Improve Blood Pressure Control Research Articles

Implementation and use of technology-enabled blood pressure monitoring and teleconsultation in Singapore’s primary care: a qualitative evaluation using the socio-technical systems approach

BackgroundTelemedicine is becoming integral in primary care hypertension management, and is associated with improved blood pressure control, self-management and cost-effectiveness. This study explored the experiences of patients and healthcare professionals and their perceived barriers and facilitators in implementing and using a technology-enabled blood pressure monitoring intervention with teleconsultation in the Singapore primary care setting.MethodsThis was a qualitative study embedded within the Primary Technology-Enhanced Care Hypertension pilot trial. Patients were selected purposively and invited to participate by telephone; healthcare professionals involved in the trial were invited to participate by email. Individual semi-structured interviews were conducted in English or Mandarin with thirteen patients and eight healthcare professionals. Each interview was audio-recorded and transcribed verbatim. Data were analyzed inductively to identify emergent themes which were then grouped into the dimensions of the socio-technical systems model to study the interactions between the technical, individual and organizational factors involved in the process.ResultsSeveral emergent themes were identified. The factors involved in the implementation and use of the intervention are complex and interdependent. Patients and healthcare professionals liked the convenience resulting from the intervention and saw an improvement in the patient-provider relationship. Patients appreciated that the intervention helped form a habit of regular blood pressure monitoring, improved their self-management, and provided reassurance that they were being monitored by the care team. Healthcare professionals found that the intervention helped to manage workload by freeing up time for other urgent matters. Nevertheless, participants highlighted challenges with usability of the equipment and management portal, data access, and some expressed technology anxiety. Participants suggested patient segmentation for the intervention to be more targeted, wished for a more user-friendly equipment and proposed allocating more resources to the intervention.ConclusionsThe implementation and use of telemedicine for hypertension management can engender various benefits and challenges to patients, healthcare professionals and the healthcare system. Stakeholder feedback gathered on the sociotechnical aspects of the technology should be taken into consideration to guide the design, implementation and evaluation of future telemedicine interventions in primary care.Trial registrationThis study was registered on ClinicalTrials.gov on October 9, 2018. ID: NCT03698890.

A socio-ecological framework examination of drivers of blood pressure control among patients with comorbidities and on treatment in two Nairobi slums; a qualitative study.

Despite the known and effective treatments to control blood pressure, there is limited information on why there are high uncontrolled hypertension rates in urban slum settings. The aim of this paper is to explore the views of treated people with uncontrolled hypertension and other key stakeholders on the facilitators and barriers to blood pressure control among people with comorbid conditions in two Nairobi slums. The study was conducted in two Nairobi slums namely, Korogocho and Viwandani. This study used a qualitative methodology using interviews and focus group discussions. Barriers and facilitators to blood pressure control were explored using the Social Ecological Model (SEM) framework. A total of 57 participants were interviewed for this study. There were 31 in-depth interviews and two focus group discussions among participants with uncontrolled hypertension and with comorbidities. Additionally, 16 key informant interviews were conducted with healthcare providers and decision/policymakers. All interviews were audio-recorded, transcribed verbatim and analysed thematically. This study identified barriers and facilitators to blood pressure control among patients with uncontrolled hypertension at the patient/individual level, family and community level, health system level and at the policy level. High cost of hypertension medicines, the constant unavailability of medicines at the health facilities, unsupportive family and environment, poor medicines supply chain management, availability and use of guidelines were among the barriers reported. The results show that uncontrolled hypertension is a major public health issue in slums of Nairobi and they highlight barriers to blood pressure control at different levels of the socio-ecological model. These findings can be used to design holistic interventions to improve blood pressure control by addressing factors operating at multiple levels of the socio-ecological framework.

Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis

BackgroundEarly detection of hypertension is associated with improved blood pressure control and a reduced risk of cardiovascular diseases. However, in rural areas of Ethiopia, evidence is scarce where access to healthcare services is low. This study aimed to estimate the proportion of undiagnosed hypertension and identify its determinants and mediators among patients with hypertension in rural northwest Ethiopia.MethodsA community-based cross-sectional study was conducted from September to November 2020. A three-stage sampling technique was used to select a total of 2436 study participants. Blood pressure was measured using an aneroid sphygmomanometer two times, 30 min apart. A validated tool was used to assess participants’ beliefs and knowledge of hypertension. The proportion, determinants, and mediators of undiagnosed hypertension were determined among patients with hypertension. The regression-based approach used to calculate the direct and indirect effects of determinants of undiagnosed hypertension. Joint significance testing was used to determine the significance of the indirect effect.ResultsThe proportion of undiagnosed hypertension was 84.0% (95% CI: 81.4–86.7%). Participants aged 25–34 years (AOR = 6.03; 95% CI: 2.11, 17.29), who drank alcohol (AOR = 2.40; 95% CI: 1.37, 4.20), were overweight (AOR = 0.41; 95% CI: 0.18, 0.98), had a family history of hypertension (AOR = 0.32; 95% CI: 0.20, 0.53), and had comorbidities (AOR = 0.28; 95% CI: 0.15, 0.54) were significantly associated with undiagnosed hypertension. The mediation analysis revealed that hypertension health information mediated 64.1% and 68.2% of the effect of family history of hypertension and comorbidities on undiagnosed hypertension, respectively. Perceived susceptibility to hypertensive disease mediated 33.3% of the total effect of age on undiagnosed hypertension. Health facility visits also mediated the effect of alcohol drinking (14.2%) and comorbidities (12.3%) on undiagnosed hypertension.ConclusionA higher proportion of hypertensive patients remain undiagnosed. Being young, drinking alcohol, being overweight, having a family history of hypertension, and having comorbidities were significant factors. Hypertension health information, knowledge of hypertensive symptoms, and perceived susceptibility to hypertension were identified as important mediators. Public health interventions aimed at providing adequate hypertension health information, particularly to young adults and drinkers, could improve knowledge and perceived susceptibility to hypertensive disease and reduce the burden of undiagnosed hypertension.

Effect of Age on Hypertension Recognition in Children With Chronic Kidney Disease: A Report From the Chronic Kidney Disease in Children Study.

Young age has been associated with poorer control of hypertension in children with chronic kidney disease (CKD). Using data from the CKiD Study (Chronic Kidney Disease in Children), we examined the relationship between age, hypertensive blood pressure (BP) recognition, and pharmacologic BP control in children with nondialysis-dependent CKD. Participants included 902 CKiD Study participants with CKD stages 2 to 4. A total of 3550 annual study visits met inclusion criteria and participants were stratified by age (0 to <7, ≥7 to <13, ≥13 to ≤18 years). Generalized estimating equations to account for repeated measures were applied to logistic regression analyses to evaluate the association of age with unrecognized hypertensive BP and medication use. Children <7 years of age had a higher prevalence of hypertensive BP and a lower prevalence of antihypertensive medication use compared with older children. At visits where participants <7 years of age had hypertensive BP readings, 46% had unrecognized, untreated hypertensive BP compared with 21% of visits for children ≥13 years of age. The youngest age group was associated with higher odds of unrecognized hypertensive BP (adjusted odds ratio, 2.11 [95% CI, 1.37-3.24]) and lower odds of antihypertensive medication use among those with unrecognized hypertensive BP (adjusted OR, 0.51 [95% CI, 0.27-0.996]). Children younger than 7 years of age with CKD are more likely to have both undiagnosed and undertreated hypertensive BP. Efforts to improve BP control in young children with CKD are needed to minimize development of cardiovascular disease and slow CKD progression.

PREVALENCE AND FACTORS CONTRIBUTING TO NONCOMPLIANCE TO LIFE STYLE MODIFICATION IN HYPERTENSIVE PATIENTS.

