Improve Blood Pressure Research Articles

Daily Versus Twice-Daily Dosing of Nifedipine for Blood Pressure Control in Pregnancy and Postpartum [ID: 1375881

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) may be managed with oral antihypertensives; however, pregnancy-induced changes in the hormonal milieu and volume of distribution make it difficult to determine optimal dosing regimens. Nifedipine is a first-line therapy for treatment of HDP. The purpose of this study is to compare 60 mg daily (QD) of extended released (XR) nifedipine to 30 mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum. METHODS: This was a retrospective chart review conducted in Mount Sinai Health System. Patients admitted from January 1, 2015 to April 30, 2021, who were diagnosed with a HDP and received nifedipine XR 30 mg BID or 60 mg QD for intrapartum or postpartum BP control were included. The primary outcome was need for dose adjustment of nifedipine or addition of another antihypertensive agent. Patients were excluded if they had preexisting renal disease or were already taking oral antihypertensives. RESULTS: Two hundred thirty-seven patients were included, 139 (59%) received 30 mg BID and 98 (41%) 60 mg QD. There was no statistically significant difference in the need for increase in nifedipine dose or addition of another oral antihypertensive between those receiving 30 mg BID versus 60 mg QD (33.8% versus 35.7%, adjusted odds ratio [95% CI], 0.90 [0.50, 1.60]; P=.71). Additionally, there was no difference in need for emergency hypertensive treatment after reaching study dose (P=.19) or readmission for BP control between the two groups (P>.99). CONCLUSION: These findings suggest that BID versus QD dosing of nifedipine XR does not improve blood pressure control in the antepartum or postpartum periods; thus, daily dosing is reasonable and may be preferable for patient convenience and compliance.

Management of hypertensive patients with ischemic heart disease and the role of a fixed-dose combination of telmisartan and metoprolol: a physician-based research survey

Background: We aimed to understand the current practices of Indian practitioners in the management of hypertensive patients with ischemic heart disease. Methods: A quantitative, cross-sectional, questionnaire-based survey involving 145 cardiologists and consulting physicians who each saw 10 patients with hypertension and IHD in their clinical practice was conducted. The questionnaire consisted of 35 questions divided into three sections on prevalence and treatment of hypertension and IHD and role of fixed-dose combinations in therapy. Results: In all, 49.0% of physicians treated 25%-50% patients with hypertension and IHD in their routine practice, majority of whom were in the age group of 40-60 years regardless of gender. Telmisartan (97.0%) and metoprolol (86.0%) were the most preferred angiotensin receptor blocker (ARB) and beta-blocker, respectively, and 91.0% of physicians preferred a combination of metoprolol with telmisartan when monotherapy fails. In the opinion of the physicians, prevention of new cardiovascular events (63.0%) and improvement in quality of life (61.0%) were the leading benefits of telmisartan and metoprolol FDC, and all agreed that this FDC improves patient compliance and adherence to therapy. Furthermore, 97.0%, 90.0%, and 40.0% of physicians agreed/strongly agreed that the FDC could be prescribed to hypertensive patients with IHD, heart failure, and IHD and diabetes, respectively. Conclusions: In this pan-India survey, it was observed that FDCs of telmisartan and metoprolol could help in improving blood pressure, heart rate, patient compliance, and adherence to therapy. Nevertheless, large-scale, prospectively designed studies are warranted to validate these findings.

Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.

The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt – Addressing the Triple Threat

BackgroundImpoverished African Americans (AA) with hypertension face poor health outcomes. PurposeTo conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension. MethodsWe engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + PF), or enhanced usual care (EUC). Coaches met with participants from PC and PC + PF practices weekly for 8 weeks then monthly over one year, discussing lifestyle changes, medication adherence, home monitoring, and communication with the healthcare team. Facilitators met with PF and PC + PF practices monthly to implement ≥1 quality improvement intervention in each of four domains. Data were collected at 0, 6, and 12 months. ResultsWe recruited 69 practices and 1596 participants; 18 practices (408 participants) were randomized to EUC, 16 (384 participants) to PF, 19 (424 participants) to PC, and 16 (380 participants) to PC + PF. Participants had mean age 57 years, 61% were women, and 56% reported annual income <$20,000. LimitationsThe PF intervention acts at the practice level, possibly missing intervention effects in trial participants. Neither PC nor PF currently has established clinical reimbursement mechanisms. ConclusionsThis trial will fill evidence gaps regarding practice-level vs. patient-level interventions for rural impoverished AA with uncontrolled hypertension.

