Control Of Hypertension Research Articles

The Impact of an Enhanced Data Visualization Tool for Hypertension in the Electronic Health Record on Physician Judgments About Hypertension Control.

Uncontrolled hypertension is a significant US health problem, despite existing effective treatments. This study assessed the impact of variations in patterns of blood pressure data on physician perceptions of hypertension control using different forms of data visualization. Physicians (N = 57) reviewed eight brief vignettes describing a fictitious patient; each vignette included a graph of the patient's blood pressure data. We examined how variations in mean systolic blood pressure (SBP), blood pressure standard deviation (SD), and form of visualization (e.g., line graph with raw values or smoothed values only) affected judgments about hypertension control and need for medication change. Smoothing successfully reduced visual noise for the physicians. For controlled hypertension, physician judgments were more consistent with clinical guidelines when using the smoothed graph compared with the raw data graph. Judgments about hypertension control with the smoothed graph were similar to judgments made using the raw data graph for cases of uncontrolled hypertension. Data visualization can direct physicians to attend to more clinically meaningful information, thereby improving their judgments of hypertension control.

Telemedicine Use and Hypertension Control in an Urban Community Health Center Cohort.

Real-time or synchronous telemedicine can be a valuable adjunctive strategy for chronic disease management, but few studies have assessed its impact on hypertension control among safety-net populations. To evaluate whether telemedicine is associated with blood pressure (BP) control. Retrospective cohort study. Mixed-effects logistic regression models clustered by the patient estimated associations between telemedicine and BP control after adjusting for patient factors and neighborhood context. Patients seeking care at an urban, multisite community health center with hypertension and ≥1 BP measurement between 2020 and 2022 (3663 patient-year observations across 2086 unique patients). The primary outcome was BP control defined as a binary variable. We used the Centers for Medicare & Medicaid Services' Controlling High Blood Pressure quality measure criteria of systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg in the most recent recording in the measurement year. Among the 2086 patients with hypertension in our sample, there were 1257 (60.3%) Latinx and 425 (20.4%) Black patients. Over 90% lived in a neighborhood of high deprivation as categorized by the social deprivation index. Telemedicine visits, compared to none, were not associated with blood pressure control (1-2 telemedicine visits aOR, 1.05 [95% CI, 0.86-1.28]; ≥3 telemedicine visits aOR, 0.86 [95% CI, 0.68-1.09]). One in-person visit per year, compared to 2-3, was associated with lower odds of BP control (aOR, 0.72 [95% CI, 0.55-0.94]). Black patients, compared to Latinx patients, were less likely of having BP control (aOR, 0.64 [95% CI, 0.48-0.87]). In this community health center cohort of patients with hypertension, telemedicine did not compromise blood pressure control. Persistent racial disparities in blood pressure control underscore the need for equity-centered strategies for hypertension management in safety-net primary care settings.

Effect of COVID-19 Pandemic Related Healthcare Disruption on Hypertension Control: A Retrospective Analysis of Older Adults with Multiple Chronic Conditions in New York City.

Disruption of ambulatory healthcare in New York City (NYC) during the COVID-19 pandemic was common, but the impact on the cardiometabolic health of vulnerable patient groups is unknown. Therefore, we estimated the effect of total care disruption (TCD) on blood pressure (BP) control among older NYC residents with hypertension and at least one other chronic condition, and examined whether neighborhood poverty moderated this impact. From the INSIGHT Clinical Research Network, we identified NYC residents ≥50 years of age with hypertension and at least one other chronic condition. TCD was defined as no ambulatory or telehealth visit during the pandemic. We contrasted the change in prevalence of controlled BP (BP <140/90) before and after the pandemic among those with and without TCD via an inverse probability weighted (IPW) difference-in-difference regression model. Among 212,673 eligible individuals, mean age was 69.5 years (SD: 10.2 years) and 15.1% experienced TCD. BP control declined from 52.4% to 45.9% among those with TCD and from 53.6% to 48.9% among those without TCD. After IPW adjustment, a larger decline in BP control was noted among those with TCD (adjusted difference-in-difference = 1.13 percentage points (95% CI 0.32-1.94, p-value=0.0058)). There was no consistent difference in the relationship between TCD and post-pandemic BP control across neighborhood poverty levels. COVID-19-related TCD was associated with a modest decline in BP control among older adults with hypertension in NYC; this was not moderated by neighborhood poverty level.

Novel pharmacological approaches to lowering blood pressure and managing hypertension.