Hypertension is denoted as the silent killer" because it often has no symptoms and is not discovered until a serious complication develops. Hypertension can be termed as an "iceberg disease". The submerged portion of the iceberg represents the hidden mass of the disease,while floating tip denotes the signs and symptoms It is estimated that 30% of those with hypertension do not know they have it.United States with hypertension,59% are being treated but only 34% are considered to be in control.This is unfortunate because it is believed that hypertension can be controlled in most people.1 World Health Organization (WHO) defined Hypertension is a condition of systolic blood pressure higher then 140mmHg or diastolic blood pressure higher than 90 mmHg. Hypertension is a major risk factor for stroke, myocardial infarction (heart attack), heart failure, aneurysms of the arteries, peripheral arterial disease &amp; is a cause of chronic kidney disease. Dietary and life style changes can improve blood pressure control &amp; decrease the risk of associated health complication.This study reviews the prevalence of noncompliance as a risk factor in the management of chronic diseases with a specific focus on hypertensive therapy. Factors leading to increased incidence of noncompliance to antihypertensive drugs therapy among hypertensive patients. The findings of the study will provide direction to the health care providers to help the clients Compliance can be enhanced if adequate information about the disease process and the importance of regular treatment is emphasized along with constant support and reinforcement,based on their learning needs and problems

Blood pressure control and its associated factors among patients with heart failure in Jordan.

Uncontrolled blood pressure (BP) has been associated with increased risk of cardiovascular events including heart failure. This study aimed to explore the factors associated with poor BP control among patients with heart failure at two major outpatient cardiology clinics in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. The validated 4-item Medication Adherence Scale was used to assess medication adherence. Binary logistic regression analysis was conducted to explore the significant and independent predictors of poor BP control. Regression analysis results revealed that being not satisfied with the prescribed medication (OR = 2.882; 95% CI: 1.458-5.695; P < 0.01), reporting moderate medication adherence (OR = 0.203; 95% CI: 22 0.048-0.863; P < 0.05), not receiving digoxin (OR = 3.423; 95% CI: 1.346-8.707; P < 0.05), and not receiving aldosterone antagonist (OR = 2.044; 95% CI: 1.038-4.025; P < 0.05) were associated with poor BP control. Future interventions should focus on increasing medication satisfaction and enhancing medication adherence, in order to improve BP control among patients with heart failure.

Imaging of Central Nervous System Hemorrhage

This article aims to familiarize the reader with the various types of nontraumatic central nervous system (CNS) hemorrhage and the various neuroimaging modalities used to help diagnose and manage them. According to the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, intraparenchymal hemorrhage accounts for 28% of the global stroke burden. In the United States, hemorrhagic stroke makes up 13% of all strokes. The incidence of intraparenchymal hemorrhage increases substantially with age; thus, despite improvements in blood pressure control through various public health measures, the incidence is not decreasing as the population ages. In fact, in the most recent longitudinal study of aging, autopsy findings showed intraparenchymal hemorrhage and cerebral amyloid angiopathy in 30% to 35% of patients. Rapid identification of CNS hemorrhage, which includes intraparenchymal hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage, requires either head CT or brain MRI. Once hemorrhage is identified on the screening neuroimaging study, the pattern of blood in conjunction with the history and physical examination can guide subsequent neuroimaging, laboratory, and ancillary tests as part of the etiologic assessment. After determination of the cause, the chief aims of the treatment regimen are reducing hemorrhage expansion and preventing subsequent complications such as cytotoxic cerebral edema, brain compression, and obstructive hydrocephalus. In addition, nontraumatic spinal cord hemorrhage will also be briefly discussed.

Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients

BackgroundStudies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension.MethodsData were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The “KHB-method” was used to perform mediation analysis.ResultsAmong 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78–7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control.ConclusionsIndividual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.

