictive markers for the efficacy of RSD, while 32% highlighted the lack of long-term efficacy studies. Experts universally agreed on the safety of the method. However, 64% stated that the duration of the RSD trials was short, and thus there is lack of data on the long-term safety of RDS. Of note, 76% considered the method as easy to perform and minimally invasive. Conclusions: The majority of the hypertension experts in Greece agree upon the efficacy of RSD and all had minimal concerns of the safety of method. More data are needed to reveal the degree of confidence among hypertension experts regarding the efficacy and the safety of the whole procedure and its specific aspects.

FIRST RESULTS OF THE NEW HUNGARIAN HYPERTENSION REGISTRY: NUMBER OF DAILY MEASUREMENTS AND PROPORTION OF PATIENTS IN DIFFERENT BLOOD PRESSURE CATEGORIES

Objective: Hypertension is a major public health problem and its proper diagnosis and treatment are crucial points of cardiovascular morbidity and mortality reduction. The aim of the new Hungarian Hypertension Registry is to evaluate the features of blood pressure measurement practice of family physicians and hypertension care specialists and to overview the blood pressure values measured during everyday practice. Design and method: Omron M3 IT devices are located for four months periods in repeated times between October 2018 and October 2023 to family physician practices and to hypertension outpatient clinics. Blood pressure values are transmitted online to an evaluating center using the Medistance system of Omron. Results: Until now 1,691 family physicians, 111 internists, 112 cardiologists and 12 hypertension specialists were being involved into the study. During 4 four-months long evaluation periods between October 2018 and October 2020, 1 701 927 blood pressure measurements were registered. The daily average number of the measurements in the three periods were 3.5, 4.8, 5.4 and 3.6, respectively. Following the ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 13.4%, 13.4% and 17%, respectively. The proportion of patients in stage 1, stage 2 and stage 3 hypertension categories were 32.1%, 17% and 7.1%, respectively. The average systolic blood pressure values in family physician practices with more than 2500 patients were higher compared with practices with less, than 1500 patients (141.8 mmHg versus 139.84 mmHg, respectively). Conclusions: In conclusions, the low daily average number of blood pressure measurements refers for limited blood pressure screening capacity of the Hungarian family physicians. In practices with more patients the blood pressure is generally less controlled. These results suggest the need for reconsideration of the blood pressure measurement guidelines and the further promotion of home blood pressure measurement.

SUSTAINABILITY OF BLOOD PRESSURE REDUCTIONS AT INTERVENTIONS LED AT BARBERSHOPS: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Objective: Novel approaches are required in order to detect and manage hypertension in low and middle-income countries. One model is by using barbershops as a contact platform to engage with patients on a regular basis. We explored the evidence for the contemporary role of barbershop led interventions to manage hypertension in community setting, by only including randomized controlled clinical trials (RCCTs) Design and method: We searched Cochrane Library, pubmed- MEDLINE, IndMED online databases to conduct a systematic review of the published RCCTs. Studies with non-barbershop led, generalised community-based setting approaches were excluded by using the Boolean operators. Graphpad was utilised for statistical analysis Results: The results yielded four clinical trials of which three met inclusion criteria, published in last 10 years (2011 to 2019). The parameters were analysed for the study design, patient characteristics, impact factor of the journals, duration, and outcomes. Cumulatively, 1826 subjects (mean 609 subjects, SD ± 367, SEM ± 212, minimum 319, maximum 1022, range 703, 95% CI -304 to 1521, p = 0.103 NS) have been evaluated across three RCCTs. The cumulative duration of the trials was 32 months (mean 11 months, SD ± 1.2, SEM ± 0.67, minimum 10, maximum 12, range 2, 95% CI 7.8 to 13.5, p = 0.0039). The baseline systolic BP of upto 140 mm Hg has been the uniform enrolment criteria. Based on the impact factor of the journals (mean 31, SD ± 35, SEM ± 20, minimum 2.8, maximum 71, range 68, 95% CI -56 to 119; p = 0.26 NS), we formulated an indexed weightage score (mean 100, minimum 9, maximum 225, SD ± 112, SEM ± 65, range 216, 95% CI -178 to 378, p = 0.26 NS). The patients who were treated with specialists, received more BP medication and different classes of medication than those treated by primary care physicians and BP reduction was 21 mmHg (p &lt; 0.0001) Conclusions: Barber based intervention model have demonstrated to be a feasible connect between the patients and healthcare providers resulting in sustained BP reductions in the community, especially when care linkage to hypertension specialists can be achieved