Hypertension is the leading cause of death globally, primarily due to its strong association with cardiovascular disease. The global prevalence of hypertension has surged over the past three decades, driven by rising rates of diabetes mellitus and obesity. Despite current antihypertensive therapies, only a small proportion of patients with hypertension achieve adequate blood pressure control, necessitating novel therapeutic strategies. In this Review we explore the challenges and emerging opportunities in hypertension management. Aprocitentan, a dual endothelin receptor antagonist, is the first agent from a novel class of antihypertensive drug to be licensed since 2007 and exemplifies innovative treatments on the horizon. Here we also address the complex factors contributing to poor hypertension control, including genetic influences, lifestyle factors, therapeutic inertia and poor patient adherence. We discuss the limitations of existing therapies and highlight promising new pharmacological approaches to hypertension management. Integrating these novel treatments alongside current pharmaceuticals combined with improved diagnostic and management strategies could substantially reduce the global burden of hypertension and associated cardiovascular disease.

The association of hypertension and antihypertensive medications on semen parameters among men presenting for fertility evaluation.

Hypertension is a common medical condition and its prevalence increases with age. Therefore, more prospective fathers will present for fertility evaluation with this diagnosis. To determine if hypertension and antihypertensive medication use are associated with impaired semen parameters. We retrospectively reviewed men with and without hypertension at the time of their index semen analysis (SA) between 2002 and 2023. Demographics, medical comorbidities, and semen parameters were evaluated between cohorts. Univariable and multivariable regression analyses were also used to determine the association of hypertension, and number and class of antihypertensive medications, and abnormal total motile sperm count (TMSC<20 million). Among 14,009 men, 10.1% (n=1410) had a diagnosis of hypertension. Hypertensive men had significantly lower ejaculate volume (2.8mL [interquartile range {IQR} 1.8-3.8] vs. 2.9mL [IQR 2.0-4.0], p<0.001) and sperm motility (58% [IQR 50-66] vs. 60% [52-68], p<0.001). Hypertension was also independently associated with abnormal TMSC (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.05-1.40, p=0.008) on multivariable analysis. Among patients with hypertension, men with an active antihypertensive medication prescription at the time of index SA were older and had lower sperm motility (57% [IQR 47-64] vs. 59% [IQR 52-67], p=0.006), sperm morphology (5% [IQR 2-7] vs. 6% [3-12], p<0.001) and TMSC (48.9M [IQR 16.1-94.9] vs. 68.4M [25.0-124.9], p<0.001) compared to patients with no prior antihypertensive medication exposure. Multivariable analysis demonstrated no significant increased risk of abnormal TMSC between unexposed patients and those taking an antihypertensive medication. More than one in 10 men presenting for initial fertility evaluation had a diagnosis of hypertension. This diagnosis, as well as antihypertensive medication exposure, were associated with impaired semen parameters. Patients interested in future fertility should be counseled regarding lifestyle modifications to appropriately treat hypertension. Further studies are required to determine the impact of antihypertensive medications and adequate control of hypertension on semen quality.

Retrospective analysis of non-pharmacological factors associated with ineffective control of arterial hypertension in a clinical sample

Introduction. Arterial hypertension (HT) is the most common risk factor of cardiovascular diseases and leads to increased premature mortality. About half of HT patients do not reach the target values of blood pressure (BP).Aim: To assess the frequency of failure to achieve the target BP level and to identify non-pharmacological factors associated with inefficient BP control in a clinical sample of patients with hypertension.Material and Methods. A sequential clinical sample of patients (n = 105, 19–84 years old) with an established diagnosis of HT receiving antihypertensive therapy (AHT), was examined. Clinical data were analyzed in groups with efficient (ECHT, n = 29) and inefficient control of hypertension (ICHT, n = 76) by the time of admission to the hospital.Results. In the entire sample, the proportion of ICHT (72%) was higher compared to ECHT (28%). The groups did not differ in age, anthropometry, menopausal status in women, and duration of HT, but with an increase in the degree of hypertension, the proportion of patients with NCAH increased. There were more women in ECHT group, and there were equal proportions of men and women in ICHT group. In the ICHT group, we observed higher values of HDLC, more frequent chronic heart failure (CHF) and single atherosclerotic plaques (AP) of carotid and other peripheral arteries; in the ECHT group, the average levels of plasma glucose, glycated hemoglobin, the proportion of smokers were higher, and type 2 diabetes and multiple AP were more common. The AHT (doses, regimen, combinations) was more adequate in the ECHT group. About half of the patients received combination therapy.Conclusion. In the clinical sample, one third of HT patients receiving AHT, had blood pressure controlled to target at hospital admission. Inefficient blood pressure control was associated with male gender, a higher level of HDLC, the high degree of HT, single AP and CHF. In the efficient control group, smoking, comorbidity with type 2 diabetes, multiple AP, higher glucose levels and HbA1c were more often noted.

