Hypertensive Patients In Community Research Articles

Prognostic implications of machine learning-derived echocardiographic phenotypes in community hypertensive patients

ABSTRACT Background Echocardiogram is commonly used to evaluate cardiac remodeling in hypertension (HTN). However, study on echocardiographic phenotypes and their prognostic implications in HTN is limited. Objective We aimed to evaluate the prognostic implications echocardiographic phenotypes in community hypertensive patients. Method A total of 1881 community hypertensive patients without overt cardiovascular disease and severe renal disease (mean age 62.8 years, women 57.9%) were included. Using Two-Step cluster analysis with four conventional echocardiographic variables, two clusters with distinct echocardiographic phenotypes were identified. Result The Cluster 1 (namely “mild-remodeling” HTN; n = 1492) had low prevalence of enlarged left atrium (LA; 0.9%) and left ventricular hypertrophy (LVH; 16.2%) and better LV diastolic function. They were younger and more likely to be men and had lower comorbid burden. The Cluster 2 (namely “severe-remodeling” HTN; n = 389) had higher prevalence of enlarged LA (26.0%) and LVH (83.0%) and worse LV diastolic function. They were older and more likely to be women and had higher comorbid burden. After a median follow-up of 4.2 years, compared to the Cluster 1, the Cluster 2 had higher incidence of cardiovascular (4.1% vs 1.7%; P = .006) and all-cause (9.8% vs 4.8%; P < .001) death, with adjusted hazard ratio of 2.80 (95% CI 1.39–5.62; P = .004) and 2.04 (95% CI 1.32–3.14; P < .001) respectively. Conclusion These findings indicate that the conventional echocardiographic variables-based algorithm could help identify asymptomatic community hypertensive patients at risk for cardiovascular and all-cause death. Further studies are needed to develop and validate phenotype-specific prevention and intervention strategies in HTN.

Prognostic implications of left ventricular hypertrophy defined by the thresholds from the international and Chinese guidelines.

To compare the predictive value of mortality between left ventricular hypertrophy (LVH) defined by Chinese thresholds and defined by international guidelines in hypertension individuals and investigate better indexation methods for LVH in Chinese population. We included 2454 community hypertensive patients with Left ventricular mass (LVM) and relative wall thickness. LVM was indexed to body surface area (BSA), height2 7 and height 1 7 . The outcomes were all-cause and cardiovascular mortality. Cox proportional hazards models were used to explore the association between LVH and the outcomes. C-statistics and time-dependent receiver operating characteristic curve (ROC) was used to evaluate the value of those indicators. During a median follow-up of 49 months (interquartile range 2-54 months), 174 participants (7.1%) died from any cause (n=174), with 71 died of cardiovascular disease. LVM/BSA defined by the Chinese thresholds was significantly associated with cardiovascular mortality (HR: 1.63; 95%CI: 1.00-2.64). LVM/BSA was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.56; 95%CI: 1.14-2.14) and using Guideline thresholds (HR: 1.52; 95%CI: 1.08-2.15). LVM/Height1.7 was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.60; 95%CI: 1.17-2.20) and using Guideline thresholds (HR: 1.54; 95%CI: 1.04-2.27). LVM/Height2.7 was not significantly associated with all-cause mortality. C-statistics indicated that LVM/BSA and LVM/Height1.7 by Chinese thresholds had better predictive ability for mortality. Time-ROC indicated that only LVM/Height1.7 defined by Chinese threshold had incremental value for predicting mortality. We found that in community hypertensive populations, race-specific thresholds should be used to classify LV hypertrophy related to mortality risk stratification. LVM/BSA and LVM/Height1.7 are acceptable normalization method in Chinese hypertension.

The factors correlated with COVID-19 vaccination coverage in Chinese hypertensive patients managed by community general practitioner

ABSTRACT This study aims to describe COVID-19 vaccination coverage and its influential factors in hypertensive patients who were administered by community general practitioners in China. A cross-sectional survey was carried out using data from electronic health record systems. The subjects were hypertensive patients who had been involved in the health management of the Essential Public Health Service (EPHS) program in Hangzhou City, China. As of Aug 3, 2022, the full and booster vaccination rates were 77.53% and 60.97% in randomly selected 96,498 subjects. There were disparities across regions, age, and gender in the distribution of COVID-19 vaccination coverage. Obesity and daily alcohol consumption were factors in the promotion of COVID-19 vaccination. Current smoking, non-daily physical exercise, irregular medication adherence, and comorbidities were risk factors for COVID-19 vaccination. Coverage rates have decreased depending on the number of risk factors. The ORs (95% CI) were 1.78 (1.61 ~ 1.96) of full vaccination and 1.74 (1.59 ~ 1.89) of booster vaccination in subjects with ≥4 risk factors, compared to those without risk factors. In summary, the progress of COVID-19 vaccination among community hypertensive patients lagged behind that of the general population during the same period. Individuals who lived in urban areas, were elderly, and had an irregular medication adherence, comorbidities, and multiple risk factors should be highlighted in the COVID-19 vaccination campaign.