IS THE CONTROL OF CARDIOVASCULAR RISK FACTORS IS DIFFERENT IN PRIMARY AND SECONDARY PREVENTION? COMPARISON OF 2 COHORTS OF HYPERTENSIVE PATIENTS WITHIN 10 YEARS

Objective: Euroaspire surveys highlighted the insufficiency of control of cardiovascular risk factor (CVRF) in coronary patient in secondary prevention. Patient profiles have changed, making it difficult to analyse these data over time. Our aim was to establish the state of CVRF control in two cohorts of French hypertensive patients in different clinical situations of primary and secondary prevention by following the variables assessed in Euroaspire. Design and method: Of each of the 22 participating hypertension specialist consultations, the first 20 patients (followed for at least one year) were included. Theoretical objectives were notified for each patient according to clinical profile. Two cohorts were formed, Cohort 1 (C1) in 2009 (n = 185) and Cohort 2 (C2) in 2019 (n = 260). Patients were classified according to their prevention (P) profile: primary (P1) and secondary (P2). Results: Baseline data are summarized in Table 1. The main statistically significant results between C2 vs C1 respectively are: younger people (58.8 vs 63.9 y) and more women in P1 (50% vs 32%); higher systolic blood pressure (BP) in P2 (143.7 vs 134.7 mm Hg), whereas higher diastolic BP in P1 (81.7 vs 76.6 mm Hg); fewer diabetic patients in P1 (19% vs 41%); poorly BP targets met in P1 (43% vs 63%); lower number of antihypertensive drugs in both groups (P1: 2.17 vs 2.66; P2: 2.62 vs 3.16); prescription of statins felt by half in P1 (30% vs 43%) within 10y. Conclusions: The high prevalence of unhealthy lifestyles, modifiable CVRF and inadequate use of drug therapies to achieve BP and lipid goals, are documented findings of the Euroaspire surveys in coronary patient, which we confirm in our hypertensive patients. Indeed, the P1 patient is less well managed than 10 years. In P2, there is no difference between the two cohorts, no improvement in BP control, possibly related with a reduction in the number of antihypertensive drugs. Ambition targets allocated for global prevention by combating the clinical inertia in titrating treatments must be a medical priority in clinical practice. Thanks to patients and Club des Jeunes Hypertensiologues.

CONTRIBUTION OF ARTIFICIAL INTELLIGENCE TO THE DECISION-MAKING PROCESS WHEN PERFORMING A HOME BLOOD PRESSURE MONITORING

Objective: Analyze home blood pressure monitoring data with the help of algorithms used in artificial intelligence and compare this method to traditional statistical analysis to categorize a subject with respect to its blood pressure status. Design and method: From an anonymized database of self-measurements performed in hypertensive patients followed in a hypertensive specialist center, artificial intelligence algorithms were used (logistic regression, gradient boosting tree, neural network) and compared with usual statistical methods. The self-measurement protocol consisted of 6 sequences over 3 days with 3 measurements per sequence, and 2 sequences per day. The mean of the 18 measures was used as a baseline to categorize the decision-making process with the thresholds SBP &gt; = 135 or DBP&gt;= 85 to define hypertension status. Results: The data base included 3910 HBPM which generated over 110,000 values to enter the analysis model. The figure shows that the AI allows to confirm or deny ‘hypertension’ in 46% of the subjects, as soon as sequence 2 is performed and that 82% of the subjects have a definite diagnosis after 4 sequences. In addition, AI is systematically more efficient than the statistical method whose performance, at 70% of patients with a definite diagnosis, remains at a plateau after sequence 4. Conclusions: Artificial intelligence algorithms are more efficient than conventional statistical methods to categorize the blood pressure status of a subject after only 2 sequences of a Home Blood Pressure Monitoring. From this hospital database it appears that 4 sequences performed over 2 days are sufficient to confirm or deny the diagnosis of hypertension in more than 80% of subjects.

