Improve Hypertension Management Research Articles

OPTIMIZATION OF PROCESS PARAMETERS FOR ENHANCING THE SKIN PERMEATION EFFICIENCY OF NISOLDIPINE LOADED ULTRA DEFORMABLE VESICLES IN TRANSDERMAL PATCHES

Objective: The study aimed to address the limitations of oral delivery and enhance the bioavailability of nisoldipine (NSD) through the development of transferosomal transdermal patches containing ultra-deformable transferosomes. Methods: NSD, known for its low oral bioavailability and adverse effects, was encapsulated in transferosomes using a thin film hydration method. 17 formulations were made using Box Behnken Design, varying Dipalmitoylphosphatidylcholine (DPPC), span-80, and stirring speed, and were evaluated for vesicle size, Polydispersity Index (PDI), and Entrapment Efficiency (EE%). The optimal formulation, selected based on these parameters, was combined into Transdermal Patches (TPs). The patches underwent extensive testing for physicochemical properties, in vitro and ex-vivo permeation, and skin irritancy. Results: The results showed transferosomes with Vesicle Sizes (VS) ranging from 124±2.25 to 400±1.55 nm and EE% from 52.88±0.23 to 90.01±1.58%, with Zeta Potentials (ZP) between-48 to-20 mV. The patch thickness (0.66±0.02 mm) and weight per square inch (382.1±1.69 mg) showed consistent manufacturing, while the Water Vapor Transmission Rate (WVT) (1.54±0.01g/m²/24h), low moisture content (1.07±0.01%), and regulated moisture absorption (3.78±0.01%) maintained formulation stability. In vitro and ex-vivo permeation indicated superior drug permeation for transferosomal patches (NP) compared to plain nisoldipine patches (NP-N), with permeation directly proportional to PEG-400 concentration. Additionally, the transferosomal patches were found to be free from skin irritation. Conclusion: The optimized Niosoldipine transferosomal patch (NP-3) composition displays good folding endurance (FE) 97.67±0.47, required for transdermal systems, and successfully allows drug permeation (DP) at 86.39±2.64% in a short timescale. Hence, the study concludes that transferosomal patches of NSD offer a promising approach for effective transdermal delivery, potentially improving hypertension management by providing a controlled and prolonged drug release.

Enhanced Transdermal Delivery of Cilnidpine Via Ultradeformable Vesicle Loaded Patch: Statistical Optimization, Characterization and Pharmacokinetic Assessment.

The study aimed to address the limitations of oral delivery and enhance the bioavailability of Cilnidipine (often prescribed as antihypertensive drug) (CND) through the development of transdermal patches containing ultra-deformable transferosomes. CND, known for its low oral bioavailability and adverse effects, was encapsulated in transferosomes using a thin film hydration method. Seventeen formulations were made (using Box Behnken Design), varying Soya lecithin, Tween-80, and rotary evaporator's speed, and evaluated for vesicle size, polydispersity index (PDI), and entrapment efficiency (EE %). The better formulation was selected based on these parameters and incorporated into transdermal patches. Physicochemical properties, in-vitro and ex-vivo permeation, and skin irritancy studies were conducted on the patches. Pharmacokinetic studies were conducted using male Wistar albino rats. The study found that the developed transferosomal formulations had vesicle sizes between 185 nm and 401 nm, entrapment efficiency (EE%) between 63% and 92%, and zeta potential ranging from -52 mV to -20 mV. Both in-vitro and ex-vivo permeation studies showed that transferosomal formulations provided significantly better drug permeation than plain Cilnidipine patches, with increased permeation linked to higher PEG-400 concentrations. The transferosomal patches did not cause skin irritation. The optimized formulation exhibited a higher % drug release (85.7±1.5%). In pharmacokinetic studies using male Wistar albino rats, the transferosomal patch CTP-17 demonstrated a higher maximum concentration (Cmax) of 1565.068 mcg/ml and a greater area under the curve (AUC) of 13225.352 μg h/ml compared to oral administration. The study concludes that the transferosomal patches of CND offer a promising approach for effective transdermal delivery, potentially improving hypertension management for prolonged periods in a controlled manner.

