Hypertensive Patients In Primary Care Research Articles

Clinical and radiographic periodontal status in hypertensive patients with or without obstructive sleep apnea 10 years after diagnosis and CPAP initiation.

Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long-term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP). In 2007-2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non-CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross-sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase-8 (MMP-8)chair-side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP),and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non-CPAP (n = 38),or adherent CPAP (n = 34) groups. The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP-8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non-CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages. Hypertensive patients with obstructive sleep apnea(OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

The effect of statins on mortality and cardiovascular disease in primary care hypertensive patients without other cardiovascular disease or diabetes.

Studies in primary healthcare (PHC) assessing the effect of primary prevention with statins on mortality and cardiovascular disease (CVD) are scarce. This study aimed to estimate the effect of statins on all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke in individuals in PHC with hypertension without CVD or diabetes. Using the Swedish PHC quality assurance register QregPV, the study included 13 193 individuals with hypertension without CVD or diabetes, who had filled a first statin prescription between 2010 and 2016, and 13 193 matched controls without a filled statin prescription at the index date. Controls were matched on sex and propensity score using clinical data and data from national registers on comorbidities, prescriptions, and socioeconomic status. The effect of statins was estimated in Cox regression models. During a median of 4.2 years of follow-up, 395 individuals in the statin group vs. 475 in the control group died, 197 vs. 232 died of cardiovascular disease, 171 vs. 191 had an MI, and 161 vs. 181 had a stroke. The treatment effect of statins was significant for all-cause mortality [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74-0.93] and cardiovascular mortality (HR 0.85, 95% CI 0.72-0.998). Overall, no significant treatment effect of statins was seen for MI (HR 0.89, 95% CI 0.74-1.07), but there was a significant interaction with sex (P = 0.008) with decreased risk of MI for women but not for men (HR 0.66, 95% CI 0.49-0.88 vs. HR 1.09, 95% CI 0.86-1.38). Primary prevention with statins in PHC was associated with reduced risk of all-cause mortality, cardiovascular mortality, and in women, lower risk of MI.

Prevalence of Primary Aldosteronism in Newly Diagnosed Hypertensive Patients in Primary Care.

Primary aldosteronism (PA) represents the most frequent cause of endocrine arterial hypertension. PA is also common in patients with mild forms of hypertension and normokalemia. To identify the prevalence of PA in newly diagnosed hypertensive patients in primary care in Southern Germany. Newly diagnosed hypertensive patients in 27 primary care centers in Munich agreed to participate in the study. Patients were screened for PA using the aldosterone-to-renin ratio (ARR). In case of elevated ARR, confirmation testing was performed. After the diagnosis of PA, subtype differentiation and subsequent therapy of PA were initiated. A total of 235 patients with newly discovered arterial hypertension were initially screened for PA. Among these, 35 were excluded because the medication indicated pre-existing treated arterial hypertension or they were on interfering antihypertensive medication. At the first screening, 2.0% of the patients had hypokalemia. Of the 200 patients with newly discovered arterial hypertension, 42 had an elevated ARR. The incidence of the presence of hypokalemia did not differ according to normal or pathological ARR. Nine patients (21%) did not show up for further testing and were lost to follow-up, and 33 patients underwent a saline infusion test. Of these, 11 patients were diagnosed with PA, leading to at least 5.5% prevalence of PA in the collective. None of the diagnosed PA patients was hypokalemic at screening. A 5.5% prevalence of PA was observed in our data of untreated newly diagnosed patients with hypertension.

Abstract P255: STUDY OF THE SEVERITY OF COVID-19 IN HYPERTENSIVE PATIENTS IN PRIMARY CARE, IN SPAIN. PRELIMINARY RESULTS.