HYPERTENSION PHENOTYPES, TARGET ORGAN DAMAGE AND STIFF ARTERIES AND SEVERITY OF COVID-19

Objective: Since the Coronavirus Disease 2019 (COVID-19) pandemic began, conflicting reports have emerged regarding its association with hypertension (HTN) in various populations worldwide. However, there is paucity of data regarding the association between the severity of COVID-19 and HTN phenotypes and HTN mediated organ damage (HMOD). Design and method: In a cohort of patients (n = 501, mean age 53.5 ± 14.6) attending a specialist hypertension clinic at King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia, we identified patients diagnosed with COVID-19 between January and November, 2020. We compared HTN phenotypes and HMOD in patients admitted with severe COVID-19 infection to those with mild disease and without disease. Data were analysed using JMP version 13 Pro (SAS for Windows). Results: Twenty-seven patients developed COVID-19 (5.38%), 8 of whom were admitted (29.6%), with one fatality (3.8%). Patients admitted with COVID-19 were more likely to have refractory HTN (43% vs. 15% vs. 8.9%, p &lt; 0.01), body mass index &gt; 30 (85.7% vs. 46% vs. 47%, p &lt; 0.05), left ventricular hypertrophy (28.6% vs. 7.7% vs. 6.5%, p &lt; 0.01), high hs-CRP (7.8 ± 1.1 vs. 2.1 ± 2 vs. 5 ± 1.5, p &lt; 0.01) and greater central systolic pressure (132 ± 5 vs. 122 ± 7 vs. 110 ± 13, p &lt; 0.01) with no difference in age and gender. Conclusions: In hypertensive patients, severe COVID-19 is associated with severe uncontrolled hypertension with HMOD and stiff arteries. While this is a small single center study, it does highlight aspects of COVID-19 in hypertensive patients which warrant further investigation.

CLINICAL CHARACTERISTICS OF YOUNG ADULTS WITH HYPERTENSION REFERRED TO A SPECIALIST HYPERTENSION CLINIC

Objective: Objective: Compared to older adults, young adults (18–39 years) with hypertension have poorer awareness of their conditions, are less likely to be treated and much less likely to have their blood pressure (BP) controlled as a result. The objective of this study was to identify the clinical characteristics of the young hypertensives, the extent of treatment and its success in achieving guideline BP targets. Design and method: Design: A pragmatic observational study of patients referred with hypertension to our clinic. Method: Consent for inclusion in the study was be requested from all patients attending the specialist hypertension clinic at St James Hospital from June to September 2019. Clinical details will be recorded to characterise the groups of interest. Details to be recorded from the patients first and most recent visit including demographics, referral information, co-morbidities, investigations and treatments. The study was approved by the local research ethics committee (Tallaght hospital, Dublin). T-tests and Chi-squared tests were applied as appropriate. Results: Results: 236 patients were recruited for the study of which 63 (26.7%) were young adults. The mean age of the young group was 32.1 years and the BMI was 30.3 kg/m2. 75% were either obese or overweight, both in line with the rest of the study cohort. 76% had a family history of hypertension. The young group were more likely to have controlled BP at a cut-off of 140/90mmHg (69.5 v 50.3%;p = 0.014) but this group were taking less anti-hypertensive medications compared to those forty years or older (1.41 drugs v 2.28;p &lt; 0.001). While the young group were more likely to have controlled BP according to the new AHA guidelines (27.1% v 13.3%;p = 0.025; cut-off 130/80mmHg), the figures were similar for both groups when the ESH guidance was used due to a higher cut-off for those over 65 years (27.1 v 28.5%). Conclusions: Conclusions: This study suggests that younger patients with hypertension require less anti-hypertensive treatment to achieve BP control. It did not identify subgroups of patients within the young group, however, the group is notable for the extent of overweight and obese patients referred to the clinic.

Referrals to, and characteristics of patients attending a specialist hypertension clinic.