Accounting for racial bias and social determinants of health in a model of hypertension control

BackgroundHypertension control remains a critical problem and most of the existing literature views it from a clinical perspective, overlooking the role of sociodemographic factors. This study aims to identify patients with not well-controlled hypertension using readily available demographic and socioeconomic features and elucidate important predictive variables.MethodsIn this retrospective cohort study, records from 1/1/2012 to 1/1/2020 at the Boston Medical Center were used. Patients with either a hypertension diagnosis or related records (≥ 130 mmHg systolic or ≥ 90 mmHg diastolic, n = 164,041) were selected. Models were developed to predict which patients had uncontrolled hypertension defined as systolic blood pressure (SBP) records exceeding 160 mmHg.ResultsThe predictive model of high SBP reached an Area Under the Receiver Operating Characteristic Curve of 74.49% ± 0.23%. Age, race, Social Determinants of Health (SDoH), mental health, and cigarette use were predictive of high SBP. Being Black or having critical social needs led to higher probability of uncontrolled SBP. To mitigate model bias and elucidate differences in predictive variables, two separate models were trained for Black and White patients. Black patients face a 4.7 × higher False Positive Rate (FPR) and a 0.58 × lower False Negative Rate (FNR) compared to White patients. Decision threshold differentiation was implemented to equalize FNR. Race-specific models revealed different sets of social variables predicting high SBP, with Black patients being affected by structural barriers (e.g., food and transportation) and White patients by personal and demographic factors (e.g., marital status).ConclusionsModels using non-clinical factors can predict which patients exhibit poorly controlled hypertension. Racial and SDoH variables are significant predictors but lead to biased predictive models. Race-specific models are not sufficient to resolve such biases and require further decision threshold tuning. A host of structural socioeconomic factors are identified to be targeted to reduce disparities in hypertension control.

Weighted EHR-based prevalence estimates for hypertension at the state and local levels in Louisiana

BackgroundModernization of public health data systems is a national priority. Improved chronic disease surveillance can provide more timely, accurate, and local measures to inform public health policy and intervention. Although electronic health record (EHR) data have great potential for surveillance, population coverage is non-random, which may result in biased estimates. Statistical approaches are needed to adjust estimates to represent the underlying population and validate the results against independent estimates.MethodsMENDS, the Multi-State-EHR-Based Network for Disease Surveillance, uses EHR data to calculate chronic disease and risk factor prevalence metrics. In this study, we applied post-stratification weighting to MENDS data from nearly 800,000 adults from Louisiana to estimate the prevalence of hypertension and hypertension control at the state and parish (county-equivalent) levels during February 2023. We then compared weighted MENDS hypertension prevalence estimates with measures derived from traditional public health surveillance.ResultsWeighted MENDS hypertension prevalence estimates were approximately 10% lower than crude MENDS estimates, and approximately 13% higher than hypertension awareness estimates from the 2021 Behavioral Risk Factor Surveillance System, with similar geographic and demographic patterns. Weighted MENDS hypertension prevalence estimates indicated that 43.0% of Louisiana adult residents had hypertension (versus 47.7% crude prevalence). Prevalence was higher than the overall state estimate among men (47.3% weighted; 55.9% crude), Black patients (50.2% weighted; 55.7% crude), those receiving Medicare (70.6% weighted; 76.2% crude), and individuals living in rural areas (46.1% weighted; 49.8% crude). Hypertension prevalence increased with age and with more clinical visits during the previous 2 years. Hypertension prevalence was highest in the southeastern parishes near New Orleans and Baton Rouge. Demographic and geographic patterns in prevalence of hypertension control were like hypertension prevalence.ConclusionsPost-stratification weighting of MENDS data brought EHR-based data estimates closer to survey-based estimates of hypertension and can improve representativeness of chronic disease indicators. These estimates can provide public health organizations with timely, accurate, and local information. Further, EHR-based systems can produce unique measures, such as the prevalence of hypertension control, which can provide a more nuanced understanding of community needs and help public health agencies evaluate the effectiveness of community interventions.

Abstract TP282: Hypertension Control in Individuals with Previous Stroke: data from ELSI-Brazil study

Abstract TP282: Hypertension Control in Individuals with Previous Stroke: data from ELSI-Brazil study

Racial and gender inequities in the control of arterial hypertension in ELSA-Brasil: An intersectional approach.