Objective: Decision-making in the management of the COVID-19 pandemic has raised questions related to the disease progression in hypertensive patients according to their BP control and the presence of comorbidities or target organ involvement. It has been reported that HTN can worse the outcomes of patients infected by COVID-19. The aim of this study is to assess the clinical and sociodemographic parameters in this population of hypertensives treated in Primary Care, according to the severity of the disease progression (mild-asymptomatic or those who required hospital admission). Design and Methods: Multicentric, observational, cross-sectional, retrospective and analytical study. The patients were selected through a random sampling in 12 provinces in Spain, among patients older than 18y with treated hypertension and COVID-19 (PCR positive) under the primary care scope (119 investigators). Data collection time was 15 months (IQR= 5), from November 2020 to February 2022, outside the first wave. Results: 1372 patients were recruited (51% women, mean age 67yo), smoking 12.5%, obesity 43.9%, diabetes 27.5%, controlled arterial hypertension 55.9% (BP<140/90). The severity of COVID-19 progression was: mild-asymptomatic 971 (71%), hospital admission 401 (29%), admission to ICU 74 (5%), death 48 (4%). Comparing the progression of the covid-19 disease of patients who requires hospital admission vs mild-asymptomatic, statistically significant differences were found between some comorbidities: COPD 21.7% vs 11.9%, p<0.001; Diabetes 33.7% vs 24.9%, p<0.05; Dyslipidemia 64.6% vs 57.9%, p<0.05; CKD 21.5% vs 11.1%, p<0.01; Stroke 9.5% vs 5.5%, p<0.05; Atrial Fibrillation 17.7% vs 7.2%, p<0.001; Heart Failure 17% vs 5.8%, p<0.01; Ischemic Heart Disease 13.2% vs 4.6%, p<0.001. As well as: GFR <60 ml/min 110 (27%) vs 140 (14%), p<0.001; ACR (median, IQR) 72 mg/g (10-118) vs 62 (7-115), p<0.05 . Conclusions: Among Spanish hypertensive patients in Primary Care, Covid-19 mortality achieves 4%. Some comorbidities such as diabetes, ischemic heart disease, atrial fibrillation, heart failure, stroke, chronic kidney disease or dyslipidemia, in which hypertension itself develop obvious vascular organ damage, results in worsening the outcomes of this population.

Psychological distress is independently related to new coronary events at 8 years' follow-up in elderly primary care patients with hypertension

ObjectiveOccurrence of psychological distress in hypertensive patients could have a negative synergistic effect on future cardiovascular events (CVEs). The aim of this study was to determine the association between anxiety or depressive symptoms in elderly hypertensive primary care patients and the development of new CVEs and all-cause mortality. MethodsA prospective cohort study was conducted in five Dutch general practices between June 2010 and January 2012. Patients with primary care managed hypertension, aged 60–85 years, were included and completed the GAD-7 and PHQ-9, measuring anxiety and depressive symptoms respectively. The incidence of new CVEs (coronary event, cerebrovascular disease, atrial fibrillation and heart failure) and all-cause mortality at 8 years' follow-up was recorded by data extraction of the digital information systems. ResultsAmong the 555 included participants (mean age 70 ± 6.6 years; 56% female), 29 (5.2%) had a new coronary event, 42 (7.6%) a cerebrovascular disease, 57 (10.3%) atrial fibrillation, 22 (4%) heart failure and 68 (12.3%) died. Elevated anxiety and depression scores increased the risk of a coronary event independently and significantly by 12% (HR 1.12; 95% CI [1.04–1.22], p = 0.005) and 18% (HR 1.18; 95% CI [1.08–1.28], p < 0.0001), respectively, adjusted for relevant (Framingham) baseline covariates. No associations were found with regard to other CVEs and all-cause mortality. ConclusionIn a random sample of elderly primary care hypertension patients there was a significant association between psychological distress and the occurrence of new coronary events after 8 years' follow-up but not with other CVEs and all-cause mortality.