PS-BPC01-5: PROGNOSTIC IMPLICATIONS OF MACHINE LEARNING-DERIVED ECHOCARDIOGRAPHIC PHENOTYPES IN ASYMPTOMATIC COMMUNITY HYPERTENSIVE POPULATIONS

Objective: Echocardiogram is commonly used to evaluate cardiac remodeling in hypertension (HTN). However, study on echocardiographic phenotypes and their prognostic implications in HTN is limited. This study aimed to elucidate these aspects. Method: A total of 1881 community hypertensive patients without overt cardiovascular disease and severe renal disease (mean age 62.8 years, women 57.9%) were included. Using Two-Step cluster analysis with four conventional echocardiographic variables, two clusters with distinct echocardiographic phenotypes were identified. Result: The Cluster 1 (namely mild-remodeling HTN; n = 1492) had low prevalence of enlarged left atrium (LA; 0.9%) and left ventricular hypertrophy (LVH; 16.2%) and better LV diastolic function. They were younger and more likely to be men and had lower comorbid burden. The Cluster 2 (namely severe-remodeling HTN; n = 389) had higher prevalence of enlarged LA (26.0%) and LVH (83.0%) and worse LV diastolic function. They were older and more likely to be women and had higher comorbid burden. After a median follow-up of 4.2 years, compared to the Cluster 1, the Cluster 2 had higher incidence of cardiovascular (4.1% vs 1.7%; P = 0.006) and all-cause (9.8% vs 4.8%; P &lt; 0.001) death, with adjusted hazard ratio (HR) of 2.80 (95% confidence interval [CI] 1.39–5.62; P = 0.004) and 2.04 (95% CI 1.32–3.14; P &lt; 0.001) respectively. Kaplan-Meier curve plotted the cumulative incidence of cardiovascular and all-cause mortality in the Figure 1 Panel A and B. Conclusion: In conclusion, these findings indicate that the conventional echocardiographic variables-based algorithm could be helpful to identify asymptomatic community hypertensive patients at risk for cardiovascular and all-cause death. Further studies are needed to develop and validate phenotype-specific prevention and intervention strategies in HTN.

Feedback based on health advice via tracing bracelet and smartphone in the management of blood pressure among hypertensive patients: A community-based RCT trial in Chongqing, China.

Lifestyle interventions have been recognized as a line of treatment for noncommunicable diseases. This study aimed to evaluate a bespoke mHealth approach to deliver personalized feedback to improve blood pressure and weight for hypertensive patients in community settings. A total of 307 participants, 50 from each community, were expected to be in the intervention or control group. A professional health facilitator was assigned for each of the 6 communities. The primary outcomes of the study are the reduction in blood pressure and weight at baseline and postintervention. Of 307 recruited, 192 participants (62.5%) completed the study (intervention: 104 and control: 88). There was no difference in attrition rates between the 2 groups (33.5% vs 41.9%, P = .291). After 6 month of intensive feedback intervention through the mHealth approach, patients had better blood pressure (133.4 ± 15.3 vs 139.7 ± 16.0) compared with control. People who were adherent to the intervention demonstrated a clinical benefit in weight and blood pressure.

Study on Medication Safety Status and Influencing Factors of Elderly Hypertension Patients in Community

Study on Medication Safety Status and Influencing Factors of Elderly Hypertension Patients in Community

Prevalence and prognosis of left ventricular diastolic dysfunction in community hypertension patients

Left ventricular diastolic dysfunction (LVDD) is common in hypertension and is a predictor of increased cardiovascular risk, however the effect of LVDD, detected by new guideline, on major adverse cardiac events (MACE) is unknown in hypertensive patients without known cardiovascular disease. The present study aims to evaluate LVDD in a community hypertension cohort study and assess the effect of LVDD on MACE. we studied 283 asymptomatic nonischemic patients with hypertension who had baseline echocardiogram between 2012 and 2014. Patients were followed for MACE (myocardial infarction, coronary revascularization procedures, heart failure, stroke, all-cause mortality) with mean follow-up of 5.4 years. A Cox proportional hazards model was used to assess the association of LVDD with MACE. At baseline, 35 of the 283 hypertensions were diagnosed with LVDD (12.3%) and 25 patients were women (15.5%). Women had higher frequency of LVDD than men (8%). During follow-up, there were 26.6% patients occurring MACE in the LVDD group at baseline, 9.9% patients occurring MACE in the group with normal diastolic function. In multivariable Cox regression analyses, LVDD was a stronger predictor of MACE (HR: 2.5; 95% CI: 1.20 to 5.25; c- statistics 0.805) than E/e′ ratio (HR: 1.13; 95% CI: 1.04 to 1.22). LVDD was strongly associated with MACE in hypertension patients.