Acute beetroot supplementation may improve blood pressure but not exercise economy in female masters swimmers

It is known that beetroot supplements may improve exercise economy and blood pressure, but this has mainly been studied in males. Given that older female athletes are underrepresented in the literature, we aimed to determine if acute beetroot supplementation (BRS) improves exercise economy and blood pressure in masters female athletes (swimmers) during a treadmill exercise test. Methods: 11 participants (57.8±10.5 y) underwent 2 randomized, double-blinded trials, ingesting beetroot (BE) or placebo (PL). Salivary NO2- (sNO2-) and blood pressure (BP) were measured pre-ingestion (Base), pre-exercise (Pre), and 5 min post-exercise (Post). Oxygen consumption (VO2) was measured during the modified Balke test until HR reached 85% of age-predicted maximum. Exercise economy (ExEc) was defined as the average relative VO2 during min 3-4.5 of the test. sNO2- was determined using NO2- detection strips. Results: sNO2- increased from Base to Post in BE vs PL (32.5±7.0 vs 2.7±3.9% change, p=0.001). No treatment differences existed for ExEc (BE: 15.51±0.47 vs PL: 15.71±0.53 ml·kg-1·min-1, p=0.48). Diastolic BP was significantly lower in BE vs PL (Base: 74.6±1.7 vs 73.2±2.3, Pre: 73.6±1.8 vs 74.5±2.1, Post: 74.5±1.7 vs 76.1±2.2 mmHg, p=0.03, treatment by time). Conclusion: Acute BRS lowered diastolic BP, but did not improve exercise economy in these trained, normotensive athletes. Further research is warranted in menopausal and post-menopausal females, including those who are hypertensive, and in other female masters athlete groups.

Using Renin Activity to Guide Mineralocorticoid Receptor Antagonist Therapy in Patients with Low Renin and Hypertension.

Mineralocorticoid receptor antagonists (MRAs) are often empirically used for patients with low-renin hypertension (LRH) or probable primary aldosteronism (PA) who decline surgery. However, the optimal approach to MRA therapy is unknown. Studies have shown that a rise in renin is an effective biomarker of prevention of cardiovascular complications of PA. This study aimed to determine whether empiric MRA therapy in patients with LRH or probable PA targeting unsuppressed renin is associated with a decrease in blood pressure and/or proteinuria. Retrospective single-center cohort study from 2005 to 2021 included adults with LRH or probable PA (renin activity <1.0 ng/ml/h and detectable aldosterone levels). All patients were empirically treated with an MRA, targeting renin ≥1.0 ng/ml/h. Out of 39 patients studied, 32 (82.1%) achieved unsuppressed renin. Systolic and diastolic blood pressure decreased from 148.0 and 81.2 to 125.8 and 71.6 mm Hg, respectively (P < 0.001 for both). Similar blood pressure reductions were seen whether patients had high (>10 ng/dl) or low (<10 ng/dl) aldosterone levels. The majority (24/39; 61.5%) of patients had at least one baseline anti-hypertensive medication stopped. Among the six patients who had detectable proteinuria and albumin-to-creatinine (ACR) measurements post-treatment, the mean ACR decreased from 179.0 to 36.1 mg/g (P = 0.03). None of the patients studied had to completely stop treatment due to adverse reactions. Empiric MRA therapy in patients with LRH or probable PA targeting unsuppressed renin can safely and effectively improve blood pressure control and reduce proteinuria.

