White Coat Research Articles

S-30-2: ASIAN MANAGEMENT OF HYPERTENSION: CURRENT STATUS, HOME BP MONITORING, AND SPECIFIC CONCERNS IN PHILIPPINES

Introduction: Cardiovascular disease (CVD) in the Philippines showed hypertension as the highest (38.6%), followed by stroke (30%), coronary artery disease (17.5 %), heart failure (10.4%). Risk factor were: diabetes at 3.9%, dyslipidemia at 72%, smoking at 31%, obesity at 4.9% (BMI). Latest hypertension prevalence is 37%. Aware hypertensives were 19%, unaware was 18%. Treatment rate was 68%, compliance was 86%, blood pressure (BP) control rate was 37%. Mortality from CVD were stroke, mostly infarct (22.6%), MI (6.5%), Heart Failure (6.5%). Drugs used were angiotensin receptor blockers (64%), calcium channel blockers (42%), beta-blockers (6%), ACE inhibitors (4%) and diuretics (1%). Current status of home BP monitoring (HBPM): HBPM is performed by 23% of hypertensive population in the Philippine. Barriers to its use include cost, availability and lack of trust regarding the accuracy of digital BP devices. Currently, physicians encourage patients to monitor BP at home to better assess their treatment to rule out white coat, masked hypertension and other parameters. Philippine sub-analysis of AsiaBP@Home study: Data on HBPM offer solution to problems encountered particularly in Asia. Based on AsiaBP@Home study as a multi-national Asian specialty center performance regarding home and clinic BP control, majority of uncontrolled hypertension simulated by the new lower ACC/AHA guideline threshold gave additional 18% increase in sustained uncontrolled hypertension (SUCH) and to additional 5% increase in white-coat uncontrolled hypertension (WUCH). In a sub-group analysis of the Philippines in this study (Fig.1), using conventional threshold values, well-controlled clinic SBP was only 69% and well controlled morning home SBP was 79%. Using the new threshold levels, the well-controlled clinic SBP decreased to 43% and well controlled morning home SBP was lower at 67%. Comparing the conventional to the new thresholds, controlled hypertension decreased from 62% to 37%, masked morning hypertension decreased from 8% to 6%, Sustained hypertension increased from 13% to 27%, and white-coat hypertension increased from 18% to 31%. Summary: Hypertension still remains a major problem in the Philippines. Office BP measurement remains to be our standard for hypertension assessment and it appears to be insufficient in guiding us in our management approach. With the availability of newer and practical tools such as the HBPM, it will certainly improve hypertension evaluation, patient awareness, physician alertness in achieving better BP control and hence, better outcomes.

A Cross-Sectional Study to Evaluate the Apron Contamination among Health-Care Professionals of a Rural Tertiary Care Setting

Abstract Background: Pathogenic microorganisms are ubiquitous, and the potential of transferring harmful microorganisms in hospitals has always been a worry. Many studies have concluded that white coats worn by physicians and nurses, as well as other hospital clothes, may have a role in the transfer of dangerous microorganisms in hospitals. Many types of clothing and equipment, including stethoscopes, otoscopes, thermometers, and physicians’ white coats, have been identified as potentially pathogen-carrying. Materials and Methods: This cross-sectional study was conducted in a tertiary care setting, where all participants were informed about the study and offered the option to provide informed consent as well as complete a questionnaire. The participants have accepted and provided informed consent as well as questionnaire. The study comprised 100 aprons from health-care workers (interns, PG students, UG students, and faculty). Results: Males and females made up 27% and 73% of the study’s total participants, respectively. Students made up 80% of the participants, whereas professors made up 20%. Only 11% of those who took part in the study had the practice of switching aprons. Distinct species grew in 85% of aprons’ chests, 81% of aprons’ pockets, and 65% of aprons’ sleeves. Gram-positive bacteria were the most common species discovered on aprons. Gram-negative microbes were also identified in small amounts from several aprons. Conclusion: Aprons can be a cause of cross-contamination, hence, wearing aprons in nonclinical places such as the cafeteria, classroom, and library should be prohibited to prevent bacterial contamination carried by health-care workers’ aprons.