Adherence To Antihypertensive Medications Among Primary Care Centre Attendees in Trinidad: A Cross-Sectional Study

Objective: To determine the adherence levels to antihypertensive medications and its associated factors among primary care attendees in Trinidad. Methods: A cross-sectional study was carried out whereby an interviewer-administered questionnaire was administered to public primary care attendees throughout Trinidad. Non-pregnant hypertensive adults, attending chronic disease clinic on anti-hypertensive medications for at least 1 year were eligible. Results: Of 225 participants (92% response rate), 58% displayed a low level of adherence to anti-hypertensive medications and 73.3% had uncontrolled hypertension, both independent of age, gender, and ethnicity. Experiencing adverse effects to prescribed medications (P=0.003) and self-reported use of herbal/alternative treatment (P=0.024) for hypertension were significantly associated with higher rates of low adherence. Having too many pills to take and fear about the potential effects of these medications on the body were both correlated with low adherence (P&lt; 0.001) Obtaining antihypertensive medications from a national chronic disease assistance program was inversely correlated with low adherence (P= 0.03). There were no statistically significant associations between adherence and average systolic blood pressure (P= 0.20), home self-monitoring (P= 0.75), daily dosing frequency (P= 0.53), or daily number of pills (P= 0.68) Conclusion: Most primary care hypertensive patients who attended chronic disease clinics at primary care health centers around Trinidad were found to have uncontrolled hypertension along with low adherence to antihypertensive medications. Education, screening for herbal use, and improvements to the existing national medication program, are discussed as interventions to improve adherence in this setting. Keywords: Hypertension, Adherence, Antihypertensive medications, Primary Care

Associations Between Gender and Racial Patient-Physician Concordance and Visit Outcomes Among Hypertensive Patients in Primary Care.

Associations Between Gender and Racial Patient-Physician Concordance and Visit Outcomes Among Hypertensive Patients in Primary Care.

Prevalence and predictive nomogram of depression among hypertensive patients in primary care: A cross-sectional study in less developed Northwest China.

Hypertensive patients commonly co-exist persistent depressive symptoms. However, these issues are not always identified, especially in primary health care, which may worsen the prognosis of hypertension. Therefore, the aim of this study was to determine the prevalence and risk factor of depression, and to develop risk nomogram of depression in hypertensive patients from primary health care Northwest China.We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years in Xinjiang between April and October 2019. The subjects were randomly divided into a training set (n = 1299) and a validation set (n = 557). Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. Using the least absolute shrinkage and selection operator (LASSO) regression model, we identified optimized risk factors of depression in the training set, followed by the establishment of prediction nomogram. The discriminative ability, calibration, and clinical usefulness of nomogram were assessed. The results were verified by internal validation in validation set.13.7% hypertensive subjects displayed depression. Seven independent risk factors of depression were identified and entered into the nomogram including age, region, ethnicity, marital status, physical activity, sleep quality, and control of hypertension. The nomogram displayed robust discrimination with an AUC of 0.760 [95% confidence interval (CI): 0.724–0.797)] and 0.761 (95%CI: 0.702–0.819), and good calibration in training set and validation set, respectively. The decision curve analysis and clinical impact curve demonstrated clinical usefulness of predictive nomogram.There is a considerable prevalence of depression in patients with hypertension from primary care of Xinjiang, Northwest China. Our nomogram may help primary care providers assess the risk of depression in patients with hypertension.

Yoga for hypertensive patients: a study on barriers and facilitators of its implementation in primary care

ABSTRACT Background International guidelines for hypertension treatment recommend the use of yoga, particularly among low-risk patients. However, evidence is lacking on the implementation potential of health-worker-led yoga interventions in low-resource, primary care settings. Objective To assess barriers to and facilitators of the implementation of a yoga intervention for hypertensive patients in primary care in Nepal. Methods The study was conducted using focus group discussions, in-depth interviews, key informant interviews, and telephone interviews. Data were collected from the ‘Yoga and Hypertension’ (YoH) trial participants, YoH intervention implementers, and officials from the Ministry of Health and Population in Nepal. Results Most YoH trial participants stated that: (1) it was easy to learn yoga during a five-day training period and practise it for three months at home; (2) practising yoga improved their health; and (3) group yoga sessions in a community centre would help them practise yoga more regularly. Most YoH intervention implementers stated that: (1) they were highly motivated to implement the intervention; (2) the cost of implementation was acceptable; (3) they did not need additional staff to effectively implement the intervention; (4) providing remuneration to the staff involved in the intervention would increase their motivation; and (5) the yoga programme was ‘simple and easy to follow’ and ‘easily performed by participants of any age’. The government officials stated that: (1) yoga is considered as a key health promotional activity in Nepal; and (2) the integration of the yoga intervention into the existing health care programme would not be too challenging, because the existing personnel and other resources can be utilised. Conclusion While there is a good potential that a yoga intervention can be implemented in primary care, capacity development for health workers and the involvement of community yoga centres in the delivery of the interventions may be required to facilitate this implementation.