Invasive validation of central blood pressure measurements using a suprasystolic monitor

Abstract Interest in the assessment of Central Blood Pressure (cBP) is steadily growing since it is a better predictor of myocardial infarction, stroke, or death than Peripheral Blood Pressure (pBP). However, pBP remains the first line for the diagnosis of hypertension (HTN) due to the ease and speed of the measurement. We sought to validate a new method to estimate cBP from brachial sphygmomanometer measurements. We estimated cBP using a sphygmomanometer that can record, after conventional pBP measurements, the pressure in the cuff maintained at a constant suprasystolic pressure. cBP is calculated using a method based on applying a physics-based model of the left subclavian artery to the brachial arterial branch to the suprasystolic brachial artery pressure waveforms. We compared this noninvasive estimated cBP to an invasive gold-standard measurement during cardiac catheterization. After clinically indicated cardiac catheterization requiring a haemodynamic assessment of a moderate coronary artery stenosis by Fractional Flow Reserve (FFR), the wire that incorporates a high fidelity electronic pressure transducer was positioned into the guiding catheter left in the ascending aorta. Simultaneous measurements were performed with a cuff placed on the patient's left arm. The output signals were recorded in a custom-based acquisition system. The comparison was obtained on the same 10 seconds recorded by the cuff and the pressure wire. The goal will be to reach 85 patients as recommended by the ARTERY Society Task Force. It recommends as an accuracy criterion to achieve a mean difference ≤ 5 mmHg with a standard deviation (SD) ≤ 8 mmHg, which are the standards adopted for this study. Patients with aortic stenosis, atrial fibrillation, or frequent (supra)ventricular extrasystoles were excluded. A total of 197 pairs of measured-estimated cBP were analysed in 78 patients with a mean age of 63 ± 8 yo, 75% of whom were men, 70% had hypertension, 26% fdiabetes, 93% dyslipidemia, 41% were tobacco users and 14% suffered from clinical peripheral artery diseases without history of revascularization. The median (InterQuartiles 25-75%) pBP was 123 [112 134] / 70 [64 77] mmHg. Measured cBP was 102 [92 11] / 78 [70 84] mmHg with a central augmentation index of 34 [23 44] %. The mean difference between estimated and measured systolic cBP was 4.9 ± 6.5 mmHg, while it was -3.9 ± 5.8 mmHg for diastolic cBP, meeting the prespecified accuracy criteria. In conclusion, our approach based on an exact matching and comparison of non-invasive suprasystolic arm cuff measurements and high-fidelity aortic BP validates that an estimation of central aortic blood pressure that can be easily carried out in daily practice and might improve HTN management. It remains to be demonstrated that more cardiovascular complications will be avoided by guiding the antihypertensive therapy with cBP instead of pBP measurements.Bland-Altman of estimated - measured cBP

Assessment of Compliance Status and Its Determinants Among Hypertensive Patients From County Areas in Zhejiang, China: A Cross-Sectional Study.

Compliance is crucial for patients to control and manage their high blood pressure. This study assesses the compliance levels of hypertensive patients in China and explores the factors influencing compliance. A descriptive, cross-sectional design was conducted. A total of 371 hypertensive patients were recruited from six County hospitals and 12 township health centers in Zhejiang Province, China. Patient compliance was measured using the Hypertensive Patient Scale (CHPS). Independent-sample T-test or variance analysis was applied to analyze CHPS scores by sociodemographic factors, and linear regression was used to explore the significant correlates of the total CHPS score. The total score of CHPS was 50.18 ± 6.12. Among the seven domains, drug treatment and lifestyle had the highest and lowest average scores, 3.59 ± 0.87 and 2.74 ± 0.73, respectively. The total score of CHPS positively associated with age (β = 0.075, p = 0.028), > 7 years of hypertension (β = 1.896, p = 0.022; Ref: < 3 years), and negatively associated with males (β = -2.224, p = 0.001; Ref: female) and rural area (β = -2.008, p = 0.007; Ref: urban area). These findings highlight the importance of related measurements of thelocal "health-oriented" healthcare system. Primary health professionals should strengthen their health behavior intervention capacity and improve hypertension management among their patients.

The effect of digital therapeutics intervention on improving hypertension management in adults: a meta-analysis of randomized controlled trial.