Understanding the management of hypertension in Asia: results of a literature search

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Servier, France Background Hypertension poses a significant healthcare burden in Asia. Detection, treatment and control of hypertension are suboptimal, despite the existence of clear international guidelines and the availability of safe and effective treatments. Purpose To understand hypertension management in Asia, based on the analysis of national guidelines, treatment patterns and patient characteristics. Methods A PubMed search was performed using four search strings relating to 1) hypertension; 2) treatment/management/drug therapy; 3) guideline, consensus, real world evidence; and 4) Asian countries. The search was restricted to English language articles published since January 2008 to July 2022. Articles were filtered by relevance to the research question, study size, scope, methodology, and country/region to identify a target of 100 final references. Results The search yielded 2,436 articles, of which 92 were selected as being most relevant. Compared with Europeans, Asians appeared to have higher systolic blood pressure (BP), diastolic BP, and mean arterial pressure, with stronger association between BP and stroke. Rates of severe hypertension were also higher. Trends identified in the literature suggested that calcium channel blockers are the most common monotherapy used in Asian countries, with a high variability across the region. In the available publications focused on the studies with RAAS inhibitors, the majority of them compared the use of angiotensin receptor blockers as mono/combination therapy versus combination therapy with ACE inhibitors, calcium channel blockers or diuretics. Among treated patients, the observed control rates were only ~35–40% (~10% or less in the general population). There is a lack of focus on selecting the most appropriate treatment for each individual patient. Areas for improvement in delivering guideline-directed therapy for improved BP control also included facilitating access to health care and compliance with medication (including support mechanisms like community programmes, telemedicine, mobile phone apps and home BP monitoring), improving diet (reducing salt intake) and encouraging exercise. Conclusions Asian patients and European patients have different clinical profiles, with more severe hypertension in Asians. Rates of BP control across Asia are low. The management of hypertension requires a focused multimodal and supportive approach with implementation of public health measures, more effective screening initiatives and evidence-based goal-driven recommendations for appropriate pharmacotherapy augmented by lifestyle changes.

Single-Pill Combination with Three Antihypertensive Agents to Improve Blood Pressure Control in Hypertension: Focus on Olmesartan-Based Combinations.

Blood pressure control remains an unmet clinical need. Only about half of patients achieve their blood pressure (BP) targets and of these, the majority require combination and double or triple therapies. International guidelines recommend the association of drugs with complementary mechanisms of action and, in particular, the combination of renin-angiotensin system (RAS) inhibitors, calcium channel blockers (CCBs), and diuretics. Among the various angiotensin receptor blockers, olmesartan (OM) is available as a monotherapy and in dual and triple single-pill combinations (SPCs) with amlodipine (AML) and/or hydrochlorothiazide (HCTZ). Several phase III and IV studies, together with real-world studies, have demonstrated the additional benefits of combining OM either with AML or with HCTZ in terms of BP control and target BP achievements both in the general population and in special subgroups of hypertensive patients, such as the elderly, diabetic, chronic kidney disease or obese patients. Ambulatory BP monitoring studies assessing 24h BP have also demonstrated that dual, as well as triple, OM-based SPCs induce a more sustained and smoother BP reduction than placebo and monotherapy. Furthermore, triple OM-based SPC has been shown to improve therapeutic adherence in hypertensive patients compared to free combinations. The availability of OM combined with HCTZ, AML or both at different dosages makes it a valuable option to customize therapy based on the levels of BP and the clinical characteristics of hypertensive patients.

