Improve Blood Pressure Control Research Articles

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 < 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 < 0.01) in comparison to reduction of SBP in group B by 10.0 mm Hg (p < 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 < 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 < 0.05) and 8.8% (9 .9 (4.2–18.7)% to 18.7 (10.4–25.4)%), p < 0.01) with the level of CRP < 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.

S-14-5: JSH GUIDELINE FOR THE MANAGEMENT OF HYPERTENSION 2019 (JSH2019) ∼ CONCEPT AND SUBSEQUENT CHALLENGES ∼

Hypertension Treatment Guidelines 2019 (JSH2019) is based on JSH2014 and complies with Minds’ clinical practice guideline creation manual, and adopts a policy of adding new evidence. For this reason, we have newly ‘ extracted clinical issues, raised them as clinical questions (CQ), conducted a comprehensive systematic review (SR), created a body of evidence, and made recommendations.’. Since conducting SR appropriately requires a huge amount of labor, we decided to form an SR team centered on young members of the Society and proceed with the work while receiving guidance from a support team of epidemiological experts. In particular, we hope that SR will lead to the development of young people who will lead the future, and we also aimed to submit the results of SR to Hypertens Res. In the end, we were able to create 17 CQs. Furthermore, in JSH2019, we calculated the absolute risk of CVD in Japanese people based on the JALS and Hisayama-town studies, and used it for risk stratification. Hypertension was defined as a blood pressure value of 140/90 mmHg or higher for which the efficacy of antihypertensive drugs has been proven in patients who are not at high risk. Evidence was also emphasized for blood pressure reduction goals. To the low-risk and the moderate-risk patients with elevated blood pressure, we recommended to achieve the target blood pressure control by modifying lifestyle habits without using antihypertensive drugs. We also asked patient groups to review the guidelines, aiming to reflect the values and wishes of patients. As we approach the third year since the publication of JSH2019, we would like to consider the remaining issues. There are still many patients whose blood pressure is not properly controlled, and many of whom are not aware that they have hypertension. Improvements in blood pressure control among the population are desired through countermeasures against clinical inertia and population tactics. This guideline was created with the aim of preventing CVD and improving patient prognosis, as described above. However, in a super-aging society, patients’ hopes are not necessarily to improve only the prognosis of life. There are many issues that need to be addressed in future guideline revisions, such as reconsidering recommendations for the elderly by appropriately understanding the ‘values and wishes of patients’ according to their age.

Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study.

Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring. The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF). This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis. Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance. Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.

PS-C08-4: TEC4HOMEBP: DEVELOPING A HOME BLOOD PRESSURE TELE-MONITORING PATHWAY TO SUPPORT PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT WITH ELEVATED BLOOD PRESSURE

Objectives: Elevated blood pressure (BP) in the emergency department (ED) is common, but clinical uncertainty exists on how best to manage asymptomatic hypertension. Telehealth for Emergency-Community Continuity of Care Connectivity via Home Blood Pressure Telemonitoring (TEC4Home BP) evaluates how home blood pressure telemonitoring (HBPTM) can support patients with elevated BP manage their health at home after visiting the ED. The aim of this study is to assess the effect of HBPTM on BP control among those discharged home from the ED with severely elevated BP. We also examined adherence to HBPTM, medical therapy and patient satisfaction. Methods: We conducted a prospective, single-centre, observational study and recruited 50 participants from Vancouver General Hospital (VGH), ED with hypertensive urgency, asymptomatic severely uncontrolled BP (> 160/100 mm Hg averaged over 3 readings) or referred to the VGH Hypertension Clinic from the ED for high BP. All participants received a validated home BP monitor (A&D UA-651BLE) and App (Sphygmo App, Calgary, AB) to automatically teletransmit 2 readings in the morning and evening daily for 3 months. Proportion of patients diagnosed with hypertension with controlled home BP defined as less than 135/85 mmHg, adherence to HBPTM, and medication therapy using the Hill Bone medication adherence scale, at 1and 3 months following discharge from the ED. Results: From May to December 2021, 50 participants (60 years old, 61% females, average baseline BP (SD) in ED 191 +/−26/ 99 +/−15 mm Hg) were recruited. Our recruitment and enrollment rate were 41% and 88%, respectively. At 1 and 3 months, average home BP (SD) was 136 +/−15/80 +/−11 and 128 +/−10 /77 +/−10 mm Hg. At 3 months, there was a 66% improvement in proportion of those who achieved target BP control. Adherence to HBPTM at 1 and 3 months was 84 and 54%, respectively. There were no differences in medication adherence at baseline and 3 months of study. Participants were highly satisfied with the HBPTM program and 79% would highly recommend the program. More detailed data analysis is currently underway and will be presented. Conclusions: HBPTM is a feasible, effective, and acceptable strategy to triage and monitor patients with significantly elevated BP when discharged from the ED. Future studies are need to advise the integration of HBPTM pathway a key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with hypertension.