Hypertension control in the Tunisian elderly

Background : Hypertension is a major public health problem. Despite therapeutic progress, blood pressure control remains insufficient particularly in the elderly. Purpose: The aim of our study was to identify the factors associated with poor blood pressure control in the elderly in Tunisia. Material and methods: We conducted a descriptive study including 101 Tunisian treated hypertensive patients, aged 65 years and over, followed on an outpatient basis between November and December 2019. Results: Median age was 73 and sex ratio was 0.57. The major cardiovascular risk factor was diabetes in 60.4% of cases, followed by dyslipidaemia (48.5%) and smoking (40.6%). About 33% of the hypertensive patients realized regular physical activity and 31% had a high-sodium diet. Our patients were completely dependent in 4% of cases and among those aged 80 and over, 68.2% were frail. The prevalence of poor blood pressure control was 59%. Adherence to treatment was satisfactory in 75.2% of cases. In multivariate analysis, the factors associated with poor blood pressure control were: non-compliance with treatment [odds ratio (OR) = 0.19; p = 0.013], frailty (OR = 7.194; p = 0.004), the number of antihypertensive tablets (OR = 0.382; p = 0.008), non-use of thiazide diuretics (OR = 25.903; p = 0.001) and the patient's lack of knowledge of antihypertensive treatment (OR = 0.56; p = 0.008). Conclusion: Detection of the risk of non-compliance, the use of combined treatments screening for frailty and informing the patient about his/her treatment are necessary to improve blood pressure control in our Tunisian context.

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status.

Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

New Horizons: Testosterone or Exercise for Cardiometabolic Health in Older Men.

Middle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.

Simultaneous photoplethysmography and blood flow measurements towards the estimation of blood pressure using speckle contrast optical spectroscopy.

Non-invasive continuous blood pressure monitoring remains elusive. There has been extensive research using the photoplethysmographic (PPG) waveform for blood pressure estimation, but improvements in accuracy are still needed before clinical use. Here we explored the use of an emerging technique, speckle contrast optical spectroscopy (SCOS), for blood pressure estimation. SCOS provides measurements of both blood volume changes (PPG) and blood flow index (BFi) changes during the cardiac cycle, and thus provides a richer set of parameters compared to traditional PPG. SCOS measurements were taken on the finger and wrists of 13 subjects. We investigated the correlations between features extracted from both the PPG and BFi waveforms with blood pressure. Features from the BFi waveforms were more significantly correlated with blood pressure than PPG features ( R = - 0.55, p = 1.1 × 10-4 for the top BFi feature versus R = - 0.53, p = 8.4 × 10-4 for the top PPG feature). Importantly, we also found that features combining BFi and PPG data were highly correlated with changes in blood pressure ( R = - 0.59, p = 1.7 × 10-4 ). These results suggest that the incorporation of BFi measurements should be further explored as a means to improve blood pressure estimation using non-invasive optical techniques.

Moderate dietary salt restriction improves blood pressure and mental well-being in patients with primary aldosteronism: The salt CONNtrol trial.

Primary aldosteronism (PA) is a frequent cause of hypertension. Aldosterone excess together with high dietary salt intake aggravates cardiovascular damage, despite guideline-recommended mineralocorticoid receptor antagonist (MRA) treatment. To investigate the antihypertensive impact of a moderate dietary salt restriction and associated physiological changes, including mental well-being. A total of 41 patients with PA on a stable antihypertensive regimen-including MRA-followed a dietary salt restriction for 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24-h urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well-being by validated questionnaires. Dietary salt intake significantly decreased from 9.1 to 5.2g/d at the end of the study. In parallel, systolic (130 vs. 121mmHg) and diastolic blood pressure (BP) (84 vs. 81mmHg) improved significantly. Patients' aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4g/d). Salt restriction entailed a significant weight loss of 1.4kg, improvement in pulse pressure (46 vs. 40mmHg) and normalization of depressive symptoms (PHQD scale, p<0.05). Salt restriction, cortisol after dexamethasone suppression test and dosage of renin-angiotensin-aldosterone-system (RAAS) blockers were independently associated with BP reduction. A moderate restriction of dietary salt intake in patients with PA substantially reduces BP and depressive symptoms. Moreover, the findings underline that a sufficient RAAS blockade seems to augment the effects of salt restriction on BP and cardiovascular risk.