Niet Eens Een Labjas? De veelstemmige verbeelding van wetenschappers en technologen in hedendaagse jeugdliteratuur. [Not Even a Lab Coat? The Polyphonic Imagination of Scientists and Technologists in Contemporary Youth Literature.] by Frauke Pauwels

Reviewed by: Niet Eens Een Labjas? De veelstemmige verbeelding van wetenschappers en technologen in hedendaagse jeugdliteratuur. [Not Even a Lab Coat? The Polyphonic Imagination of Scientists and Technologists in Contemporary Youth Literature.] by Frauke Pauwels Toin Duijx NIET EENS EEN LABJAS? De veelstemmige verbeelding van wetenschappers en technologen in hedendaagse jeugdliteratuur. [NOT EVEN A LAB COAT? The Polyphonic Imagination of Scientists and Technologists in Contemporary Youth Literature.] By Frauke Pauwels. Universiteit Antwerpen, 2021, 391 pages. ISBN: None In 2021, Frauke Pauwels obtained her doctorate under strict COVID-19 measures at the University of Antwerp for a study about the imagination of scientists, among others, in contemporary children’s literature. Her dissertation (in Dutch) was published by the university and can be read online: file://vuw/Personal$/Homes /D/duijxawm/Downloads/179365.pdf. The Flemish government has put enormous efforts into stimulating science, technology, engineering, and mathematics (STEM), in particular STEM education and STEM careers. Children are strongly encouraged to develop STEM skills from an early age. Children’s literature studies have been neglecting this topic. In her research project, Pauwels tries to fill that gap by analyzing images of science, technology, and its practitioners that have been spread through (mainly) Dutch children’s fiction and nonfiction for children. In the first chapter, Pauwels describes the context in which children are growing up nowadays. STEM policies can be situated within the transition toward a knowledge economy. Studies on STEM attitudes indicate that young people value science and technology; however, they do not consider building STEM careers. Several research projects showed that children who are interested in science are considered as nerds, as different from other children in their peer group. In children’s media, scientists tend to be presented as the alchemist, the idealist, the stupid virtuoso, the unemotional scientist, the adventurer, the mad scientist, or the helpless scientist. The second chapter discusses the way readers interpret narratives and engage with characters. Pauwels uses concepts and insights from cognitive and affective poetics to describe the connection of textual mechanisms with children’s readings and cognition, and refers to analyses and the corpus dealing with STEM characters. The next chapter gives an overview of the way prototypical scientists are represented in contemporary children’s books. She brilliantly analyzes children’s books in which scholars appear and shows that these are often very stereotypical in clothing, setting, and register. Scientists always seem to be wearing a lab coat, and most of them [End Page 77] are men, women being much less common. In chapter 4, Pauwels presents a second series of analyses. She demonstrates that several books of the corpus also offer stepping stones for empathy or identification with scientifically and technologically oriented characters. The portrayal of children as akin to scientists, or as scientists in becoming, as well as the suggestion that scientists differ from other people, is the most recurrent motif in the studied corpus. In the last chapter, Pauwels concentrates on the special topic “Children, Climate Change, and Science.” Children and youth have been united behind the science during climate debates and protests all over the world. In society and literature, children are symbolizing hope for the future and have been cast as saviors of the world. Nevertheless, science and technology are not part of the solutions in fiction. In several examples of the corpus, children’s acts on the basis of care and enchantment are rewarded, but scientists who help save the world can barely be found. Frauke Pauwels concludes her engaging and well-documented dissertation on a hopeful note: while science and technology are mostly represented as objective and rational, children’s literature adds other qualities to the scientific mindset, such as paying attention to nature, being curious, feeling enchanted, and caring for other beings and for the environment. That way, children’s literature can contribute to give another view on the aspects of STEM and prepare children for a changing society in which these aspects play an important role. Toin Duijx Leiden University Freelance staff member of the International Youth Library Copyright © 2023 Bookbird, Inc