PS-C31-8: UNCONTROLLED HYPERTENSION AND ITS ASSOCIATED FACTORS AT PRIMARY HEALTH CARE FACILITIES IN MAPUTO CITY, MOZAMBIQUE

Objective: the main objective of this study was to estimate the prevalence of uncontrolled hypertension in patients being followed up at primary health care facilities of Maputo City, and to identify factors associated to poor blood pressure control. Design and Methods: a cross-sectional study was conducted from September to December 2021 in nine primary health care facilities randomly selected in Maputo City. Five hundred consecutive hypertensive patients aged 18 years or older, on medical therapy and being followed up for more than six months who consented to participate were enrolled. Data was collected through face-to-face interviews, review of medical records and anthropometric and blood pressure measurements to the participants. Three blood pressure measurements were taken in the same arm, with two minutes of interval. The mean of the last two readings was considered for analysis. Uncontrolled hypertension was defined as blood pressure ≧ 140/90 mmHg. Therapeutic inertia was defined as non-increase in antihypertensive therapy after two or more follow-up consultations in patients with a blood pressure ≧ 140/90 mmHg. Hill Bone scale was used to assess adherence to antihypertensive therapy. Data analysis was performed using SPSS 22. Logistic regression was performed to estimate age- and education-adjusted Odds Ratios (OR) and 95% confidence intervals (95%CI) for uncontrolled hypertension. A p-value less than 0.05 was considered significant. Results: among the 500 participants, 385 (77%) were female, the mean age was 59.7 years [standard deviation (SD) ± 10.4] and the mean duration of hypertension was 8.9 years (SD ± 8.2). Most participants had primary education 300 (60%). The prevalence of uncontrolled hypertension was 73.2%. It was more common in patients 60 years or older compared to younger patients (adjusted OR 2.42; 95%CI: 1.30–4.52); among patients without formal education compared to those with higher levels (adjusted OR 0.45, 95%CI: 0.22–0.92, for secondary or higher education); in patients that referred difficulties in having access to the antihypertensive medication (adjusted OR 1.76, 95%CI 1.16 -2.69) and when therapeutic inertia was found (adjusted OR 2.53, 95%CI 1.10–5.86). Conclusions: uncontrolled hypertension is an important problem in primary health care in Maputo City and is associated to advanced age, lower levels of education, difficulty to access anti-hypertensive medication and therapeutic inertia. Training of health professionals and greater availability of anti-hypertensive medication in primary health care centers could improve blood pressure control.

S-21-3: EFFECTIVENESS AND ACCEPTABILITY OF MOBILE PHONE TEXT MESSAGING INTERVENTION TO IMPROVE BLOOD PRESSURE CONTROL (TEXT4BP) AMONG HYPERTENSIVE PATIENTS IN NEPAL

Objectives: In LMICs, the rapid uptake and availability of mobile phones provide excellent opportunities for host of an intervention. However, research on the effectiveness and acceptability of mHealth in these settings remains limited. The main objective of this feasibility study was to assess the effectiveness and acceptability of a mobile phone text messaging intervention (TEXT4BP) to improve blood pressure control and treatment adherence among hypertensive patients in Nepal. Design and Methods: The TEXT4BP study was a two-arm, parallel-group, unblinded, randomized controlled pilot trial that recruited 200 clinically diagnosed hypertensive patients aged 18–69 years visiting at a tertiary referral hospital in Kathmandu, Nepal. We co-designed the contextual text messages informed by the formative qualitative studies that used COM-B (capability, opportunity, motivation, and behavior) model and Technology Acceptance Model (TAM) model. Patients in the intervention arm (n = 100) received text messages containing information on hypertension, diet, medication, and physical activity three times per week for three months. The control arm (n = 100) received standard care. Primary outcomes were changes in blood pressure and medication adherence at three months. Secondary outcomes included blood pressure control, medication adherence self-efficacy, and hypertension knowledge. Feasibility measures, such as attrition rate, was calculated. A nested qualitative study assessed the acceptability of the intervention. Results: Over the 12 weeks of follow-up, the retention rate was 77%. The intervention group had a greater reduction in systolic and diastolic BP vs usual care [-7.09/-5.86 (p = 0.003) vs -0.77/-1.35 (p = 0.28) mmHg] [adjusted difference: systolic B = -6.50 (95% CI, -12.6; -0.33) and diastolic BP B = -4.60 (95% CI, -8.16; -1.04)] (fig 1), coupled with a greater proportion achieving target BP (70% vs 48%, p = 0.006) at three months. The intervention arm showed an improvement in compliance to antihypertensive therapy (p < 0.001), medication adherence (p < 0.001), medication adherence self-efficacy (p = 0.023), and knowledge on hypertension and its treatment (p = 0.013). In addition, intervention participants expressed a high rate of acceptability and desire to continue the TEXT4BP intervention in the future too. Conclusion: The TEXT4BP study has generated promising evidence that text messaging intervention is feasible, acceptable, and effective in improving blood pressure control in low-resource settings like Nepal. The findings will inform further large-scale mHealth research and contribute to clinical practice with evidence-based hypertension guidelines in Nepal. Trial reg: ACTRN12619001213134