The management of hypertension is suboptimal in Ireland and internationally. The role of a specialist hypertension clinic is not always defined but an analysis of the reasons for referral are likely informative. Also, a description of the clinical characteristics of patients with hypertension will inform requirements for comprehensive hypertension management in the community and secondary care. Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Reasons for referral, clinical characteristics of patients, their investigations and treatment were analyzed. 236 patients were included in the study. The majority of patients, 83%, were obese or overweight. A family history of hypertension was a frequent finding with 70.8% of patients reporting same. 26.7% of patients were under the age of 40. 78% of referrals were from primary care and the most referrals were to investigate secondary causes of hypertension or because the patient was ≤40 years of age. Calcium channel blockers were the treatment most frequently prescribed (51.7%). Clinic blood pressure for the cohort was 137/81 mmHg and this was replicated by their ambulatory BP. This insight into the contemporary management of hypertension highlights the frequency of obesity and a positive family history in those with hypertension. Most referrals were consistent with international guidance though deviations were evident. Findings suggest a national program for hypertension with greater focus on public health interventions and better resourcing of primary care is required.

Starting Antihypertensive Drug Treatment With Combination Therapy

Starting Antihypertensive Drug Treatment With Combination Therapy

Risk Stratification and Management of Arterial Hypertension and Cardiovascular Adverse Events Related to Cancer Treatments: An Oncology Network from Piedmont and Aosta Valley (North-Western Italy) Consensus Document

Cancer patients receiving a potentially cardiotoxic oncologic therapy have an increased risk of cardiovascular adverse events (CVAEs), especially in presence of concomitant arterial hypertension (AH). Therefore, cancer patients should be evaluated before, during and after cardiotoxic treatments, to early identify new-onset or worsening AH or CVAEs. An expert panel of oncology networks from Piedmont and Aosta Valley (North-Western Italy) aimed to provide recommendations to support health professionals in selecting the best management strategies for patients, considering the impact on outcome and the risk–benefit ratio of diagnostic/therapeutic tools. We proposed an useful document for evaluating and managing AH related to cancer treatments. Patients should be divided into 4 cardiovascular (CV) risk groups before starting potentially cardiotoxic therapies: patients with low/moderate risk who should be entirely evaluated by oncologists and patients with high/very high risk who should be referred to a cardiologist or arterial hypertension specialist. According to the CV risk class, every patient should be followed up during cancer treatment to monitor any possible CV complications. Adequate control of AH related to antineoplastic treatments is crucial to prevent severe CVAEs. In the presence of high-profile risk or lack of response to anti-hypertensive therapy, the patients should be managed with a cardiovascular-oncology expert center.

The Odyssey from Symptom to Diagnosis of Pulmonary Hypertension from the Patients and Spouses Perspective.

Introduction/objective:Diagnostic delays in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are related to increased morbidity and mortality. The risk of a delayed, or even a missed, diagnosis is high as the conditions are rare. The aim was to describe patients’ and spouses’ experiences of the journey from the first symptom to an established diagnosis.Methods:A secondary analysis of 31 transcripts, based on 2 primary datasets containing interviews with 17 patients and 14 spouses, was carried out and analyzed according to qualitative content analysis.Results:One overarching category was revealed from the content analysis; “The journey from doubt and hope to receive the diagnosis.” Five subcategories were identified as: overall experiences; ignoring symptoms; seeking primary care/hospital specialty care; blame and stigma; and finding a pulmonary hypertension specialist clinic. The main finding was that both patients and spouses experienced that waiting for a diagnosis and the deteriorating state of health led to anxiety and frustration. The knowledge about rare diseases among health professionals needs to be improved to enable a timelier diagnosis and initiation of treatment.Conclusion:Patients’ and spouses’ lives were negatively affected by having to search for a correct diagnosis. In order for health care to identify rare diseases earlier, a well-functioning and responsive health care system, in primary care as well as in specialist care, is needed. Symptoms like breathlessness and fatigue are often unspecific but should not be ignored. Keeping the patient and spouse in the loop, and providing information that the search for an answer might take time is essential for health care providers to create trust.