Social capital, depressive symptoms, and perceived quality of care among hypertensive patients in primary care

BackgroundDepression is an important issue in the management of hypertension. However, little attention has been paid to addressing such aspects of psychological health among patients with hypertension. We aimed to estimate the prevalence of depressive symptoms among patients with hypertension in primary care settings and to identify the potential role of social capital in predicting depressive symptoms. The influence of psychological well-being on the perceived quality of hypertensive care was also examined.MethodsIn Shenzhen, China, an on-site cross-sectional study was conducted from March to September 2017. In total, 1046 respondents completed a face-to-face survey interview. We examined the associations between social capital, depressive symptoms, and perceived quality of care.ResultsThe results showed that 10.7% of patients with hypertension who attended primary care facilities had depressive symptoms. Two components of social capital—social ties (9.63 vs. 10.67; OR = 1.314, 95% CI 1.165–1.483; P < .001) and trust (3.46 vs. 3.89; OR = 2.535, 95% CI 1.741–3.691; P < .001)—were protective factors for depression among patients with hypertension in primary care settings. We also found that depressive symptoms were negatively associated with perceived quality of care (30.5 vs. 32.5; β = 1.341, 95% CI 0.463–2.219; P = .003)..ConclusionsWe found inverse associations between depressive symptoms and perceived quality of care and between social capital and the occurrence of symptoms of depression. Our findings suggest that strategies addressing both hypertension and depressive symptoms should be implemented to better manage hypertension. Appropriate social interventions should be designed and implemented.

Abstract 13930: Sex and Race/Ethnic Differences in Primary Prevention of Atherosclerotic Cardiovascular Disease Among Patients Diagnosed With Hypertension

Introduction: Randomized controlled trials evidence indicates that atherosclerotic cardiovascular disease (ASCVD) can be prevented in patients with hypertension if risk factors such as high blood pressure, high cholesterol, elevated glucose levels, and smoking are controlled. While it is known that sex and race/ethnic disparities persist for ASCVD, disparities in risk factor control have not been well-described in primary care. Methods: Hypertensive adult patients free of ASCVD were included in a retrospective analysis of electronic health record data from a large US integrated healthcare system from 2018. Patients were categorized based on achieving clinical practice guideline targets from their last available measurement including blood pressure &lt;130/80 mm Hg; statin therapy among patients with indication (LDL-C &gt;190, diabetic between ages 40-70, or with 10-year ASCVD score ≥7.5%), HbA1c of &lt;7%, and not smoking. Multivariable Poisson regressions were developed to explore associations between achieving three targets (A1c reported separately among patients with value) and sex and race/ethnicity. Results are presented as relative risk (RR) and 95% confidence intervals (95%CI) and adjusted for age, obesity, years since hypertension diagnosis, and insurance, sex, insurance, preferred language. Results: Among women, African Americans were 11% more likely to fail to achieve the three targets (RR:1.11; 95%CI: 1.01-1.21). Among men, African Americans were 19% more likely to fail to achieve the three targets compared to Caucasian men (RR: 1.19; 95%CI: 1.05-1.35). The risk of failing to achieve the three targets was not statistically significantly different between Hispanic/Latino groups and Caucasians but trended to be smaller. Hispanic/Latino women (47.2%) and men (50.9%) had the highest proportions of failing to achieve HbA1c targets. Conclusions: Disparities were observed in control of ASCVD risk factors among hypertensive patients in primary care and were not fully explained by measured demographic or clinical characteristics. Monitoring of changes in disparities across sex, racial, and ethnic groups is important to ensure equity effectiveness as interventions to prevent ASCVD in primary care are developed, tested, and implemented.

Nocturnal hypertension in primary care patients with high office blood pressure: A regional study of the MAPAGE project.