Football Training: Prophylaxis of Hypertension and Prediabetes in Malaysia

According to the 2019 National Health and Morbidity Survey (NHMS), 3.4 million Malaysians are affected by at least two of the three major noncommunicable diseases (NCDs), i.e., diabetes, hypertension, and high cholesterol. The fundamental issue in Malaysia is that individuals are unwilling to attend the hospital for periodic examinations and to seek preventative medical care. It is necessary to adapt football training as a hobby and concurrently as a preventative measure against the NCDs as it appears to be the optimal strategy. In Germany, a prospective interventional study was conducted. Statistical analysis using IBM SPSS Statistics version 26 revealed that providing middle-aged hypertensive patients with football training can improve blood pressure control and minimize the need for antihypertensive medication. Using SPSS version 22, it has been demonstrated in a randomized control trial in the Faroe Islands that football training combined with professional nutrition counseling had a greater effect on metabolic and cardiovascular health prediabetes individuals aged 55 to 70 than expert dietary advice alone. At the state level, Selangor has greatly progressed in health sector reform. Initiatives to minimize noncommunicable diseases have received special attention. This study implies that the mission and vision of the Selangor Health and Sports Council align. After a comprehensive assessment, a viable policy for integrating football training as a preventative intervention should be considered.

Recruitment and retention of primary care practices in the Southeastern Collaboration to Improve Blood Pressure Control

BackgroundRacial disparities related to hypertension prevalence and control persist, with Black persons continuing to have both high prevalence and suboptimal control. The Black Belt region of the US Southeast is characterized by multiple critical priority populations: rural, low-income, and minority (Black). MethodsIn a cluster-randomized, controlled, pragmatic implementation trial, the Southeastern Collaboration to Improve Blood Pressure Control evaluated two multi-component, multi-level functional interventions – peer coaching (PC) and practice facilitation (PF) (separately and combined) – as adjuncts to usual care to improve blood pressure control in the Black Belt. The overall goal was to randomize 80 primary care practices (later reduced to 69 practices) in Alabama and North Carolina to one of four interventions: 1) enhanced usual care (EUC); 2) EUC plus PC; 3) EUC plus PF; or 4) EUC plus both PC and PF. Several measures to facilitate recruitment and retention of practices were employed, including practice readiness assessment. ResultsContact was initiated with 248 practices during the study enrollment period. Of these, 99 declined participation, 39 were ineligible, and 41 were being evaluated for inclusion when the target number of practices was reached. The remaining 69 practices eventually were enrolled, with 18 practices randomized to EUC, 19 to PC, 16 to PF, and 16 to PC plus PF. Only two practices (2.9%) were withdrawn during the study. Several facilitators of and barriers to practice recruitment and retention were identified. ConclusionOur findings underscore the importance of a structured approach to recruiting primary care practices in a pragmatic implementation trial.ClinicalTrials.gov registration number NCT02866669

Effectiveness of Android-based Hypertension Self-Care Education to Improve Blood Pressure Control among Hypertensive Patients at Yogyakarta: Study Protocol

Introduction: Hypertension is a serious health problem and the major cause of early death worldwide. Hypertension prevalent is in 34.1% of all residents in Indonesia, even being the first of the top ten diseases in the Public Health Center Ngemplak I Sleman Yogyakarta. Although various efforts have been made, hypertension cannot be controlled optimally, so that there are still 21.48% of the target 100% who have not utilized health services. The study aims to develop, implement and evaluate android-based hypertension self-care education to improve blood pressure control among hypertensive patients at Public Health Center Ngemplak I Sleman Yogyakarta, Indonesia. Methods: This research is an exploratory sequential mixed-method design. It will begin with a qualitative study to explore the content for developing android-based hypertension self-care education. After that, we built the intervention and will implement it for three month in hypertensive patients. Then, it will evaluate the effectiveness of android-based hypertension self-care education on self-care knowledge, attitudes, behavior, and blood pressure control in hypertensive patients. The quantitative research design will use a Randomized Control Group Pretest – Posttest Design with a sample size of 108 hypertensive patients in the intervention and control group. Discussion: Android-based hypertension self-care education is a new method developed and seen for its effectiveness in improving blood pressure control abilities. The study results will help the hypertensive patients achieve optimal self-care.

Benefits in Cardiac Function from a Remote Exercise Program in Children with Obesity.

Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre−post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro−Wilks test). Pre−post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p < 0.05). Significant variations in echocardiographic interventricular septum (IVSd) thickness (p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity.

Sustainable protocol-based management of hypertension in one institution in northern Malawi.