S-28-3: COMPARATIVE EFFECTIVENESS AND IMPLEMENTATION OF DIGITAL HEALTH INTERVENTIONS FOR PEOPLE WITH HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Background: Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes is lacking. This study aimed to compare the effectiveness of short message service (SMS), smartphone application and website interventions on improving blood pressure in people with hypertension, and to report on their reach, uptake and feasibility. Methods: CINAHL, Cochrane Central, Embase, Medline and PsychInfo were searched on 25th May 2022 for randomised controlled trials (RCTs) published in English from 1st January 2009 that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Risk of Bias was assessed using Cochrane Risk of Bias 2 (RoB 2). Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. The level of evidence was evaluated using GRADE. Results: Of 3,235 records identified, 29 RCTs from 12 countries (n = 7,592 participants) were included. Eleven studies used SMS as the primary mode of delivery of the digital health intervention, 13 employed smartphone applications, and five implemented the interventions via websites. Overall, digital health intervention group participants achieved a -3.62 [-5.22, -2.02] mm Hg greater reduction in systolic blood pressure compared to control group participants. All three different modes of delivery of the intervention resulted in statistically significant reductions in systolic blood pressure compared to the control group, with no statistically significant differences between the three different modes of delivery (p = 0.73). Due to considerable heterogeneity between included studies and the high risk of bias overall, the level of evidence was assigned a low overall score. SMS intervention studies reported higher reach compared to smartphone application and website-based intervention studies, but smartphone application studies reported higher uptake compared to the other two. Conclusion: Digital health interventions were associated with improved blood pressure control, compared to usual care, regardless of the mode of delivery. Considering that at least 92% of the global population has access to a digital telecommunication medium and that numerous digital health tools are available for hypertension management, clinicians should familiarise themselves with this modality of program delivery and encourage people with hypertension to use evidence-based digital health tools for improving their self-management of hypertension. Digital health interventions now have the option of several modes of delivery and choice should be made based on context, feasibility, economics, and patients preference, emphasising the importance of study co-design.

ISH-PP-7: SCALING-UP HYPERTENSION CARE IN RESOURCE-CHALLENGED SETTINGS GLOBALLY

High blood pressure (BP) is the leading modifiable risk factor for death. More than 1.4 billion people suffer from hypertension worldwide. BP control remains less than 30% in high-income countries and < 10% in low- and middle-income countries (LMIC) rural areas, leading to significant disparities in hypertension-related cardiovascular mortality. Immediate action is needed to address suboptimal hypertension care globally and related inequalities. Evidence shows that strategies that leverage the existing infrastructure to deliver hypertension care are more likely feasible and rapidly scalable at marginal cost. The Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) trial demonstrated that a community health worker-led multicomponent intervention tailored to rural settings improved BP control. It was also cost-effective and affordable (less than US$2 per capita annually). Likewise, community health worker-led models of hypertension care were beneficial in urban slums in Argentina, China, Colombia, India, Indonesia, Malaysia, Nepal, Pakistan, and Kenya. The partnership between WHO and Resolve to Save Lives is an excellent initiative to focus national attention on hypertension treatment in many low- and middle-income countries. Strong advocacy and multi-sectoral collaborations are also needed to implement policy strategies for hypertension prevention, including access to healthy foods and the built environment to promote physical activity. A (proposed) Global Hypertension Care Task Force jointly led by WHO and ISH could catalyse improvement in BP control rates. Every country should establish a dedicated national coordinating center for stewardship and implementing the hypertension control agenda through multifaceted, cost-effective strategies, including population-level policy initiatives and health systems strategies targeting high-risk individuals. Such efforts could save the lives of more than 100 million people aged 30–70 years, who would otherwise die prematurely by 2030, and help achieve Sustainable Development Goal 3.4