Nocturnal hypertension (NH) is an independent cardiovascular risk factor. We aimed to describe the frequency of NH among primary care hypertensive patients and to analyze NH determinants. This observational, cross-sectional, multicenter study enrolled the patients of 23 general practitioners in Burgundy region, France. We included the first patient of the day with office blood pressure≥140/90mmHg, whatever the reason for consultation. All included patients had 24-hour ambulatory blood pressure monitoring (ABPM). Nocturnal hypertension was considered nighttime mean blood pressure≥120/70mmHg, as per current guidelines. Medical, sociodemographic, and deprivation data were collected. Nocturnal hypertensive and non-hypertensive patients were compared. The determinants of NH were identified using logistic regression models. From July 2015 to November 2018, 447 patients were analyzed. Mean office blood pressure was 158.6/91.5mmHg, and 255 patients (57.0%) were taking at least one antihypertensive drug. Among the 409 (91.5%) valid ABPM, 316 (77.3%) showed NH. In multivariate analyses, male sex (odds ratio [OR]=2.20, 95% confidence interval [CI] 1.29-3.75), first office diastolic blood pressure>100mmHg (OR=5.71, 95% CI 1.53-21.40), and current smoking (OR=5.91, 95% CI 2.11-16.56) were independent predictors of NH. Obesity was associated with a reduced risk of NH (OR=0.43, 95% CI 0.25-0.75). No association was found between deprivation status or sociodemographic factors and NH. To conclude, NH was identified in more than three out of four patients with high office blood pressure. Male smokers with high diastolic blood pressure were most affected by NH. ABPM may improve hypertension management in these patients.

SAT-LB301 Hyperaldosteronism From Adrenal Adenoma in a Young Patient

Introduction Primary aldosteronism (PA) is the most common cause of secondary hypertension (HTN) that is often underdiagnosed. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex- matched patients with essential HTN and the same degree of blood pressure elevation. We present a case of a 17-year old male with primary hyperaldosteronism. Case Report 17-year-old male with no past medical history presented to the emergency department referring bitemporal cephalea, pain in left arm, dyspnea, heart palpitations, a blood pressure (BP) of 220/110 mmHg and a serum potassium of 1.5mmol/L (n. 3.5-5). The patient was admitted to the hospital for better handling of his BP, potassium repositions, monitoring and further management. During hospitalization he referred leg cramps, asthenia, adynamia, nausea, cephalea, and blurred vision. Physical examination demonstrated decreased muscle strength, jugular regurgitation II and hyperreflexia on lower extremities. Thyroid and pulmonary examinations were normal. BP continued elevated despite the concurrent use of 3 antihypertensive drug classes (ARA2, BB, CCB), referred to endocrinologist after being diagnosed with resistant hypertension suspecting of a primary hyperaldosteronism. Lab tests were run obtaining a plasma aldosterone concentration 44ng/dl (n. 4-31), plasma active renin (PRA) 0.05ng/ml/hr (n. 0.2-1.6), aldosterone/PAR ratio 880 (<25 normal). Suprarenal CT scan revealed right suprarenal lesion 2.2 x 2.1 cm, round appearance, hypodense (14 HU) compatible with an adenoma. He underwent unilateral adrenalectomy. Histopathological report from excised adrenal tumor was compatible with a benign adenoma. Patient was discharged with a regularized blood pressure without antihypertensives and normokalemic. No clinical symptoms were reported in follow-up. ConclusionPrimary aldosteronism (PA) is the most common form of secondary hypertension (HTN) with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. PA is characterized by hypertension, hypokalemia, suppressed plasma renin and increased aldosterone excretion. Aldosterone producing adenomas (APAS) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The most sensitive screening test for PA is the aldosterone-to-renin ratio. After case confirmation, all patients with PA should undergo adrenal CT as the initial study. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist.

Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar.

ABSTRACTThis study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.

Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data

BackgroundIn hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.MethodsIn this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.ResultsMore than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men).ConclusionsOur findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.