BLACK WOMEN, WHITE COATS: BLACK WOMEN UNDERGRADUATE STUDENTS' USE OF COMMUNITY CULTURAL WEALTH TO PERSIST IN HEALTHCARE CAREERS

In this qualitative, participatory action research study, we examine how six Black women undergraduate students develop, cultivate, and sustain their healthcare career aspirations while examining challenges Black women undergraduate students experience during their pursuit of a healthcare career. Using community cultural wealth to frame our study, we collected two interviews per participant along with participant-generated photographs. We found that student participants experienced multiple forms of oppression, financial challenges, and lack of access to academic resources, but they were able to persist through support from family, faculty, and peers, along with faith-based practices and creative arts. Findings provide insights for higher education leaders, STEM and health sciences faculty, and the healthcare industry to advance equity for Black women pursuing healthcare careers.

Behind the White Coat: The Prevalence of Burnout among Obstetrics and Gynecology Residents in Azerbaijan

Behind the White Coat: The Prevalence of Burnout among Obstetrics and Gynecology Residents in Azerbaijan

Visual preference appraisals of children for physician attire: A cross-sectional study

Background: Psychologists highlight the importance of appearance and its effect on the first impression and subsequent, development of interpersonal relationship between the patient and the treating doctor. Adult responses to different attires of treating doctors have been well-documented, though there has been very little information regarding child patients on this aspect. The aim of the present study was to assess the preferences of child patients toward the dress code of their treating doctors and to relate the influence of age and previous exposure on such preferences. Materials and Methods: The present study was designed as a cross-sectional study wherein data were collected from 2500 child patients belonging to primary, secondary, and high school levels with the help of a questionnaire. A total of 10 photographs of 5 male and 5 female pediatric consultants of full size in the same background and stance of models in different dress codes were shown to the selected participants while they were asked to give their preferences in order. The results obtained were subjected to statistical analysis wherein statistical tests used included Chi-square and Fisher’s exact tests and linear association. P < 0.05 was considered statistically significant. Results: The findings of the present study suggested that 35.6% of subjects preferred a white coat followed by scrubs with cartoons (21.8%) for male pediatric consultants while 38.2% of the subjects preferred a white coat followed by formal attire (28.4%) for female pediatric consultants. Furthermore, age had a significant impact on the preferences. Conclusions: White coat was the most preferred attire followed by scrubs with cartoons and formal attire.

Editorial: A Ghost Story

Ghost doctors in white coats. The topic surprised me and it kept going around in my mind (see previous editorial: The Strange Case of Galté). The article about the Chilean lawyer Galté is illustrative and exciting. Nevertheless, it is not the only one. There is a fair amount of literature on the subject and also renowned mediums who have published books

АССОЦИАТИВНОЕ СОЗНАНИЕ В КОНТЕКСТЕ ПРОФЕССИОНАЛЬНОЙ РЕАЛЬНОСТИ (НА ПРИМЕРЕ РУССКИХ И ИНДИЙСКИХ СТУДЕНТОВ-МЕДИКОВ)