S-34-2: TRENDS IN HYPERTENSION IN SINGAPORE AND EVIDENCE-BASED SOLUTIONS

Trends data on Singapore from the Institute of Health Metrics and Evaluation show that the attributable risk of cardiovascular disease (CVD) from high blood pressure (BP) declined from 1990 to 2010, then plateaued till about 2015, and has increased over the last five years. Moreover, several data sources, including the multi-institutional Sing Health Diabetes Registry, indicate a worsening in BP control from 2013 to 2019. Singapore acute myocardial infarction (AMI) registry shows a rise in the incidence of AMI during this time. These alarming trends collectively call for immediate action to improve BP control. The SingHypertension cluster randomized controlled trial evaluated a multicomponent intervention versus usual care in eight polyclinics in Singapore: 4 clinics were randomized to intervention and 4 to usual care. 916 adults with uncontrolled hypertension were enrolled. The intervention comprised of physicians trained in risk-based treatment, subsidized single-pill combination (SPC) medications, nurse-delivered motivational conversation, and telephone follow-ups. At 24 months, the intervention led to improved BP control, lowered cardiovascular risk and albuminuria, and better quality of life in patients in intervention clinics compared to those in than care. Wide-scale implementation of a multicomponent intervention such the SingHypertension is likely to reduce hypertension-related morbidity and mortality in Singapore and possibly many other countries.

PS-C33-7: TRUE RESISTANT HYPERTENSION IN A TERTIARY HYPERTENSION CLINIC IN SAUDI ARABIA

Objective: Resistant hypertension(RH), defined as office blood pressure (BP) above goal despite the use of more than three anti-hypertensives (one ideally being a diuretic) or BP that requires more than four agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies. Based on this definition of RH, the prevalence rates vary around 15–30% worldwide. However, there is paucity of data on RH, particularly true RH in the Middle-East. The aim of this study was to explore the prevalence, clinical characteristics and choice of anti-hypertensives in a Saudi RH population. Design & Methods: We analysed retrospectively clinic and ambulatory BP monitory (ABPM) data in Saudi patients between January 2016 to June 2018. Office HTN was defined as greater than 140 systolic or greater than 90 diastolic, mm Hg. HTN was confirmed using one of the following ABPM cut-offs; 24-hr greater than 130/80 or daytime greater than 135/85, mm Hg. Results were analysed using JMP version 13, p less than 0.05 considered significant. Results: The mean age of the population(n = 540) was 54 ± 15 years, 40% female. The overall prevalence of RH was 47% in our cohort, of which 35% was true RH. The patients with RH were older; 62 ± 13 vs. 50.5 ± 14 years with no significant gender difference. RH was associated with diabetes (OR = 6.2, CI%, 3–12); CAD(OR = 3.3, CI%, 2–5); history of coronary revascularization(CABG/PCI) (OR = 3, CI%, 2–5); CKD(OR = 5.7, CI%, 3–12) and heart failure(OR = 1.9, CI%, 1–3). The average number of anti-hypertensives was 4.2 ± 1 in RH compared with 1.1 ± 1 in control group. Only a third of the patients were prescribed spironolactone in the RH group with some 10% on an alpha blocker. Conclusions: To the best of our knowledge, this is the first study in the Middle-East to establish the prevalence of true RH using ABPM. With a high prevalence rate, our cohort of RH is complex with high number of co-morbidities, sub optimal prescription rates of spironolactone or alpha-blockers, representing a therapeutic challenge.

PS-C13-14: ARNI DECREASED NIGHTTIME BLOOD PRESSURE EVALUATED BY WRIST-TYPE NOCTURNAL MONITORING DEVICE IN A PATIENT WITH TREATMENT-RESISTANT HYPERTENSION AFTER RENAL DENERVATION