Across all WHO regions, Africa has the highest prevalence of hypertension with 46% of the population >25 years estimated to be hypertensive. Blood pressure (BP) control is poor, with <40% of hypertensives diagnosed, <30% of those diagnosed receiving medical treatment, and <20% with adequate control. We report an intervention to improve BP control in a cohort of hypertensive patients attending a single hospital in Mzuzu Malawi, by introducing a limited protocol of four antihypertensive medications taken once-daily. A drug protocol based on international guidelines, drug availability in Malawi, cost and clinical effectiveness was developed and implemented. Patients were transitioned to the new protocol as they attended for clinic visits. Records of 109 patients completing at least three visits were assessed for BP control. Two-thirds of patients (n=73) were female and average age at enrolment was 61.6 ± 12.8 years. Median [interquartile range] systolic BP (SBP) was 152 [136;167] mm Hg at baseline and reduced over the follow-up period to 148 [135; 157, p<0.001 vs baseline]. Median diastolic BP (DBP) reduced from 90.0 [82.0; 100] mm Hg to 83.0 [77.0; 91.0], p<0.001 vs baseline. Patients with highest baseline blood pressures benefited most and there were no associations noted between BP responses and either age or gender. We conclude that a limited evidence based once-daily drug regimen can improve blood pressure control by comparison with standard management. Cost effectiveness of this approach will also be reported.

Mobile APP-assisted family physician program for improving blood pressure outcome in hypertensive patients

BackgroundThis study was aimed to examine the effectiveness of App-assisted self-care in a Beijing community based on intelligent family physician-optimised collaborative model (IFOCM) program. MethodsWe conducted a survey of 12,050 hypertensive patients between Jan 2014 and Dec 2021. Generalized linear model was used to analyze the covariates that associated with blood pressure (BP) control. Decision tree and random forest algorithm was used to extract the important factors of BP outcome.ResultsThe study included 5937 patients, mean age 66.2 ± 10.8, with hypertension in the baseline; 3108(52.4) were female. The community management resulted in mean systolic BP and diastolic BP reductions of 4.6 mmHg and 3.8 mmHg at follow-up. There were 3661 (61.6%) hypertension patients with BP control, increasing from 55.0% in 2014 to 75.0% in 2021. After adjusted for covariates, antihypertensive medication adherence, diabetes, and APP-assisted self-care were common predictors associated with BP control in GLM model and machine learning algorithm.ConclusionCommunity management based on IFOCM program significantly improved BP control in hypertensive patients. APP-assisted self-care would be beneficial for the management of chronic disease.

Remote physiologic monitoring for hypertension in primary care: a prospective pragmatic pilot study in electronic health records using propensity score matching.

Since 2019, the Centers for Medicare and Medicaid Services covers remote physiologic monitoring (RPM) for blood pressure (BP) per hypertension diagnosis and treatment guidelines. Here, we integrated Omron VitalSight RPM into the health system's electronic health record to transmit BP and pulse without manual entry, assessed feasibility, and used pragmatic prospective matched cohort studies to assess initial effects in (1) uncontrolled (last two office BP ≥140/90 mmHg) and (2) general (diagnosed hypertension or last office BP ≥140/90 mmHg) hypertension patient populations. Seventeen clinicians at two internal medicine practices were oriented. Eligible patients were aged 65-85 years had Medicare insurance with ≥1 office visit in the previous year. We prospectively identified matched controls (age, sex, BP, and number of office visits in previous year) from other primary care practices within the health system and estimated the association between RPM availability (clinic-level) and patient BP outcomes after 6 months. ClinicalTrials.gov: NCT04604925. Feasibility. Uptake was low at pilot clinics: 10 physicians prescribed RPM to 118 patients during the 6-month pilot. This included 7% (14/207) of the prespecified uncontrolled hypertension cohort and 3.3% (78/2356) of the general hypertension cohort. Surveyed clinicians (n = 4) reported changing their patients' medical treatment in response to RPM BPs, although they recommended having a dedicated RN or LPN to review BP readings. Effectiveness. At 6 months, BP control was greater at pilot practices than among matched controls (uncontrolled: 31.4% vs 22.8%; P = .007; general: 64.0% vs 59.7%; P < .001). Systolic BP at last office visit did not differ (mean [SD] 146.0 [15.7] vs 147.1 [15.6]; P = .48) in the uncontrolled population, and was lower in the general population (131.8 [15.7] vs 132.8 [15.9]; P = .04).The frequency of antihypertensive medication changes was similar in both groups (uncontrolled P = .986; general P = .218). Uptake notwithstanding, RPM may have improved BP control. A potential mechanism is increased physician awareness of and attention to uncontrolled hypertension. Barriers to RPM use among physicians require further study.