The paper presents data analysis of the association experiment aimed at studying the influence of professional culture on the linguistic consciousness of medical students. Being the most developed technique of psycholinguistic analysis of semantics, the association experiment reveals objectively the semantic relations of words and language stereotypes existing in a native speaker’s mind and reflecting the “mentality specific features”. The study sample consisted of Russian (n = 50) and Indian (n = 50) students of the Northern State Medical University, aged 17 to 20 years, studying General medicine. Study material included the results of a written questionnaire with seven stimulus words (doctor, Hippocratic Oath, medicine, hospital, patient, profession, lab coat). The stimulus list was prepared in Russian and English. The survey was conducted in the language of study participants. Linguistic units of different parts of speech and word combinations were allowed as answers. The analysis of a professionally determined specificity of consciousness of Russian and Indian students indicates the predominant positive orientation of ethnic stereotypes in all respondents. Both universal and nationality-related components, indicating the national and cultural markedness of the linguistic sign and peculiarities of ethno-linguistic consciousness are revealed. The associative behavior of both Russian and Indian students manifested itself in two directions: on the one hand, emotionally-evaluative reactions and descriptive associations were observed; on the other hand, reactions related to the professional reasoning development were traced. Word-reactions associated with social realities typical of Russian and Indian society are noteworthy.The total number of associations given by Russian students is slightly higher. In general, respondents’ reactions indicated their ambition to vocation realization and goals achievement. The results obtained can be considered as a culture-specific “associative profile” of images of consciousness, integrating mental and sensual knowledge possessed by a particular ethnic group.

S-39-1: COVID-19 AND HYPERTENSION IN JAPAN, AND KANAGAWA RASI COVID-19 STUDY

Severe acute respiratory syndrome coronavirus 2 (SARSCoV2) caused a global coronavirus disease-2019 (COVID19) pandemic, as declared by the World Health Organization on March 11, 2020. COVID19 was confirmed for the first time in January 2020, and despite epidemic prevention efforts, the number of patients with COVID19 continued to increase, primarily in metropolitan areas. To prevent the further spread of COVID19, the Japanese government announced a state of emergency on 7 April 2020, similar to the lockdowns impleme nted in other countries. We showed a significant increase in office BP with the white coat phenomenon was observed during the state of emergency, as well as an increase in related stress, thereby indicating that we should pay more attention to BP management during stressful global events, including the COVID19 pandemic, to prevent cardiovascular events (Kobayashi K, et al. Hypertens Res 2022; Kobayashi K, et al. Ito S, et al. J Diabetes Investig Apr 18 Epub, 2022). In addition, since the onset of the COVID19 pandemic, the possible roles of renin angiotensin system (RAS) inhibitors in COVID19 have been debated as favorable, harmful, or neutral. ACE2 not only is the entry route of SARSCoV2 infection but also triggers a major mechanism of COVID19 aggravation by promoting tissue RAS dysregulation, which induces a hyperinflammatory state in several organs, leading to lung injury, hematological alterations, and immunological dysregulation. ACE inhibitors and ARBs inhibit the detrimental hyperactivation of the RAS by SARSCoV2 and increase the expression of ACE2, which is a counterregulator of the RAS. Several studies have investigated the beneficial profile of RAS inhibitors in COVID19; however, this finding remains unclear. Further prospective studies are warranted to confirm the role of RAS inhibitors in COVID19 (Matsuzawa Y, et al. Hypertens Res 2020; Matsuzawa Y, et al. Hypertens Res, 202; Sato R, et al. Clin Exp Nephrol 2022).