Angiotensin receptor-neprilysin inhibitor (ARNI), Sacubitril/Valsartan has been reported to decrease nighttime blood pressure (BP). Moreover, Sacubitril/Valsartan is expected to be useful in treatment resistant hypertension because neprilysin inhibition offers an additional effect to reducing BP levels. In this case report, we observed decreasing nighttime BP by changing from angiotensin-1 receptor blocker (ARB) and hydrochlorothiazide (HCTZ) to Sacubitril/Valsartan in a patient with sustained resistant hypertension despite he had been conducted the procedure of renal denervation. Additionally, we evaluated nighttime BP by newly developed wrist-type nocturnal BP monitoring device, Nightview (Omron HEM9601T, Omron health care, Kyoto, Japan). A 46 year old Asian male, who had underwent renal denervation 8-years ago, suffered for treatment-resistant hypertension despite of administration of multiple antihypertensive medications including combination agent of ARB/HCTZ, Ca-channel antagonist, beta-blocker, alpha-blocker, and mineralocorticoid receptor antagonist. His average of usual daytime (morning and evening) home BP level was 155/85 mmHg. We performed a 7-day consecutive nighttime BP measurement using wrist-type BP monitoring device, which also revealed nocturnal hypertension, 125/65 mmHg. To decrease his daytime or nighttime BP levels, we initiated administration of sacubitril/valsartan 400 mg instead of combination agent of ARB/hydrochlorothiazide (Candesartan 8 mg and Hydrochlorothiazide 6.25 mg). Then, we performed nighttime BP measurements using wrist-type device again, which revealed decreasing nighttime BP to 119/61 mmHg just after initiating Sacubitril/Valsartan instead of combination agent of ARB/HCTZ. His usual daytime home BP also decreased to 140/80 mmHg. Additionally, NT-pro BNP also decreased from 87 to 55 pg/mL. From these observations in this case report, ARNI is expected to improve BP control, especially nighttime BP level, in patients with uncontrolled treatment-resistant hypertension despite multiple drug and denervation therapy. ARNI may be also expected to prevent heart failure in resistant hypertension.

Racial and Ethnic Disparities in Hypertension: Barriers and Opportunities to Improve Blood Pressure Control.

To characterize the barriers and opportunities associated with racial and ethnic disparities in blood pressure (BP) control. Blood pressure (BP) control rates in the USA have worsened over the last decade, with significantly lower rates of control among people from racial and ethnic minority groups, with non-Hispanic (NH) Black persons having 10% lower control rates compared to NH White counterparts. Many factors contribute to BP control including key social determinants of health (SDoH) such as health literacy, socioeconomic status, and access to healthcare as well as low awareness rates and dietary habits. Numerous pharmacologic and non-pharmacologic interventions have been developed to reduce racial and ethnic disparities in BP control. Among these, dietary programs designed to help reduce salt intake, faith-based interventions, and community-based programs have found success in achieving better BP control among people from racial and ethnic minority groups. Disparities in the prevalence and management of hypertension persist and remain high, particularly among racial and ethnic minority populations. Ongoing efforts are needed to address SDoH along with the unique genetic, social, economic, and cultural diversity within these groups that contribute to ongoing BP management inequalities.

JS-ISH-ESH-3: POST-TRAUMATIC STRESS DISORDER AND HYPERTENSION

Post-traumatic stress disorder (PTSD) is a psychiatric condition that may affect people who have experienced or witnessed a traumatic event, which causes intense, disturbing thoughts and feelings related to this experience, that last long after the traumatic event and cause significant distress and/or impairment in social, occupational, or other important areas of functioning It affects approximately 3.5% of U.S. adults every year and an estimated 6.8% subjects will be diagnosed with PTSD in their lifetime, with a prevalence more than doubled in women compared to men. Several studies have reported a relation between PTSD diagnosis, hypertension and cardiovascular diseases. The association was initially reported in veterans cohorts and later described also in general population. In particular, in wounded US military servants, the incidence of hypertension was independently associated with the injury severity score and the chronicity of PTSD. More recently, in a series of patients from Bukavu, man-made trauma and PTSD were strongly associated with hypertension, over and above classical environmental and lifestyle factors. PTSD has also been involved in the pathogenesis of resistant hypertension and poor drug adherence, either directly or through mediation of altered expression of emotions and somatization. PTSD should be considered among the mechanisms involved in onset and maintenance of hypertension, particularly in military servants and war veterans, subjects living in countries exposed to war and chronic violence, migrants, refugees and patients with resistant and difficult-to-control hypertension. Further research is required to unravel the mechanisms underlying the association of PTSD and hypertension, and to define the optimal therapeutic strategy and psychological interventions required to improve blood pressure control, psychological well-being and to decrease cardiovascular risk in patient suffering from both conditions.