EFFECT OF A WEB-BASED MANAGEMENT PLATFORM ON HYPERTENSION CONTROL IN COMMUNITY: A RANDOMIZED CLINICAL TRIAL

Objective: To assess the effect of multi-component intervention delivered by a web-based platform on improving blood pressure control rate. Design and method: A cluster andomised clinical trial of a hypertension management program was conducted from January 1 to December 31, 2018 in 66 communities. Communities were andomised to either the intervention group (usual care combined with multi-component intervention delivered by a web-based platform) or control group (usual care only). The intervention included health education, lifestyle modification, self-monitoring and treatment. In order to support the implementation of intervention program, a web based-platform was established. Automated classification and personalized follow-up schedule would be generated by prespecified algorithm according to the patients’ information. The primary outcome was the change in blood pressure control rate from baseline to 12 months among hypertension patients in the intervention and control group. The secondary outcomes were the changes in blood pressure and lifestyle factors. Results: A total of 3,872 participants (2,994 in the intervention group and 878 in control group) were included in the analysis. Blood pressure control rate at baseline was 31.4% in the intervention group and 30.2% in the control group. After 12 months of the intervention, the blood pressure control rate for the intervention group compared with the control group was significantly higher (65.9% vs 42.0%; odds ratio, 1.25; 95%CI,1.19–1.32; P &lt; 0.001). The intervention effect on systolic blood pressure was -8.0 mmHg (95%CI, -9.8 to -6.2 mmHg; P &lt; 0.001) and on diastolic blood pressure was -1.7 mmHg (95%CI, -2.8 to -0.6 mmHg, P = 0.003). The blood pressure control rate showed a gradual increment throughout the whole intervention duration. What's more, greater improvement was observed in the proportion of regular exercise (17.8%; 95%CI, 15.3%-20.3%; P &lt; 0.001). Conclusions: This trial found that a multi-component intervention delivered by a web-based platform appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. Telemedicine may be a better way to manage hypertension patients in community.

Association among high blood pressure health literacy, social support and health-related quality of life among a community population with hypertension: a community-based cross-sectional study in China

ObjectivesThe prevalence of hypertension is increasing worldwide. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL) and social support (SS), which may have an impact on health-related...

Abnormal Obesity Phenotype Is Associated with Reduced eGFR among Diabetes Mellitus and Hypertensive Patients in a Peri-Urban Community in Ghana.

Background Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia due to obesity and defects in insulin action. Significant complications of DM include kidney disease due to its association with hypertension and obesity. Thus, the contribution of the various obesity phenotypes to the kidney impairment observed among hypertensive and diabetes mellitus patients is of major concern. Aim The study assessed the association between obesity phenotypes and reduced glomerular filtration rate among diabetes mellitus and hypertensive patients. Methods Three hundred and ten (310) adult patients diagnosed with type 2 diabetes mellitus, hypertension, or both who attended the Presbyterian Hospital, Dormaa Ahenkro, from October 2016 to March 2017 were recruited for the study. Blood samples were collected to analyze biochemical parameters (fasting blood glucose (FBG), lipid profile, and creatinine). Questionnaires were used to collect sociodemographic information, and anthropometrics were appropriately measured. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation, and reduced eGFR was defined as eGFR <90 ml/min/1.73 m2. Results The prevalence of metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically abnormal nonobese (MANO), and metabolically abnormal obese (MAO) phenotypes among the study participants was 30.65%, 4.50%, 52.90%, and 11.94%, respectively. The highest prevalence of reduced eGFR (29/37 (78.38%)) was seen among the MAO group. This was followed by the MANO, MHO, and MHNO with a reduced eGFR prevalence of 62.20%, 57.64%, and 37.89%, respectively. After normalization with MHNO, the reduced eGFR was 1.51, 1.64, and 2.06 times expressed in MHO, MANO, and MAO. For the total samples, when MHNO was maintained as a reference, reduced eGFR was significantly associated with MANO (aOR = 3.07 (95% CI = 1.76–5.35), P < 0.001) and MAO (aOR = 5.67 (95% CI = 2.66–17.27), P < 0.001) even after adjusting for age, gender, smoking, and alcohol intake. This association was maintained among the female study participants when stratified by gender, and in addition, among the female participants, reduced eGFR was also associated with MHO (aOR = 4.19 (95% CI = 1.06–16.53), P=0.041). Conclusion There is a high prevalence of abnormal metabolic phenotypes among diabetes mellitus patients, and these were significantly associated with reduced eGFR among our study participants.