Digital therapeutics (DTx) intervention is an emerging therapy for the treatment and long-term management of hypertension. We aim to systematically evaluate the overall effect of DTx intervention on improving hypertension management. The systematic review and meta-analysis of RCTs was conducted and the PubMed, EMBASE, Web of Science, and Cochrane Library were searched to identify eligible RCTs published between Jan 1, 1982 and Sep 10, 2023. Random-effect models were utilized to pool estimates of net changes in systolic blood pressure (BP), diastolic BP, BP control rate, body mass index, weight, waist circumference, and physical activity between the DTx group and control group. 15 RCTs were included with a total of 3789 participants. Compared with the control group, DTx intervention was associated with significant changes in systolic BP, diastolic BP, and BP control rate of -3.75 mmHg(95% CI -5.74 to 1.77), -1.79 mmHg (95% CI -2.81 to -0.77) and 1.47% (95% CI 1.10 to 1.95), respectively. In addition, DTx intervention was statistically significant for improving other risk factors such as lower BMI (-0.5 kg/m2, 95% CI -0.86 to -0.15), increased physical activity (66.73 min/week, 95%CI 49.64 to 83.81), and reduced waist circumference (-2.91 cm, 95% CI -5.15 to -0.66). No difference between groups was demonstrated in weight (P = 0.30). Subgroup analyses revealed consistent effects of the change in SBP and DBP across study duration, age, sample size, patient baseline status, and intervention scenario settings(P > 0.05). DTx intervention may be useful for lowering BP and long-term management of hypertension. More large-size trials providing evidence on the same product are needed.

Position statement on hypertension by Indian Society of Hypertension, 2023.

The Indian Society of Hypertension (InSH) highlights the urgency for India-specific guidelines on hypertension management. Hypertension affects over one billion people worldwide, with India bearing a significant burden due to its population, diversity, and demographics. In India, hypertension affects 21% of women and 24% of men, while pre-hypertension affects 39% of women and 49% of men. The prevalence of hypertension increases in the population with obesity. Even 7% of school-going children in India have hypertension, especially in urban and overweight children. However, awareness and control of hypertension in India are inadequate. Only 57% of women and 38% of men have been diagnosed with hypertension; among them, only a fraction receive appropriate medication. The overall control of hypertension stands at 15%, with regional variations. Hypertension significantly contributes to cardiovascular and renal diseases, and better detection and treatment could reduce their impact in India. At the total population level, reducing systolic blood pressure (SBP) by 2 mm Hg may significantly affect cardiovascular disease. Considering the unique challenges faced in India, the InSH stresses the importance of a tailored approach to hypertension management. They plan to disseminate guidelines through practitioner training and patient awareness campaigns. These guidelines will cover screening, diagnosis, management, handling hypertension with other conditions, long-term follow-up, and patient education. In conclusion, this position paper calls for immediate action to improve hypertension management in India and alleviate the associated disease burden and mortality.

HYPERTENSION IN THE ELDERLY: CHALLENGES IN MANAGEMENT AND TREATMENT

Hypertension is a prevalent and significant health issue among the elderly, contributing to increased risks of cardiovascular diseases, stroke, and kidney failure. Managing hypertension in older adults poses unique challenges due to age-related physiological changes, comorbidities, and polypharmacy. This review explores the complex pathophysiology of hypertension in the elderly, including age-related changes in vascular function and the impact of comorbid conditions. It examines the difficulties in diagnosing hypertension, such as variability in blood pressure readings, white coat syndrome, and masked hypertension, highlighting the need for accurate monitoring through home and ambulatory techniques. The review discusses current management strategies, emphasizing the importance of setting appropriate treatment goals, implementing lifestyle modifications, and utilizing pharmacological treatments, including new antihypertensive drugs and combination therapies. It also addresses challenges such as adverse drug reactions, medication adherence, and the management of polypharmacy. Recent advances, including innovations in drug delivery systems and digital health technologies, offer promising solutions for improving hypertension management. Future research directions include exploring precision medicine, understanding the role of the gut microbiome, and addressing health disparities. Clinicians are advised to adopt personalized treatment approaches, integrate technological tools, and address socioeconomic barriers to optimize hypertension management in the elderly. This review underscores the need for ongoing research and tailored strategies to improve outcomes and quality of life for older patients with hypertension.