PS-BPP06-7: ASSOCIATION BETWEEN SALT INTAKE AND BLOOD PRESSURE IN COMMUNITY-DWELLING OLDER PEOPLE: THE SONIC STUDY

Objective: It is well known that excessive salt intake is associated with hypertension (HT) and salt intake reduction lowers blood pressure. However, the knowledge of salt intake and blood pressure in the older people is not sufficient. This study aimed to clarify the relationship between salt intake and blood pressure among community-dwelling Japanese older people. Design and method: This study was cross-sectional design based on a prospective cohort study called the SONIC (Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians) study. We used data collected from 2010 to 2012. The dependent variable was the blood pressure at the venue and the independent variable was salt intake. Salt intake was calculated using the brief-type self-administered diet history questionnaire (BDHQ). After adjustment for energy using the residual method, Salt intake was classified into quartiles. Blood pressure values for each quartile were compared by Jonckheere-Terpstra test. Results: The number of participants was 2,163 (female: 53.3%). Persons who may have over- or under-reporting nutrition and had no blood pressure data was excluded. Participants of 70 ± 1 years old were 947 (HT: 50.2%), 80 ± 1 years old were 951 (HT: 63.9%), 90 ± 1 years old were 265 (HT: 50.6%). There was no clear difference of systolic blood pressure among the four quartiles of salt intake. Participants taking angiotensin II receptor blocker (ARB) were 448, and mean systolic blood pressure in the four quartiles of salt intake were Q1:142.1 ± 17.7mmHg, Q2: 145.2 ± 17.3, Q3: 146.1 ± 17.2, and Q4: 147.8 ± 18.8. There was a stepwise increase in systolic blood pressure with increasing salt intake quartile (p = 0.018 for trend). Conclusions: For the elderly taking ARBs, salt reduction was shown to improve blood pressure control, but for the other elderly, no effect of salt intake was observed. Further studies are needed to examine including other factors what affects blood pressure for older population.

S-47-4: THE BURDEN OF CARDIOVASCULAR DISEASE ATTRIBUTABLE TO HIGH SYSTOLIC BLOOD PRESSURE ACROSS CHINA AND ITS PROVINCES FROM 2005 TO 2018

Background: The temporal trends and geographical disparity in the burden of cardiovascular diseases (CVD) attributable to high systolic blood pressure (SBP) have not been fully discussed before in Chinese population. The current study was performed to quantify the CVD burden attributable to high SBP in China, which is crucial to inform and improve blood pressure control measures. Methods: We evaluated death numbers, age-standardized mortality rate and years of life lost (YLLs) and corresponding estimated annual percentage changes (EAPC) for CVD and its subcategories attributable to high SBP from 2005 to 2018. We polled data from China Chronic Disease and Risk Factor Surveillance, the China Health and Nutrition Survey and China Hypertension Survey to estimate the BP level between 2005 and 2018. A comparative risk assessment method was applied to compute the deaths and health burden attributable to high SBP for CVD and its subtypes by age, sex, year and provinces. Findings: We estimated that 2·67 million (95%UI 2·61 to 2·73) CVD deaths in China were attributable to elevated SBP in 2018. Age-standardized CVD mortality rate associated with high SBP decreased by 17·89% for China overall between 2005 and 2018, and the EAPC was -1·50 (95% UI -1·55 to -1·45). The death numbers for ischemic heart disease, ischemic stroke due to high SBP showed a relative growth in most provinces, while age standardized mortality rates declined in 2018 compared with 2005 in most provinces, which were in line with the national trend. YLLs for total CVD attributable to high SBP increased from 40·13 million (95%UI, 39·70 to 40·52) in 2005 to 48·16 million (95%UI, 47·44 to 48·90) in 2018 for China overall. YLL rates varied considerably across provinces, ranging from 3217·15 per 100 000 (95%UI 2947·43 to 3441·83) in Fujian to 7196·20 per 100 000 (95%UI 6864·28 to 7498·94) in Heilongjiang in 2018. Age-standardized YLL rates for ischemic heart disease and ischemic stroke attributable to high SBP were high in northeast provinces, including Heilongjiang, Liaoning and Jilin. Interpretation: The deaths and YLLs for CVD attributable to high SBP increased substantially in recent years, especially for the elderly, although age-standardized CVD mortality rate has decreased in China between 2005 and 2018. Preventive interventions should be implemented to lower the prevalence of high SBP among Chinese overall in order to reduce the SBP-related CVD adverse health effect.