This study investigated the association of the intersectional categories of gender-race/color with inadequate blood pressure (BP) control in Brazilian adults using antihypertensive drugs to treat hypertension. This is a cross-sectional analysis conducted with 4448 participants living with hypertension from visit 2 (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) undergoing pharmacological treatment. The association of the intersectional categories - White woman, Brown woman, Black woman, White man, Brown man, Black man - with inadequate BP control (systolic BP levels ≥140mmHg and/or diastolic BP levels ≥90mmH) was estimated by the prevalence ratio (PR) and 95% confidence interval (95% CI) obtained by generalized linear models with Poisson distribution, adjusted covariates. The age-standardized prevalence of inadequate BP control ranged from 18.9% (White women) to 35.6% (Black men). After adjusting for sociodemographic characteristics, health-related behavior, health conditions, and the class number of antihypertensive medications, compared to White women, Black men (PR: 1.49 95% CI: 1.26-1.75), Brown men (PR: 1.42 95% CI: 1.18-1.72), Black women (PR: 1.36 95% CI: 1.12-1.65), and White men (PR: 1.32 95% CI: 1.09-1.60) showed poorer BP control. Results corroborate a higher prevalence of inadequate BP control in Black and Brown men. Furthermore, this intersectional approach evidenced that the prevalence of inadequate BP control in Black women is higher than that in White men, when compared to White women. Findings highlight that, for the development of more equitable BP control strategies, one must consider the specificities of socially marginalized intersectional groups, especially Black men and women.

Cost-Effectiveness of Intensive Blood Pressure Control in Youth With Chronic Kidney Disease.

Intensive blood pressure (BP) control in youth with chronic kidney disease (CKD) slows progression, delaying the need for kidney replacement therapy (KRT). Most youth with CKD have hypertension and BP control is difficult to achieve outside of controlled experimental settings. Implementing effective BP control strategies in this population may be cost-saving despite requiring additional resources. Our objective was to determine the economic and clinical impact of intensive versus usual care for BP management in youth with CKD in a microeconomic model. We developed a decision tree from the US payer perspective to estimate the total costs and clinical effect of an intensified BP intervention over 5 years, modeled after the ESCAPE trial (Effect of Strict Blood Pressure Control and Angiotensin-Converting Enzyme [ACE] Inhibition on Progression of Chronic Renal Failure in Pediatric Patients) protocol. We compared this intervention to usual care in a hypothetical population of youth with mild-to-moderate CKD. Probabilities were informed by published literature; cost estimates were informed by publicly available data. Our outcomes were the net discounted cost of an intensive BP intervention, number needed to treat with the intervention to prevent 1 KRT episode, and incremental cost per KRT episode avoided. An intensive BP intervention, with a goal of an average 24-hour mean arterial pressure <50th percentile, improved outcomes with net cost savings of $9440 per participant over 5 years compared with usual care. To prevent 1 episode of KRT over 5 years, 13 participants need to receive intensive BP intervention. Routine use of the ESCAPE protocol for intensive BP control in youth with CKD could save overall costs for the payer and improve clinical outcomes.

FREQUENCY OF MICROALBUMINURIA IN TYPE 2 DIABETICS WITH NORMAL CREATININE CLEARANCE

Background: Microalbuminuria is an early indicator of diabetic nephropathy and a strong predictor of cardiovascular and renal complications in type 2 diabetes mellitus (T2DM). It reflects early glomerular damage and serves as a marker for worsening renal function. Identifying microalbuminuria at an early stage is essential for timely intervention to prevent progression to overt nephropathy and end-stage renal disease. Several demographic, clinical, and lifestyle factors contribute to its development, necessitating further investigation into its prevalence and associated risk factors in diabetic populations. Objective: This study aimed to determine the prevalence of microalbuminuria in T2DM patients with normal creatinine clearance and examine its associations with demographic, clinical, and lifestyle factors. Methods: A cross-sectional study was conducted at a tertiary care hospital among 164 T2DM patients. Data were collected on demographic characteristics, including age, gender, and body mass index (BMI), as well as clinical factors such as duration of diabetes, hypertension, dyslipidemia, smoking status, and glycemic control. Blood pressure and HbA1c levels were recorded. Lifestyle factors, including physical activity and dietary adherence, were assessed through structured questionnaires. Microalbuminuria was detected using a midstream urine sample, analyzed with a dipstick test. Associations between microalbuminuria and independent variables were evaluated using chi-square tests, with a p-value of &lt;0.05 considered statistically significant. Results: Microalbuminuria was detected in 55 patients, accounting for 33.5% of the study population. There was no significant association between microalbuminuria and gender (p = 0.53) or age (p = 0.28). However, a significant association was observed with diabetes duration, with 32.7% of patients with diabetes for over 10 years having microalbuminuria compared to 22.0% of those with shorter disease duration (p = 0.01). Hypertension was significantly more prevalent in the microalbuminuria group (76.4% vs. 53.2%, p &lt; 0.001). Poor glycemic control (HbA1c &gt;7.0%) was associated with a higher prevalence of microalbuminuria (63.6% vs. 45.9%, p = 0.02). Additionally, a sedentary lifestyle (63.6% vs. 32.1%, p = 0.04) and poor dietary adherence (54.5% vs. 22.9%, p = 0.03) were significantly associated with microalbuminuria. Conclusion: The study revealed a high prevalence of microalbuminuria among T2DM patients, strongly associated with poor glycemic control, hypertension, and unhealthy lifestyle behaviors. These findings highlight the importance of early screening, lifestyle modifications, and optimized management of diabetes and hypertension to prevent renal complications.