Increased respiratory modulation of cardiovascular control reflects improved blood pressure regulation in pregnancy.

Hypertensive pregnancy disorders put the maternal-fetal dyad at risk and are one of the leading causes of morbidity and mortality during pregnancy. Multiple efforts have been made to understand the physiological mechanisms behind changes in blood pressure. Still, to date, no study has focused on analyzing the dynamics of the interactions between the systems involved in blood pressure control. In this work, we aim to address this question by evaluating the phase coherence between different signals using wavelet phase coherence. Electrocardiogram, continuous blood pressure, electrocardiogram-derived respiration, and muscle sympathetic nerve activity signals were obtained from ten normotensive pregnant women, ten normotensive non-pregnant women, and ten pregnant women with preeclampsia during rest and cold pressor test. At rest, normotensive pregnant women showed higher phase coherence in the high-frequency band (0.15-0.4Hz) between muscle sympathetic nerve activity and the RR interval, blood pressure, and respiration compared to non-pregnant normotensive women. Although normotensive pregnant women showed no phase coherence differences with respect to hypertensive pregnant women at rest, higher phase coherence between the same pairs of variables was found during the cold pressor test. These results suggest that, in addition to the increased sympathetic tone of normotensive pregnant women widely described in the existing literature, there is an increase in cardiac parasympathetic modulation and respiratory-driven modulation of muscle sympathetic nerve activity and blood pressure that could compensate sympathetic increase and make blood pressure control more efficient to maintain it in normal ranges. Moreover, blunted modulation could prevent its buffer effect and produce an increase in blood pressure levels, as observed in the hypertensive women in this study. This initial exploration of cardiorespiratory coupling in pregnancy opens the opportunity to follow up on more in-depth analyses and determine causal influences.

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.

Safety, Feasibility, and Acceptability of Telemedicine for Hypertension in Primary Care: A Proof-of-concept and Pilot Randomized Controlled Trial (SATE-HT).

Hypertension (HT) continues to be a leading cause of cardiovascular death and an enormous burden on the healthcare system. Although telemedicine may provide improved blood pressure (BP) monitoring and control, it remains unclear whether it could replace face-to-face consultations in patients with optimal BP control. We hypothesized that an automatic drug refill coupled with a telemedicine system tailored to patients with optimal BP would lead to non-inferior BP control. In this pilot, multicenter, randomized control trial (RCT), participants receiving anti-HT medications were randomly assigned (1:1) to either the telemedicine or usual care group. Patients in the telemedicine group measured and transmitted their home BP readings to the clinic. The medications were refilled without consultation when optimal control (BP < 135/85 mmHg) was confirmed. The primary outcome of this trial was the feasibility of using the telemedicine app. Office and ambulatory BP readings were compared between the two groups at the study endpoint. Acceptability was assessed through interviews with the telemedicine study participants. Overall, 49 participants were recruited in 6 months and retention rate was 98%. Participants from both groups had similar BP control (daytime systolic BP: 128.2 versus 126.9 mmHg [telemedicine vs. usual care], p = 0.41) and no adverse events. Participants in the telemedicine group had fewer general outpatient clinic attendances (0.8 vs. 2, p < 0.001). Interviewees reported that the system was convenient, timesaving, cost saving, and educational. The system could be safely used. However, the results must be verified in an adequately powered RCT. Trial registration: NCT04542564.

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.

Activation of the Vascular Smooth Muscle GLP-1/NCX1 Pathway Regulates Cytoplasmic Ca2+ Homeostasis and Improves Blood Pressure Variability in Hypertension