S-16-3: ANTIHYPERTENSIVE TREATMENT PRESCRIBING BEHAVIOURS IN FRENCH GENERAL PRACTICE IN 2021

Hypertension (HT) is the leading reason for visits to general practitioners (GPs). Due to insufficient adherence and marked therapeutic inertia, there is room for improving blood pressure control in France. The objective of this study is to describe the antihypertensive treatment prescribing behaviours in French general practice. Method: Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians, including GPs (n = 1200), contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population. The following definitions were used to categorise the prescribing behaviours: INITIATION, for hypertensive patients already registered with the GP and who had been prescribed an antihypertensive treatment for the first time in 24 months; RENEWAL, for hypertensive patients whose therapeutic class had not changed, apart from dosage modifications, changes of molecule within the same class and titrations; CHANGE, for hypertensive patients for whom a therapeutic class had been added, withdrawn, and/or changed. Results: In 2021, a total of 11 557 545 hypertensive patients had received an antihypertensive treatment prescription following consultation with a GP. These were distributed as follows (see figure). Conclusion: These findings provide informative data on the prescribing behaviours of GPs, primarily marked by a renewal rate that does not appear to reflect the reality of blood pressure control in France. Prescription modifications are in the minority, and essentially consist of class rotations. This observation requires urgent reflection when it comes to the training of prescribers and the value placed on blood pressure control under the French public health objectives pay-for-performance scheme (ROSP).∗IQVIA EMR LPD Médecins Généralistes “. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data

PS-C36-12: PRESCRIPTION PATTERN OF ANTIHYPERTENSIVE MEDICATIONS, COMPLIANCE AND CONTROL OF BLOOD PRESSURE AMONG HYPERTENSIVE OUTPATIENTS AT TERTIARY CARDIAC HOSPITAL IN BANGLADESH

Objectives: Blood pressure control in hypertensive patients depends not only on antihypertensive medications but drug compliance and lifestyle changes. The aim of the study is to look at the commonly used antihypertensive drugs and patients adherence to drug and lifestyle modification and their blood pressure control. Method: This is a cross sectional descriptive study among known hypertensive patients visited at hypertension clinic at National Heart Foundation Hospital and Research institute. Data was collected and entered according to structured questionnaire in software. Then data was analyzed using SPSS 20. Result: A total number of 920 patients were included in this study. Male and female were almost equal, 468 (50.9%) and 452 (49.1%) respectively. Mean age was 49.1 + 12.33 (min. 14 years and max. 90 years). Body mass index (BMI) is 26.57(+3.97) with 21% has obesity. 19% of patients were current smokers (male to female, 14.89% to 5.1%) and 8.1% are smokeless tobacco users. 14% of patient consume extra salt in main meal. Among other risk factors diabetes mellitus was 5.86% (54 patients), dyslipidemia was 2.3% (in 21 patients) and family history was positive in 78 patients (8.5%), chronic kidney disease was noted in < 1%. Mean duration of hypertension was 5.44 (+5.29) years. Single drug was prescribed in 246 (26.7%) patients where ARB prescribed in 119 (12.9%) patients followed by betablocker in 60 (6.5%) and CCB in 38 (4.1%) patients. ARB and CCB were used most (78 patients, 8.5%) as combination of dual drug (or single pill combination), followed by betablocker and CCB combination in 47 (5.1%) patients and ARB and betablocker in 38 (4.1%) patients. ARB, betablocker and CCB were used combinedly in 44 (4.8%) patients when three drugs were used. Overall, most commonly used antihypertensive drug was amlodipine in 188 (20.4%) patients followed by losartan potassium (15.2%), Olmesartan (13.3%) and Bisoprolol (10.9%). Out of 920 patients 171 (18.6%) were non-adherent to drug in whom control of blood pressure is poor (28.2% vs 7.3%, p. < 0.0001) and almost similar was seen in patients who were non-adherent to lifestyle changes (280 patients, 30.4%) (uncontrol vs control, 33.3% vs 27.1%, p < 0.04). Conclusion: Prescribing drugs is not enough to control hypertension. Drug compliance and adherence to lifestyle modification are important part of management plan that every physician should give emphasis to improve blood pressure control among hypertensive patients.