Abstract 17: The Effectiveness of a Community Health Worker-Led Intensive Blood Pressure Intervention on Stroke

Background: Hypertension is the most important modifiable risk factor for stroke, a leading cause of death in China. Despite national efforts, stroke incidence and mortality rates remain high in China, with significant urban-rural disparities. Objectives: We aimed to examine the effectiveness of non-physician health worker-led antihypertensive interventions on the risk of stroke in rural China. Methods: We included 33,995 hypertensive participants from 326 villages in rural China using 48-month follow-up data from the China Rural Hypertension Control Project (CRHCP). In the CRHCP trial, non-physician healthcare workers initiated and titrated antihypertensive medications using a simple stepped-care protocol recommended by clinical guidelines. The primary outcome was total stroke during the 48-month follow-up period. Secondary outcomes included fatal and nonfatal strokes. We conducted a secondary analysis adjusted for pre-defined baseline covariates to examine the robustness of the intervention effect on stroke. Safety outcomes were also assessed at 48 months. Results: During a median of 48.2 months of follow-up, 1,151 strokes (1.7% yearly rate) occurred in participants in intervention villages compared to 1,484 strokes (2.4% yearly rate) in participants in usual care villages. The non-physician health worker-led intervention reduced stroke by 28% (hazard ratio = 0.72; 95% CI: 0.67, 0.77) in intervention compared to usual care participants. Similar reductions were also observed for fatal (hazard ratio = 0.74; 95% CI 0.63, 0.87) and nonfatal stroke (hazard ratio = 0.71; 95% CI 0.66, 0.78). Participants in intervention villages had a significantly lower rate of hospitalizations and deaths compared to usual care participants (risk ratio = 0.94; 95% CI 0.91, 0.98). There were no significant differences in rates of injurious falls, symptomatic hypotension, or syncope between the intervention and usual care villages. Conclusion: This study shows that a nonphysician health worker-led intensive BP control was effective at reducing stroke among rural residents in China. The non-physician community health worker-led intervention should be scaled up in China and other low- and middle-income countries to reduce the burden of stroke.

Long-Term Blood Pressure Trends After a Remote Hypertension Intervention: A Secondary Analysis of the Digital Care Transformation: Remotely Delivered Hypertension Management Program.

Hypertension is a major cardiovascular risk factor, yet traditional care often results in suboptimal blood pressure (BP) control at the population level. We implemented a remote hypertension management program that monitored home BP and titrated medications per algorithm. This study assessed the program's long-term effects by examining participants' office BP up to 42 months post-enrollment. Participants of the remote hypertension program were categorized into 4 groups: (1) enrolled-maintenance (achieved goal home BP of ≤130/80 mm Hg), (2) enrolled-early exit (left before achieving goal BP), (3) education-only (lifestyle modifications and medications compliance), and (4) white coat hypertension group (high office BP but normal home BP). Office BP readings of participants were collected up to 42 months post-enrollment. A linear mixed-effects regression model estimated mean BP levels and studied factors associated with above-goal systolic BP in the maintenance group. Office BP readings from 3601 participants (mean age, 61±11 years; 57% female; 60% white; 52% atherosclerotic cardiovascular disease) were extracted from electronic health records and analyzed. All groups sustained office BP below their qualifying values (P<0.001) over 42 months. In the maintenance group, 89.7% of participants maintained systolic BP at goal, compared with 63.5% in the early exit group, 69.4% in the education-only group, and 90.7% in the white coat hypertension group. Age >50 years was associated with above-goal systolic BP in the maintenance group. Participants who achieved BP control through the remote hypertension program maintained goal systolic BP in 90% of cases up to 42 months post-enrollment. These findings highlight the long-term benefits of remote, intensive management programs for effective hypertension control.