An assessment of variation in quality of hypertension guidelines across income settings using the AGREE II tool

Background Hypertension affects over one billion people worldwide, posing a significant global health burden. Clinical practice guidelines could play a key role in guiding healthcare providers in improving hypertension management. However, how the quality of hypertension CPGs differs across country income settings is not well understood. This study aims to explore variation in the quality of hypertension CPGs, comparing low-, middle-, and high-income countries, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Methods A Medline and grey literature search was conducted to identify hypertension CPGs in English from every country from January 2012 to September 2022. Two reviewers independently assessed and scored each CPG against the AGREE II tool. Results were described and the Kruskal-Wallis test was used to test for statistically significant difference in the domain scores across country income groups. Results Forty-three CPGs were included for analysis from across income settings. Guidelines from HICs scored higher in four out of the six domains. The highest scoring domain was 4: “clarity and presentation” (median score 83%), the lowest scoring was domain 6 “editorial independence” (median score 0%). Statistically significant differences between income settings were observed for domain 3 “rigour of development” (p &lt;0.001), domain 4 “clarity and presentation” (p = 0.03) and domain 6 “editorial independence” (p = 0.04). Conclusions Whilst some variation exists in guideline quality across country income levels, the greatest degree of variation exists across the domains of the AGREE II tool. Global efforts to improve the quality of hypertension guidelines should focus on the transparent statement of editorial independence of guideline committees and apply rigorous replicable methods in the authoring of guidelines. Establishing national and international communities of practice to collaborate across income settings may reduce duplication of resource, allow for shared learning and promote the development of high-quality hypertension CPGs.

Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension.

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.

Abstract MP09: Characteristics of Antihypertension Medication Adherence Among Patients with Resistant Hypertension in the RADIANCE HTN-TRIO Ultrasound Renal Denervation Trial

Background: About 50% of patients are nonadherent to antihypertensive medications (AHM), impairing blood pressure (BP) management. The RADIANCE-HTN TRIO trial screened patients with resistant hypertension by first placing them on a fixed-dose combination triple pill (ARB+amlodipine+HCTZ). Ambulatory BP measurement 4 weeks later found 43% had controlled BP and were thus ineligible for enrollment. A total of 136 patients with uncontrolled BP were randomized to ultrasound renal denervation (uRDN) or sham-control. This analysis assessed adherence characteristics among patients in the trial. Method: TRIO patients consented to have chemical adherence testing that detected AHM or their metabolites in spot urine samples at baseline, 2 and 6 months. Full adherence (FA) was defined by all prescribed drugs detected in the sample. Results: Adherence data were available at any timepoint for 129 and all timepoints for 91 patients. Among patients with data at all timepoints, 66% (60/91) were FA and 34% (31/91) were partially- or fully nonadherent (PA/NA) to any of their prescribed medications. Adherence rates did not differ between treatment groups or geographies. Women were less likely to be FA (p&lt;0.001) (Table). PA/NA patients had higher rates of peripheral and cerebrovascular disease, and higher BP before and after triple pill. Adherence to triple pill was 81% at baseline, 85% at 2-months, and 83% at 6-months. Medications were titrated after 2-months. At 6-months, adherence to additional medication classes prescribed was: aldosterone antagonist 71%, beta blockers 62%, and centrally-acting alpha-2 agonists 60%. Conclusions: The stringent TRIO study design uncovered significant medication nonadherence that translated into a high rate of apparent resistant HTN. It also showed high adherence to a fixed-dose triple pill. One third of enrolled patients were not fully adherent to medications, and these patients had higher BP and higher rates of vascular disease. Understanding clinical features associated with medication adherence may improve hypertension management.

Abstract P316: Beyond the Cuff: Revolutionizing Hypertension Care through Human-Centered Design and Tech-Driven Solutions in an Urban Community Health Center

Community Health Centers serve populations burdened with cardiovascular disease due to social determinants of health, necessitating innovative solutions in resource-limited environments. Wi-Fi/Bluetooth-enabled home blood pressure monitors have emerged as clinical tools for diagnosing, monitoring, and managing hypertension. The real time data enables timely interventions by care teams of patients being monitored. A multifaceted approach beyond clinic settings, supported by digital tools, can help reduce healthcare costs by preventing avoidable emergency room visits. We posited that implementing a self-monitored blood pressure (SMBP) program, supplemented by holistic, human-centered patient coaching and feedback, in a community health center setting would enhance patient engagement, medication adherence, and hypertension control. We designed and piloted a small SMBP program using Bluetooth-enabled blood pressure devices, targeting adult patients with documented uncontrolled blood pressure seen in our health centers in a 6- month window. This was further augmented by a holistic, human-centered individual and group-level coaching session. Patients enrolled in the SMBP program received comprehensive education on hypertension, including medication management and lifestyle changes, as well as data-driven feedback on their blood pressure profiles during virtual group and individual outreach sessions. The program's goals were to increase patient engagement in their care, adherence to interventions, leading to better blood pressure control. Results were significant: 22 of 32 participants graduated, achieving improved blood pressure control with medication and lifestyle changes. Average reductions of 17 mmHg in systolic and 6 mmHg in diastolic blood pressure were noted after being in the program for an average of three months. Among the graduates, 50% required medication intensification, and 60% adopted lifestyle changes, indicating the program's effectiveness. Our pilot affirmed the efficacy of utilizing digital solutions and integrated strategies to improve hypertension control and empower patients to make timely changes with data feedback. The key findings from our pilot led to the expansion of the SMBP program to serve a larger cohort of patients in our clinic. This underscores the critical role of patient engagement, technology integration, and an integrated approach to care in improving hypertension management, particularly in underserved communities.