Factors Associated With Blood Pressure Control Among Patients in Community Health Centers

Understanding the multilevel factors associated with controlled blood pressure is important to determine modifiable factors for future interventions, especially among populations living in poverty. This study identified clinically important factors associated with blood pressure control among patients receiving care in community health centers. This study includes 31,089 patients with diagnosed hypertension by 2015 receiving care from 103 community health centers; aged 19-64 years; and with ≥1 yearly visit with ≥1 recorded blood pressure in 2015, 2016, and 2017. Blood pressure control was operationalized as an average of all blood pressure measurements during all the 3 years and categorized as controlled (blood pressure <140/90), partially controlled (mixture of controlled and uncontrolled blood pressure), or never controlled. Multinomial mixed-effects logistic regression models, conducted in 2022, were used to calculate unadjusted ORs and AORs of being in the never- or partially controlled blood pressure groups versus in the always-controlled group. A total of 50.5% had always controlled, 39.7% had partially controlled, and 9.9% never had controlled blood pressure during the study period. The odds of being partially or never in blood pressure control were higher for patients without continuous insurance (AOR=1.09; 95% CI=1.03, 1.16; AOR=1.18; 95% CI=1.07, 1.30, respectively), with low provider continuity (AOR=1.24; 95% CI=1.15, 1.34; AOR=1.28; 95% CI=1.13, 1.45, respectively), with a recent diagnosis of hypertension (AOR=1.34; 95% CI=1.20, 1.49; AOR=1.19; 95% CI=1.00, 1.42), with inconsistent antihypertensive medications (AOR=1.19; 95% CI=1.11, 1.27; AOR=1.26; 95% CI=1.13, 1.41, respectively), and with fewer blood pressure checks (AOR=2.14; 95% CI=1.97, 2.33; AOR=2.17; 95% CI=1.90, 2.48, respectively) than for their counterparts. Efforts targeting continuous and consistent access to care, antihypertensive medications, and regular blood pressure monitoring may improve blood pressure control among populations living in poverty.