Association of Nondiabetic Glucometabolic Status and Aortic Stiffness in Community Hypertension Patients [Letter

Association of Nondiabetic Glucometabolic Status and Aortic Stiffness in Community Hypertension Patients [Letter

Status and influencing factors of blood pressure control among 35 – 74 years old community hypertensive patients in Luohu district of Shenzhen, 2019

Objective To investigate the condition and impact factors of blood pressure control among 35 – 74 years old hypertension patients in Luohu district, Shenzhen city of Guangdong province and to provide evidences to improve health management of the patients. Methods Using stratified random sampling, we recruited 1 205 hypertension patients aged 35 – 74 years at 10 community health service centres affiliated to Shenzhen Luohu Hospital Group. Face-to-face interviews with a self-designed questionnaire, physical examination and laboratory test were conducted among the patients during February 2019. Results Of all the patients, 618 (51.3%) had their blood pressure well-controlled. The results of unconditional multivariate logistic regression analysis showed that the patients with following characteristics were more likely to have well-controlled blood pressure: with locally registered permanent residence (odds ratio [OR] = 1.379, 95% confidence interval [95% CI]: 1.088 – 1.748), taking antihypertensive medication regularly (OR = 1.598, 95% CI: 1.173 – 2.177), and having a physical examination every year (OR = 1.578, 95% CI: 1.221 – 2.040); the results also revealed that male patients were less likely to have well-controlled blood pressure (OR = 0.762, 95% CI: 0.603 – 0.963) compared to female patients. Conclusion Among 35 to 74 years old community hypertension patients in Luohu district of Shenzhen city, the blood pressure control rate was relatively high and was mainly influenced by gender, whether having local household registration, whether having antihypertensive medication regularly and whether taking a physical examination every year.

Effect of Irbesartan on Elderly Hypertensive Patients in Community and Evaluation of Adverse Drug Reactions

Effect of Irbesartan on Elderly Hypertensive Patients in Community and Evaluation of Adverse Drug Reactions

Association of Nondiabetic Glucometabolic Status and Aortic Stiffness in Community Hypertension Patients

BackgroundDiabetes is most commonly associated with aortic stiffness, but the importance of nondiabetic glucometabolic status for aortic stiffness (AS) in hypertension patients is unclear.MethodsWe included 1065 hypertension patients without diabetes in a cohort study. Carotid–femoral pulse wave velocity (cfPWV) >10 m/s can broadly be defined as AS. Pearson correlation analysis and multiple regression analysis are used to reveal the relationship between elevated fasting blood glucose (FBG) and AS.ResultsThe 1065 hypertension patients (mean age 60 years) included 48% male, 22% smokers, 94.3% with anti-hypertensive drugs, 17.9% with AS, 80% with abdominal obesity, 42% with elevated triglycerides (TG), and 27% with elevated FBG. The mean values for office systolic blood pressure (SBP)/diastolic blood pressure (DBP) and central SBP/DBP were 130/85mmHg and 132/86mmHg. Mean cfPWV was 8.7m/s. Multiple regression analysis revealed that age, office SBP, and elevated FBG were independently related to AS in the whole hypertension. Elevated FBG had 1.6-fold risk of AS in hypertension patients compared with below the cutoff. In subgroup analysis, elevated FBG increased 2.68-fold risk for AS in those without metabolic syndrome (MS), not in MS. The area under curve (AUC) of office SBP was higher than central SBP for AS in receiver operating characteristic (ROC) analysis.ConclusionWe found that elevated FBG was an independent risk factor for AS in hypertension patients without MS, although there was a high proportion of abdominal obesity. Office SBP was better than central SBP to assess AS in community hypertension.

Effectiveness of a Transtheoretical Model-Based Intervention to Improve Blood Pressure Control of Hypertensive Patients in China: A Clustered Randomized Controlled Trial.