Abstract MP21: Hypertension in Young Adults: Social Determinants of Prevalence, Awareness, Treatment, and Control

Introduction: Hypertension (HTN) is the leading modifiable risk factor for CVD and a major cause of preventable deaths in the US. Social determinants of health (SDoH) impact HTN management. Methods: HTN prevalence, awareness, treatment, and control were assessed in NHANES 2017-2020 among young (18-39 years), middle-aged (40-64 years), and older adults (≥65 years). Exposures included 5 social needs: low education, low income, no health insurance, food insecurity, and no/limited employment. Sample included participants with SDoH measures and HTN as defined per 2017 ACC/AHA guidelines or use of BP lowering medications (N=3720, representing 89 million adults). Multinomial regression estimated the association of number of social needs (0, 1, or ≥2) with HTN status including aware, treated (among aware) and controlled (among treated), adjusted for age, sex, and race/ethnicity. NHANES weights were used in analyses. Results: HTN prevalence was 22.7% among young adults. Young adults were more likely than middle-aged and older adults to be unaware or untreated compared to controlled for HTN (P&lt;0.001). Young adults with HTN were more likely to be uninsured, food insecure, and low income compared to older adults (Figure). Adults with HTN and ≥2 social needs were more likely than adults with no social needs to be untreated (OR 1.79; 95% CI 1.15- 2.78; P=0.009) or uncontrolled (OR 1.71; 95% CI 1.27-2.32; P&lt;0.001) compared to having controlled HTN. Conclusions: SDoH strongly associate with HTN screening and management. Treatment and control are less common among adults with multiple social needs, particularly for younger individuals. Improving insurance coverage, employment, and food security for young adults could improve HTN management.

P073 KNOWLEDGE OF HYPERTENSION AND HOME BLOOD PRESSURE MONITORING AMONG HYPERTENSIVE PATIENTS IN INDIA: RESULTS FROM THE GRAND STUDY

Background and Objective: Hypertension remains a significant risk factor for cardiovascular diseases in India, contributing substantially to cardiovascular mortality. Despite the rising prevalence of hypertension, blood pressure control among hypertensive patients remains low, emphasizing the need for improved hypertension management and treatment. Home blood pressure monitoring (HBPM) serves as a vital tool in hypertension management, yet its recognition and utilization in developing countries like India remain limited. This study aimed to assess the knowledge of hypertension and HBPM among hypertensive patients across 18 medical centers in 12 States in India. Methods: A survey was conducted among 1,920 hypertensive patients, analyzing the patients’ background, the reasons for home blood pressure (HBP) measurement and non-HBP measurement, and associated factors to knowledge levels of hypertension and HBPM. Results: Findings revealed that 47.5% were measuring HBP, with reasons mainly attributed to physicians’ recommendations, while cost and lack of physician guidance were common reasons for non-HBP measurement. High knowledge levels of hypertension and HBPM significantly associated with measuring HBP (OR 16.23; 11.28-23.35, P-value &lt;0.001), however, a significant gap existed in adherence to the optimal guidelines-based procedures of HBPM with only 40.7% following any 2 out of 8 steps to measure HBP. Conclusions: These results highlight the necessity for increased physicians’ recommendations of HBP measurement and providing clear instructions for measuring HBP aligned with guideline-based procedures.