S-04-2: AUTOMATED OFFICE BLOOD PRESSURE IN RESEARCH VERSUS CLINICAL PRACTICE

A white coat response which increases BP when recorded in clinical practice has been recognized as a cause of apparent hypertension. Automated office (AO) BP measurement was developed to improve the accuracy of office BP. By recording multiple readings using an automated sphygmomanometer with the patient resting quietly alone, the white coat response which averaged 15 mmHg was eliminated, with AOBP being similar to the awake ambulatory (A) BP. In a Spanish study of 27,211 patients in the community, the difference between awake ambulatory BP and routine office BP was even greater (25 mmHg). Based on these studies, Canadian and American guidelines now recommend AOBP as the preferred method for recording BP in the office. However, European guidelines continue to focus on improving the accuracy of office BP by stricter adherence to proper BP measurement technique. AOBP is considered to be impractical, with concerns that readings take too long, require a dedicated room and lack support from longitudinal outcome studies. In reality, none of these criticisms are valid. Guidelines on the proper measurement of BP in the office have been published as far back as 1939, yet, there has never been a meta-analysis showing that routine office BP is as good a predictor of cardiovascular outcome as the BP recorded under research conditions. Awake ABP is a gold standard for determining the risk of future cardiovascular morbidity and mortality. In 19 research studies, mean systolic AOBP was only 0.3 mmHg different from the mean awake ABP. When data comparing attended versus unattended AOBP in research studies were analysed, the mean systolic attended AOBP was still 6 mmHg higher. The presence of office staff appears to be sufficient to increase office BP. AOBP has been criticized for being too variable. In a recent study comparing AOBP to home BP readings, both types of measurements exhibited similar degrees of variability, yet only home BP is recommended as an alternative to 24-hour ABPM. This conclusion ignores data showing mean AOBP, home BP and awake ABP being similar. Guidelines for clinical practice should be evidence-based. It may not be possible to record AOBP on every patient. However, AOBP readings should be recommended as the optimum method for recording BP in routine clinical practice, whenever it is feasible to do so.

PS-P04-2: 24 HOUR AMBULATORY BLOOD PRESSURE PROFILE OF HYPERTENSIVE AND PRE-HYPERTENSIVE HEALTHCARE WORKERS IN A PHILIPPINE TERTIARY HOSPITAL

Objectives: To determine the blood pressure profile and phenotypes of hypertensive health care workers and its association to BP control dipping status. Design and Methods: This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM). Clinical profile, and ABPM data were also evaluated Results: 181 patients were included with majority from 50–59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The most frequent anti-hypertensive drug was an angiotensin receptor blocker (ARB, most cited was Losartan), comprising 62% among those on antihypertensive medication followed by calcium channel blockers (CCB- 23%). Majority or 73% were on mono therapy. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%). Healthcare workers who work &gt; 9 hours were 2.05 times more likely to be non-dippers compared to healthcare workers who works up to 9 hours. Conclusion: Among health care workers, 24 hour blood pressure were uncontrolled more in females 50–59years old, with association on working hours&gt; 8 hours, without association to shift work, and job classification. There is a significant association of longer work hours and nocturnal dipping pattern. This study highlights the importance of 24-hour ABPM to detect 24-hr pattern and identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients on maintenance medications.

Hipertenzija kod dece i adolescenata

Until recently, secondary hypertension used to be the most common form of hypertension in the paediatric population. Due to the increasing prevalence of obesity-related hypertension in children and adolescents, the share of secondary hypertension has decreased from 85% to 9%. Today, primary hypertension has become the dominant form of hypertension in the paediatric population. The purpose of this paper is to show the prevalence of various forms of hypertension and the prevalence of primary hypertension in children and adolescents relative to sex, age and body weight category in the General Hospital "Dr. Laza K. Lazarević" in Šabac. In children with secondary hypertension, the impact of body weight was not assessed since an organic cause of hypertension had been identified in these patients. All children from the age of a new-born to the age of 18 years with a diagnosis of hypertension (International Classification of Diseases, tenth revision (IDC-10), code I10-I15) in the period from 1 January 2013 to 31 December 2022 were selected from the medical digital database. This analysis included all children who showed blood pressure values above 95th percentile for age, sex and height in children under 13 and above 120/80 mmHg in children over 13, upon repeated measurements of blood pressure in the General Hospital, who were presumed to have hypertension. These children were referred to further evaluation at tertiary healthcare institutions, where a diagnosis of hypertension was made. Of the 134 children referred to the General Hospital due to elevated blood pressure levels measured in the primary care physician's office, hypertension was diagnosed in almost one in four subjects (24.6%). Primary hypertension was diagnosed in 18 (54.5%), secondary hypertension in 8 (24.2%) and white coat hypertension in 7 (21.2%) children. Primary hypertension was more common in boys (70.6%) than girls (37.5%). Among children with primary hypertension, overweight and obese children represented 66.7% of the group at the time of diagnosis. Statistical data analysis did not find a statistically significant difference in the prevalence of primary hypertension among the body weight or age categories. Since primary hypertension is the most significant and potentially reversible factor for the development of cardiovascular disease, early detection and treatment of primary hypertension in children is crucial in the prevention of cardiovascular disease in adults.