Background: Hypertension is the most common cardiovascular disease, and its main harmful effect is chronic damage to target organs. In some patients with well-controlled blood pressure, target organ damage still occurs. GLP-1 agonists have significant cardiovascular benefits, but their antihypertensive effect is limited. The cardiovascular protective effect of GLP-1 is worth studying. Methods: The ambulatory blood pressure of spontaneously hypertensive rats (SHRs) was detected by ambulatory blood pressure monitoring, and the characteristics of blood pressure and the effect of subcutaneous intervention with a GLP-1R agonist on blood pressure were observed. To explore the mechanism of the cardiovascular benefit of GLP-1R agonists in SHRs, we evaluated the effects of GLP-1R agonists on vasomotor function and calcium homeostasis in vascular smooth muscle cells (VSMCs) in vitro. Results: Although the blood pressure of SHRs was significantly higher than that of WKY rats, the blood pressure variability of SHRs was also significantly higher than that of the control group. The GLP-1R agonist significantly reduced blood pressure variability in SHRs, but the antihypertensive effect was not obvious. GLP-1R agonists can significantly improve the cytoplasmic calcium overload of VSMCs in SHRs by upregulating the expression of NCX1, improving the systolic and diastolic functions of arterioles, and reducing blood pressure variability. Conclusions: Taken together, these results provide evidence that GLP-1R agonists improved VSMC cytoplasmic Ca2+ homeostasis through upregulated NCX1 expression in SHRs, which plays a key role in blood pressure stability and broad cardiovascular benefits.

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials.

Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 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. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility. European Union's Horizon 2020 Research and Innovation Programme.

Abstract P441: Association of Monthly Resistance Training Volume With All-Cause Mortality in NHANES 1999-2006

Introduction: The WHO Physical Activity Guidelines recommend at least 2 days of resistance training (RT) per week. RCTs have shown a dose-response between RT volume and improving blood pressure, lipids, and markers of glycemia. There is discordance between the Guidelines recommending a frequency while empirical evidence supports a volume. Our objective was to test whether RT Guidelines and volume were associated with lower mortality. Methods: Data are from the 1999–2006 NHANES cycles. Participants self-reported past 30 days of physical activity including type, which was used to assign METs, number of sessions, and average session duration in minutes. Those who reported engaging in RT (push-ups, sit-ups, and weightlifting) with no missing data were included ( N =1,391). RT volume was measured in monthly MET-minutes, calculated as the product of the number of sessions, mean session duration, and intensity. Mortality was ascertained from the linked National Death Index through the end of 2019. Covariates included monthly aerobic physical activity volume, sex, age, and education. Cox proportional hazards regression was used to estimate hazard ratios for all-cause mortality by RT Guideline adherence and RT volume. Results: Participants had a mean age of 41.3±16.3 years and were mostly male (62.7%). Most participants met the Guidelines ( n =1,041, 74.8%). The mean monthly RT volume was 2,210±2,550 MET-minutes. Mortality incidence was 11.4% with a mean follow-up time of 189±41.6 months (159 events, 263,585 total person-months). Neither meeting the Guidelines nor monthly RT volume was associated with all-cause mortality (Table 1.). There was no evidence of effect modification by sex or age. Conclusions: According to these findings, current Guidelines promoting RT for health benefits are not supported by empirical data. However, the absence of an association between monthly RT volume and all-cause mortality warrants further investigation using better instrumentation for assessing RT volume.

The Effect of Cassava-Dried Shrimp Crackers on Urine Protein in Maternity Hypertension in Maros District Health Center

Maternal Mortality Rate is a serious world health problem. According to the World Health Organization in 2017 around 295,000 women died and after pregnancy and childbirth in 2018 increased to 830,000. The main cause of maternal death is preeclampsia, therefore hypertension and urine protein as causes of preeclampsia need to be controlled. Research has shown that certain nutrients can improve blood pressure and urine protein. The research objective was to analyze the effect of cassava cracker consumption on urine protein in maternity hypertension. This type of research used quasi-experimental and the populations in this study were all Maternities at Cenrana and Tompobulu Health Center. The sample was 15 pregnant women at Puskesmas Cenrana as an experimental group and 15 pregnant women at Tompobulu health center as a control group. The results of the paired t test showed that the consumption of ebi cassava crackers at fourth’s week had a significant effect on changes in urine protein in pregnant women in intervention group with a value of p&gt; α 0.05 = 0.008, while in the control group there was no effect with a value of p&gt; α 0, 05 = 0.250. It was concluded that consumption of ebi cassava crackers during four weeks changed the urine protein from positive to negative. Hopely, every hypertensive pregnant woman consumes cassava crackers to prevent positive urine protein.