O45 INDIVIDUAL VS. HEALTH SYSTEM FACTORS IN HYPERTENSION CONTROL PERFORMANCE: DISTRICT-LEVEL CARE CASCADE ANALYSIS

Background: High-quality health systems are crucial for achieving optimal health outcomes, particularly in managing chronic conditions like hypertension. Effective hypertension control reduces the risk of cardiovascular diseases (CVD). This study examines the relative importance of individual factors (social determinants of health, SDOH) versus health system factors in influencing the stages of the hypertension care cascade in Indonesia, focusing on the controlled rate as the endpoint. This study aims to analyze which factors impact the hypertension care cascade. Methods: The performance of 514 districts in Indonesia was analyzed using multivariate regression. Dependent variables included the percentages of individuals ever tested, diagnosed, treated, and controlled for hypertension. Independent variables encompassed healthcare resource availability, socioeconomic factors, and demographic factors. Results: The regression analysis revealed several key findings: The physician ratio positively and significantly impacted all stages of the care cascade, with coefficients increasing from 0.087 in testing to control 0.356 (p&lt;0.01 for all). The midwife ratio positively influenced testing (0.072), diagnosis (0.135), and treatment (0.160) but not control (0.016, p&gt;0.1). Conversely, Average years of schooling positively correlated with testing (0.111, p&lt;0.05). GNI PPP per capita was positively associated with testing (0.235, p&lt;0.01), diagnosis (0.189, p&lt;0.05), and treatment (0.228, p&lt;0.05), but not control (-0.253, p&gt;0.1). Median age showed a strong positive association across all stages, with coefficients of 1.212 for testing, 1.443 for diagnosis, 1.509 for treatment, and 1.274 for control (p&lt;0.01 for all). Regression shows a pattern that while individual SDOH significantly influenced the early stages of the care cascade (testing and diagnosis), these factors had minimal impact on the control rate. Instead, health system performance was particularly critical for achieving control. Conclusion: Individual SDOHs are more influential in the early stages of the care cascade, while health system factors are crucial for controlling hypertension. Efforts to improve hypertension management should focus on enhancing health system resources to achieve better control rates and reduce CVD risks.

Abstract P444: Radial pulse wave velocity measurement method with dual ultrasound probe for low power wearables

Background: Wearables for continuous blood pressure monitoring hold the promise to drastically improve hypertension management, but current solutions still lack the required accuracy. Ultrasounds might be able to overcome this limitation because they can measure quantitative parameters highly correlated with blood pressure, such as artery diameter, its motion over the cardiac cycle (AWM) and local pulse wave velocity (PWV). Here we validate radial PWV measurement with an ultrasound method that can be integrated in low power wearables. Methods: The study was conducted on 8 healthy subjects at rest. The ultrasound scan was performed on the left arm with a research scanner and two linear probes held at a fixed distance and used to image two transversal sections of the radial artery at 11.5 kHz for 10 seconds. The first image of each section is segmented to identify the artery walls and AWM is reconstructed by tracking the phase of the wall echo. PWV is extracted from the delay of artery wall motion waveforms on the 2 sections. Reference values of carotid-radial PWV were acquired with Diatecne PulsePen ETT immediately after the ultrasound acquisition on the same arm. Results: The estimate and accuracy of the local radial PWV of proposed ultrasound method is in agreement with the reference carotid-radial PWV obtained with the tonometer. The accuracy of the methods is estimated from the beat-to-beat variability of the delays between the waves used for the estimates. Conclusions: The proposed method allows to measure the radial pulse wave within shorter distances compatible with integration in wearables. Leveraging TDK ultrasound MEMS platform, this paves the route for low power wearable for continuous cardio-vascular monitoring.

Celery Leaf Consumption Movement (GAME BUSRI): A Community-Based Intervention to Promote Blood Pressure Control in Elderly Individuals with Hypertension in Purwakarta Indonesia

Hypertension, a major risk factor for cardiovascular disease, poses a significant health challenge, particularly among the elderly. The "GAME BUSRI" intervention, promoting celery leaf consumption, offers a promising complementary therapy for blood pressure management. This study aimed to evaluate the effectiveness of this community-based intervention in reducing blood pressure among hypertensive elderly individuals in Purwakarta, Indonesia. A quasi-experimental pretest-posttest control group design was employed. Participants were recruited from the community and assigned to either the intervention group (receiving daily celery leaf decoction and health education) or the control group (receiving health education only). Blood pressure measurements were taken at baseline and after the 8-week intervention period. Data were analyzed using appropriate statistical tests. The intervention group demonstrated a statistically significant reduction in both systolic and diastolic blood pressure compared to the control group. The mean reduction in systolic blood pressure was 11.33 mmHg (p &lt; 0.001), and the mean reduction in diastolic blood pressure was 8.67 mmHg (p &lt; 0.001). No adverse events were reported. The "GAME BUSRI" intervention effectively reduced blood pressure in hypertensive elderly individuals. This community-based approach, utilizing a readily available and culturally acceptable resource, holds promise for improving hypertension management and reducing cardiovascular risk in this population.