"Ditch the White Coats": What LGBTQ+ Patients Prefer in their Primary Care Provider.

"Ditch the White Coats": What LGBTQ+ Patients Prefer in their Primary Care Provider.

PS-C36-1: CLINICAL INERTIA IN THE HYPERTENSIVE PATIENTS TREATED BY HYPERTENSION SPECIALISTS

Background: Only about 30% of hypertensive patients in Japan is reported to have properly controlled blood pressure (BP). The clinical inertia (Inertia) seems to be one of the factors behind the inadequate BP control. Purpose: We investigate the achievement rate of the BP lowering target in 2020 for outpatients in the division of hypertension, and confirm the prevalence of inertia as a possible factor for the failure to achieve their BP targets. Methods: Subjects were 517 outpatients (mean age 68.6 ± 13.2 years, 54% of women) who regularly visited the division of hypertension from March to September 2020 and took antihypertensive drugs prescribed by hypertension specialists. We calculated the average of office BP (OBP) in the two visits during the same period, and the average of home BP (HBP) for the three days before each two visits. In addition, we investigated the antihypertensive drugs taken during that period and complications such as diabetes and chronic kidney disease, and collected blood chemistry and urine test data. From these data, as of December 2021, the attending doctors determined whether each patient achieved the BP target according to the Japanese Society of Hypertension 2019 (JSH2019), and chose one reason from the options in the patients who failed to achieve target BP. Results: The target for OBP in all subjects was &lt; 130/80 (48%), &lt; 140/90 (140 group, 15%), &lt; 140/90 mandatory, and &lt; 130/80 if tolerable (37%). The percentage of those who achieved each OBP target was 48% (OBP achievers, N = 246). As a result of investigating the reason for the OBP non-achievement (N = 273) by the attending doctors, 20% answered “judged to be the optimal BP level (Optimal)”, 20% answered “due to the white coat effect ”, and then “Inertia” was the next highest at 14%. Regarding the achievement rate of HBP for OBP achievers, 36% did not measure HBP, 38% achieved &lt; 135/85 or &lt; 130/80 (HBP 135), and 26% (N = 65) did not achieve it. Among the HBP 135 other than the 140 group (N = 66), the unachieved rate of &lt; 125/75 was 58% (N = 38). The reasons for non-achievement of HBP (N = 103 in total), “Optimal” was the most common answer (42%), followed by “Inertia” (27%). Conclusion: Inertia existed as a factor explaining insufficient BP control even in the patients treated by hypertension specialists. From now on, in order to increase the rate of achieving the BP target, we should make an effort to overcome inertia.

S-12-1: PAST AND FUTURE OF HYPERTENSION RESEARCH

Research on hypertension has achieved, in the last few decades, important results on the pathophysiology, diagnosis and treatment of the high blood pressure (BP) condition. However, as listed in the 2018 European guidelines, several aspects remain unclarified either because they have not been explored by properly designed studies or because data remain controversial. This presentation will discuss some of the questions that represent important unmet needs for hypertension research. One, absence of randomized evidence-based trials on the benefit of antihypertensive treatment in important clinical conditions such as white coat hypertension, masked hypertension, resistant hypertension, hypertension of the very elderly people (e.g. nonagenarians) and hypertensives classifiable as frail because of the high number of comorbidities and poor life expectancy. Two, hypertension of relatively young people (e.g. &lt; 45 or 40 years) in whom low event incidence prevents the performance of event-based trials, making prevention or progression of subclinical organ damage probably the only reliable and feasible approach. Three, the benefit of funding treatment on out-of-office (ambulatory and/or home) BP either as an alternative or an addition to classical office BP reduction, a fundamental therapeutic issue never addressed in the past. Four, the BP threshold at which to start treatment in naive hypertensives and the goal BP value to try to reach in different demographic and clinical hypertension subgroups. And finally, the problem of residual risk in apparently well treated hypertensive individuals, i.e. their persistence at a risk level clearly higher than that of the control population. A final consideration will be that assessing this issue by randomized trials will probably be difficult and that future research will thus have to rely more and more frequently on observational studies which can now be based on large population data-bases that extend over many years and can, via extensive information and high quality analysis, substantially reduce the risk of the risk of confounding associated with this approach.