BackgroundHypertension can result in great cardiovascular risk, while medication adherence and blood pressure control of patients were suboptimal. Therefore, we conducted a 12-month clustered randomized controlled trial to evaluate the effectiveness of transtheoretical model (TTM)-based health intervention mode on blood pressure of Chinese newly-diagnosed hypertensive patients.MethodsThis trial was conducted in six primary healthcare centers, Shunyi District, Beijing, China from September 2016 to September 2017. A total of 400 patients were included and randomized, 194 patients in the control group and 206 patients in the intervention group. Patients in the intervention group received TTM-based health intervention and those in the control group received usual care. Multilevel modeling was used to adjust for clustering effect and repeated measurements.ResultsSystolic blood pressure of patient was reduced by 4.534 mm Hg at 3-month follow-up [95% CI (−3.054, −1.403), p = 0.005], 3.982 mm Hg at 6-month follow-up [95% CI (−7.387, −0.577), p = 0.022], and 5.803 mm Hg at 12-month follow-up [95% (−9.716, −1.891), p = 0.004]. Diastolic blood pressure of patient was reduced by 3.383 mm Hg at 3-month follow-up [95% CI (−5.724, −1.042), p = 0.005], 0.330 mm Hg at 6-month follow-up [95% CI (−2.870, 2.210), p = 0.799], and 3.129 mm Hg at 12-month follow-up [95% CI (−6.048, −0.21), p = 0.036]. Medication adherence of patients was improved at all the three time points. For stages of change for taking medication, patients in the intervention group were 8.401-fold more likely to be in a higher stage at 3-month follow-up [95% CI (4.186, 16.862), p < 0.001]. The odds ratio of being in a higher stage was 8.454 at 6-month follow-up [95% CI (3.943, 18.123), p < 0.001] and 19.263 at 12-month follow-up [95% CI (7.979, 46.505), p < 0.001].ConclusionTranstheoretical model-based health intervention might be a promising strategy to improve medication adherence of newly-diagnosed hypertensive patients in community.

Analysis on the Status Quo and Influencing Factors of Self-management of Elderly Hypertensive Patients in Community

Analysis on the Status Quo and Influencing Factors of Self-management of Elderly Hypertensive Patients in Community

Research on Application of Evidence-based Nursing in Nursing Intervention of Hypertension Patients in Community

Research on Application of Evidence-based Nursing in Nursing Intervention of Hypertension Patients in Community

The blood pressure control and arteriosclerotic cardiovascular risk among Chinese community hypertensive patients

The present study aimed to describe the blood pressure (BP) control rate and 10-years arteriosclerotic cardiovascular disease (ASCVD) risk estimation among community hypertensive patients. A total of 196,803 subjects were enrolled. The control rates calculated as the intensive (SBP < 130 mmHg and DBP < 80 mmHg) and standard (SBP < 140 mmHg and DBP < 90 mmHg) threshold. Multivariable logistic analysis was employed to assess the associations between cardiovascular factors and BP control. Sensitivity, specificity and Youden’s index were used to identify the ability of high risk of ASCVD estimation by different thresholds. The control rate was 16.34% and 50.25% by the intensive and standard threshold, respectively. Besides regular medication, the risk factors for BP control included older age, male, unhealthy lifestyle, obesity, dyslipidemia and abnormal FPG. 25.08% of subjects had high risk of 10-years ASCVD estimation. The sensitivity, specificity and Youden’s index of intensive threshold was 84.37%, 16.15% and 0.51%, and were significantly different from 50.55%, 50.42% and 0.98% of the standard threshold, respectively. Half of community hypertensive patients did not control BP, and nearly a quarter have high risk of 10-years ASCVD risk estimation. The intensive threshold resulted in a one-third reduction in the control rate compared to the standard threshold. No matter which threshold was used, a single BP control status seemed not a suitable indicator for identification of high risk of 10-years ASCVD risk estimation.

Association of diastolic blood pressure with history of stroke in community hypertensive patients: a cross-sectional study

Association of diastolic blood pressure with history of stroke in community hypertensive patients: a cross-sectional study

The effect of culture-based education in improving knowledge of hypertension patients in Makassarese community in Indonesia

This research aimed to determine the effect of culture-based education in improving knowledge of hypertension patients in the Makassarese Community, Indonesia. This study used a quasi-experiment with two groups pretest-posttest control group design. The sample was 36 respondents, which were divided into two groups, which were given culture-based education and control group is given ordinary education. Each group was given a pretest and posttest. This study shows that there was an increasing knowledge of the intervention group after receiving cultural-based education. The research results showed t-value 1.92 with significant p-value >0.005 with the mean values in the intervention group 27.78 and 11.67 in the control group. Education of culture-based hypertension affects increasing knowledge of people with hypertension in the community. Therefore, it is expected that culture-based education can be used as a health education program to increase the knowledge of hypertension patients effectively.