Abnormal left ventricular and left atrial mechanics in patients with resistant hypertension

Abstract Introduction Patients with resistant hypertension (RH) suffer from a high rate of cardiovascular (CV) complications and have poor prognosis. Given the poor prognosis in RH patients, early identification of subclinical myocardial abnormalities is of clinical importance to allow for timely preventive therapeutic interventions. Speckle tracking echocardiography (STE) is a valuable technique to detect subclinical myocardial dysfunction in hypertensive patients and, therefore, could assist in clinical risk stratification and provide important therapeutic implications. Purpose The study aimed to investigate whether left ventricular (LV) and left atrial (LA) myocardial mechanics are impaired in patients with RH compared to controlled hypertension (CH) patients and normotensive controls (NC). Methods This was a prospective cross-sectional study in which 54 age and sex-matched participants: 17 with RH (mean age 60.5±12.4 years), 18 with CH (57.7±12.2 years), and 19 NC (54.7±11.9 years) were consecutively recruited. Clinical and conventional echocardiographic measurements were obtained, followed by a two-dimensional STE analysis to assess LV and LA strain. Stepwise multivariable linear regression analysis was performed to identify independent predictors of LV and LA strain indices. Results The demographical characteristics were similar across the three groups (Table 1). Patients with RH had elevated BP readings and pronounced cardiac remodelling compared to CH and NC (p&amp;lt;0.001). Peak systolic global longitudinal strain (GLS) was lower in RH and CH groups compared to NC (RH: -16.7±1.9% and CH: -19.8±1.4% vs NC: -21.4±1.3%; p&amp;lt;0.001 and p=0.005, respectively), and being lower in RH compared to CH (p&amp;lt;0.001). Peak systolic global circumferential strain (GCS) was lower between RH and NC (RH: -18.3±3.6% vs NC: -21.7±2.2%, p=0.004) but not between RH and CH (RH: -18.3±3.6% vs CH: -20.3±2.9%, p=0.13). Peak systolic global radial strain (GRS) was lower in RH than in CH and NC (RH: 32.8±8.1% vs CH: 45.0±8.9% and NC: 49.1±5.2%, p&amp;lt;0.001 for all). LV twist was similar amongst the three groups (p&amp;gt;0.05). For the LA longitudinal strain indices, patients with RH had significantly lower reservoir, conduit, and pump strains than NC (p&amp;lt;0.001, p&amp;lt;0.001 and p=0.04, respectively) and CH (p=0.01, p=0.02 and p=0.02, respectively). Of note, the presence of RH remained independently associated with worse GLS (β=3.1, p&amp;lt;0.001), GRS (β= -8.6, p&amp;lt;0.001), LA reservoir (β= -6.0, p=0.005) and pump strains (β=3.5, p=0.007) after adjusting for demographical and clinical variables (Table 2). Conclusion Patients with RH show evidence of greater cardiac remodelling with subclinical impairment of their LV and LA mechanics when compared to CH and NC. The subclinical identification of myocardial abnormalities in patients with RH may provide a therapeutic window of opportunity for their reversal and potentially mitigate the occurrence of accompanied CV complications.

Characteristics and Biological Activities of Bioactive Peptides Derived from Bulgur Waste

Bulgur is one of the ready or semi-ready to eat cereals produced from wheat specifically Triticum durum variety. Residues of bulgur processing are known as bulgur waste that rich in some food components. Protein is one of the main components of bulgur that may remain in the wastes. This study was carried out to obtain and investigate the properties of bioactive peptides of bulgur waste proteins. Protein isolated from bulgur waste was hydrolyzed enzymatically to bioactive peptides and their potential activity against oxidation stress, microbial inhibition and hypertension control was determined. The bulgur waste proteins extracted from samples were hydrolyzed at different time intervals using pepsin, trypsin, chymotrypsin and protease under the optimum conditions of enzymes and o-phthalaldehyde (OPA) method was used to determine the degree of hydrolyses. The highest rate of hydrolysis efficiency was observed by protease as 10.08% at 240 min treatment while, the highest antioxidant capacity was measured with chymotrypsin (526.35% at 240 min) by 2,2′-azino-bis(3- ethylbenzothiazoline-6-sulphonic acid) (ABTS) and with trypsin (151.93 % at 240 min) by 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods. Trypsin hydrolysates showed the highest antibacterial activity against Escherichia coli whereas pepsin hydrolysates exhibited the highest activity against Staphylococcus aureus. It has been observed that trypsin, chymotrypsin and protease hydrolysates have higher antihypertensive effects than protease hydrolyzates. The highest antihypertensive effect was obtained with protein hydrolyzate obtained by hydrolysis with chymotrypsin for 180 minutes. As a result, the novel peptides indicated to offer the selected biological effects, suitable to use as a food additive for different purposes in industrial applications.