S-32-3: RECENT IDACO ANALYSIS ON THE RISK OF PROGRESSION TO SUSTAINED HYPERTENSION FROM WHITE-COAT HYPERTENSION OR MASKED HYPERTENSION

In the general population, the cardiovascular risk is increased in patients with masked hypertension (MH), whereas in individuals with white-coat hypertension (WCH) it is virtually the same as in the normotensive individuals. However, no conclusive evidence exists as to whether WCH and MH are accompanied by a greater rate of development of a sustained hypertensive state, i.e. hypertension both in and outside the clinical environment. We investigated the risk of progression to sustained hypertension in initially untreated participants of cohort studies included in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) study. Within the IDACO, 5 populations comprising 1081 individuals had ambulatory (ABP) and conventional (CBP) blood pressure measured at baseline and at follow up. We excluded from the analysis subjects on BP-lowering treatment at baseline (n = 252) and individuals with untreated sustained hypertension at baseline (n = 80), leaving 749 subjects included in the current analysis. The cut-off value for elevated CBP was &gt; = 140/90 mm Hg and for daytime ABP &gt; = 135/85 mm Hg. At baseline, 110 individuals (14.7%) was defined as MH, 64 subjects as WCH (8.5%), and 575 (76.8%) as normotensives. MH patients were older (50 vs 45 years compared to normotensives, P &lt; 0.01) and more frequently male (50.9 vs 31.5% compared to normotensives, P &lt; 0.01). During median follow-up of 9.7 years, there were 264 incident cases of sustained hypertension. In the analyses adjusted for cohort, sex, age, body mass index, smoking and drinking, both MH (HR 2.23, 95%CI 1.57 to 3.17) and WCH (HR 1.84, 95%CI 1.37 to 2.47) significantly increased risk of progression to sustained hypertension. In conclusion, long-term risk of progression to sustained hypertension is 2-fold higher in individuals with masked hypertension or white coat hypertension at baseline as compared to normotensive subjects at baseline. However, this observation might be due to more frequent initiation of antihypertensive therapy in both groups.

10 important financial investments for orthopods in India

10 important financial investments for orthopods in India

“Ditch the white coats”: What LGBTQ+ patients prefer in their primary care provider

Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population. The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals. In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results. Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: "Ditch the white coats"; "Meet me where I am"; "The relationship is key"; and "Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs." The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population. These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.