Prescribing pattern of anti-hypertensive medications among hypertensive outpatients at selected hospitals of South Gondar Zone, Amhara, Ethiopia: a hospital based cross sectional study

BackgroundIrrational prescription has a lion share for uncontrolled blood pressure. There is no study assessing prescription pattern among hypertensive patients at the study sites. Therefore, the objective of the current study was to evaluate prescription patterns for hypertension and blood pressure (BP) control at randomly selected hospitals of South Gondar Zone.MethodsA hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021. Hypertensive patients were selected by systematic random sampling proportionally from study hospitals. Structured questionnaires were used to collect socio-demographic chacteristics and adherence. Data abstraction form was used to collect prescription patterns, BP level and other necessary information. The association of prescription patterns and other variables with blood pressure control was determined by using binary logistic regression.ResultsAll recruited 423 patients were included in data analysis. Among prescriptions for hypertension, on average 93.5% were found to be in line with WHO guideline. About 53% of prescriptions for hypertension were monotherapies. Patient level low medication regimen complexity, and monotherapy were associated with blood pressure control (Ajusted Odds Ratio [AOR] = 2.04, [1.07–3.91]; AOR = 3.83 [1.42–10.35], respectively). Patients with inappropriate drug selection, and non-adherence were less likely to have controlled BP (AOR = 0.47 [0.26–0.85]; AOR = 0.52 [0.34–0.85], respectively). Moreover, patients who didn’t have health insurance and follow regular aerobic exercise were less likely to have controlled BP (AOR = 0.42 [0.26–0.68]; AOR = 0.53 [0.32–0.88], respectively).ConclusionDiuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Patient level low medication regimen complexity and monotherapy were positively associated with BP control whereas, non-adherence, inappropriate drug selection, having no health insurance, and didn’t follow regular aerobic exercise were negatively associated with BP control. Clinicians should be adherent to treatment guidelines and focus on modifiable factors to improve BP control.

Individual Characteristics, Adherence, and Barriers to Medication Adherence of Hypertensive Patients at the Indonesia - Timor Leste Border

Background: Until the last decade, the incidence of hypertension has increased sharply. It has been reported that individuals with hypertension show a low level of adherence to their therapy management. Moreover, there has been no previous research evaluating individual characteristics, adherence, and barriers to medication adherence among people with hypertension at the border of Indonesia and Timor Leste.Purpose: This study aimed to identify individual characteristics, adherence, and barriers to medication adherence among hypertensive patients.Methods: A total of 112 hypertensive patients recruited using a quota sampling method at the border of Indonesia and Timor Leste participated in this cross-sectional study. Data were collected using the Hill-Bone Questionnaire to identify adherence and the Adherence Barrier Questionnaire (ABQ) to identify barriers to medication adherence. Individual characteristics were also collected. To confirm the hypertension condition at the time of data collection, measurements of blood pressure were retaken. Descriptive statistics and Chi-square analysis were used for data analysis. Results: The average of systolic blood pressure was 163.85(18.24) mmHg, and the diastolic blood pressure was 99.30(11.57) mmHg. The Chi-square test showed that education and occupation had a significant relationship with adherence (p<0.05) and barriers to medication adherence (p=0.000). Meanwhile, other characteristics, including age, gender, and marital status, were not significantly related to adherence (p>0.05) and barriers to medication adherence (p>0.05).Conclusion: There is a relationship between education and occupation with adherence and barriers to medication adherence, but there is no relationship when viewed from such individual characteristics as age, gender, and marital status. Further research is needed to identify effective educational methods to increase the knowledge, motivation, and self-efficacy of hypertensive patients to improve blood pressure control.

Preference and Adherence to a Fixed-Dose Combination of Bisoprolol-Aspirin and Blood Pressure Control: Results of an Open-Label, Multicentre Study.

This study assessed blood pressure (BP) control and adherence in patients given a fixed-dose combination (FDC) of bisoprolol (BIS) + aspirin (ASA) compared to those given these two drugs as separate tablets. Patients with hypertension and/or coronary heart disease treated with two-pill BIS (5-10 mg) and ASA (75-100 mg) were switched to FDC BIS + ASA (either 5/75 mg or 10/75 mg) ≥4 weeks prior to study initiation. Adherence was estimated from pill counts and patients' diaries (1-2 months and 3 months after inclusion) and using Morisky's Medication Adherence Scale (MMAS) at 3 months. BP control with the two treatments was compared. A total of 356 patients were enrolled (mean (SD) age: 64.3 ± 11.9 years, 56.5% male). Mean (SD) duration of prior treatment with two-pill BIS and ASA was 17.8 ± 26.6 months. FDC adherence was excellent or good (≥76%) in 98.3% and 98.0% of patients based on pill counts and patients' diaries, respectively. Overall MMAS score was 3.1 ± 1.0. A significant decrease was observed in mean systolic BP, mean diastolic BP and heart rate over the 3-month period (all p < 0.001). FDC BIS + ASA was associated with excellent adherence and improved BP control. The majority (78.7%) of patients preferred the FDC.