Influence of ROI width in evaluation of regional and global longitudinal strain in patients with hypertrophic cardiomyopathy

Abstract Background Longitudinal strain (LS) is useful in evaluating global and regional left ventricular function in patients with hypertrophic cardiomyopathy (HCM), but it is not fully investigated the influence of the ROI width on LS value in patients showing localized or asymmetrical hypertrophy. Purpose The purpose of this study is to evaluate regional and global LS in patients with HCM showing localized or asymmetrical hypertrophy, compared with hypertensive patients with diffuse and symmetrical hypertrophy as control, and to clarify the influence of ROI width on LS value. Methods We retrospectively investigated LS in patients with apical hypertrophy (APH), asymmetrical septal hypertrophy (ASH) and hypertension (control group). LS in hypertrophic region (APH: apical 6 segments, ASH: basal and mid septal 4 segments) and global LS (GLS) were compared with control group. LS was measured with uniform ROI width by default (D method) and after manual adjustment of ROI width as covering the whole thickness in the hypertrophic region (A method) (Figure). Results LS in hypertrophic region was decreased in patients with APH and ASH compared with control group. LS was decreased in A method than D method in patients with APH (Table). Conclusions We should consider the setting of ROI width in evaluating regional myocardial systolic function by LS in patients with HCM showing localized or asymmetrical hypertrophy. Figure

Treatment Strategies to Control Blood Pressure in People With Hypertension in Tanzania and Lesotho: A Randomized Clinical Trial.

Hypertension is the primary cardiovascular risk factor in Africa. Recently revised World Health Organization guidelines recommend starting antihypertensive dual therapy; clinical efficacy and tolerability of low-dose triple combination remain unclear. To compare the effect of 3 treatment strategies on blood pressure control among persons with untreated hypertension in Africa. This was an open-label, parallel, 3-arm randomized clinical trial to evaluate noninferiority of a strategy starting 2 pills vs full-dose monotherapy with stepped escalation (noninferiority margin 10%) and superiority of starting low-dose 3 pills vs monotherapy allowing for monthly up titration. Recruitment lasted from March 5, 2020, to March 30, 2022. The setting was 2 hospitals in rural Lesotho and Tanzania. Participants included nonpregnant Black African individuals 18 years and older with uncomplicated, untreated hypertension (standardized office blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic). Participants were randomized 2:2:1 to stepped monotherapy (amlodipine, 10 mg, with escalation to add hydrochlorothiazide if needed), 2-pill strategy (amlodipine, 5 mg; losartan, 25 mg), or 3-pill strategy (amlodipine, 2.5 mg; losartan, 12.5 mg; hydrochlorothiazide, 6.25 mg). Drugs were up titrated monthly until reaching the target blood pressure (≤ 130/80 mm Hg for participants aged <65 years; ≤140/90 mm Hg for those aged ≥65 years). Proportion of participants reaching target blood pressure at 12 weeks. Of 1761 participants screened, 1268 were enrolled (median [IQR] age, 54 [45-65] years; 914 female [72%]), with 505 in the monotherapy cohort, 510 in the 2-pill cohort, and 253 in the 3-pill cohort. In noninferiority analyses, 207 of 370 participants (56%) receiving the 2-pill strategy and 173 of 338 participants (51%) receiving the stepped monotherapy strategy achieved the blood pressure target (adjusted odds ratio [aOR], 1.18; 95% CI, 0.87-1.61), fulfilling noninferiority. In superiority analyses after multiple imputation for missing outcome data, 57% of participants receiving the 3-pill strategy, 55% receiving the 2-pill strategy, and 49% receiving the stepped monotherapy strategy reached the target blood pressure (aOR, 1.24; 95% CI, 0.94-1.63; P = .12 and aOR, 1.28; 95% CI, 0.91-1.79; P = .16 for the 2-pill and 3-pill vs stepped monotherapy strategies, respectively). Results of this randomized clinical trial show that in 2 African settings, for adults with uncomplicated untreated hypertension, a strategy starting a 2-pill low-dose treatment was noninferior to starting stepped monotherapy. Two-pill and 3-pill low-dose strategies were not superior to stepped monotherapy. Wide CIs preclude the ability to rule out potentially clinically important effects of the additional pill strategies for hypertension control. ClinicalTrials.gov Identifier: NCT04129840.