S-11-3: CLINICAL IMPLICATION OF AORTIC STIFFNESS

Modern clinical practice stresses the importance of basing healthcare practices and health policy on the best available clinical evidence. However, it is a long journey to translate research evidence into routine clinical practice through closing fundamental translational gaps. There have been numerous studies and meta-analyses demonstrating the prognostic value of arterial stiffness beyond established CVD risk factors, including age and blood pressure. Nevertheless, clinical practice guidelines rarely recommend the routine use of arterial stiffness in daily care. To facilitate the routine use of arterial stiffness measurements, the corresponding translational gaps in the clinical application should be analyzed and addressed. To justify the routine clinical use of any biomarkers, several criteria must be met. For the many methodologies to estimate arterial stiffness, their reliability and reproducibility in a standard clinical setting should be firstly demonstrated. Moreover, in a busy clinical environment, a less complicated measurement procedure with operator independence is more welcomed. Second, these techniques must carry the ability to add additional risk discrimination beyond the conventional risk prediction systems such as Framingham risk score or SCORE and should be cost effective. Not only the independent prognostic value but also the significant reclassification ability should be shown. Lastly, clear indication of the implementation of arterial stiffness techniques should be provided including but not limited to being used for risk stratification, treatment monitoring, or as a therapeutic target. Previous studies pertaining to arterial stiffness have been endeavored to address most but not all the above requirements. The independent value of arterial stiffness in predicting cardiovascular events have been presented. Moreover, its ability to predict incident hypertension and target organ damage, including brain, heart, and kidney have also been confirmed. In an individual patient data meta-analysis of cf-PWV for subjects at intermediate risk, adding cf-PWV into standard risk factors rendered a net reclassification of 15% and 27% for coronary heart disease events and CVD death, respectively. Such analysis provide justification to apply arterial stiffness measurements in routine clinical practice. They can make risk prediction more accurate by re-classifying subjects with intermediate cardiovascular risk into a higher risk level, in which treatment is indicated or into a lower risk level, in which further therapy could be safely avoided. In subjects with intermediate risk such as whitecoat hypertension, isolated diastolic hypertension, or borderline hypertension, the uncertainty in risk prediction may be further reduced by measuring arterial stiffness. Of the techniques for estimating arterial stiffness, advantages and disadvantages of each technique are observed. Although cf-PWV has the strongest evidence base supporting clinical value, the operator independence limits its widely use in routine practice. Cuff-based devices require less training, but may be less accurate. Further research is required to address this important unmet need. Besides, recommendation of the routine use of arterial stiffness techniques could be further supported by conducting randomized controlled trials adopting arterial stiffness as a treatment target, a treatment monitoring instrument, or as a tool incorporated in the intervention strategies such as risk stratification for subjects with intermediate risk profiles. To obtain health insurance reimbursement, cost-effectiveness analysis accompanied with the prospective studies for arterial stiffness is also warranted to support its routine clinical implement. In summary, the distinctive clinical value of arterial stiffness techniques relies on the ability of a single assessment to provide important information regarding blood pressure progression and susceptibility to end organ damage. The most useful scenario seems to be the more accurate risk classification for subjects at intermediate CVD risk, in which condition the need for treatment is uncertain, such as patients with masked or white coat hypertension. Therefore, arterial stiffness can be seen as complimentary to current blood pressure, and both should be considered when risk prediction is required for making timely and relevant treatment decisions. The role of arterial stiffness as a treatment target, treatment monitoring strategy in response to therapy, or a tool in the intervention strategy should be further uncovered in prospective studies or randomized controlled trials.

PS-C11-8: RELATIONS BETWEEN WHITE COAT EFFECT OF BLOOD PRESSURE AND ARTERIAL STIFFNESS

The aim of this study was to analyze the relationship between brachial-ankle pulse wave velocity (b-a PWV) and white coat effect (WCE), that is the difference between the elevated office blood pressure (BP) and the lower mean daytime pressure of ambulatory BP. A total of 444 patients with WCE for systolic BP (54.1% female, age 61.86 ± 13.3 years) were enrolled in the study. Patients were separated into low white coat effect (&lt; 9.5mmHg) and high white coat effect (&gt; = 9.5mmHg) according to the median of WCE. The subjects with a high WCE showed a greater degree of arterial stiffness than those with a low WCE for systolic BP values (P &lt; 0.05). The b-a PWV were 17.2 ± 3.3m/s and 18.4 ± 3.4 m/s in low WCE and high WCE, respectively. The b-a PWV increased with the increase of WCE, showing a positive correlation between them (P &lt; 0.05 for non-linearity). The significant association between the high WCE (β = 87.95, 95% Cl 35.97–139.93, P = . 001) and the b-a PWV was confirmed by the results of multiple regression analysis after adjusting for confounding factors. Similar results were observed in subgroups. In conclusion, WCE is significantly associated with arterial stiffness. More research is needed to determine the WCE and target organ damage.