Identifying personalized barriers for hypertension self-management from TASKS framework

ObjectiveEffective management of hypertension requires not only medical intervention but also significant patient self-management. The challenge, however, lies in the diversity of patients' personal barriers to managing their condition. The objective of this research is to identify and categorize personalized barriers to hypertension self-management using the TASKS framework (Task, Affect, Skills, Knowledge, Stress). This study aims to enhance patient-centered strategies by aligning support with each patient's specific needs, recognizing the diversity in their unique circumstances, beliefs, emotional states, knowledge levels, and access to resources. This research is based on observations from a single study focused on eight patients, which may have been a part of a larger project.ResultsThe analysis of transcripts from eight patients and the Global Hypertension Practice Guidelines revealed 69 personalized barriers. These barriers were distributed as follows: emotional barriers (49%), knowledge barriers (24%), logical barriers (17%), and resource barriers (10%). The findings highlight the significant impact of emotional and knowledge-related challenges on hypertension self-management, including difficulties in home blood pressure monitoring and the use of monitoring tools. This study emphasizes the need for tailored interventions to address these prevalent barriers and improve hypertension management outcomes.

Concurring the Silent Killer: How to improve hypertension management through Innovative Knowledge Systems in Nyamasheke District, Rwanda

Concurring the Silent Killer: How to improve hypertension management through Innovative Knowledge Systems in Nyamasheke District, Rwanda

Home Blood Pressure Monitoring dan Health Education pada Manajemen Hipertensi Kehamilan

The incidence of hypertension in pregnancy occurs in 5 – 10 out of 100 pregnant women. Home blood pressure monitoring (HBPM) is a method of screening blood pressure at home. Pregnant women with hypertension also need health education as an effort to live a healthier life. This research aims to determine the effectiveness of HBPM and Health Education in reducing blood pressure in pregnant women. Quasi-experimental research design with nonrandomized pretest-post test group design method. Sample of 30 pregnant women with hypertension. The statistical test used the Paired Samples t-Test. The research results of Home blood pressure monitoring and Health Education were significantly effective in reducing the blood pressure of pregnant women, both systolic and diastolic values ​​with a p value of 0.000 (p &lt; 0.05). Meanwhile, in the comparison group, the systolic p value was 0.000 (p&lt;0.05), the diastolic value was 0.001 (p&lt;0.05). The combination of HBPM and Health Education can help improve hypertension management and minimize complications due to recurrent hypertension in pregnant women.

Revolutionizing Aneurysm detection: The role of artificial intelligence in reducing rupture rates.

Cerebral aneurysms, affecting 2-5% of the global population, are often asymptomatic and commonly located within the Circle of Willis. A recent study in Neurosurgical Review highlights a significant reduction in the annual rupture rates of unruptured cerebral aneurysms (UCAs) in Japan from 2003 to 2018. By analyzing age-adjusted mortality rates of subarachnoid hemorrhage (SAH) and the number of treated ruptured cerebral aneurysms (RCAs), researchers found a substantial decrease in rupture rates-from 1.44 to 0.87% and from 0.92 to 0.76%, respectively (p < 0.001). This 88% reduction was largely attributed to improved hypertension management. Recent advancements in artificial intelligence (AI) and machine learning (ML) further support these findings. The RAPID Aneurysm software demonstrated high accuracy in detecting cerebral aneurysms on CT Angiography (CTA), while ML algorithms showed promise in predicting aneurysm rupture risk. A meta-analysis indicated that ML models could achieve 83% sensitivity and specificity in rupture prediction. Additionally, deep learning techniques, such as the PointNet + + architecture, achieved an AUC of 0.85 in rupture risk prediction. These technological advancements in AI and ML are poised to enhance early detection and risk management, potentially contributing to the observed reduction in UCA rupture rates and improving patient outcomes.