Research on the life stress and hypertension among young couples of childbearing age

Objective: To investigate the current status of life stress and hypertension among couples of childbearing age across diverse economic regions in China, and to explore relevant influencing factors. Methods: This study was a cross-sectional study, with subjects from the "Research on the standardized system of comprehensive prevention and control of birth defects based on preconception-prenatal-postnatal whole chain". From February to May 2021, urban and rural couples of childbearing age (18-49 years old) from Beijing, Henan, and Gansu provinces were enrolled, representing the eastern, central, and western regions of China, respectively. The detection rate, cognition and control of hypertension in the general population, as well as the detection rate of hypertension in different genders and regions were analyzed. Subjects were divided into hypertensive group and non-hypertensive group based on whether their blood pressure was≥140/90 mmHg (1 mmHg=0.133 kPa), and the general clinical data of the two groups were compared. Subjects were also divided into prehypertension and hypertension group and normal blood pressure group based on whether their blood pressure was≥130/80 mmHg, and the general clinical data of the two groups were compared, with subgroup analyses conducted by gender. Multifactorial logistic regression model was applied to identify factors associated with prehypertension and hypertension in both males and females. Results: A total of 1 942 couples of childbearing age, comprising 3 884 individuals, aged (29.8±5.2) years were enrolled, with 1 942 males (50.0%). The overall hypertension detection rate was 6.3% (246/3 884), with a detection rate of 10.5% (203/1 942) in males and 2.2% (43/1 942) in females. The hypertension detection rates in Beijing, Henan, and Gansu were 6.2% (92/1 482), 11.6% (139/1 200), and 1.2% (15/1 202), respectively. The overall detection rate of prehypertension and hypertension was 40.5% (1 574/3 884). Multifactorial logistic regression analysis showed that life pressure factors had no effect on female blood pressure levels (P>0.05), while a significant or high level of life/work pressure was a risk factor for prehypertension and hypertension in males (OR=2.30, 95%CI 1.06-4.99, P<0.05). Conclusion: The detection rate of prehypertension and hypertension among young couples of childbearing age in China is high, with poor awareness and control of hypertension. There are sex differences in the relationship between life pressure and blood pressure levels. Comprehensive consideration of individual living environments and mental health factors is crucial in blood pressure management. Measures to reduce life stress and enhance mental resilience should be implemented to address this public health issue.

Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study.

Cardiovascular disease (CVD) morbidity and mortality is increasing in Africa, largely due to undiagnosed and untreated hypertension. Approaches that leverage existing primary health systems could improve hypertension treatment and reduce CVD, but cost-effectiveness is unknown. We evaluated the cost-effectiveness of population-level hypertension screening and implementation of chronic care clinics across eastern, southern, central, and western Africa. We conducted a modeling study to simulate hypertension and CVD across 3,000 scenarios representing a range of settings across eastern, southern, central, and western Africa. We evaluated 2 policies compared to current hypertension treatment: (1) expansion of HIV primary care clinics into chronic care clinics that provide hypertension treatment for all persons regardless of HIV status (chronic care clinic or CCC policy); and (2) CCC plus population-level hypertension screening of adults ≥40 years of age by community health workers (CHW policy). For our primary analysis, we used a cost-effectiveness threshold of US $500 per disability-adjusted life-year (DALY) averted, a 3% annual discount rate, and a 50-year time horizon. A strategy was considered cost-effective if it led to the lowest net DALYs, which is a measure of DALY burden that takes account of the DALY implications of the cost for a given cost-effectiveness threshold. Among adults 45 to 64 years, CCC implementation would improve population-level hypertension control (the proportion of people with hypertension whose blood pressure is controlled) from mean 4% (90% range 1% to 7%) to 14% (6% to 26%); additional CHW screening would improve control to 44% (35% to 54%). Among all adults, CCC implementation would reduce ischemic heart disease (IHD) incidence by 10% (3% to 17%), strokes by 13% (5% to 23%), and CVD mortality by 9% (3% to 15%). CCC plus CHW screening would reduce IHD by 28% (19% to 36%), strokes by 36% (25% to 47%), and CVD mortality by 25% (17% to 34%). CHW screening was cost-effective in 62% of scenarios, CCC in 31%, and neither policy was cost-effective in 7% of scenarios. Pooling across setting-scenarios, incremental cost-effectiveness ratios were $69/DALY averted for CCC and $389/DALY averted adding CHW screening to CCC. Leveraging existing healthcare infrastructure to implement population-level hypertension screening by CHWs and hypertension treatment through integrated chronic care clinics is expected to reduce CVD morbidity and mortality and is likely to be cost-effective in most settings across Africa.