PS-BPR02-6: NOT FOR THE FAINT OF HEART: A CASE REPORT OF BRADYCARDIA INDUCED HYPERTENSION

Background: Bradycardia is an underreported and often overlooked contributor to resistant hypertension. We present a case of refractory hypertension and bradycardia with atrial fibrillation and marked improvement in BP control following pacemaker implantation. Case Presentation: A 66-year-old asymptomatic Chinese male with a past history of hypertension with unilateral adrenalectomy (no hyperaldosteronism), remote myocardial infarction, treated obstructive sleep apnea, and type 2 diabetes presented with gradually increasing blood pressure (BP) and decreasing heart rate (HR). From 2019 to 2020, his 24-hour ambulatory BP average increased from 140/49 mmHg to 188/66 mmHg with a decrease in HR from 55 to 43 bpm; there was no significant nocturnal dipping. Home and office BPs were similar. Daily medications included candesartan 64 mg, amlodipine 20 mg, chlorthalidone 50 mg, spironolactone 50 mg, doxazosin 8 mg, hydralazine 300 mg, nitropatch 0.8 mg/hour, and kayexalate for persistent hyperkalemia. Medication adherence was confirmed by a pharmacy database review. Secondary hypertension workup was negative for Cushing's Disease, pheochromocytoma, and renal artery stenosis. Plasma aldosterone was undetectable and plasma renin activity was 1.95 (normal 0.10–1.10ng/L/s) while taking the above medications. Serial 24-hour Holter monitors captured sinus bradycardia without pauses. Echocardiogram revealed concentric left ventricular (LV) hypertrophy, left atrial enlargement, and LV ejection fraction of 55%. Subsequent 2-week Holter monitoring revealed atrial fibrillation with average HR of 44 bpm and multiple prolonged ventricular pauses (longest 5.1 seconds). Following pacemaker insertion, BP normalized to an average of 130/80 mmHg with only 3 agents. Conclusion: There is a paucity of literature on severe bradycardia resulting in resistant hypertension; the English language PubMed database documents 3 reported cases. Severe bradycardia may impair cerebral and renal blood flow, increase LV filling pressures through prolonged diastole causing greater ventricular stretch and increased force of contraction, and may alter arterial stiffness. This case demonstrates a rare but important phenomenon of refractory hypertension and bradycardia with marked improvement in BP control following pacemaker insertion. It is important that physicians are aware of this potential phenomenon when evaluating patients with resistant hypertension and bradycardia.

PS-C07-10: DYNAMICS OF BLOOD PRESSURE ON SPIRONOLACTONE TREATMENT IN PATIENTS WITH RESISTANT HYPERTENSION AND RHEUMATOID ARTHRITIS DEPENDING ON THE ACTIVITY

Objective: to determine the features of the dynamics of blood pressure (BP) in patients with resistant hypertension (RH) and rheumatoid arthritis (RA) depending on the decrease in laboratory activity of RA. Design and methods: 60 patients with RH in combination with RA were included in the study. Outpatient BP measurement and ambulatory blood pressure monitoring (ABPM) were performed. Patients after 12 months of treatment with spironolactone were divided into two groups: A - reached the target value of low laboratory activity of RA - CRP &lt; 5.0 mmol / l (n = 27), B - did not reach (n = 33). The average age of patients in group A was 62.7 ± 8.4 years (81.6% women), group B - 63.1 ± 7.4 years (78.4% women). RA activity was determined by the disease activity index (DAS 28-CRP) and was 5.7 ± 2.3 in group A, 5.8 ± 1.8 in group B before the treatment. Results: After reduction of RA activity, the improvement of BP control is more pronounced: in group A the levels of office systolic BP (SBP) were reduced by 15.0 mm Hg, diastolic (DBP) by 7.5 mm Hg and pulse (PBP) by 10.0 mm Hg (all p &lt; 0.01) in comparison to reduction of SBP in group B by 10.0 mm Hg (p &lt; 0.05). After ABPM performing identical results were obtained: in group A the average day-night (dn), day (d) and night (n) SBP, DBP and PBP were decreased (average SBPdn by 13.7 mm Hg, DBPdn by 9.7 mm Hg, PBPdn by 7.7 mm Hg; average SBPd by 10.5 mm Hg, DBPd by 5.8 mm Hg, PBPd by 6.6 mm Hg; average SBPn by 19.2 mm Hg, DBPn by 7.0 mm Hg, PBPn by 9.1 mm Hg (all p &lt; 0.05)) against a less significant decrease in group B. Nocturnal SBP and DBP decrease were increased by 8.2% (from 4.5 (-2.8–13.8)% to 12.7 (7.4–25.4)%), p &lt; 0.05) and 8.8% (9 .9 (4.2–18.7)% to 18.7 (10.4–25.4)%), p &lt; 0.01) with the level of CRP &lt; 5.0 mmol / l after 12 months of treatment. Conclusions: In patients with RA in combination with RH administration of spironolactone to existing triple therapy enhances the antihypertensive effect of drugs, which is manifested by more frequent achievement of target blood pressure levels.