Improving the drug compliance of hypertensive patients in primary care: importance of health education and self-management

Improving the drug compliance of hypertensive patients in primary care: importance of health education and self-management

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

BackgroundThis study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. MethodsPrimary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. ResultsA total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p < 0.001). WCH phenomenon (high OBP with low HBP) was observed in 22.7% of the patients, MUCH (low OBP with high HBP) in 15.8%, uncontrolled hypertension (high OBP with high HBP) in 29.9%, and controlled hypertension (low OBP with low HBP) in 31.6%. In multivariate logistic regression analysis, WCH was determined by stage-1 systolic hypertension (odds ratio [OR] 8.6, 95% confidence intervals [CI] 5.7, 13.1) and female gender (OR 1.6, 95% CI 1.1, 2.4), whereas MUCH was determined by high-normal systolic OBP (OR 6.2, 95% CI 3.8, 10.1) and male gender (OR 2.0, 95% CI 1.2, 3.1). ConclusionsIn primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH.

PCV14 - TREATMENT EFFECT OF PHARMACEUTICAL CARE FOR HYPERTENSIVE PATIENTS IN PRIMARY CARE: A SYSTEMATIC REVIEW AND META-ANALYSES

To know the different Pharmaceutical Care’s (PC) models have been developed for hypertensive patients care to provide evidences of effectiveness about blood pressure control, cardiovascular risk and quality of life compared with conventional care for hypertension. This is a systematic review with a meta-analysis which used the strategy outlined by the Cochrane guideline for answering the question: what models of PC for pharmacotherapeutic management have been developed for hypertensive patients in primary care and what is the overall clinical impact? The search strategies were modeled without filters for the follow databases: MEDLINE® (March 27, 2017), EMBASE (March 27, 2017), Scopus (March 27, 2017), LILACs (March 27, 2017), CENTRAL Cochrane Library (March 27, 2017), and Web of Science (March 27, 2017). To assess the quality of the studies, Downs and Black validated instrument (1998) was used. The systematic review protocol is CRD42017079761, PROSPERO database. It can be access at: <https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79761>. A total of 41 scientific articles were included. The results of the peer review were consistent with the agreement between the researchers [Kappa = 0.86; 95 % CI, 0.66-1.0; (p <0.001)]. In the gray literature, none found study fitted in this revision criteria. Intervention and control group had 4195 (2340 men) and 4978 (3053 men), which had losses of 1338 and 913, respectively. The mean reduction in systolic (SBP) and diastolic (DBP) blood pressure were, 10.2±7.9 [p=0.015] and, 4.9±4.2 [p=0.032], respectively. Quality of life had a mean improvement of 13.4±10.7 [p=0,762] in PC group. The treatment effect was [RR= 0.412; CI95% 0.215-0.618] for blood pressure and cardiovascular risk assessed by ASCVD scale was [RR= 0.718; CI95% 0.552-0.897]. We conclude there are several different models of pharmaceutical care which have presented good results as blood pressure control and cardiovascular risk reduction, consolidating an important treatment effect.

Herramienta para mejorar la eficiencia en el manejo clínico de pacientes hipertensos

ObjectiveTo create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. Material and methodsA web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or “control”, based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). ResultsA total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area “Diagnostic and analytical tests” (0.69±0.10), and the lowest in “Continuous training programmes for patients and professionals” (0.42±0.21). ConclusionsThe efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time.

Social capital and depression among migrant hypertensive patients in primary care

This study was to investigate prevalence of depression among migrant hypertensive patients in primary care and to examine hypertensive patients' social capital and its relationship with the prevalence of depression. An on-site–based cross-sectional study was performed in Shenzhen, China. A total of 830 migrant hypertensive patients completed the survey by using systematic sampling design. A questionnaire including information of depressive symptoms and social capital was administered by face-to-face interview surveys. We found that the prevalence of depression was 11.0% among migrant hypertensive patients in primary care. Social ties (odds ratio = 1.197, 95% confidence interval: 1.034, 1.387) and trust (odds ratio = 2.061, 95% confidence interval: 1.342, 3.165) were statistically significant associated with the prevalence of depression. Our study shows that the prevalence of depression is high among migrant hypertensive patients in primary care. It also suggests an inverse association between social capital and depression among migrant hypertensive patients. Although causal pathways between social capital and depression cannot be established by the present study, it is plausible to design and implement social interventions to improve mental health of migrant hypertensive patients in primary care.